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Biomedical subjects

M Panja

Publications and source records attributed to M Panja.

At least 19 recordsLinked to original sources
PubMed2005

High sensitive C-reactive protein: a novel biochemical markers and its role in coronary artery disease.

A series of prospective studies provide consistent data documenting that mild elevation of baseline levels of hs-CRP among apparently healthy individuals is associated with higher long-term risk for future cardiovascular events. This predictive capacity of hs-CRP is independent of traditional cardiovascular risk factors and offers a prognostic advantage over measurement of lipid alone. PHS and CARE trial suggest that the increased risk associated with systemic inflammation may be modified with certain preventive therapies and that inflammatory marker specifically hs-CRP may help to identify those who would benefit most from these pharmacological intervention. hs-CRP is the novel and evolving biomarker which provides a most useful predictive indicator for subsequent cardiovascular events. Based on various studies, increased hs-CRP levels in patients with high risk cardiovascular disease without documented CAD warrant treatment with statin even if LDL-C levels are within target range. Patients with documented CAD and high hs-CRP levels should be followed, and there risk factors should be managed aggressively.

Biomarkers↗
PubMed2005

Myocardial metabolism: pharmacological manipulation in myocardial ischaemia.

Acute myocardial ischemia may result in diverse outcomes ranging from asymptomatic episodes to frank myocardial infarction. Reperfusion therapy becomes the mainstay of treatment of patients with evolving MI and provide practical approach for salvage of ischemic myocardium. Favorable modulations of metabolic events during and after ischemia results in increased myocardial salvage in reperfused myocardium. The use of GIK showed great advantage in enhancing myocardial salvage in patients with AMI. Use of other metabolic agents show great promise in experimental studies and merits further evaluation in human trials. Metabolic modulation of ischemic myocardium continues to be a unique and untapped approach to favorably effect ischemic myocardium. Metabolic adjuncts can be employed to lessen ischemic injury and thereby enhance the salutary effects of reperfusion. The use of metabolic manipulations which enhance glycolytic pathways and inhibit potentially noxious fatty acid intermediates may also offer a noble approach for the protection of transiently ischemic myocardium in patients with coronary artery disease. And one thing is certain, that is -- agents that modify myocardial metabolism in disease states have definitely enhanced the therapeutic armamentarium to fight the problem and improve the well being of the patients.

Cardiovascular Agents↗
PubMed2004

Pseudoaneurysm following lateral wall myocardial infarction.

Pseudoaneursym (PA) formation of left ventricle (LV) following acute myocardial infarction (AMI) is uncommon and is usually believed to be associated with a grave prognosis. We describe a case of 55 year old male patient presented with AMI and heart failure with a systolic murmur later diagnosed to have PA of the lateral wall of LV on echocardiography (transthoracic and transesophageal, TTE andTEE). Cardiac MRI and coronary angiogram (CAG) were performed. CAG showed 60% lesion at origin of major obtuse marginal artery (OM1). The patientwas advised surgical treatment, but he refused and took discharge against medical advice on 27th dayof admission on stable condition.

Aneurysm, False↗
PubMed2000

Current understanding of pathogenesis of coronary artery disease and its future implications.

Coronary artery disease (CAD) is the most important cause of morbidity and mortality in a population. Percutaneous coronary intervention and coronary artery by-pass grafting have greatly changed the treatment of CAD, still many questions remain unanswered. Atherosclerosis is a normal consequence of ageing but some patients may experience it at an earlier age. As regarding pathogenesis of atherosclerosis, it is described often as a focal process which is diffuse in nature primarily involving the vessel intima. Salient features of 'lesion prone areas' in atherosclerosis include increased endothelial permeability to an intimal accumulation of plasma proteins, including albumin, fibronogen and LDL. The clinical expression of atherosclerotic disease activities is determined by pathologic events leading to coronary thrombosis. A vulnerable plaque has the characteristics of: Extracellular lipid pool occupies a large proportion of overall plaque volume, the fibrous cap which separates the lipid core from luminal blood is thinner within, and high macrophage density. Typically these plaques cause < 50% cross-sectional stenosis of the artery. The contribution of CAD is clearly of both genetic and environmental in origin. An increase in shedding of cell adhesion molecules may be a characteristic of atherosclerotic lesion. There is also suggestion that plasminogen activation inhibitor type I (PAI-1) has an important role in atherogenesis. Angiogenic growth factors and their endothelial receptors function as major regulators of blood vessel formation. Thereapeutic angiogenesis can be achieved by exogenously adding VEGF and/or other angiogenic growth factors.

Angiogenesis Inducing Agents↗
PubMed2000

The newer unconventional indications of permanent pacemakers.

