Day 1 :
William J. Rowe
Medical University of Ohio at Toledo, USA
Keynote: Hypertension Risk from Iron Brake Particulate Matter
William J. Rowe M.D. FBIS (Fellow British Interplanetary Society), FACN (Fellow American College of Nutrition, Retired Fellow Royal Society of Medicine), is a board certified specialist in Internal Medicine. He received his M.D. at the University of Cincinnati and was in private practice in Toledo, Ohio for 34 years. During that time he supervised over 5000 symptom - limited maximum hospital-based treadmill stress tests. He studied 3 world class extraordinary endurance athletes and published their exercise-related magnesium deficiencies. This triggered a 20 year pursuit of the cardiovascular complications of Space flight. All his publications are posted on his website
Of 12 moon walkers, James Irwin on day after return from Apollo 15 mission, showed extraordinary bicycle ( B) stress test (ST) hypertension ( 275/125) after 3 minutes exercise; supervising > 5000 maximum treadmill ST, author never witnessed ST- blood pressure approaching this level. Symptom-limited maximum B stress test showed “cyanotic fingernails”; possibly venous blood trapped peripherally, supporting author’s “Apollo 15 Space Syndrome,” postulating that severe fingertip pain during space walks, triggered by plasma fluid, trapped distally; mechanism could be related to endothelial dysfunction, providing “silent ischemia” warning. Neil Armstrong returned to Earth with severe diastolic hypertension ( 160/135), consistent with ischemic left ventricular dysfunction; 50 mm increase in comparison with resting BP 110/85. With inhalation of lunar dust, brought into habitat on space suit, with high lunar iron (I) this dust inhalation, along with reduced (R) space flight- transferrin, R antioxidant, calcium (Ca) blocker - magnesium, conducive to severe oxidative stress, Ca overload with potential endothelial injuries. Using moon walker studies as example, my recent editorials show that I dust, released from brakes, with over 90% of brakes made of I, is a major hypertension factor and may also contribute to myocardial infarctions.
- Hypertension, Cardiac Surgery, Vascular Biology
William J. Rowe
Medical University of Ohio at Toledo, USA
Philippine Heart Center, Philippines
Title: Anomalous Left Coronary Artery from the Right Pulmonary Artery
Camille-Marie Go-Cacanindin has obtained her Medical Degree at the age of 25 years from University of Santo Tomas Faculty of Medicine and Surgery and Pediatric Residency Training from Philippine Children’s Medical Center. She is currently a Pediatric Cardiology Fellow in training at Philippine Heart Center, a tertiary cardiovascular referral center.
Anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA) occur in 1 in 300 000 live births. The most common origin of the abnormal LCA is from the pulmonary truncal sinuses. The rarest form of ALCAPA presents with anomalous left coronary artery arising from the right pulmonary artery. This is a case of 1 month old female presenting with Dyspnea , 2D echocardiography revealed ALCAPA. Intraoperativley, the Left Coronary Artery was found to be originating from the Right Pulmonary Artery. The patient underwent coronary implantation and LeCompte procedure.
In the most common form of ALCAPA, the abnormal coronary artery arises from the adjacent pulmonary valvar sinus, rather than the pulmonary trunk. In this case, the Anomalous Left Coronary Artery originated the Right Pulmonary Artery. Such case has an incident of 1 in 2,000,000 live births. This is the first reported case in a tertiary cardiovascular referral center. In fetal life, this has no detrimental effect since pressures and saturations are similar in the aorta and pulmonary artery. After birth, however, the pulmonary artery contains desaturated blood at pressures that rapidly fall below systemic pressures. The left ventricle is perfused with desaturated blood at low pressures leading to infarction with ventricular dysfunction. Coronary translocation and Lecompte maneuver was done which provided relief for the patient’s condition.
Rubyat Hasan Chowdhury
BIRDEM General Hospital, Bangladesh.
