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CARDIOLOGY
Update 2014
DISCLAIMER
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not
necessarily represent those of editor(s) of the book.
All brand names and product names used in this book are trade names, service marks, trademarks or registered
trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this
book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative
information about the subject matter in question. However, readers are advised to check the most current
information available on procedures included and check information from the manufacturer of each product to be
administered, to verify the recommended dose, formula, method and duration of administration, adverse effects
and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither
the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property
arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services.
If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce
copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary
arrangements at the first opportunity.
CARDIOLOGY
Update 2014
Editor
HK Chopra
President Elect, CSI-2014
Chairman, Scientific Committee
66th Annual Conference of CSI 2014
Sr Consultant Cardiologist, Moolchand Medcity
New Delhi, India
Co-Editors
S Ramakrishnan
AK Pancholia
Manish Bansal
Additional Professor
Department of Cardiology
All India Institute of Medical Sciences
New Delhi, India
Joint Secretary, National CSI
Head
Department of Clinical and Preventive
Cardiology and Research Centre
Arihant Hospital, Indore, MP, India
EC Member, National CSI
Consultant Cardiologist
Medanta: The Medicity
Gurgaon, Haryana, India
Overseas Offices
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2015, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent
those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their
respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject
matter in question. However, readers are advised to check the most current information available on procedures included and check
information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of
administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions.
Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or
related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services
are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any
have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
Dedicated to
Our parents, teachers, patients and
All the members of
Cardiological Society of India
PRINCIPAL CONTRIBUTORS
A Banerji
AK Pancholia
Sr Consultant
Department of Cardiology
Command Hospital (NC)
Kolkata, West Bengal, India
e-mail: [email protected]
Head
Department of Clinical and Preventive Cardiology and Research Centre
Arihant Hospital, Indore, MP, India
EC Member, National CSI
e-mail: [email protected]
Adarsh Kumar
Alok Mazumdar
Aditya Kapoor
Professor
Department of Cardiology
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Lucknow, UP, India
e-mail: [email protected]
Ajay Bahl
Associate Professor
Department of Cardiology
PGI, Chandigarh, India
e-mail: [email protected]
Sr Consultant Cardiologist
Director Cath Lab and In-charge
Cardiovascular Sciences
BR Singh Hospital (Eastern Railways HQ Hospital)
Kolkata, West Bengal, India
e-mail: [email protected]
Ambuj Roy
Additional Professor of Cardiology
All India Institute of Medical Sciences
New Delhi, India
e-mail: [email protected]
Amit Vora
Sr Consultant Cardiologist
Kikabhai Hospital, Breach Candy Hospital
Nanavati Hospital, Lilawati Hospital and
Cumballa Hill Hospital, Mumbai, Maharashtra, India
e-mail: [email protected]
Ajay Naik
Cardiac Electrophysiologist and Interventional Cardiologist
Care Institute of Medical Sciences (CIMS)
Ahmedabad, Gujarat, India
e-mail: [email protected]
Ajit Mullasari
Director
Department of Cardiology
Institute of Cardiovascular Diseases
The Madras Medical Mission
Chennai, Tamil Nadu, India
e-mail: [email protected]
AK Kar
Consultant Interventional Cardiologist
BM Birla Heart Research Centre
Kolkata, West Bengal, India
Past President
Cardiological Society of India (CSI)
e-mail: [email protected]
Anil Dhall
Director
Department of Cardiology
Delhi Heart and Lung Institute
New Delhi, India
e-mail: [email protected]
Anil Kumar
Sr Consultant Interventional Cardiologist
Bombay Hospital and Medical Research
Hon Professor of Cardiology
Grant Medical College and JJ Group of Hospital
Mumbai, Maharashtra, India
Past President, National CSI
e-mail: [email protected]
Anita Saxena
Professor, Department of Cardiology
All India Institute of Medical Sciences
New Delhi, India
e-mail: [email protected]
viii
B Hygriv Rao
Clinical Director
Department of Cardiology
Peerless Hospital, Kolkata, West Bengal, India
Past President, National CSI
e-mail: [email protected]
Aparna Jaswal
Senior Consultant Electrophysiologist
Fortis Escorts Heart Institute
Okhla Road, New Delhi, India
e-mail: [email protected];
[email protected]
Balaji Pakshirajan
Sr Consultant Cardiologist
Institute of Cardiovascular Diseases
Madras Medical Mission
Chennai, Tamil Nadu, India
e-mail: [email protected]
Binoy John
Arup Dasbiswas
BKS Sastry
Asha Moorthy
Professor and Head of Cardiology
Cardiac Care Centre
Sri Ramachandra University
Chennai, Tamil Nadu, India
e-mail: [email protected]; [email protected]