In recent years, the indications for permanent pacemakers have expanded. The interest has focussed on hypertrophic cardiomyopathy, dilated cardiomyopathy and a new entity called hypertensive hypertrophy with cavity obliteration (HHCO). Pacemaker therapy is establishing itself for the prevention of atrial fibrillation. Pacing for neurocardiogenic syncope with newer pacing mode has encouraging datas. Pacemaker for long QT syndrome, after cardiac transplant and for haemodynamic improvement in occasional cases of first degree atrio-ventricular block is getting attention. The AHA and ACC guidelines updated in 1998 for implantation of cardiac pacemakers, now include several of these newer indications.

Atrial Fibrillation↗
PubMed1998

Coronary artery lesions in Takayasu's arteritis--clinical and angiographic study.

Two hundred and twenty five patients of Takayasu's arteritis were studied over 13 years. Male:Female ratio was 1:7. Mean age of the study population was 19 +/- 4 years. Of these 225 patients, 75 patients had symptoms and/or signs of cardiac involvement and these patients were subjected to coronary angiography. Significant coronary artery occlusion (i.e. more than 50% narrowing of luminal diameter) was present in 9 patients. Incidence of coronary artery lesions in Takayasu's arteritis is 12% in this study. The proximal segments of coronary arteries were involved while the distal segments were spared. Out of 34 patients with angina pectoris, only 3 patients had significant coronary arterial narrowing.

Adolescent↗
PubMed1996

Significance of exercise induced increase in the diastolic pressure as an indicator of severe coronary artery disease.

A total of 100 patients were studied for the diastolic blood pressure response to treadmill exercise testing. No change in the diastolic pressure or lowering of the pressure was considered normal response. Seventy-four patients had normal and 26 patients had abnormal diastolic blood pressure response. Forty patients underwent coronary angiography. Fifty-five per cent of the patients with normal diastolic pressure response had normal coronaries compared to 20% with abnormal response. Eleven per cent with normal response and 40% with an abnormal response had triple vessel disease whereas 10% with abnormal response had left main coronary artery disease. Exercise induced ST segment depression was almost equal in both groups. Hence it can be concluded that abnormal diastolic pressure response to treadmill exercise testing is a fairly good indicator of coronary artery disease irrespective of ST segment changes.

Adult↗
PubMed1996

A study of inferior vena cava obstruction.

Inferior Vena Cava obstruction as a major cause of hepatic venous outflow block is not so common. A prospective study of 20 cases gave us an opportunity to device a management protocol for this disorder. Out of 20 cases we had studied, 12 had only inferior Vena Cava obstruction while rest of the 8 cases had both hepatic vein and IVC blockade. However, balloon cavoplasty showed remarkable results with substantial clinical and haemodynamic improvement in cases with isolated IVC obstruction. Therefore, we suggest that patients with IVC obstruction should be actively managed with Vena-cavography followed by cavoplasty. Treatment of Hepatic venous obstruction along with IVC obstruction is controversial; bypass shunt is usually required and long term follow-up studies are required to establish safety and efficacy.

Adolescent↗
PubMed1995

Significance of exercise induced increase in diastolic pressure as an indicator of severe coronary artery disease.

A total of 100 patients were studied for the diastolic blood pressure response to treadmill exercise testing. No change in the diastolic pressure or lowering of the pressure was considered normal response. Seventy four patients had normal and 26 patients had abnormal diastolic blood pressure response. Out of these, 40 patients underwent coronary angiography. Fifty five percent of the patients with normal diastolic pressure response had normal coronaries compared to 20% with abnormal response (p < 0.03). Fifteen percent with normal response had triple vessel disease or left main coronary artery disease whereas forty percent with an abnormal response had significant disease (p < 0.03). Exercise induced ST segment depression was almost equal in both groups. Hence we can conclude that abnormal diastolic pressure response to treadmill exercise testing is a fairly good indicator of coronary artery disease irrespective of ST segment changes.

Blood Pressure↗
PubMed1994

Ventricular late potentials after thrombolysis.

High frequency low amplitude signals that prolong the terminal portion of the QRS complex in the electrocardiogram are termed late potentials (LPs). It has been established for quite some time that the presence of LPs after acute myocardial infarction (AMI) is associated with an increased risk of ventricular tachyarrythmias and sudden cardiac death (SCD), and vice versa. It is also known that thrombolytic therapy after AMI significantly decreased the incidence of ventricular tachyarrythmias and SCD. The object of this study was to find out whether thrombolysis in AMI decreased the incidence of LPs. Fifty two male patients of the age group 41-46 years with first anterior wall AMI were studied. Thirty of them presented within 6 hours of chest pain and were given intravenous streptokinase (IVSK) in addition to conventional therapy. The remaining 22 received conventional therapy but no thrombolysis. There was no significant difference in these two groups regarding age, CKMB, hypertension, diabetes, smoking, prior use of beta blockers, and ejection fraction. Eight out of the 30 patients receiving IVSK were positive for LPs as against 13 out of the 22 in the control group. This difference was statistically significant (p > 0.02 < 0.01). Thus thrombolysis in the early hours of anterior AMI diminishes the incidence of LPs.

Adult↗
PubMed1993

Aortic regurgitation in hypertrophic cardiomyopathy.

