6^th International Conference on Clinical & Experimental Cardiology November 29-30, 2015 San Antonio, USA

Anjali Om is a sophomore at Virginia Commonwealth University in the Guaranteed Admissions BS/MD program. Dr. Prabal Guha is an electrophysiologist at McLeod Regional Medical Center in Florence, SC. He completed his medical school and internal medicine training in India and a fellowship in cardiology at SUNY Syracuse. His interest is in basic electrophysiology, in the study of the role of potassium channels in cardiac arrhythmia, and he is currently an assistant professor of medicine at USC Columbia.

Nearly a million patients undergo percutaneous coronary interventions (PCI) in the United States every year.1 These patients are at high risk for arrhythmia, which can be precipitated by electrolyte imbalances, such as hypokalemia or hypomagnesemia.2 The effect of PCI or contrast used on these electrolytes post-procedure has not been well studied. \r\nWe retrospectively analyzed the charts of 426 consecutive patients who had serum magnesium levels checked within two days pre-PCI and within two days post-PCI from January 2010-July 2015. Normal serum magnesium level in our lab was 1.4-2.0 (mEq/L). Of the 426 patients, 139 (33%) had a decrease of 0.4 mEq/L or more. Ninety (21%) patients had post-PCI serum magnesium levels ≤ 1.4 mEq/L. Despite PCI, the risk of arrhythmia in these patients remains high, especially in the immediate post-procedure period. If untreated, hypomagnesaemia post-PCI could precipitate arrhythmia in such high-risk patients. If confirmed in a larger series of patients, this new observation could necessitate a post-PCI check of electrolytes in all patients to minimize the risk of arrhythmia. The pathophysiology of hypomagnesaemia post-PCI would need further elucidation. \r\n

Naresh Sen is a Consultant Cardiologist affiliated with Narayana Hrudayalaya Institute of Cardiac Science, India. He got his medical graduation from Rajasthan University, Jaipur and post-graduation in internal medicine from South America and post doctoral training in Cardiology from USA. He has also been elected for Fellowship award of European Society of Cardiology (FESC) and American College of Cardiology (FACC). He worked in Cardiology (Invasive & Non-Invasive) as Registrar or Consultant at renowned cardiac hospital ports of India like NH & Medanta last 5 years. He has special interest in coronary artery disease and heart failure prevention. He has published around 20 publications in Cardiology .For his hard work, he was awarded as best cardiology consultant in Rajasthan, 2013 by Director of AIIMS, New Delhi.

Background- CRT (Cardiac Resynchronization Therapy) has been approved beneficially in heart failure patients with refractory optimized medical therapy on based of many studies. The guidelines have shown CRT is indicated in NYHA class III-IV, QRS >150 ms, LBBB (Left bundle branch block) to improve heart functions, ventricular remodeling and clinical symptoms.rnPurpose-comparison of stress induced mechanical dyssynchrony between rate dependent LBBB and RBBB (Right bundle branch block) and beneficial role of CRT to improve LV function and reduce mortality.rnMethod-Patients presenting dyspnea on exertion NYHA class I-II to III-IV by stress test , normal QRS to rate dependent LBBB or RBBB by Stress test or Dubutamine Stress Echo were studied. CRT on cardiac function was assessed by Cath study, Echo and MRI (Magnetic Resonance Imaging).rnResult- 46 Patients, male/female ratio (1.87), 12 months observational study done on stress induced rate dependent LBBB and RBBB with worsening dyssynchrony and poor LV function were treated with CRT. Results have shown improved LV function in rate dependent LBBB patients (31+/-6 %) v/s RBBB patients (4.5+/-4%) with P value <0.04. and reduce mortality among rate dependent LBBB with CRT v/s without CRT ( 5% v/s 20 %) and another side mortality difference between rate dependent RBBB with CRT and without CRT were not found significantly.rnConclusion- Stress induced rate dependent LBBB with mechanical dyssynchrony leads to heart failure is benefited by CRT than Rate dependent RBBB.rn

Naresh Sen is a Consultant Cardiologist affiliated with Narayana Hrudayalaya Institute of Cardiac Science, India. He got his medical graduation from Rajasthan University, Jaipur and post-graduation in internal medicine from South America and post-doctoral training in Cardiology from USA. He has also been elected for Fellowship award of various societies of Cardiology. He worked in Cardiology (Invasive & Non-Invasive) as Registrar or Consultant at renowned cardiac hospital ports of India like NH & Medanta last 5 years. He has special interest in coronary artery disease and heart failure prevention. He has published around 20 publications in Cardiology. For his hard work; he was awarded as best cardiology consultant in Rajasthan, 2013 by Director of AIIMS, New Delhi.