Ashok K Omar
Director Noninvasive Cardiology and HOD
Heart Command and Emergency
Fortis Escorts Heart Institute
New Delhi, India
e-mail: [email protected]
Ashok Seth
Awarded Padma Shri
Chairman
Fortis Escorts Heart Institute
Chairman
Cardiology Council, Fortis Group of Hospitals
Past President
Cardiological Society of India
Vice President
Asian Pacific Society of Cardiology
e-mail: [email protected]
Ashwin B Mehta
Awarded Padma Shri
Director
Department of Cardiology
Jaslok Hospital and Research Centre
Mumbai, Maharashtra, India
Past President, National CSI
e-mail: [email protected]
Atul Mathur
Director Interventional Cardiology
Fortis Escorts Heart Institute
New Delhi, India
e-mail: [email protected]
BP Singh
Professor and Head
Department of Cardiology
IGIMS, Patna, Bihar, India
e-mail: [email protected]
Chetan P Shah
Consultant Interventional Cardiologist and Rhythm Specialist
Lilavati Hospital, Fortis Hospital
Kikabhai Premchand Cardiac Institute, King Circle
Director, Cath Lab
Surana Sethia Hospital
Director, Heart Rhythm Clinic, Ghatkopar
Mumbai, Maharashtra, India
e-mail: [email protected]
CM Nagesh
Associate Professor of Cardiology
Sri Jayadeva Institute of Cardiovascular Science and Research
Bengaluru, Karnataka, India
e-mail: [email protected]
CP Roy
Director
Medical Education and Research
Administrative Coordinator Cardiology
Max Super Speciality Hospital Saket, New Delhi, India
e-mail: [email protected]
C Venkata S Ram
Director, Apollo Institute for Blood Pressure Management/Blood
Pressure Clinics
Professor of Medicine, Apollo Medical College, Hyderabad, India
Director, Texas Blood Pressure Institute
Director, Clinical Research and Medical Education, DNA
Clinical Professor of Internal Medicine
University of Texas Southwestern Medical Center
Vice-President, American Society of Hypertension Specialists Program
Dallas, Texas, USA
e-mail: [email protected]
Principal Contributors
Dayasagar Rao
GN Mahapatra
Dev B Pahlajani
GR Kane
Dhiman Kahali
Sr Consultant Interventional Cardiologist
BM Birla Heart Research Centre
Kolkata, West Bengal, India
e-mail: [email protected]; [email protected];
[email protected]
Dorairaj Prabhakaran
Executive Director
Centre for Chronic Disease Control (CCDC)
Professor of Chronic Disease Epidemiology
Program Director for the Fogarty International Centre
New Delhi, India
e-mail: [email protected]
Geetha Subramanian
Professor and Head
Department of Cardiology
Madras Medical College and
Rajiv Gandhi Government General Hospital
Emeritus Professor of Cardiology
Tamil Nadu Dr MGR Medical University
Chennai, Tamil Nadu, India
e-mail: [email protected]
Geevar Zachariah
Chief Cardiologist
Mother Hospital
Thrissur, Kerala, India
e-mail: [email protected]
George Koshy A
Professor and Head
Department of Cardiology, Government Medical College
Thiruvananthapuram, Kerala, India
e-mail: [email protected]
Sr Consultant Cardiologist
PD Hinduja National Hospital and Research Centre
Mumbai, Maharashtra, India
e-mail: [email protected]
G Sengottuvelu
Fellowship in Interventional Cardiology (France)
Senior Consultant and Interventional Cardiologist
Apollo Hospitals, Chennai, Tamil Nadu, India
Adjunct Professor, The TN Dr MGR Medical University
Chennai, Tamil Nadu, India
e-mail: [email protected]
GS Sainani
Director, Department of Medicine
Jaslok Hospital and Research Centre
Mumbai, Maharashtra, India
Past President, National CSI
e-mail: [email protected]
Gurpreet S Wander
Professor and Head, Department of Cardiology
Hero DMC Heart Institute
Dayanand Medical College and Hospital
Ludhiana, Punjab, India
e-mail: [email protected]
G Vijayaraghavan
Vice Chairman and Director
Medical Services
Kerala Institute of Medical Sciences
President, SOCOMER, Trivandrum, Kerala, India
e-mail: [email protected]
Harinder K Bali
Director, Department of Cardiology
Fortis Hospital, Mohali, Punjab, India
e-mail: [email protected]
Harsh Wardhan
Chairman
Department of Cardiology
Rockland Group of Hospitals
New Delhi, India
e-mail: [email protected]
HK Chopra
Chief Cardiologist
Saraf Hospital,
Kochi, Kerala, India
e-mail: [email protected]
G Karthikeyan
IB Vijayalakshmi
George Thomas
ix
KK Sethi
Padmashree Awardee
Chairman and Managing Director
Delhi Heart and Lung Institute, New Delhi, India
Past President, National CSI
e-mail: [email protected]
Jabir A
Sr Consultant Cardiologist
Lisie Heart Institute
Lisie Hospital, Kochi, Kerala, India
e-mail: [email protected]
Jagat Narula
Director, Cardiovascular Imaging Programme
Mount Sinai Cardiovascular Institute
Editor-in- Chief, JACC: CV Imaging
New York, USA
e-mail: [email protected]
Jagdish Hiremath
KK Talwar
Chairman, Department of Cardiology
Max Super Specialty Hospital
New Delhi, India
e-mail: [email protected]
K Meenakshi
Professor of Cardiology, Madras Medical College
Member of Board for Superspeciality
The Tamil Nadu Dr MGR Medical University
Chennai, Tamil Nadu, India
e-mail: [email protected]
Krishna CK
Johann Christopher
K Sarat Chandra
Sr Consultant Cardiologist
Indo US Hospital
Ameerpet, Hyderabad, India
Hon Editor
Indian Heart Journal
Hyderabad, India
e-mail: [email protected]
JPS Sawhney
Chairman, Department of Cardiology
Sir Gangaram Hospital
New Delhi, India
e-mail: [email protected]
Kajal Ganguly
Professor and Head
Department of Cardiology
NRS Medical College
Kolkata, West Bengal, India
e-mail: [email protected]
