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Background: Pulmonary hamartomas are benign lung lesions. Histopathologically, pulmonary hamartoma is composed of varying amounts of mesenchymal elements, including chondroid tissue, mature adipose tissue, fibrous stroma, smooth muscle, and entrapped respiratory epithelium. Most pulmonary hamartoma cases are asymptomatic and found incidentally during imaging. They usually appear as well-circumscribed lesions with the largest dimension of less than 4 cm. Asymptomatic giant pulmonary hamartomas that more than 8 cm are rare. Case presentation: In the current case report, a 12.0 × 9.5 × 7.5 cm lung mass was incidentally noticed in a 59-year-old female during a heart disease workup. Grossly, the lesion was lobulated with pearly white to tan-white solid cut surface and small cystic areas. Microscopically, representative tumor sections demonstrate a chondromyxoid appearance with relatively hypocellular stroma and entrapped respiratory epithelium at the periphery. No significant atypia is noted. No mitosis is noted, and the proliferative index is very low (< 1%) per Ki-67 immunohistochemistry. Mature adipose tissue is easily identifiable in many areas. Histomorphology is consistent with pulmonary hamartoma. A sarcoma-targeted gene fusion panel was further applied to this case. Combined evaluation of microscopic examination and sarcoma-targeted gene fusion panel results excluded malignant sarcomatous transformation in this case. The mediastinal and hilar lymph nodes are histologically benign. After surgery, the patient had an uneventful postoperative period. Conclusions: Giant pulmonary hamartoma is rare; our case is an example of a huge hamartoma in an asymptomatic patient. The size of this tumor is concerning. Thus, careful and comprehensive examination of the lesion is required for the correct diagnosis and to rule out co-existent malignancy. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases are the most frequent cause of death worldwide. The aim of this study was to identify and demonstrate correlations between mortality data and etiological factors in EU countries. The relationships presented could thus provide a better understanding of etiological factors and possible points for interventions to prevent cardiovascular diseases. The focus was on the following diseases: hypertensive heart disease, atrial flutter/atrial fibrillation, myocardial infarction, and ischemic heart disease, as well as heart failure. Methods: The data in this study come from WHO databases. Connections between the mortality rates and the possible influencing factors were analyzed. The significant factors from the correlation analysis were simultaneously evaluated using a stepwise multiple regression analysis. Results: Analysis of hypertensive heart disease in women reveals the following factors to be significant: drug expenses, health expenses on gross domestic product, and smoking. For men, population density, first admission to a drug treatment center, and drug expenses per person emerged as important factors. Admission to drug treatment centers and length of hospitalization were significant factors for atrial fibrillation and flutter. Fine dust pollution was the most important factor in heart failure. The most important influencing factor for myocardial infarction and ischemic heart disease is nitrogen dioxide concentration. For women, the second highest value is health expenses, followed by the number of outpatient contacts per year. For men, outpatient contacts are in second place. Conclusions: Prevention measures must be taken by the government. The extent to which population density has an influence on cardiovascular diseases should be examined in more detail. In order to reduce the number of initial admissions to drug treatment centers, behavioral prevention related to drug use could be improved. [ABSTRACT FROM AUTHOR]

46,XX individuals born with severely masculinized genitals due to congenital adrenal hyperplasia (CAH) who have been assigned male at birth and reared male can successfully establish a male gender identity/role, find employment, marry, function sexually with a female partner, and develop positive mental health status. While there were a few individuals who reportedly did not fare well or who changed gender to female, the majority of those identifying as males appear to have an overall good quality of life. Parental/family support, along with the support of others, appears essential to a positive outcome as a male, or as a female. This paper suggests that serious consideration should be given to male gender assignment and rearing and, in certain situations, is justified. Disorders of sex differentiation teams should inform parents about the option for male assignment and rearing in 46,XX CAH infants with severe genital masculinization, which is a rare condition. To provide this option is concordant with the principles of ethics, transparency and with the Endocrine Society Guidelines and the American Academy of Pediatrics’ policy of fully informed consent. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome is one of the escalating, but underdiagnosed hormonal disorder in women of reproductive age. The present study is an attempt to explore long term health implications in four Rotterdam the phenotypes of Polycystic ovary syndrome. For this purpose, a total of 223 PCOS women with age ranged from 18 to 45 years and living in the Chandigarh Capital Region were selected from the OPD, PGIMER, Chandigarh, (North India). Polycystic ovary syndrome among women were diagnosed as per the Rotterdam Criteria (2004). Findings of the study indicated that hirsutism (47.5%), acne (30.9%), seborrhoea (32.2%), menstrual irregularity (55.6%), and ovarian size >10 cm³ (54.7%) were most frequently encountered symptoms in women having classic PCOS phenotype as compared to women with non-PCO PCOS, non-hyperandrogenic and ovulatory PCOS phenotype. The correspondence analysis depicted that classic PCOS phenotype were more closely and significantly associated with all the symptoms of PCOS with 83.6% variance, while ovulatory PCOS depicted least association with the symptoms of PCOS indicating that oligoanovulation play a vital role in the manifestation of symptoms related to PCOS. The classic PCOS phenotype showed higher prevalence of metabolic perturbations than other phenotypes, thereby confirming classic PCOS phenotypes are at greater risk of long-term health consequences. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac disease in pregnancy remains a major concern, particularly in developing countries like India. Pregnancy in women with heart disease increases the risk of maternal and foetal complications. Approximately 1% to 4% of pregnant women have concomitant cardiac disease. Aim: To examine the foetomaternal outcomes of pregnant women in the corrected vs. non corrected heart disease groups. Materials and Methods: This was a cross-sectional study conducted in the Department of Obstetrics and Gynaecology at IPGME&R, Kolkata, West Bengal, India, from February 2020 to July 2021. A total of 50 pregnant women were included in the present study, with 25 in the corrected heart disease group and 25 in the non corrected heart disease group. Foetomaternal outcomes, including intrapartum complications, maternal intensive care unit admission, mode of delivery, and foetal complications, were observed. Comparative analyses were conducted using the Student's t-test and Chi-square test. The p-values <0.05 was considered statistically significant. Results: Data from the present study showed that out of a total of 50 pregnant women with heart disease, the majority (60%) were young (≥25 years). Approximately 48% of women were in their second pregnancy. The most common cardiac lesion in the corrected group was closure of Atrial Septal Defect (ASD) in 8 (16%) cases, while in the non corrected group, the most common was mitral regurgitation in 11 (22%) cases. In the corrected heart disease group, 15 (30%) had a caesarean section and 10 (20%) delivered vaginally, whereas in the non corrected group, 17 (34%) had a caesarean section and 8 (16%) delivered vaginally. Adverse cardiac events occurred in 2 (4%) of the corrected group, whereas 11 (22%) were observed in the non corrected group (p-value=0.0088, significant). Preterm birth and low birth weight babies were more common in the non corrected heart disease group (p-value=0.0449, significant). Conclusion: The study concludes that most women with cardiac disease are young. Compared to the Corrected Group of Heart Disease (CGHD), the non corrected group of pregnant women are more likely to experience severe cardiac complications and require admission to the intensive care unit. The foetomaternal outcome is better in the corrected group. Successful management of pregnant women with heart disease requires a comprehensive multidisciplinary approach to optimise foetomaternal outcomes. [ABSTRACT FROM AUTHOR]