Background: Actinomycosis is an uncommon disease caused by Actinomyces spp., gram-positive, anaerobic or micro aerobic bacteria that normally colonize the human mouth and GIT and genital tracts. It represent such as cervicofacial actinomycosis following dental focus of infection, pelvic actinomycosis in women with an intrauterine device, and rarely cardio-pulmonary actinomycosis in smokers with poor dental hygiene may mimic as tuberculosis, fungal infection and malignancy.rnrnMethod: Bacterial cultures and pathology are the diagnostic tools, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens.rnrnResult (clinical case): 27 years old male normotensive and euglycemic, smoker with poor oral hygiene presented with right lower chest pain with shortness of breath and low grade fever last 6 days. On examination dental caries, right chest bulging with diminished breath sounds, raised WBC counts, normal ECG, Chest X-Ray showed right sided pleural effusion and bilateral opacity & pericardial effusion which were confirmed by 2D echo and CT chest. Initially he was suspected as tubercular or malignant lesion based on tapped pleural fluid but he was ruled out for same due to normal range of ADA, ADA-2 and gama-interferon value or cytology. Finally he was diagnosed as an actinomycosis isroelii on based of culture. As per antibiotic sensitivity he was treated with imipenum plus cilastin intravenously for 2 wks with support of pericardial and pleural drain followed by oral amoxycilin-clav for 3 weeks and other supportive. No surgical interventions were required. After 5 weeks follow-up he became asymptomatic and recovers clinically and radio logically.rnrnConclusion: Patients with actinomycosis require prolonged high doses of Penicillin G or amoxicillin and other sensitive antibiotics. In developing countries physician should consider the rarest possibility of cardiopulmonary actinomycosis in difficult to treat pneumonitis and pericardio-pleural effusion. Early diagnosis will reduce the hospital stay or mortality in such kind of patients.rn

Bayram G. Hodjakuliyev graduated in 1974, Saint Petersburg Medical Institute named after Pavlov. In 1974-1976 years went internal medicine in the Institute of Cardiology named after A.L. Myasnikov, under the leadership of Corresponding Member of USSR Academy of Sciences prof. N.M Muharlyamov. From 1980 to 1989 he worked in Turkmen State Medical Institute. In 1989-1992 he held a doctorate in the Institute of Cardiology named A.L Myasnikov defended his doctoral dissertation. In 1994, Bayram G. Hodjakuliyev was awarded the title of professor. The main scientific activities are cardiology, rheumatology and gastroenterology. Under his leadership was prepared 25 PhD and 2 doctoral dissertations. He is the author of books for students, such as \"Internal Medicine\", \"Clinical Pharmacology\", \"Clinical Physiology\", \"Emergencies\" and monographs - \"Diagnosis and treatment of diseases cardiovascular system \",\" Differential diagnosis of internal diseases \",\" Atlas of the symptoms and syndromes of internal diseases \",\" Cardiology for family doctors \",\" Handbook gastroenterologist, he is the author of 3 patents and more than 300 publications.