KC Goswami
Professor, Department of Cardiology
AIIMS, New Delhi, India
e-mail: [email protected]
KK Aggarwal
President, Heart Care Foundation of India
Sr Consultant Physician, Cardiologist and Dean Medical Education
Moolchand Medcity, New Delhi, India
Editor-in-Chief, IJCP Group
National Vice President Elect, Indian Medical Association
Chairman, Ethical Committee, Delhi Medical Council
New Delhi, India
e-mail: [email protected]
KK Kapur
Senior Consultant
Department of Non-Invasive Cardiology
Indraprastha Apollo Hospitals
New Delhi, India
e-mail: [email protected]; [email protected]
Consultant Intensivist
Moolchand Medcity
New Delhi, India
e-mail: [email protected]
K Venugopal
President, CSI
Professor and Head, Department of Cardiology
Pushpagiri Institute of Medical Sciences
Tiruvalla, Kerala, India
e-mail: [email protected]
Manish Aggarwal
Sr Consultant Cardiology
Moolchand Medcity
New Delhi, India
e-mail: [email protected]
Manish Bansal
Consultant Cardiologist
Medanta: The Medicity
Gurgaon, Haryana, India
e-mail: [email protected]
Manoj Agny
Consultant Cardiothoracic Surgeon
Hospitals - Saifee, Nanavati, Seven Hills, Breach Candy
Mumbai, Maharashtra, India
e-mail: [email protected]
Principal Contributors
Manotosh Panja
Neeraj Pandit
Head
Department of Cardiology
Ram Manohar Lohia Hospital
New Delhi, India
e-mail: [email protected]
Mark Monane
Chief Medical Officer
Cardio Dx, USA
e-mail: [email protected]
Sr Consultant Cardiologist
Jupiter Hospital
Thane, Maharashtra, India
e-mail: [email protected]
Mehta S
NN Khanna
M Khalilullah
Director and Senior Consultant Cardiologist
The Heart Centre, New Delhi, India
Past President, National CSI
e-mail: [email protected]>; m khalillulah
[email protected]; [email protected]
Mohit D Gupta
Associate Professor of Cardiology
Department of Cardiology
GB Pant Hospital, New Delhi, India
e-mail: [email protected]
Mona Bhatia
Head of Department
Radiology and Imaging
Fortis Escorts Heart Institute, New Delhi, India
e-mail: [email protected]
M Somasundaram
Sr Consultant Cardiologist
Apollo Hospitals, Chennai, Tamil Nadu, India
e-mail: [email protected]
Nakul Sinha
Sr Consultant and Chief Interventional Cardiologist
Sahara Hospital, Lucknow, UP, India
e-mail: [email protected]
Narender O Bansal
Professor and Head, Department of Cardiology
Grant Medical College and Sir JJ Group of Hospitals
Mumbai, Maharashtra, India
e-mail: [email protected]; [email protected]
Navin C Nanda
Distinguished Professor of Medicine and Cardiovascular Disease
University of Alabama, Birmingham, USA
President, ISCU
Chairman, Board of Directors, AACIO
Editor-in-Chief, Echocardiography Journal, USA
e-mail: [email protected]
Nitin Burkule
N Trehan
Chairman and Managing Director
Medanta-The Medicity
Gurgaon, Haryana, India
e-mail: [email protected]
OP Yadava
CEO and Chief Cardiac Surgeon
National Heart Institute
New Delhi, India
e-mail: [email protected]
Pankaj Manoria
Chief Interventional Cardiologist
Manoria Heart Care Centre
Bhopal, Madhya Pradesh, India
e-mail: [email protected]
PB Jayagopal
Chairman and Director
Sr Interventional Cardiologist
Lakshmi Hospital
Palakkad, Kerala, India
e-mail: [email protected]
PC Manoria
Director
Manoria Heart Care and Intervention Centre
Bhopal, Madhya Pradesh, India
Past President, National CSI
e-mail: [email protected]
PC Rath
Sr Interventional Cardiologist
Apollo Hospitals
Hyderabad, India
e-mail: [email protected]
Peeyush Jain
Principal Consultant Cardiologist
Fortis Escorts Heart Institute
New Delhi, India
e-mail: [email protected]; [email protected];
[email protected]; [email protected]
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Purshotam Lal
Consultant Cardiologist
Care Hospital, Hyderabad, India
e-mail: [email protected]; [email protected]
Chairman
Metro Group of Hospitals
Noida, UP, India
e-mail: [email protected]; [email protected]
Poonam Malhotra
Associate Professor
Department of Cardiac Anaesthesia
AIIMS, New Delhi, India
e-mail: [email protected]
PP Mohanan
Director and Head
Department of Cardiology
West Fort Hi Tech Hospital, Thrissur, Kerala, India
e-mail: [email protected]
Pradeep Nambiar
Rabin Chakraborty
Senior Consultant Interventional Cardiologist and
Electrophysiologist
Salt Lake City, Kolkata, West Bengal, India
Chief of Cardiology and Director of Cath Lab
Director and Head Apollo Gleneagles Heart Institute
Chief of Faculty and Program Incharge
Postgraduate Cardiology Training, DNB Cardiology and IGNOU
e-mail: [email protected], [email protected]
Raghu Krishnaswamy
Sr Consult Cardiologist
Care Hospital
Hyderabad, India
e-mail: [email protected]
Prafulla Kerkar
Head
Department of Cardiology
Seth GS Medical College and KEMH Hospital, Mumbai
Consultant Interventional Cardiologist
Asian Heart Institute, Mumbai, Maharashtra, India
e-mail: [email protected]
Prakash Deedwania
Rajeev Gupta
Chief Cardiology
VACCHCS/UCSF, Fresno, Ca
Professor of Medicine, UCSF School of Medicine
San Francisco, USA
e-mail: [email protected]
Praveen Chandra
Rajeev Lochan
Chairman
Interventional Cardiology
Medanta: The Medicity, Gurgaon, Haryana, India
Chairman, NIC-201415
e-mail: [email protected]
Interventional Cardiologist
Saudi German Hospital
Dubai, UAE
e-mail: [email protected]; [email protected]
Praveen Jain
Sr Consultant
Department of Cardiology
Batra Hospital and Medical Research Centre
New Delhi, India