Ischemic heart disease (IHD) is the leading cause of morbidity and mortality in both genders; however, young women fare the worst, likely reflecting the more complex spectrum of IHD in women when compared to men. Substantial sex-based differences exist in the underlying risk factors, risk enhancers, presentation, diagnosis, and pathophysiology of IHD that are mainly attributed to the influence of female sex hormones. This article reviews the spectrum of IHD including obstructive epicardial coronary artery disease (CAD), myocardial infarction with no obstructive coronary artery disease, ischemia with no obstructive coronary artery disease, spontaneous coronary artery dissection, coronary microvascular dysfunction, vasospastic angina, and coronary thrombosis/embolism that occur in women throughout various stages of their life cycle. We aim to update clinicians on the diagnosis and management of these various types of IHD and highlight where further randomized controlled studies are needed to determine optimal treatment and inform guideline-directed medical therapy. [ABSTRACT FROM AUTHOR]

Heart failure affects over 2.6 million people in the United States. While women have better overall survival rates, they also suffer from higher morbidity as shown by higher rates of hospitalization and worse quality of life. Several anatomical differences in women's hearts affect both systolic and diastolic cardiac physiology. Despite these findings, women are significantly underrepresented in clinical trials, necessitating extrapolation of data from males. Because women have sex-specific etiologies of heart failure and unique manifestations in genetic-related cardiomyopathies, meaningful sex-related differences affect heart failure outcomes as well as access to and outcomes in advanced heart failure therapies in women. This review explores these gender-specific differences and potential solutions to balance care between women and men. [ABSTRACT FROM AUTHOR]

Cardiovascular disease significantly jeopardizes pregnancies in the United States, impacting 1% to 4% of pregnancies annually. Among complications, cardiac arrhythmias are prevalent, posing concerns for maternal and fetal health. The incidence of arrhythmias during pregnancy is rising, partly due to advances in congenital heart surgery and a growing population of women with structural heart disease. While most arrhythmias are benign, the increasing prevalence of more serious arrhythmias warrants a proactive approach. Guidance and reassurance suffice in many cases, but persistent symptoms require cautious use of antiarrhythmic drugs or other therapies for a safe outcome. Managing more serious arrhythmias requires a comprehensive, multidisciplinary approach involving specialists, including maternal-fetal medicine physicians, cardiologists, electrophysiologists, and anesthesiologists. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) in women remains understudied, under-recognized, underdiagnosed and undertreated. Initiatives such as the Lancet Women and Cardiovascular Disease Commission help to identify sex and gender-related gaps in research, care and outcomes and to guide next steps in addressing them. This article highlights important aspects of the Lancet Commission report and expands on the evidence and proposed strategies for reducing the global burden of CVD in women. Furthermore, the article explores the benefits of cross-specialty collaborations for the treatment and prevention of CVD in women and discusses the impact of gender-related disparities in academic cardiology. [ABSTRACT FROM AUTHOR]

Symptomatic women with angina are more likely to have ischemia with no obstructive coronary arteries (INOCA) compared to men. In both men and women, the finding of INOCA is not benign and is associated with adverse cardiovascular events, including myocardial infarction, heart failure and angina hospitalizations. Women with INOCA have more angina and a lower quality of life compared to men, but they are often falsely reassured because of a lack of obstructive coronary artery disease (CAD) and a perception of low risk. Coronary microvascular dysfunction (CMD) is a key pathophysiologic contributor to INOCA, and non-invasive imaging methods are used to detect impaired microvascular flow. Coronary vasospasm is another mechanism of INOCA, and can co-exist with CMD, but usually requires invasive coronary function testing (CFT) with provocation testing for a definitive diagnosis. In addition to traditional heart disease risk factors, inflammatory, hormonal and psychological risk factors that impact microvascular tone are implicated in INOCA. Treatment of risk factors and use of anti-atherosclerotic and anti-anginal medications offer benefit. Increasing awareness and early referral to specialized centers that focus on INOCA management can improve patient-oriented outcomes. However, large, randomized treatment trials to investigate the impact on major adverse cardiovascular events (MACE) are needed. In this focused review, we discuss the prevalence, pathophysiology, presentation, diagnosis and treatment of INOCA. [ABSTRACT FROM AUTHOR]

Background: The outcomes of trauma may have a ridge defect, and it would be hard to replace it with a simple dental implant treatment technique. In some cases, horizontal and vertical bone augmentation therapy is needed for implant placement. Case Presentation: The case report described a 24-year-old female diagnosed with a severe bony defect and was managed in collaboration with an orthodontic and periodontic treatment plan. Alveolar bone augmentation was approached using Misch's fashion, an autogenous block graft harvested from intra-oral (ramus). Moreover, Khoury's split bone block technique was applied to reconstruct the seat. Conclusion: For complicated abnormalities, autogenous bone is still the best choice. Autogenous bone is the gold standard for bone grafting due to its biocompatibility, absence of antigenicity, and osteoconductive and osteoinductive qualities. Further graft extenders or growth factors may result in better outcomes. [ABSTRACT FROM AUTHOR]

The successive waves of liberation of women's voices mark the beginning of a questioning and analysis of our medical practices, particularly in terms of gynecology and obstetrics. The appearance of negative testimonies on social networks concerning gynecological and obstetrical violence forces us to question ourselves. The gynecological examination represents a significant stage in a woman's life. The conditions for its realization are not trivial because it requires the patient to reveal her privacy to a stranger. What do women think of this review? What do they have to teach us in terms of good medical and relational practices? [ABSTRACT FROM AUTHOR]

The 52nd Annual Conference of the Pakistan Cardiac Society was held in Sukkur, Pakistan, and was commended by Prof. Nusrat Shah for contributing to the overall development of the area. Prof. Shah emphasized the importance of preventing heart diseases and raising awareness about seeking medical help and controlling blood pressure. The conference also recognized the achievements of Prof. Nadeem Qamar in establishing cardiac care centers and reducing morbidity and mortality from heart disease. The conference included sessions on various topics related to cardiology and featured a joint session with the American College of Cardiology. [Extracted from the article]