Title: Non-Cardiac Causes of Raised Troponin-I in Adult Patients Admitted Under Cardiology Department in a Tertiary Level Hospital
Dr Rubyat Hasan Chowdhury has completed his MBBS from University of Dhaka in 2007 and achieved his fellowhip in Medicine from Bangladesh College of Physicians and Surgeons in 2016. He has a vast experience in different fields of medicine including Cardiology, Nephrology, Neurology, Gastroenterology, Endocrinology etc. Currently he is serving as Senior Medical Officer, Coronary Care Unit, Bangladesh Institute of Research and Rehabilitation on Diabetes, Endocrine and Metabolic Disorders (BIRDEM). He has attended more than 20 national and International Conferences.
Objective: To find out different causes of raised troponin I in adult patients other than cardiac cause. Methodology: This cross sectional study was carried out enrolling 65 subjects with raised troponin I, in the Department of Cardiology, BIRDEM, Dhaka, over a period of six months from July 2013 to December 2013. Results: Most common non-cardiac cause of raised troponin I were sepsis (38.46%), CKD (32.3%), stroke (15.38%) and defibrillation (13.86%) in this present study. The mean age was 50.92 ± SD 12.77 years and their age ranged from 35 to 66 years. Majority (44.61%) of the respondents were found in the age group of 51-59 years. Gender distribution revealed that 40 (61.54%) were male and rests 25 (38.46%) were female . Hypertension (46.15%), dyslipidaemia (36.92%), diabetes mellitus (20%) and smoking (40%) were pre-existing risk factors in the study group. Chest pain (58.46%), breathlessness (46.15%), raised temperature (38.46%) and focal neurological deficit (15.38%) were the common presenting symptoms. X- ray revealed, cardiomagaly (9%) and pulmonary oedema (39%). Old infarct (12.3%), LV hypertrophy (43.07%) and arrhythmia (21.53%) were evident in ECG. Majority (52.3%) of the subjects had ≥60% LV dysfunction on Echocardiography. 18.46% had 50-59% LV dysfunction. 6.17 percent subjects had less than 30 % LV dysfunction. Conclusion: From the study result it can be concluded that subjects with sepsis, CKD, stroke and post-defibrillation are the commonly encountered with raised troponin I in cardiology wards other than ACS. As such, it could be noted that in case of patients with raised troponin I, these common condition should be excluded to avoid unnecessary treatment of ACS in subjects with raised troponin I.
Warsaw Medical University, Poland
Title: Alterations in the cardiovascular system in patients with cirrhosis - assessment of a haemodynamic profile
Maciej Kusztal - 6th year medical student of Warsaw Medical University. His main objects of interest comprise internal medicine and cardiology but also emergency medicine and intensive care. Maciej’s research projects were awarded on several medical congresses for student and young scientists in Poland and his last project was granted with financial support from Ministry of Science and Higher Education in Poland.
Background/Introduction: Cirrhotic cardiomyopathy (CCM) is a condition concerning heart muscle dysfunction, occurring among
patients with cirrhosis. Cirrhosis leads to the development of a hyperdynamic syndrome, which is
manifested by high cardiac output, increased heart rate and effective arterial blood volume,
accompanied by reduced total systemic vascular resistance.
Purpose: The aim of the study is to screen patients with cirrhosis, which may lead to earlier diagnosing CCM and hyperdynamic syndrome with its consequences among them.
Methods: The study included 70 patients over 18 years old, with cirrhosis, caused by alcohol ([ALD], 22),
autoimmune (26), viral (9) other reasons (13), qualified for liver transplantation. 39 of them were
male. Median age was 47. We disqualified patients with a history of cardiovascular diseases. Each
patient had a 6-minute walking test (6MWT) done and a hemodynamic monitoring using non-invasive hemodynamic monitor device was also performed.
Results: Basic group characteristic differs between aetiologies of liver diseases. Median NTproBNP level was highest in ALD group (253pg/ml) and viral group (177,5 pg/ul) compared to autoimmune group (51
pg/ul) and other (114 pg/ml). Median QTc interval was more prolonged in patients with viral
aetiology (456ms) and ALD aetiology (441ms) than autoimmune aetiology (422ms) and other
aetiology (431ms). Highest median CO were observed in viral group (6L/min) and ALD group
(5,7L/min) and lower in autoimmune group (5,35L/min) and other (5,2L/min). Median SVRI was
lowest in viral aetiology (1700 dyn- s/cm –5 /m 2 ) and ALD aetiology (1888 dyn- s/cm –5 /m 2 ) and higher
in autoimmune aetiology (2067 dyn- s/cm –5 /m 2 ) and other aetiology (2432 dyn- s/cm –5 /m 2 ).