e-mail: [email protected]
Pravin K Goel
Professor and Head
Department of Cardiology
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Lucknow, UP, India
e-mail: [email protected]; [email protected]
P Syamasundar Rao
Professor of Pediatrics and Medicine
Director, Pediatric Cardiology Fellowship Programs
Emeritus Chief of Pediatric Cardiology
University of Texas-Houston Medical School
Childrens Memorial Hermann Hospital
Houston, Texas, USA
e-mail: [email protected]
Rajiv Bajaj
Rajneesh Kapoor
Director and Interventional Cardiology
Medanta - The Medicity
Gurgaon, Haryana, India
e-mail: [email protected]
Rakesh Yadav
Professor of Cardiology
AIIMS, New Delhi, India
e-mail: [email protected]
Ramakanta Panda
Vice Chairman and Managing Director
Chief Consultant: Cardiovascular Thoracic Surgery
Asian Heart Institute, Mumbai, Maharashtra, India
e-mail: [email protected]
Principal Contributors
Ramesh B Byrapaneni
RP Sapru
Managing Director
Medwin Hospitals
Hyderabad, India
Org Secretary, 66th Annual Conference of CSI-2014
e-mail: [email protected]
Former Head
Department of Cardiology
PGI Chandigarh, India
e-mail: [email protected]
Ranjith MP
Department of Cardiology
Government Medical College
Kozhikode, Kerala, India
e-mail: [email protected]
Ravi R Kasliwal
Chairman, Clinical and Preventive Cardiology
Medanta-The Medicity
Gurgaon, Haryana, India
e-mail: [email protected]; [email protected]
RK Kotokey
RR Mantri
RS Sambi
Senior Clinical Associate
National Heart Institute
New Delhi, India
e-mail: [email protected]
Professor
Department of Medicine
Assam Medical College, Dibrugarh, Assam, India
e-mail: [email protected]
Professor
Department of Biostatistics
AIIMS
New Delhi, India
e-mail: [email protected]
R Krishna Kumar
Sameer Shrivastava
Head
Department of Noninvasive Cardiology
Fortis Escorts Heart Institute
New Delhi, India
e-mail: [email protected]
RK Saran
Sandeep Singh
Additional Professor
Department of Cardiology
Cardiothoracic Sciences Centre
AIIMS, New Delhi, India
e-mail: [email protected]
Rochita Venkataramanan
Chief Radiologist
The Apollo Heart Centre
Greams Road,Chennai, Tamil Nadu, India
e-mail: [email protected]
Rony Mathew
Senior Consultant of Cardiology
Head, Department of Cardiology
LISIE Hospital
Kochi, Kerala, India
e-mail: [email protected]
Roopa Salwan
Director- Myocardial Infarction Programme
Sr Consultant
Department of Cardiology and Intervention Cardiology
Max Healthcare, New Delhi, India
e-mail: [email protected]; [email protected]
Roxy Senior
Professor of Clinical Cardiology
National Heart and Lung Instiute, Imperial College, London, UK
Consultant Cardiologist and Director of Echocardiography
Royal Brompton Hospital, London, UK
Northwick Park Hospital Harrow
e-mail: [email protected]; [email protected];
[email protected]
Sanjay Chugh
Chief Interventional Cardiologist
Head, Department of Cardiology
Chairman CV Sciences
Institute of Heart and Vascular Diseases
Jaipur Golden hospital
New Delhi, India
e-mail: [email protected]
Sanjay Tyagi
Director, Professor and Head
Department of Cardiology
GB Pant Hospital
Maulana Azad Medical College, New Delhi, India
e-mail: [email protected]
Sanjeev Sharma
Professor and Head
Department of Cardiology
AIIMS, New Delhi, India
e-mail: [email protected]
Santanu Guha
Professor and Head, Department of Cardiology
Medical College, Kolkata, West Bengal, India
General Secretary, National CSI
e-mail: [email protected]
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Shuvanan Ray
Satyavan Sharma
Professor and Head, Department of Cardiology
Bombay Hospital Insitute of Medical Sciences and
Consultant Interventional Cardiologist
Bombay Hospital
Mumbai, Maharashtra, India
Past President, National CSI
e-mail: [email protected]
Satyendra Tewari
Additional Professor
Department of Cardiology
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Lucknow, Uttar Pradesh, India
e-mail: [email protected]; [email protected]
Saumitra Ray
Professor, Department of Cardiology
Vivekananda Institute of Medical Sciences
Kolkata, West Bengal, India
e-mail: [email protected]
Savitri Shrivastava
Director
Department of Pediatric Cardiology
Fortis Escorts Heart Institute
New Delhi, India
e-mail: [email protected]
SB Gupta
Sr Consultant Physician Cardiologist
Asian Heart Institute and Research Centre
Mumbai, Maharashtra, India
email: [email protected]
SC Manchanda
Senior Consultant
Department of Cardiology
Sir Ganga Ram Hospital, New Delhi, India
e-mail: dr. [email protected]
Shashank Joshi
Sivakadaksham
Senior Interventional Cardiologist
Siva Cardio Diabetic Care Clinic
Bharathy Raja Hospital and Apollo Hospital
Chennai, Tamil Nadu, India
e-mail: [email protected]
SK Chutani
Sr Consultant, Internal Medicine, Cardiology and
Cardiac Electrophysiology and Heart Rhythm Management
New Delhi, India
e-mail: [email protected]
SKD Bhardwaj
Sr Consultant Cardiologist
542 Civil Lines (North)
Saket Colony Marg, Muzaffarnagar, Uttar Pradesh, India
e-mail: [email protected]
SK Dwivedi
Professor
Department of Cardiology
King Georges Medical University
Lucknow, UP, India
e-mail: [email protected]
SK Kaushik
Sr Professor and Head, Department of Cardiology
Principal, RNT Med College and
Cont Asso Gr of Hospital
Udaipur, Rajasthan, India
e-mail: [email protected]
SK Parashar
Chief Cardiologist
Metro Hospital and Heart Institute
Lajpat Nagar, New Delhi, India