Background: During pregnancy and delivery, hemodynamics are altered and complex congenital heart disease has been associated with adverse maternal and neonatal outcomes. We sought to investigate pregnancy outcome and complications in relation to complexity of heart condition. Materials and methods: We studied women with ACHD discussed at multidisciplinary conferences at Lund University Hospital March 2009-May 2021. We studied 149 pregnancies in 101 women. We scored each woman retrospectively according to the modified World Health Organization (mWHO) risk classification and included patients in risk class I (n = 36, 24.1%), II (n = 43, 28.9%), II-III (n = 43, 28.9%), III (n = 24, 16.1%) and IV (n = 3, 2.0%). Results: Women with mWHO class ≥III underwent cesarean section more often than women in less complex mWHO classes, (OR, 5.1; 95% CI, 2.0–12.5; p<0.001). The odds of premature delivery were significantly higher among pregnant women with mWHO class ≥III (OR, 6.7; 95% CI, 2.6–17.4; p<0.001). We found no difference in incidence of preeclampsia, gestational hypertension, gestational diabetes, hemorrhage >1000 ml or cardiac defect in the neonate depending on WHO-class. Women in mWHO classes III-IV had a higher rate of fetal growth restriction (FGR) compared to women in mWHO classes I, II, II-III (p<0.007). Conclusions: Our findings indicate that women with more complex heart disease (mWHO classes III or IV) tend to have a higher rate of cesarean section, premature birth and FGR. [ABSTRACT FROM AUTHOR]

Introduction: Prevalence estimates place maternal heart illness anywhere from 0.3 to 3.5 percent. Up to 20.5% of all maternal deaths of non-obstetrical cause are attributable to cardiovascular disease. Aim: The aim of the study was the management of patients with the multidisciplinary approach to maternal cardiovascular disease and its influence on maternal and fetal outcomes in a tertiary care centre. Objectives: 1. To find out the prevalence and spectrum of heart disease in Pregnancy. 2. To find out the outcome of pregnancy with heart disease in a tertiary care centre. Materials and Methods: This prospective study of one year was done on pregnant with heart disease coming to the Obstetrics and Gynaecology department in collaboration with the cardiology department of IGIMS, Patna. A study was done on 65 pregnant with heart disease between the age group 20 to 35 years were compared to a control group of 65 pregnant women who were hospitalised during the same time period but did not have heart disease. All the pregnant women with heart disease were included in this study. Patients with medical disorders like Kidney disease, Liver disease, Pulmonary Disease, Diabetes Mellitus were excluded from the study. We used IBM's SPSS v23 to analyse the collected data. Result: Prevalence of heart disease in pregnancy was 5.8% in present study and mostly of RHD (62.5%), followed by corrected CHD (12.5%) and CHD (10.9%). Patients of NYHA Class I and II (58.5%), Class III (26.2%), and Class IV (15.4%). The mitral valve was most often impacted by RHD (35.3% of all cases), followed by the tricuspid valve (15.0%). Eight (1.1%) people had cardiac surgery for therapeutic reasons. Six percent of all corrective surgeries included closing an atrial septal defect (ASD). The most common kind of congenital abnormality was a ventricular septal defect (VSD, 3%), followed by atrial septal defect (ASD, 1.5%) and pulmonary ductal atresia (PDA, 1.5%). Patients with heart disease had a higher rate of MTP, emergency LSCS and instrumental births than the controls. Deaths during pregnancy were 4 (6.2%) with cardiac disease and no maternal mortality in control group and all belonged to NYHA Class 4 were anaemic. In patients with a left ventricular ejection fraction of 45% or below, death was high. Two women died intrapartum from RHD, and two died postpartum from Peripartum cardiomyopathy. There were significantly more incidences of low-birth-weight infants (36.4%) compared to the control group (p = 0.001). Cases had a statistically significant greater frequency of obstetric problems, as well as an increased risk of developing anaemia, hypertension, hypothyroidism, cholestasis, FGR, and GDM (p-value 0.017). Multiparity, severe valvular lesion, NYHA function class III or IV, arrhythmia, and low ejection fraction were associated with poor maternal outcome in the current study. Conclusion: Maternal morbidity and mortality due to heart disease can be reduced appreciably by antenatal care, early diagnosis, and management with the help of cardiologists and surgery in selected cases. [ABSTRACT FROM AUTHOR]

An editorial is presented which expresses the views on the gender-related differences in cardiovascular care, emphasizing the continued prevalence of cardiovascular disease (CVD) as the leading cause of death in women. Topics include the heightened risks of CVD during pregnancy, challenges in managing cardiovascular issues in pregnant women, and the importance of multidisciplinary teams in tailoring care to address the unique needs of women with heart disease.

This article discusses the different stages of heart failure (HF) and their associated risks. The authors conducted a meta-regression analysis of 66 observational studies and found that 1-year mortality was highest in patients with advanced HF, followed by worsening HF, new-onset HF, and chronic HF. The study also highlights the need for accurate definitions of worsening HF and new-onset HF, as well as the potential impact of age and sex on HF staging. The authors suggest that a more phenotypic classification of HF, taking into account factors beyond left ventricular ejection fraction, may be necessary. Additionally, the study raises questions about the inclusion of worsening HF as an outcome in future clinical trials. Overall, the findings emphasize the importance of accurately defining and understanding the different stages of HF for improved patient management and treatment. [Extracted from the article]