Aortic regurgitation (AR) has been sparsely reported in Hypertrophic Cardiomyopathy (HCM) but neither its frequency nor severity has been determined. 30 patients of HCM were evaluated both by Echocardiography as well as by Cardiac Catheterisation and angiography over a 2 year period. Most of them had echocardiographically normal aortic cusps. Patients were divided into 2 groups, those with AR (Group-I) and those without AR (Group-II). Group-I patients (10 patients) were significantly older than group-II (51 +/- 4 years vs 38 +/- 3 years, p < 0.001) and had larger end-diastolic dimension (EDD) (5 +/- 0.5 vs 2.5 +/- 0.4 cms p < 0.001) and end-systolic dimension (ESD) (3.2 +/- 0.3 vs 2.7 +/- 0.4 cms p < 0.05) of Left ventricle (LV) in Echo. LC Wall thickness, and LV asymmetric septal hypertrophy (ASH) and fractional shortening (FS) were similar in the 2 groups. Mitral regurgitation (MR) was more common in Group-I (100% vs 45% p < 0.001) although there was no difference in left atrial (LA) size between the two groups. The HCM patients were compared with a control group of 20 normal subjects. None of them (Normal) had any AR murmur or Doppler or angiography proved AR. Thus nearly 1/3rd of patients with HCM had mild AR by Doppler or aortic root angio and about 10% of HCM patients also had aortic early diastolic murmur. The AR most probably results from high velocity systolic blood flow causing microscopic or macroscopic damage to the valve cusps.

Adult↗
PubMed1992

Cardiac involvement in non-specific aorto-arteritis.

Cardiac involvement in 75 cases (mean age 21.1 +/- 6 years) with non-specific aorto-arteritis was studied. Detailed clinical examination, echocardiography and cardiac catheterization, including angiography, were done in all the cases, as was coronary angiography. Features of cardiac failure like sinus tachycardia, cardiomegaly, left ventricular third heart sound gallop and pulmonary congestion were detected in 27 cases with reduction of left ventricular ejection fraction (25-48%). Systemic hypertension was seen in 60 cases. Central aortic pressure, left ventricular systolic pressure and left ventricular end-diastolic pressure were increased in 66 cases. Pulmonary hypertension and increased pulmonary vascular resistance were detected in 6 cases. Aortic and mitral regurgitation were seen in 15 and 12 cases, respectively. Three patients had features of dilated cardiomyopathy such as generalized cardiomegaly, systemic and pulmonary congestion but without any cardiac murmurs and with normal central aortic pressure. The coronary angiogram revealed obstruction of the left anterior descending artery in 3 cases and right coronary artery obstruction in another 3 cases. Histopathological studies revealed non-specific inflammatory changes with fibrosis in cardiac musculature and the great vessels.

Adolescent↗
PubMed1991

Early experience with percutaneous transluminal coronary angioplasty in unstable angina.

Percutaneous transluminal coronary angioplasty was done in 13 of 105 patients with unstable angina, 10 of whom were males. Diagnostic coronary angiography revealed single vessel disease in 10 cases and two vessel disease in 3 cases; the degree of stenosis varied from 70-90%. Only a single major coronary artery was dilated. Immediate angiographic success was achieved in 12(92.3%) cases. The success rate at the time of discharge from hospital was 10 (76.9%) cases. Immediate complications encountered were acute myocardial infarction in 2 cases, they refused coronary artery bypass grafting and unsuccessful dilation in 1 case. No death occurred during the hospital stay. During follow-up of 6-9 months, 8 patients were symptom free (66.6%), 2 patients required repeat percutaneous transluminal coronary angioplasty and 2 patients died. In conclusion, percutaneous transluminal coronary angioplasty may be undertaken relatively safely in unstable angina, it leads to substantial improvement in symptoms during the early follow-up period. This therapeutic approach is highly beneficial particularly in single vessel disease.

Adult↗
PubMed1991

Cardiac changes implicated in chronic heart block.

Fifteen cases of chronic heart block were studied. Eight of them could be designated as idiopathic or primary heart block; the others were associated with hypertension, diabetes and ischaemic heart disease, either singly or in various combinations. In six cases, the whole heart was available for histopathological study of the conduction system. In the other 9 cases, only a portion of the heart muscle was available for examination. A V nodal fibrosis extending upto the proximal bundle of His was seen in all the six whole heart autopsy materials. Fibrosis of the adjacent myocardium was seen in five cases. In three cases, conducting system fibrosis was associated with atherosclerotic (1 case) or diabetic changes (3 cases) of the intramural vessels. In the 9 partial autopsy studies, myocardial fibrosis was seen in two cases, diabetic microangiopathy in one and atherosclerotic changes in two including an old thrombus in one. Thus, diabetic microangiopathy was seen in total four cases. These changes may be responsible for the cardiomegaly and cardiac failure associated with conduction defects observed in diabetes. In the idiopathic group also, heart block could be considered as a significant facet of a primary myocardial degenerative process.

Chronic Disease↗