Past President, National CSI
e-mail: [email protected]
Smita Mishra
Senior Consultant Pediatric Cardiology
Fortis Escorts Health Care
New Delhi, India
e-mail: [email protected]
Snehal Kulkarni
SN Routray
Principal Contributors
Sonia Arora
Sundeep Mishra
Soumitra Kumar
Sr Consultant Cardiologist
Indraprastha Apollo Hospitals, New Delhi, India
e-mail: [email protected]
S Padmavati
President, All India Heart Foundation
East of Kailash, New Delhi, India
Past President, National CSI
e-mail: [email protected]; [email protected]
S Ramakrishnan
Additional Professor, Department of Cardiology
All India Institute of Medical Sciences
New Delhi, India
Joint Secretary, National CSI
e-mail: [email protected]
S Shanmugasundaram
Emeritus Professor of Cardiology
Tamil Nadu Medical University and
Cardiologist, Billroth Hospitals, Chennai, Tamil Nadu, India
e-mail: [email protected]
SS Iyengar
Sunil Modi
SV Patted
Professor and Head
Department of Cardiology
JN Medical College
Nehru Nagar, Belagavi, Karnataka, India
e-mail: [email protected]
Tiny Nair
Head, Department of cardiology
PRS Hospital, Karamana
Trivandrum, Kerala, India
e-mail: [email protected]
TK Mishra
Professor and Head
Department of Cardiology
SCB Medical College, Cuttack, Odisha, India
e-mail: [email protected]
UC Samal
Ex-Professor of Cardiology and Head, Medicine, PMCH
Patna, Bihar, India
Past Member Senate Patna University and Medical Council of India
Past Member ACC-India Board of Advisers
Permanent Invitee ICC HFFI, Patna, Bihar, India
e-mail: [email protected]
Ulhas Pandurangi
Sr Consultant Cardiologist
Manipal Hospital, Bengaluru, Karnataka, India
e-mail: [email protected]
SS Mishra
Upendra Kaul
ST Yavagal
Suman Bhandari
Director of Cardiology and Cath Labs
Fortis Escorts Heart Institute
New Delhi, India
e-mail: [email protected];
[email protected]
V Chockalingam
Vidyut Jain
Sr Consultant Cardiologist
Choithram Hospital, Indore, MP, India
e-mail: [email protected]
Vijay K Trehan
Professor, Department of Cardiology
GB Pant Hospital, New Delhi, India
e-mail: [email protected]
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Viveka Kumar
Vinod K Shah
Sr Interventional Cardiologist
Sir HN Hospital and Research Centre
Raja Rammohan Roy Road, Mumbai, Maharashtra, India
e-mail: [email protected]
V Jacob Jose
Vinod Sharma
VK Bahl
Vishal Rastogi
Senior Interventional Cardiologist
Head, Advanced Heart Failure Program
Fortis Escorts Heart Institute, New Delhi, India
e-mail: [email protected]
Vitull K Gupta
Health and Human Rights Activist
Assistant Professor, AIMSR
Consultant, Kishori Ram Hospital and Diabetes Care Centre
Kishori Ram Road, Basant Vihar, Bhatinda, Punjab, India
Chairman, Association of Physicians of India (Malwa Branch)
Press Secretary, Cardiological Society of India
(Punjab and CHD Chapter)
Chairperson, Organizing Committee, APICON 2014, Ludhiana
Member, Advisory Board, Indian Heart Journal
Secretary, Northern Cardiology Network Bhatinda, Punjab, India
e-mail: [email protected]
Professor of Cardiology
CMC Hospital, Vellore, Tamil Nadu, India
e-mail: [email protected]
VS Narain
Professor
Department of Cardiology
King Georges Medical University, Lucknow, UP, India
e-mail: [email protected]
Yatin Mehta
Chairman
Medanta Institute of Critical Care and Anesthesiology
Medanta: The Medicity, Gurgaon, Haryana, India
e-mail: [email protected]
Yugal K Mishra
Director
Department of Cardiovascular Surgery
Escorts Heart Institute and Research Centre, New Delhi, India
e-mail: [email protected]
PREFACE
Cardiovascular disease (CVD) remains the leading cause of morbidity and premature mortality in both the developed and developing
nations alike. Coronary heart disease is the leading cause of cardiovascular mortality worldwide with more than 17.5 million deaths.
The burden of CVD poses significant challenges in a transforming country like India, with its enormous population of more than 125
billion with different regional, social, and cultural strata. We are already the diabetic capital of the world. By 2025, we will be CVD
capital of the world with estimation of 69.8 million CVD cases. Today, CVD accounts for 29% of all deaths in India. Coronary artery
disease (CAD) burden is rising rapidly in India. The menace of CAD has risen from 1% in 1960 to 3% in 2003, 7% in 2011, and 14% in
2014 in Indias urban population. It has been rightly documented that To be an Indian, is itself a risk for premature coronary artery
disease, because of genetic predisposition due to high levels of lipoprotein (Lpa) and faulty lifestyle. The disease is often diffuse,
premature, and triple vessel with poor distal run off. The risk of CAD in Indians is 34 times higher than Americans, 6 times higher
than Chinese and 20 times higher than Japanese. CAD affects Indians 510 years earlier than any other community in the world. The
prevalence of metabolic syndrome is highest in India up to an extent of 60% between the age group of 40 and 60 years with dominance
of hypertension, 60% at age of 60 years, 70% at the age of 70 years, and 80% at the age of above 80 years. India faces a double burden
of diseases, the newer modern ones and the old era disease like rheumatic heart disease (RHD). RHD still remains rampant with a
prevalence of 1.61.8%. There is no dearth of congenital heart disease in India with a prevalence of 0.41% of live births.