Most risk stratification tools for pregnant patients with heart disease were developed in high-income countries and in populations with predominantly congenital heart disease, and therefore, may not be generalizable to those with valvular heart disease (VHD). The purpose of this study was to validate and establish the clinical utility of 2 risk stratification tools—DEVI (VHD-specific tool) and CARPREG-II—for predicting adverse cardiac events in pregnant patients with VHD. We conducted a cohort study involving consecutive pregnancies complicated with VHD admitted to a tertiary center in a middle-income setting from January 2019 to April 2022. Individual risk for adverse composite cardiac events was calculated using DEVI and CARPREG-II models. Performance was assessed through discrimination and calibration characteristics. Clinical utility was evaluated with Decision Curve Analysis. Of 577 eligible pregnancies, 69 (12.1%) experienced a component of the composite outcome. A majority (94.7%) had rheumatic etiology, with mitral regurgitation as the predominant lesion (48.2%). The area under the receiver-operating characteristic curve was 0.884 (95% CI: 0.844-0.923) for the DEVI and 0.808 (95% CI: 0.753-0.863) for the CARPREG-II models. Calibration plots suggested that DEVI score overestimates risk at higher probabilities, whereas CARPREG-II score overestimates risk at both extremes and underestimates risk at middle probabilities. Decision curve analysis demonstrated that both models were useful across predicted probability thresholds between 10% and 50%. In pregnant patients with VHD, DEVI and CARPREG-II scores showed good discriminative ability and clinical utility across a range of probabilities. The DEVI score showed better agreement between predicted probabilities and observed events. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives: There is conflicting evidence around the role of sex hormones with cardiovascular outcomes. The aim of this study was to examine the association of sex hormones with the risk of myocardial infarction (MI) in pre- and post-menopausal women, and men in the UK Biobank. Methods: The UK Biobank is a prospective population-based cohort study, that recruited over 500,000 (aged 40–69 years) women and men between 2006 and 2010. Sex specific cox regression models, estimating hazard ratios (HRs) and women to men ratio of HRs (RHR) with respective 95% confidence intervals (CI), were used to model the association of sex hormones [oestrogen, testosterone, oestrogen: testosterone (O/T) ratio, sex hormone–binding globulin (SHBG) and the free androgen index (FAI)], measured at study baseline, with incident MI for women and men. Results: Data were from 479,797 participants [264,282 (55.1%) women] without a history of MI at study baseline. Over 12.5 years of follow-up, there were 4,908 MI events in women and 10,517 in men. Neither oestrogen nor testosterone were associated with MI in women and men after multiple adjustment. For men, but not women, a unit higher log-transformed O/T ratio was associated with a lower risk of MI 0.79 (0.65, 0.95) after adjustment for traditional CVD risk factors. The corresponding women to men RHR (95% CI) was 1.24 (0.99, 1.56). Higher SHBG (per unit) was also associated with a lower risk of MI in men 0.94 (0.89, 0.99), and not in women 1.02 (0.95, 1.09) after multiple adjustment, the corresponding women to men RHR (95% CI) was 1.09 (1.00, 1.18). Higher FAI was associated with a higher risk of MI in men 1.09 (1.02, 1.15), though not in women 0.97 (0.92, 1.02), the corresponding women to men RHR was 0.89 (0.82, 0.97). Finally, there were differential effects in the association of SHBG and FAI between pre- and post-menopausal women. Conclusions: A higher O/T ratio was associated with a lower risk of MI, and a higher FAI with a higher risk of MI after adjustment for CVD risk factors in men, but not in women. Thus, hormone ratios, rather than each alone, may play an important role in modulating the effect of MI. Plain Language Summary: There are conflicting findings surrounding the association of sex hormones and myocardial infarction (MI) (heart disease). In particular, high oestradiol levels in women are often thought to be protective and explain why the rates of heart disease are lower in women than men. For men, those with low levels of testosterone are often thought to be more prone to develop heart disease in their lifetimes. Our study presents a comprehensive analysis of the association of sex hormones (in isolation and also together via their ratios), in women and men using the large-scale UK Biobank. We found that neither oestrogen nor testosterone alone were associated with heart disease in women and men after accounting for cardiovascular risk factors, but the ratio of testosterone and oestrogen was associated with a lower risk of heart disease in men, though not in women. We also saw the association of sex hormone–binding globulin (SHBG), and free androgen index (FAI) (calculated by the ratio of total testosterone level to SHBG) with heart disease was different between women and men, and between pre- and post-menopausal women. This paper highlights the complex interplay between sex hormones with heart disease in the presence of age and cardiovascular risk factors. In particular the balance (ratio) of sex hormones maybe more important, rather than each in isolation, when exploring their association with heart disease. Highlights: Neither oestrogen nor testosterone were associated with MI in women and men after multiple adjustment. For men, but not women, higher oestrogen/testosterone ratio was associated with a lower risk of MI after adjustment for traditional CVD risk factors. Higher SHBG was associated with a lower risk of MI in men, but not women overall. Higher FAI was associated with a higher risk of MI in men but not women overall. There were differential effects in SHBG and FAI between pre- and post-menopausal women. [ABSTRACT FROM AUTHOR]

Background: Subepicardial hematoma due to spontaneous coronary artery rupture (SCAR) is exceedingly rare. Case presentation: An asymptomatic 68-year-old woman with Graves' disease was introduced to us because of an abnormal right hilar shadow. Graves' disease had been treated effectively with thiamazole. Without any chest trauma or disease related to coronary artery rupture, computed tomography revealed a 44-mm mass lesion that occupied the front of the right atrium. Two branches arising from the proximal right coronary artery surrounded the lesion and appeared to be the feeding vessels. We suspected a tumor and performed radical surgery. The lesion was completely removed using an ultrasonic scalpel and revealed as organized subepicardial hematoma. Conclusion: This is the rare surgical case of organized subepicardial hematoma due to SCAR. A high grade of suspicion is necessary for the correct diagnosis. Graves' disease is not considered as an underlying disease of SCAR. [ABSTRACT FROM AUTHOR]

Risk prediction of arrhythmia during pregnancy in adult congenital heart disease (ACHD) patients is currently lacking, and the impact of preconception catheter ablation on future antepartum arrhythmia has not been studied. We conducted a single-center, retrospective cohort study of pregnancies in ACHD patients. Clinically significant arrhythmia events during pregnancy were described, predictors of arrhythmia were analyzed, and a risk score devised. The impact of preconception catheter ablation on antepartum arrhythmia was assessed. The study included 172 pregnancies in 137 patients. Arrhythmia events occurred in 25 (15%) of pregnancies, with 64% of events occurring in the second trimester and sustained supraventricular tachycardia being the most common rhythm. Univariate predictors of arrhythmia were history of tachyarrhythmia (OR 20.33, 95% CI 6.95–59.47, p < 0.001, Fontan circulation (OR 11.90, 95% CI 2.60–53.70, p < 0.001), baseline physiologic class C/D (OR 3.72, 95% CI 1.54–9.01, p = 0.002) and history of multiple valve interventions (OR 3.10, 95% CI 1.20–8.20, p = 0.017). Three risk factors (excluding multiple valve interventions) were used to formulate a risk score, with a cutoff of ≥2 points predicting antepartum arrhythmia with sensitivity and specificity of 84%. While recurrence of the index arrhythmia was not observed following successful catheter ablation, preconception ablation did not impact odds of antepartum arrhythmia. We provide a novel risk stratification scheme for predicting antepartum arrhythmia in ACHD patients. The role of contemporary preconception catheter ablation in risk reduction needs further refinement with multicenter investigation. • Most antepartum arrhythmias in congenital heart disease occur in the second trimester • Prior arrhythmia, physiologic class and Fontan palliation predict arrhythmia during pregnancy • Novel risk score predicts arrhythmia in pregnant women with congenital heart disease • Preconception catheter ablation did not impact future risk of antepartum arrhythmia, though index arrhythmia did not recur during pregnancy [ABSTRACT FROM AUTHOR]

Proper monitoring of heart failure patients is important. Since these patients have lot of comorbid, they will need many drugs hence one has to be very careful while treating heart failure patients. [Extracted from the article]

