Search

Migraine is one of the most prevalent causes of functional disability worldwide. Migraine patients experience headaches of varying degrees, which are related with a higher level of disability and are triggered by psychological and physiological stressors. Migraine is estimated to affect 16.6% of the world's population, with women being three times more likely to experience it than men. Despite considerable advancements in modern and traditional medicine, a complete cure remains uncertain. In Ayurvedic treatises, migraine headache is referred to as Ardhavabedhaka under the classification of Shiroroga (diseases related to the head region).35-year-old Indian male police inspector, suffering from recurrent right hemi-cranial headaches once in three days for the last three months, presented symptoms of Tridhoshaja Ardhvabhedaka (Migraine) associated with Amlapitta (hyperacidity).After a thorough assessment of the patient, the treatment was meticulously planned based on the patient's Dosha pradhanyatha and Vyadhi avastha (stage of disease). For the proper Samprapti vighatana, Nidana parivarjana (abstinance from the eitiological factors), Deepana, Paachana, Siravyadha, Nasya and Dosha Shamana Chikitsa principles were adopted. Further, the severity of the migraine was assessed by MIDAS and NPR score, which subsequently decreased from 19 to 4, and the NPR scale decreased from 8 to 2 till completion of the therapeutic intervention.This case report unequivocally highlights the pivotal role of the Ayurveda treatment regimen in effectively managing migraine. Overall, effective treatment of migraine cases requires the correct assessment of Dosha status and Vyadhi avastha and the correct selection of the appropriate medicine and procedures like Siravyadha and Nasya at that appropriate stage of the disease.

Context: The optimal treatment strategy for in-stent restenosis (ISR) still remains under debate. Moreover, there have been scarce data on Indian patients relating to ISR treatment. Aim: The aim of this study was to determine the clinical profile and angiographic pattern of patients with ISR and to evaluate the outcome of these patients being treated for ISR. Settings and Design: This was a cross-sectional study which consisted of patients who had coronary angiographic characteristic of ISR. Materials and Methods: Patients were divided into subgroups as per presentation, acute coronary syndrome (ACS), and non-ACS. After the ISR event and treatment, the patients were followed up for a minimum period of 6 months for any adverse events. The primary outcome of the study was occurrence of a major adverse cardiac event. Statistical Analysis: Chi-square test, Fisher's exact test, Student's t-test, or Mann–Whitney test was applied according to type and distribution of variable (SPSS software). Results: One hundred patients with 109 culprit lesions of ISR were included in the study. The ACS was dominant clinical presentation mode, occurring in 62 patients. Fifty-four percent of the patients were treated with percutaneous coronary intervention, 26% were managed with coronary artery bypass grafting, and 19% were treated with optimized medical therapy. Majority of the adverse events (12 out of 15 patients) occurred in the ACS group, with a statistically significant difference at 6-month follow-up (P = 0.021). Conclusion: Patients with ISR have ACS as the most common mode of presentation. Patients with ISR presenting with ACS are at high risk and must be closely monitored. The treatment of ISR with drug-eluting stent or drug-coated balloon is most effective.

Tombstone ST-elevation myocardial infarction (STEMI) is a rare variant of STEMI leading to worse clinical outcomes. We report a case of tombstone STEMI in a 65-year-old male, who presented with acute chest patient. The clinical, electrocardiographic and angiographic characteristic of the patient is discussed.

Background: The assessment of the IVC diameter is self explanatory for evaluation of the individuals’ volume status. Studies regarding IVC diameter estimation in normal individuals are scarce. Aim: The present study aimed to define normal criteria of size and dynamics of the inferior vena cava (IVC) by M-mode echocardiography in normal individuals. Methods: This was a prospective, single-center, observational study carried out at Sri Jayadeva Institute of Cardiovascular Sciences and Research between December 2011 and April 2014. A total of 4126 consecutive individuals were enrolled. Normal IVC diameter was measured both during inspiration and expiration by M-mode echocardiography in subcostal view. Results: The IVC diameter varied from 0.46 to 2.26 cm in the study individuals. The IVC diameter ranged from 0.97 to 2.26 cm during expiration and from 0.46 to 1.54 cm during inspiration. A strong correlation was observed between IVC diameter and height, weight and BMI of the individuals, calculated using Pearson correlation. The correlation coefficients for expiratory and inspiratory IVC diameters as a function of BMI were 0.686 and 0.7, respectively. Conclusions: Our findings corroborate the correlations between height, weight and BMI with IVC diameter. Future studies could be focused to bring about a steadfast formula for calculating IVC diameter based on demographic parameters of an individual.

Single coronary artery is a rare congenital coronary artery anomaly, the incidence of which is 0.024-0.066% as described in literature. Report of cases having single coronary artery along with acute myocardial infarction are scanty and reports of percutaneous intervention in such a situation are even fewer, technically challenging and potentially cataclysmic. As single coronary artery supplies the entire myocardium, occlusion of this can result in significant ischemic insult, resulting in severe biventricular dysfunction. Percutaneous Coronary Intervention (PCI) of single coronary artery is technically challenging and carries high risk which may be equated to left main intervention. We report a rare interesting case of L1 variety of single coronary artery which presented as acute inferoposterior myocardial infarction with successful rescue PCI to Left Circumflex Artery (LCx).

Breakage of angioplasty device in coronary artery can cause panic in the catheterization laboratory. These broken fragments may serve as a nidus for thrombus formation; hence, removal of these fragments becomes mandatory. Since the incidence of guidewire fracture during angioplasty are rarely reported, evidence-based approaches are not available for the management of such incidental conditions. Here, we report an interesting case of entrapment and unravelling of guidewire. We successfully retrieved unravelled guidewire using a noncompliant balloon inflated in the guiding catheter. Subsequently, the procedure was completed successfully with an implantation of a stent in the culprit lesion. We are of opinion that this novel technique is quite easy and less cumbersome than other described techniques reported earlier.

The presence of tendon xanthomas is an almost certain indicator of familial hypercholesterolemia (FH). They also reflect coronary atherosclerotic burden and therefore must be treated aggressively. Tendon xanthomas also occur in two rare conditions, cerebrotendinous xanthomatosis and sitosterolemia, which are not easily confused with FH, can be easily differentiated with clinical history and biochemical tests.