The evolution of the management of CAD over the last 50 years has been dramatic. Until the early and mid-1960s, medical
therapy though often ineffective was the mainstay of treatment. By the 1970s, with the advent of coronary artery bypass graft surgery,
treatment of CAD was revolutionized and the overall strategy became an invasive one. Then there was a shift to a less invasive therapy
with the start of percutaneous transluminal coronary interventions in the 1980s and the stent era in the early 1990s. In the late
1990s and early years of this century, we have come nearly a full circle with prevention and comprehensive risk reduction therapies
becoming the foundation of the management of CAD. Long-term follow-up studies have clearly demonstrated that myocardial
revascularization procedures are usually directed at severely stenotic lesions and are highly effective in relieving angina but do not
reduce the subsequent risk of major acute coronary events (MACE), such as unstable angina, myocardial infarction, arrhythmias,
heart failure, or sudden cardiac death. The differential effect is due to the fact that the culprit lesions for most cases of MACE have an
average of 50% stenosis or less, whereas all myocardial revascularization procedures are directed at more than 70% stenotic lesions.
The lack of survival benefits, definitely adds to the cost, possible excess risk of stroke and major bleeding requiring transfusions,
guides the need to control and restrain our enthusiasm to treat every stenotic lesion irrespective of the degree of angina or exercise
tolerance, thus, helping us to probe our minds by evolving intervention era and preventive strategies for curbing CVD burden in the
world.
In the new paradigm, myocardial revascularization procedures retain their major role as a part of the comprehensive strategy in the
management of acute CAD, and preventive strategies enhance the potential CAD management. Several landmark clinical trials have
documented the efficacy of aspirin, statins, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers,
glycoprotein IIb/IIIa inhibitors in CVD protection. The data on lifestyle modification with increased physical activity, reduction in
obesity, meticulous control of hypertension, diabetes and cessation of tobacco, stress management, consumption of more fruits, nuts
and vegetables are the foundation of the nonpharmacological management in todays preventive cardiology. We must also focus on
effective strategies to attack on Heart Attack by pharmacoinvasive approach by using timely tenecteplase at home, in the clinic, in the
ambulance, emergency care, primary care hospital followed by coronary intervention in the tertiary care hospital with adequately
trained and experienced interventional cardiologists to have the morbidity and mortality benefits.
There is an explosion of rapid advances in the different fields of cardiology with late breaking trials every now and then. It is really
a Herculean task to remain up-to-date. The axiom of yesterday is the question of today and hopefully the truth of tomorrow. We have
really progressed from the era with inactivity advocacy as therapeutic strategy to the most effective pharmacoinvasive approach,
where the patient is wheeled into cath lab to identify and open up the clogged arteries with the thrombus burden. Evidence-based
medicine is the need of the hour. Keeping all this in mind, we have made a sincere attempt to bring out state-of-the-art CSI Cardiology
Update-2014 to the needs of clinicians quest for knowledge and update, and keeping them abreast with the recent advances in
cardiology to help practice clinical cardiology meticulously with CVD morbidity and mortality benefits.
It gives me an immense pleasure and great deal of satisfaction to present to you the enormous contribution by galaxy of eminent
authors of international repute and experts in the field of cardiology in this state-of-the-Art CSI Cardiology Update-2014, despite
their busy schedule. I really thank them from the bottom of my heart and appreciate their enthusiasm and zeal of their contribution.
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HK Chopra
CONTENTS
SECTION 1: CLINICAL AND PREVENTIVE CARDIOLOGY
1. Development of Cardiology in India: Where are We Today?............................................................................. 3
S Padmavati
Cardiac situation 3
Medical manpower 3
Cardiac manpower 4
Cardiothoracic surgery 4
Training programs 4
Centers for tertiary care 4
Comparison with industrialized countries 4
Quality of cardiac care 4
Research 4
Prevention 5
Binoy John
Mechanism22
Genetic variability on platelet function test 24
Predicting adverse cardiovascular events 24
Treating aspirin and clopidogrel resistance 24
Future direction and clinical consideration 25
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Dabigatran31
Rivaroxaban31
Apixaban32
Edoxaban32
Concomitant use of NOAC and digoxin 32
Transition to oral vitamin K antagonists from novel oral anticoagulants 32
Bleeding in patients recieving novel oral anticoagulants 32
Acute coronary events and novel oral anticoagulants 33
Renal impairment and novel oral anticoagulants 34
Warfarin versus novel oral anticoagulants: a revisit 34
AK Pancholia
Nonpharmacological therapies 36
Pharmacotherapies39
Cell therapy 41
Others43
11. Lipid Management Beyond Statins Targeting HDL and TG: Challenges 2014............................................. 59
Saumitra Ray
Contents
Management of hypertriglyceridemia 68
Pharmacotherapy for hypertriglyceridemia 68
Pharmacokinetics69
Clinical studies 69
PP Mohanan
Hypertension82
Heart failure 82
Myocardial infarction 82
Renal function 82
Diabetes82
Stroke83
Left ventricular hypertrophy 83
Atrial fibrillation 83
Molecular structure 85
Electrophysiological properties 86
Dosing86
Metabolism86
Indications 87
Evidences with some key trials with the drug 88
Adverse effects of amiodarone 88
Antiplatelet agents 90
Antiplatelet drugs under development 93
Guidelines for antiplatelet therapy 93
Current choice of antiplatelet therapy: Indian perspective 93
Rajeev Lochan
Antiplatelet agents 97