Background: Rheumatic heart disease (RHD) remains prevalent in the developing world and reproductive-age women are disproportionately affected. It is among the common est cardiac diseases during pregnancy and is associated with poor pregnancy outcomes. Despite its importance among reproductive-age women, there are no local studies that characterize the clinical characteristics, risk of poor pregnancy outcomes and contraception which represents one effective way to prevent unplanned pregnancies in this population. Methods: This was a hospital-based descriptive cross-sectional study. Non-pregnant reproductive-age women with echocardiographically diagnosed RHD were consecutively recruited from in- and out-patients units of the Jakaya Kikwete Cardiac Institute (JKCI). A clinical research form was used to gather socio-demographic, clinical characteristics, contraception status and echocardiographic information. The maternal/pregnancy risk class was determined using the modified World Health Organization (WHO) classification of maternal risk. Results: Two hundred thirty-eight women of reproductive age with RHD were recruited. The median age (range) was 36 years (15–49). Two-thirds were dyspneic on moderate exertion and 17.2% had New York Heart Association class IV heart failure. A quarter had atrial fibrillation/flutter. On echocardiography, mitral regurgitation was the most common valvular lesion (68.1%), followed by mitral stenosis (66.8%), and 12.2% of participants had reduced left ventricular ejection fraction. Two-thirds (66%) had a high pregnancy risk (class IV) based on the modified WHO classification system. The proportion of participants using contraception was 7.1% and common methods were: bilateral tubal ligation 5 of 17 (29.4%) and hormonal implant (4 of 17). The most common reason for the choice of a method was safety, 10 out of 17 (58.8%). Conclusion: The majority of women of reproductive age with RHD in our hospital cohort are at the highest pregnancy risk based on the modified WHO classification and a very small proportion of them are on contraception. These results call for action among clinicians to offer counselling to these patients, educating them on their risk and offering appropriate contraception advice while waiting for definitive interventions. [ABSTRACT FROM AUTHOR]

Background: Mixed-type total anomalous pulmonary venous connection is a rare condition in which the pulmonary veins possess multiple drainage sites. In the treatment of multiple lesions, it is sometimes necessary to treat only the main lesion first and repair additional residual lesions during follow-up. Case presentation: We report a case of additional repair of a remaining type Ia lesion in a 19-year-old woman with mixed-type total anomalous pulmonary venous connection who had previously been treated for a type IIa lesion alone. The vertical vein was used as a free graft in the surgery, and the reconstruction was successful without turbulence or kinking. Conclusions: Our results suggest that the use of the vertical vein as a free graft for the repair of residual type Ia lesions in adulthood allows reliable reconstruction regardless of the spatial relationship between the left atrial appendage and the left superior pulmonary vein. [ABSTRACT FROM AUTHOR]

Background: Heart diseases are the most significant non-obstetrical causes of maternal deaths, accounting for up to 15% of all cases. The present retrospective analysis is an attempt to assess the spectrum and impact of cardiac diseases on pregnancy. Aims and Objectives: The aims of this study were to analyze the maternal and perinatal outcomes and spectrum of heart disease in pregnancy. Materials and Methods: The study was carried out in the Department of Obstetrics and Gynecology at PGIMS, Rohtak, where retrospective record of inpatient obstetrics registry of pregnant women with cardiac diseases was analyzed. Clinical information obtained from the patient's medical records including clinical presentation, laboratory investigations, 2-D echocardiography, maternal, and neonatal outcomes were noted. All pregnant women as well as postpartum patient with cardiac disease were included in the study. Results: A total of 62 pregnant women with heart diseases were hospitalized during the study period. Spectrum of heart disease among these women analyzed and we found that the 22 had rheumatic heart disease (RHD), 14 had congenital heart disease (CHD), and 14 had cardiomyopathies (CMP). LSCS was done for 24 and out of these, nine were elective LSCS while 15 were emergency LSCS. Vaginal deliveries were performed in 31 women. Twenty-eight women got shifted to intensive care units during course of treatment. Three intrauterine deaths were noted in our study. Conclusion: We have concluded from the present study and after reviewing the literature about spectrum of heart diseases in pregnancy, that the most common cardiac lesions complicating the pregnancy are RHD followed by CHD and CMP. Successful management of heart disease with pregnancy can be achieved by timely diagnosis and safe transfer of patient to the cardiomaternal tertiary care, where multidisciplinary teams are available. [ABSTRACT FROM AUTHOR]

The number of women with congenital heart disease (CHD) becoming pregnant are increasing. Although menstrual irregularities appear to occur more often in these patients, knowledge on their fertility is limited. In this nationwide cohort study, we evaluated the risk of impaired fertility in women with CHD compared with unaffected women using time to pregnancy (TTP). The Danish National Birth Cohort (DNBC) of pregnant women constituted the study population. Information on TTP and use of medically assisted reproduction (MAR) treatment was reported at a first trimester interview. Women with CHD were identified by linkage to the Danish National Patient Registry. TTP was divided into three categories; 0–5 months, 6–12 months (i.e. subfertile), and > 12 months or use of MAR treatment (i.e. infertile). Relative risk ratios (RRR) for subfertility and infertility with 95% confidence intervals were estimated using multinomial logistic regression. Among 93,832 pregnancies in 84,922 women, CHD was diagnosed in 333 women (0.4%), contributing with 360 pregnancies. The CHD was of simple complexity in 291 women (87.4%). No association was found between CHD and longer TTP (RRR of 1.02 (95% CI: 0.75–1.40) for subfertility, and RRR of 0.86 (95% CI: 0.61–1.20) for infertility). Similar was observed when comparing women with simple CHD and unaffected women. The number of women with complex CHD was too low for evaluation. Women with CHD had no increased risk of impaired fertility, assessed by TTP, when compared with unaffected women. Separate analysis of women with complex CHD was hampered by low numbers. • Self-reported time to pregnancy was compared between women with congenital heart disease and unaffected women. • No indication of impaired fertility was found when comparing the risk of subfertility and infertility between groups. • Results persisted when evaluating only women with heart defects of simple complexity. • The group of women with complex heart defects were too small for separate evaluation. [ABSTRACT FROM AUTHOR]

Aim: To highlight the uncommon manifestation of acrochordon in a postmenopausal woman. Background: Acrochordons are benign mesenchymal neoplasms. They are frequently noted in women of reproductive age group. Their occurrence in postmenopausal women is rare. Case description: A 56-year-old multiparous postmenopausal woman presented with a large vulval acrochordon of size 8 cm x 7.5 cm x 7.5 cm. Total surgical excision was performed under regional anesthesia and its diagnosis was confirmed on histopathology. Conclusion: Vulvar acrochordons are uncommon. Their occurrence in a postmenopausal age group is rare. Complete surgical excision is the cure. Clinical significance: Their clinical features mimic malignancy hence histopathology is important for definitive diagnosis. Ultrasonography aids in the initial diagnosis of the lesion. [ABSTRACT FROM AUTHOR]

Angiomyxoma is an infrequent tumor that originates from the mesenchyme and is primarily found in the female pelvic and perineal regions. Its diagnosis before surgery can be challenging due to its vague clinical manifestations and non-specific radiological features. One common symptom of this condition is painless swelling occurring around the pelvis and perineum. We report here a case study of a 36-year-old woman who complained of a large abdominal mass initially suspected to be retroperitoneal. The magnetic resonance imaging (MRI) results pointed towards a serous cystadenoma, while further examination during surgery suggested an initial possible diagnosis of degenerative fibroid. However, subsequent histopathological analysis confirmed that it was actually an angiomyxoma. It is crucial to consider aggressive angiomyxoma (AA) as one of the potential diagnoses for painless swellings in the genitofemoral region, particularly among women who are fertile and capable of reproduction. This particular case exemplifies the significance of including uncommon tumors like uterine angiomyxoma when making a differential diagnosis for pelvic masses, regular follow-up and monitoring for patients with a history of uterine masses, and the significance of histopathological examination to confirm the diagnosis of rare tumors. [ABSTRACT FROM AUTHOR]