There was no statistical difference in distance median value between aetiological groups (407m in
ALD patients’ group, 412,5m in autoimmune patients’ group, 384m in viral patients’ group and 400m
for other aetiology patients’ group; p=NS). The haemodynamic parameters (CO, SV, SVRI) were not
correlated with MELD score and Child Pugh score (p=NS). DBP was positively correlated with MELD
score (r=-0,25; p=0,009) and Child-Pugh score (r=-0,31; p=0,003). The distance was negatively
corelated with severity of the liver disease based on MELD score (r=-0,34; p=0,0048) score and Child-
Pugh score (r=-0,321 ; p=0,0072).Preliminary results show statistically significant correlations
between distance in 6MWT and eGFR (r=0,78;p=0,0082), Systemic Vascular Resistance(SVR) at the
end of 6MWT (r=0,197 ;p=0,0011), Diastolic Blood Pressure (DBP) at the end of 6MWT
(r=0,45;p=0,014) and NT-proBNP (r=0,28 ;p=0,0008) level, patient’s weight (r=0,286; p=0,044) and
height (r=0,37; p=0,008).
Conclusion(s): Preliminary results show that we can detect subclinical alterations in patients’ circulatory parameters by non-invasive haemodynamic monitoring. In our study patients with viral and ALD etiology
presented more advanced liver cirrhosis stages and more pronounced manifestations of
hyperdynamic syndrome which may later progress to CCM. Positive correlation of liver cirrhosis stage
and NTproBNP, QTc and 6MWT distance may suggest heart function impairment in course of liver
Liaquat University of Medical Health Sciences, Pakistan
Title: Assessment of Triglyceride to High-density Lipoprotein Ratio as an Indicator of Coronary Artery Disease
Dr Naveed has completed his MBBS at the age of 25 years from Liaquat University of Medical Health Sciences,Jamshoro Hyderabad, Pakistan and postdgraduate studies from National Institute of Cardiovascular Diseases Karachi. He is the Clinical Fellow of Adult Cardiology. He is also certified BLS and ACLS Instructor from AHA in College of Physicians and Surgeons in Pakistan.
Introduction: Increased ratio of Triglyceride (TG)/ High-density Lipoprotein (HDL) has been known as an accompanying finding in conditions like obesity and metabolic syndrome. Therefore, the aim of this study was to assess the utility of TG/HDL ratio as a diagnostic tool for the assessment of coronary artery disease (CAD).
Methods: This study was conducted at a semi-private hospital Karachi; patients above 15 years of age and undergone angiography or PCI were included. Patients with Congenital Heart Disease and familial hyperlipidmeia were excluded. TG/HDL ratio was obtained for all patients, severity of the disease was classified as normal, mild to moderate, moderate to severe, and very severe based on coronary angiography. Analysis of variance was applied to assess significant differences in mean TG/HDL ratio among severity of disease. P-value<0.05 was considered significant.
Results: A total of 2,212 CAD patients were reviewed out of which 1613 (72.9%) were male and 599 (27.1%) were female. Average age of the patients was 55.12 years (±SD=9.93). Of these 2212 patients, 533 (24.1%) had very severe disease, 1213 (54.8%) had moderate to severe disease, 258 (11.7%) had mild to moderate disease, and 208 (9.4%) were normal. A Significant and an increasing trend was observed in TG/HDL ratio with the severity of disease (p=0.0001) Statistically significant difference was observed in the TG/HDL ratio of patients with mild to moderate, moderate to severe and very severe disease from normal patients. However, no statistically significant difference was seen in the TG/HDL ratio between the patients with moderate to severe and very severe disease.
Conclusions: A positive relationship between Triglyceride to HDL Ratio and severity of coronary artery disease was observed. Therefore, TG/HDL ratio can be used as an indicator of severity of coronary artery disease in addition to other parameters of lipid profile.