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Tiny Nair
Geevar Zachariah
Contents
28. Role of Psychosocial Factors and Relaxation Techniques in the Etiology and
Prevention of Cardiovascular Diseases.............................................................................................................160
SKD Bhardwaj
GS Sainani
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Prakash Deedwania
Background173
Prevalence173
Pathophysiology of cardiometabolic syndrome 174
Clinical implications 174
Therapy174
Progression from metabolic syndrome to diabetes and cardiovascular disease 177
Management of individual risk factors 178
Manish Aggarwal
History189
Classification189
Risk factors for coronary microvascular dysfunction 189
Pathophysiology190
Management190
Contents
Shashank Joshi
19501990244
1990Present246
Future251
Nitin Burkule
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SK Parashar
George Thomas
Complications of MI295
Cardiac rupture 296
Mitral regurgitation 299
Atrial infarction 302
Diastolic dysfunction 302
Contents
SS Iyengar
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Dev B Pahlajani
PAMI: best option out there! 367
Rescue PCI367
Facilitated PCI367
Delayed routine and selective PCI368
PCI of an infarct artery versus non-infarct artery 368
Stent in PCI369
Antiplatelet therapy to support delayed PCI after fibrinolysis 369
Anticoagulant therapy to support delayed PCI after fibrinolysis 369
Anticoagulant therapy to support primary PCI after fibrinolysis 369
CABG in patients with STEMI370
Pharmacological therapy 370
Contents
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Mechanism436
Equipment436
Procedure437
Lesion selection 437
Indications437
Outcomes438
Clinical results 439
Rationale for use 439
Contents
Indications for HCR463
Relative contraindications 463
Technical aspects of HCR464
Sequencing HCR464
Rationale for HCR464
Factors against HCR464
Current guidelines 464
HCRIndian scenario 465
Alok Mazumdar
Natural history of vein grafts 474
Pathophysiology of saphenous vein graft disease 474
Percutaneous treatment (PCI) of saphenous vein graft obstructions 475
Value of intravascular ultrasound in vein graft interventions 475
Strategies to prevent no-reflow in Saphenous vein graft interventions 475
The ACC/AHA indications for post-CABG-SVG Disease interventions 477
Practical approaches to SVG PCI477
Evaluation496
Coarctation of aorta 496
Aortic aneurysm 498
Thoracic aortic aneurysm 500
Abdominal aortic aneurysm 501
Aortic dissection 504
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Epidemiology513
Diagnosis and evaluation 513
Therapeutic strategies 516
Revascularization516
Endovascular treatment 516
Acute limb ischemia 520
Epidemiology of PAD523
Natural history of PAD523
Clinical presentation 523
Imaging studies 524
Management of lower extremity PAD524
Acute limb ischemia 525
Aditya Kapoor
Natriuretic peptides 538
Biomarkers of myocardial injury: cardiac troponin T or I538
Extracellular matrix markers 539
Aldosterone539
Markers of inflammation 539
Adrenomedullin539
Copeptin539
Neutrophil gelatinase-associated lipocalin 539
Kidney injury molecule-1 539
Quiescin Q6539
High-sensitivity ST2539
Contents
Galectin-3540
Multimarker approaches 540
Pathophysiology542
Causes542
Diagnosis543
Echocardiography543
Diagnosis561
Treatment strategies of ADHF562
Pharmacologic agents in development for ADHF566
Nakul Sinha
Diabetes570
Hypertension570
Anemia570
Fatigue/generalized weakness 571
Preamble573
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Management573
Pathophysiology574
Chetan P Shah
SECTION 9: HYPERTENSION
91. Approach to a Newly Diagnosed Hypertensive..............................................................................................589
Definition589
Diagnosis and initial evaluation 590
Evaluation of target organ damage 590
Secondary hypertension 590
General approach to patient 591
Specific strategies and approach for patient in different age groups 591
Approach to hypertension treatment 593
A Banerji, S Sengupta
Definitions602
Epidemiology of cardiovascular disease and hypertension 602
Indian epidemiological perspective 603
Markers of increased cardiovascular risk in hypertension 603
Management of hypertension 603
Contents
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Rajeev Gupta
TK Mishra
Scenario656
Renovascular syndromes with RAS656
Functional classification of atherosclerotic RAS656
Pathophysiology of renovascular hypertension 656
Hypertension in RAS657
Medical therapy of renovascular hypertension 657
RAS and refractory hypertension 658
Revascularization658
Endovascular renal angioplasty and stenting 658
Lessons learnt 659
Cause of no drastic benefit of revascularization in ARAS660
Surgical modality 660
C Venkata S Ram
Contents
IB Vijayalakshmi
Background691
Transthoracic echocardiography 691
Echocardiography versus clinical examination 691
Accurate diagnosis is eluding clinicians 692
Echocardiography features of carditis 692
Is echocardiography superior in the diagnosis of carditis? 693
Integrative approach to assessment of severity of mitral regurgitation 693
G Karthikeyan
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Evaluation727
Treatment728
I Sathyamurthy, K Jayanthi
Ajay Bahl
SB Gupta
Definition740
Epidemiology740
Nomenclature740
Etiopathogenesis741
Clinical features 741
Differential diagnosis 741
Contents
Diagnosis 741
Risk factors 742
Management742
Prognosis742
Roopa Salwan
Prevalence745
Concepts about pathophysiology 745
Multivessel epicardial coronary artery spasm 745
Coronary microvascular impairment 745
Catecholamine cardiotoxicity 745
Patient demographics and presenting signs and symptoms 746
Echocardiographic findings 746
Echocardiography747
Cardiac magnetic resonance imaging 747
Cardiac catheterization and angiographic findings 748
Systolic and diastolic dysfunction in stress cardiomyopathy 748
Management750
Recurrence rate and prognosis 750
Peeyush Jain
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Ajay Kumar Sinha, Vikas Singh, Pramod Kumar, Anand Gopal, Sanjeev Kumar
ST Yavagal
Contents
Rajiv Bajaj
Physiology802
Antenatal care 802
Delivery803