Diabetes is considered a chronic metabolic disease characterized by elevated glucose levels due to either complete or relative deficiency of insulin hormone or the existence of factors antagonizing insulin action. Biomarkers are molecular, biochemical, physiological, anatomical elements, or imaging features that can be used for accurate diagnosis, disease progression assessment, prediction and monitoring of treatment effects, and determination of disease severity. This study investigated the association between two biomarkers, Atrial Natriuretic Peptides (ANP) and Cardiac Troponins (CT), and heart disease risk in diabetic women. Blood samples were collected from diabetic and healthy women, and ANP and CT levels were measured using ELISA. Diabetic women exhibited significantly higher ANP levels, potentially attributed to factors like hyperinsulinemia and elevated blood sugar. ANP is involved in cardiovascular disease development. CT levels were also significantly elevated in diabetic women and linked to vascular calcification and inflammation. ANP and CT may serve as valuable biomarkers for assessing heart disease risk in diabetic women, indicating vascular damage and inflammation. Further research is needed to validate these findings and explore their predictive value for specific cardiovascular diseases. These biomarkers show potential as early diagnostic predictors of heart diseases in diabetic women, warranting further investigation for clinical applications. [ABSTRACT FROM AUTHOR]

Objective. We studied the prevalence and major predisposing factors of permanent atrial fibrillation (PAF) in a population of hypertensive post-menopausal (HPMW) women. Materials and Methods. We enrolled 125 consecutive HPMW with PAF, 125 HPMW in sinus rhythm were the control group (CG). Women with valvular heart disease, coronary artery disease, WPW syndrome, left ventricular (LV) ejection fraction <45% and thyroid disorders were excluded. The mean age was similar: 53±3 years for women on PAF and 51±6 for women with sinus rhythm (P<0.45). All women who underwent M-B mode echocardiography, LV mass, function, and left atrial (LA) volume were assessed according to American Society of Echocardiography guidelines. Diabetes was assessed according to American Diabetes Association guidelines. Results. In a population of 8945 consecutive women, 4497 were hypertensive (50.2%) and 125 were on PAF (0.3%). We observed a highly significant difference between the two groups in relation to obesity: 31 (24.8%) in the AF-group and 15 (12%) in CG, Chi-squared 10, P<0.0016, OR 2.8, 95%; to increased LA volume: 37 (29.6%) in AF-group and 13 (10.4%) in CG, Chi-squared 14.4, P<0.0001, OR 3.62, 95%. No difference in diabetes: 30 (24%) in AFgroup and 28 (22.4%) in CG, Chi-squared 0.09, P<0.76, OR 1.09, 95%, and LV diastolic dysfunction (LVDD): 24 (19.2%) in AF-group and 20 (16%) in CG, Chi-squared 0.44, P<0.5, OR 1.25, 95%. In contrast to what was expected LV hypertrophy had a lower incidence of 59 (47.2%) in AF-group than in CG 84 (67.2%), Chi-squared 10.21, P<0.0014, OR 0.44, 95%. Conclusions. The prevalence of PAF in HPMW is not elevated, obesity and increased LA volume are strong determinants of PAF, not depending on age. LVDD, LV hypertrophy, and diabetes status seem not to play a relevant role as PAF determinants. [ABSTRACT FROM AUTHOR]

Mid-life, the years leading up to and following the menopause transition, in women is accompanied by a change in cardiometabolic risk factors, including increases in body weight, changes in body composition, a more insulin-resistant state, and a shift towards a more atherogenic dyslipidemia pattern. Cardiovascular disease (CVD) risk assessment should be performed continually throughout the lifespan, as risk is not stagnant and can change throughout the life course. However, mid-life is a particularly important time for a woman to be evaluated for CVD risk so that appropriate preventive strategies can be implemented. Along with assessing traditional risk factors, ascertainment of a reproductive history is an integral part of a comprehensive CVD risk assessment to recognize unique female-specific or female-predominant factors that modify a woman's risk. When there is uncertainty about CVD risk and the net benefit of preventive pharmacotherapy interventions (such as statins), measuring a coronary artery calcium score can help further refine risk and guide shared decision-making. Additionally, there should be heightened sensitivity around identifying signs and symptoms of ischemic heart disease in women, as these may present differently than in men. Ischemia from coronary microvascular disease and/or vasospasm may be present even without obstructive coronary artery disease and is associated with a heightened risk for major cardiovascular events and reduced quality of life. Therefore, correctly identifying CVD in women and implementing preventive and treatment therapies is paramount. Unfortunately, women are underrepresented in cardiovascular clinical trials, and more data are needed about how to best incorporate novel and emerging risk factors into CVD risk assessment. This review outlines an approach to CVD screening and risk assessment in women using several methods, focusing on the middle-aged population. [ABSTRACT FROM AUTHOR]

Cardiac diseases are the main cause of death for both sexes worldwide. Treatment varies widely according to the sex of a patient, as there are differences in physiopathology, epidemiology, clinical presentation and management. However, women have been largely excluded from research studies in this field. At present, differences are starting to be recognized and more attention is being paid to the identification of female-specific (or emergent) atherosclerotic risk factors. Diagnostic testing also merits attention because cardiac imaging offers important information to help diagnosis and guide cardiac disease management. In this sense, multimodal imaging should be used with the most cost-effective approach, integrating this information into the clinical sphere according to the pretest probability of the disease. In this review, we address sex-specific features of ischemic heart disease that should be considered in the clinical assessment of women, as well as the value of different imaging techniques (including technical and clinical aspects) for management of women with ischemic heart disease, and identify future areas of action concerning ischemic heart disease in women. [ABSTRACT FROM AUTHOR]

Virilization of the 46,XX infant may be attributed to maternal or fetoplacental origin. Maternal sources may be endogenous, as with an androgen-producing tumor, or drug-related. Iatrogenic virilization by maternal drug exposure is rarely reported, with individual case reports and case series demonstrating the effects of progesterone and other medications affecting the pituitary-ovarian axis.1-3 The class of medications known as aromatase inhibitors are recognized as effective in treating hormone receptor-positive breast cancer by preventing the conversion of androgens into estrogens by aromatase. In fetal development, placental aromatase plays a critical role in preventing virilization of the XX fetus by maternal and fetal androgens during development. In the setting of placental aromatase deficiency, the XX fetus may be virilized. It is conceivable, therefore, that maternal exposure to aromatase inhibitors early in gestation may lead to in utero virilization, though there have been no known reports of this phenomenon to date. We present a case of virilization of a 46,XX infant attributed to pharmacologic aromatase inhibition. The infant's parents provided informed consent for the reporting of this case. [ABSTRACT FROM AUTHOR]