Objectives: Study of myocardial remodeling of Left Ventricle (LV), depending on the duration of the postoperative period in patients after Mitral Valve Replacement (MVR).\r\n\r\nMethods: The observation involved 105 patients after MVR aged 23 to 57 with circulatory failure (CF) of NYHA Class II and III. 63 of them were women, 42 were men. Depending on the duration of the postoperative period, the patients were divided into 3 groups 1st group included 32 (30, 5%) patients with early postoperative period of 1-2 years, 2nd group included 38 (36, 2%) patients with postoperative period of 6-10 years, and 3rd group included 35 (33, 3%) patients with that of over 10 years. \r\n\r\nResults: In patients of Group 1, LV indicators remained within normal limits. In group 3, compared with group 1, the following were increased: End-Diastolic Dimension (EDD) - 10,6%; End-Diastolic Volume (EDV)-24 %; End-Systolic Dimension (ESD)-14,7%; End-Systolic Volume (ESV)-32,3%, Left Atrium (LA)-16,1%, Ejection Fraction (EF) was reduced by 11,8%, Integral Systolic Remodeling Index (ISRI)-17,6%. In group 2, compared with group 1, the following were increased: Sphericity Index in Systole (SIs)-8,2%; Sphericity Index in Diastole (SId)-6,2%, Myocardial Stress in Systole (MSs)-4,7%, Myocardial Stress in Diastole (MSd) - 1,8%, Indexed Myocardial Mass (IMM)-11,5%, and in the patients of group 3, SIs-13,1%, SId - 6,2%, MSs-23,4%, MSd-7,4%, IMM-24,6%. Despite the absence of LV dilatation in patients of group 1, a slight improvement was observed in the indicators of remodeling: SIs-0,61±0,1cm, SId-0,80±0,1cm, MSs-126,9±20,8 g/cm2, MSd-71,6±9,8g/cm2, IMM-128,2±15,7g/m2 and LA-4,7±0,3cm, reduction of ISRI-77,3±10,2. For the patients of group 1 and group 2, eccentric LV non-dilated hypertrophy was typical, where for the patients of group 3; it was eccentric LV dilated hypertrophy.\r\nConclusions: Thus, in the remote period (over 10 years) in patients after MVR, dilatation of the heart chambers is largely developed as associated hemodynamic load on the LV myocardium. \r\n

Bayram G. Hodjakuliyev graduated in 1974, Saint Petersburg Medical Institute named after Pavlov. In 1974-1976 years went internal medicine in the Institute of Cardiology named after A.L. Myasnikov, under the leadership of Corresponding Member of USSR Academy of Sciences prof. N.M Muharlyamov. From 1980 to 1989 he worked in Turkmen State Medical Institute. In 1989-1992 he held a doctorate in the Institute of Cardiology named A.L Myasnikov defended his doctoral dissertation. In 1994, Bayram G. Hodjakuliyev was awarded the title of professor. The main scientific activities are cardiology, rheumatology and gastroenterology. Under his leadership was prepared 25 PhD and 2 doctoral dissertations. He is the author of books for students, such as \"Internal Medicine\", \"Clinical Pharmacology\", \"Clinical Physiology\", \"Emergencies\" and monographs - \"Diagnosis and treatment of diseases cardiovascular system \",\" Differential diagnosis of internal diseases \",\" Atlas of the symptoms and syndromes of internal diseases \",\" Cardiology for family doctors \",\" Handbook gastroenterologist, he is the author of 3 patents and more than 300 publications.\r\n

Purpose of study: To examine the impact of risk factors on the remodeling process and systolic function of the Left Ventricle (LV) in patients after Mitral Valve Replacement (MVR)\r\n\r\nInformation and methods: 125 patients of 28-63 years were examined after MVR. 76 of them were women, 49 were men. The patients were divided into 4 groups. Group 1 comprised 31 patients with Ischemic Heart Disease (IHD), where Group 2 included 29 patients without IHD. Group 3 comprised 33 patients with High Blood Pressure (av. blood pressure-150, 8 ± 4, 1), Group comprised 32 patients with normal blood pressure (av. -114, 0 ± 3, 3). Comparative analysis was performed between the patients of Groups 1, 2, 3 and 4.\r\n\r\nResults: In Group 1, there had been an increase in the size of LV in: End Diastolic Volume (EDV) - 19,5%, End Systolic Volume (ESV)-13,4%, Myocardial Stress In Systole (MSs)-23,3% and in Diastole (MSd)- 21,5%, Indexed Myocardial Mass (IMM)-17,4%, lowering of Ejection Fraction (EF) up to 6,5%, in comparison with Group 2. In Group 3, there had been an increase in LV in: ESV - 24,9%, EDV-19,5%, MSd-30,2%, MSs-31,3 %, IMM-19,8%, lowering of EF in 12%, as opposed to Group 4. Therefore, in patients undergoing mitral valve replacement, the presence of ischemic heart disease and hypertension contribute to the increase of hemodynamic load on myocardium, influencing the remodeling processes and systolic function of LV. \r\n