Mitral stenosis 803
Mitral regurgitation 803
Mitral regurgitation with mitral stenosis 803
Aortic stenosis 803
Aortic regurgitation 804
Right-sided valvular disease 804
Multivalvular disease 804
Endocarditis804
Congestive heart failure 804
Arrhythmias804
Surgical correction during pregnancy 804
Prosthetic valve management 804
Key points 805
M Somasundaram, K Meenakshi
Treatment821
Newer treatments 821
Incidence825
Risk factors 825
Pathophysiology825
Diagnosis826
Clinical presentation 826
Management827
Role of IVC filters in pulmonary embolism 828
Newer oral anticoagulants (NOACS)829
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BKS Sastry
Pathophysiology870
Clinical presentation 870
Diagnostic work-up 871
Treatment871
Pulmonary thromboendarterectomysurgery for chronic thromboembolic pulmonary hypertension 872
Surgical results 872
Postoperative residual pulmonary hypertension 872
Postsurgical follow-up 872
Pulmonary arterial hypertension-specific therapies 872
Balloon angioplasty 873
Lung transplantation 873
Contents
Key principles in resuscitation: strengthening the links in the chain of survival 874
Chest compression only CPR in witnessed out-of-hospital cardiac arrest 875
Is cardiopulmonary resuscitation first or defibrillation first? 875
Devices in cardiopulmonary resuscitation 876
When should cardiopulmonary resuscitation be stopped? 877
Should we allow family member to witness cardiopulmonary resuscitation? 878
Should hypothermia be a part of the postcardiac arrest care? 878
Normal RV879
Right ventricle in pulmonary arterial hypertension 879
Ventricular interdependence 880
RV failure 880
Echocardiography using pulse Doppler to perform MPI883
Prognostic indicators in PAH884
Specific drugs 885
Ulhas Pandurangi
Definition909
Epidemiology909
Risk stratification 909
Implantable cardioverter defibrillator 910
Pharmacotherapy911
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BP Singh, Ravi Vishnu Prasad, Nishant Tripathy, Nirav Kumar, Pawn Kumar, Shamboo Kumar
Rabin Chakraborty
Neurogenic control of the heart and its effects on blood pressure 920
Diagnostic evaluation of neurocardiogenic syncope 921
Syncope secondary to structural cardiac or cardiovascular disease 924
Unexplained syncope in patients with high risk of sudden cardiac death 926
Classification928
Management strategies 928
Geetha Subramanian
K Meenakshi
Indications943
Precautions944
Clinical significance and implications 944
Contents
151. Which Patients may Benefit More by Giving Antihypertensive Drugs at Night?......................................965
SK Dwivedi
Ajay Naik
Neeraj Pandit
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Epidemiology1008
Pathophysiology1008
Etiology of ischemic stroke 1009
Classification of acute ischemic stroke 1009
Diagnosis of ischemic stroke 1010
Treatment1011
Classification of ACHD1017
Pathophysiology of ACHD1017
How to suspect ACHD1019
Auscultation in individual ACHD1021
Chest X-ray 1023
Electrocardiogram1024
160. How to Deliver the Best Care for Patients with Congenital Heart Disease in India................................1028
Anita Saxena
Contents
Smita Mishra
Definition1054
Epidemiology1054
Classification1054
Pathophysiology1054
Natural history 1055
Clinical features 1055
Investigations1056
Management strategy 1056
Future trends 1058
N Trehan, U Dhir
OP Yadava, A Kundu
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167. A New Era in Heart Transplantation with Donation after Circulatory Death...........................................1079
Manoj Agny
Pradeep Nambiar
Methods1082
Results1084
Comment1085
Mona Bhatia
Rochita Venkataramanan
Contents
GN Mahapatra
Yatin Mehta
Background1135
Aims of ECMO1135
ECMO terminology 1135
Decision to institute ECMO1135
Contraindication of ECMO1135
Types of ECMO1136
VV ECMO 1137
VA ECMO1138
Central versus peripheral ECMO 1139
Uses of ECMO 1140
ECMO for cardiac surgery 1140
ECMO in cardiogenic shock 1140
ECMO in heart failure 1140
ECMO and sepsis 1141
Noncardiac indications for ECMO1143
Acute respiratory distress syndrome 1143
Clinical trials 1143
ECMO and CRRT1143
ECMO and organ preservation 1144
ECMO and lung transplantation 1145
Meconium aspiration and ECMO 1147
Novoseven use in a noncardiac pediatric ECMO patient with uncontrolled bleeding 1147
Circuit management 1147
Past and future of ECMO: the cardiohelp 1149
ILA activve (Novalung, Germany) for CO2 removal during ECMO1150
Complications1150
Poonam Malhotra
Types of ECMO1152
Indications of VV ECMO and VA ECMO1152
Cardiac indications of ECMO 1153
Venoarterial ECMO versus ventricular assist device 1154
Venoarterial ECMO for cardiorespiratory failure 1155
ECMO as bridge to transplant 1155
Venoarterial ECMO contraindications 1155
Quantification of differential ECMO return flow through an axillary artery anastomosis graft with
spectral Doppler echocardiography 1155
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Echocardiography has a pivotal role throughout the care of patients support on ECMO1156
Echocardiography before ECMO commencement (selection of patients) 1156
Echocardiography during ECMO initiation and cannulation 1158
Echocardiography and monitoring ECMO response 1163
Echocardiography in detection of ECMO complications 1166
Echocardiography during patients recovery and weaning of support 1169
Pitfalls of echo in ECMO1171
Echo is fundamental during ECMO in following ways 1171
KK Aggarwal
Background1181
Scales of measurements 1181
Major steps under research methodology 1181
Data collection: bias, confounding and effect modification 1183
RP Sapru
V Jacob Jose
181. Corus CAD Test: A Gene Expression Test to Help Exclude the
Diagnosis of Obstructive Coronary Artery Disease......................................................................................1195
Mark Monane
RK Kotokey, Patil Vijay Kumar, Nayanjyoti Bez, Atul Pandey, Sayyed Imran, Luhamdao Bathari
Contents
P Syamasundar Rao
Index.............................................................................................................................................................................. 1217
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