Context • Pelvic organ prolapse (POP) is a leading health problem, in which pelvic organs—the uterus, bladder, and rectum—bulge from the vagina, causing bladder and bowel dysfunction. Uterovaginal prolapse (UVP), Nutual-Rahim, affects more than 50% of parous women (women who have had children), especially those above 60 years of age. Objective • The current case study intended to evaluate the benefits of a holistic Unani treatment in ameliorating POP symptoms, healing decubitus ulcers, preventing further prolapse, improving quality of life, and maintaining social independence. Design • The research team developed a case report. Setting • The study took place at the National Institute of Unani Medicine in Bengaluru, Karnataka, India. Participant • The participant was a 70 year-old female patient at the Institute with backache, spotting from the vagina, foul-smelling vaginal discharge, general weakness, and fourth-degree UVP with multiple decubitus ulcers. Intervention • The participant orally received Majun Moocharus, 7 g twice daily for 60 days,and took sitz baths (Abzan) once daily for 20 minutes for 60 days, which used a medicated decoction of 3g of alum (phitkari ) and 10 g each of a medicated decoction (Joshanda) of nutgalls from the Aleppo oak, Quercus infectoria (Mazu), root of lemon grass Andropogan jwarancusa (Izkhar), and pomegranate rind from Punica granatum (Post anar). She also used vaginal tampons (Hamul) which each used 2g of the same medicinal powder with 10 ml of rose oil and which was inserted into her vagina once per day for 60 days, in combination with pelvic-floor-muscle exercises. Results • The ulcers were healed within a week. The monthly follow-ups for ten months showed no cervical descent or symptoms associated with it. Conclusions • The current case study found that a fourth-grade UVP can be managed effectively with Unani medications. The participant’s ulcers were healed, her clinical symptoms of UVP were reduced, and her quality of life improved. Clinical trials are recommended with large sample sizes to create a higher level of evidence for the efficacy of the Unani medicine. [ABSTRACT FROM AUTHOR]

Background: Women with congenital heart disease (CHD) have increased risk for adverse events during pregnancy and delivery. Prior studies have assessed pregnancy and delivery outcomes at tertiary referral centers (TRC). The aim of our study was to assess pregnancy outcomes in women with CHD who deliver in a non-tertiary referral center (non-TRC). Methods: Clinical demographics were collected, including anatomic complexity, physiologic state and pre-pregnancy risk assessment. Patients were stratified by delivery location, either TRC or non-TRC. Maternal and neonatal complications of pregnancy were reported. Results: Women with CHD who delivered in a TRC had a higher pre-pregnancy risk when assessed by the Zahar and CARPREG-II scores, and had more patients fall into a higher WHO classification. There was no difference in rates of maternal cardiac complications between delivery locations (11%) and neonatal complications (20%) between deliveries at TRC and non-TRC. Conclusions: There were not increased maternal cardiac or neonatal complications when delivery occurred at a non-TRC. Neonatal complications remained high regardless of delivery location. This study suggests that proper risk assessment may help identify women who are candidates for safe delivery at non-TRC in women with CHD, and that neonatal resources should be considered when planning delivery location. [ABSTRACT FROM AUTHOR]

Objective. We studied the prevalence and major predisposing factors of permanent atrial fibrillation (PAF) in a population of hypertensive post-menopausal (HPMW) women. Materials and Methods. We enrolled 125 consecutive HPMW with PAF, 125 HPMW in sinus rhythm were the control group (CG). Women with valvular heart disease, coronary artery disease, WPW syndrome, left ventricular (LV) ejection fraction <45% and thyroid disorders were excluded. The mean age was similar: 53±3 years for women on PAF and 51±6 for women with sinus rhythm (P<0.45). All women who underwent M-B mode echocardiography, LV mass, function, and left atrial (LA) volume were assessed according to American Society of Echocardiography guidelines. Diabetes was assessed according to American Diabetes Association guidelines. Results. In a population of 8945 consecutive women, 4497 were hypertensive (50.2%) and 125 were on PAF (0.3%). We observed a highly significant difference between the two groups in relation to obesity: 31 (24.8%) in the AF-group and 15 (12%) in CG, Chi-squared 10, P<0.0016, OR 2.8, 95%; to increased LA volume: 37 (29.6%) in AF-group and 13 (10.4%) in CG, Chi-squared 14.4, P<0.0001, OR 3.62, 95%. No difference in diabetes: 30 (24%) in AFgroup and 28 (22.4%) in CG, Chi-squared 0.09, P<0.76, OR 1.09, 95%, and LV diastolic dysfunction (LVDD): 24 (19.2%) in AF-group and 20 (16%) in CG, Chi-squared 0.44, P<0.5, OR 1.25, 95%. In contrast to what was expected LV hypertrophy had a lower incidence of 59 (47.2%) in AF-group than in CG 84 (67.2%), Chi-squared 10.21, P<0.0014, OR 0.44, 95%. Conclusions. The prevalence of PAF in HPMW is not elevated, obesity and increased LA volume are strong determinants of PAF, not depending on age. LVDD, LV hypertrophy, and diabetes status seem not to play a relevant role as PAF determinants. [ABSTRACT FROM AUTHOR]

This study was conducted to identify ischemic heart disease-related factors and vulnerable groups in Korean middle-aged and older women using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Among the 24,229 people who participated in the 2017–2019 survey, 7249 middle-aged women aged 40 and over were included in the final analysis. The data were analyzed using IBM SPSS and SAS Enterprise Miner by chi-squared analysis, logistic regression analysis, and decision tree analysis. The prevalence of ischemic heart disease in the study results was 2.77%, including those diagnosed with myocardial infarction or angina. The factors associated with ischemic heart disease in middle-aged and older women were identified as age, family history, hypertension, dyslipidemia, stroke, arthritis, and depression. The group most vulnerable to ischemic heart disease included women who had hypertension, a family history of ischemic heart disease, and were menopausal. Based on these results, effective management should be achieved by applying customized medical services and health management services for each relevant factor in consideration of the characteristics of the groups with potential risks. This study can be used as basic data that can be helpful in national policy decision making for the management of chronic diseases. [ABSTRACT FROM AUTHOR]

Dr. Saifur Rehman Administrator Karachi Metropolitan Corporation has called upon the healthcare professionals to work with devotion, dedication and do something good so that they are remembers with good words even when they are gone. He was speaking as a chief guest in the inaugural session of the Dr. Abdul Haq Khan Cardiology symposium held at the Karachi Institute of Heart Diseases (KIHD) Campus. [Extracted from the article]

Objective Accumulating evidence suggests increased cardiovascular risk in women with polycystic ovarian syndrome (PCOS) due to a cluster of factors, such as obesity, lipid abnormalities, impaired glucose tolerance (IGT), and hypertension. Markers such as high-sensitivity C-reactive protein (hs-CRP) and plasminogen activator inhibitor-1 (PAI-1) can provide an adjunctive method for the assessment of cardiovascular risk and can indicate future coronary heart diseases in women with lean PCOS. Materials and Methods In this prospective case-control study, women clinically diagnosed with PCOS (n = 25) with normal body mass index (BMI) and age and BMI-matched healthy controls (n = 75) were enrolled. The quantitative data were expressed as mean ± standard deviation (SD). Unpaired Student's t -test was used to compare the values (PCOS vs. controls) and Pearson's correlation coefficient was used to elucidate the relationship between the variables. Results The mean level of fasting blood sugar, serum total cholesterol, low-density lipoprotein (LDL), thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), hs-CRP, and PAI-1 were significantly increased in PCOS patients (p < 0.000) compared with the control patients. Of the reported cases, 54.16% had hs-CRP levels greater than 3 mg/L. When the cases were further divided into normal (n = 20) and IGT (n = 5), hs-CRP values were significantly higher in IGT group as compared with normal glucose tolerance (NGT) group. On bivariate correlation analysis, hs-CRP had significant correlations with PAI-1 (r = 0.41, p < 0.000), waist-to-hip ratio (WHR; r = 0.23, p = 0.02), fasting blood sugar (FBS; r = 0.26, p = 0.009), LDL (r = 0.20, p = 0.03), TSH (r = 0.42, p < 0.000), and LH-to-FSH ratio (r = 0.24, p = 0.01). Conclusion Women with lean phenotype of PCOS suffer from many metabolic abnormalities such as abdominal obesity, dyslipidemia, hyperandrogenemia, and insulin resistance. The findings of the study suggest that environment of ongoing low-grade inflammation due to infiltration further exacerbates the metabolic derangements and cardiovascular risk. The investigations as hs-CRP and PAI-1 will help in early identification, diagnosis, and management of cardiovascular diseases associated with lean type of PCOS. These markers can prove to be beneficial in monitoring any unfavorable changes in cardiometabolic profile of such patients. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are common for men and women but there are differences between the sexes in terms of clinical symptoms, pathophysiology and response to the treatment. Cardiovascular diseases (CVD) in women is commonly underdiagnosed and often women tend to have a lower perception of the risk. That can lead to delayed diagnosis and failed recognition of symptoms. Women develop heart diseases later than men because of the protection in the reproductive phase of their life. Once they enter menopause the risk increases. Estrogen provides a protective effect against heart disease in women. Therefore, the risk of CVD increases after menopause in most cases. The presented work emphasizes the importance of the menopausal period as the time of increasing CVD risk. It also emphasizes the importance of monitoring the health of women in their middle age, a critical time in which early intervention strategies should be implemented to reduce the risk of CVD. [ABSTRACT FROM AUTHOR]

Due to medical advances, women with congenital heart disease (CHD) are living longer, healthier lives and many are considering pregnancy. The hemodynamic changes of pregnancy present high risks of morbidity and mortality for many women with CHD. As little is known about these women's reproductive health experiences, this study explores their perceptions of pregnancy and family planning care as related to CHD. Women ages 18-45 years with a diagnosis of CHD associated with a World Health Organization (WHO) classification II–IV for pregnancy morbidity and mortality participated in individual, semi-structured interviews exploring their experiences, attitudes, and preferences toward parenthood, pregnancy, contraception and family planning care provision. Interviews were audio-recorded, transcribed verbatim. Two independent coders performed analysis using deductive and inductive coding approaches. Twenty women with CHD participated in interviews (average age 30.1 years, SD 5.85). Nine women had a prior pregnancy and 14 considered becoming a parent in the future. We identified 5 key themes among the women: (1) CHD impacted their reproductive health goals and decisions; (2) Women with CHD perceived a lack of safe contraceptive methods for their condition; (3) Women desired tailored, disease-specific sexual and reproductive health (SRH) information; (4) Women viewed their cardiologist as the primary source for SRH information and prefer provider-initiated discussions starting in adolescence; and (5) Women desire coordinated pre-pregnancy and intrapartum care between their cardiologists and women's health providers. These results provide a foundation for interventions to improve patient-centered interdisciplinary reproductive healthcare for this population. [ABSTRACT FROM AUTHOR]

Background: The risk of ischemic heart disease (IHD) due to the impact of gonadotropin‐releasing hormone (GnRH) agonists among female patients with breast cancer remains a controversy. Methods: Information from the Registry for Catastrophic Illness, the National Health Insurance Research Database (NHIRD), and the Death Registry Database in Taiwan were analyzed. Female patients with breast cancer were selected from the Registry for Catastrophic Illness from January 1, 2000, to December 31, 2018. All the breast cancer patients were followed until new‐onset IHD diagnosis, death, or December 31, 2018. A Kaplan–Meier survival curve was drawn to show the difference between patients treated with and without GnRH agonists. The Cox regression analysis was used to investigate the effects of GnRH agonists and the incidence of IHD. Results: A total of 172,850 female patients with breast cancer were recognized with a mean age of 52.6 years. Among them, 6071(3.5%) had received GnRH agonist therapy. Kaplan–Meier survival curves showed a significant difference between patients with and without GnRH therapy (log‐rank p < 0.0001). Patients who received GnRH therapy had a significantly decreased risk of developing IHD than those without GnRH therapy (HR = 0.18; 95% CI = 0.14–0.23). After adjusting for age, treatment, and comorbidity, patients who received GnRH therapy still had a significantly lower risk of developing IHD (AHR = 0.5, 95% CI = 0.39–0.64). Conclusion: The study showed that the use of GnRH agonists for breast cancer treatment was significantly associated with a reduced risk of IHD. Further research is required to investigate the possible protective effect of GnRH on IHD. [ABSTRACT FROM AUTHOR]

Simple Summary: Women are less likely to be correctly diagnosed with and subsequently treated for coronary artery disease (CAD). CAD is a result of atherosclerosis, a chronic disease of the arterial wall with a significant inflammatory component. Its complication, acute coronary syndrome (ACS), was described to be connected with inflammation in women more often than in men. Thus, a simple marker based on accessible laboratory tests, like total blood count, may be of great use. This paper describes an association between ACS occurrence and systemic inflammatory response index (SIRI), systemic inflammatory reaction index (SII), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR), as well as it looks for the relationship between these and classic CAD risk factors. Our results suggest that with further well-designed research, the abovementioned markers may become a new CAD risk factor in elderly women. Coronary artery disease (CAD) in women occurs later than in men. Underlying atherosclerosis, a chronic process of lipoprotein deposition in arterial walls with a prominent inflammatory component, is influenced by several risk factors. In women, commonly used inflammatory markers are generally found to be related to the occurrence of acute coronary syndrome (ACS), as well as the development of other diseases that influence CAD. New inflammatory markers derived from total blood count—systemic inflammatory response index (SII), systemic inflammatory reaction index (SIRI), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR)—were analyzed in the group of 244 elderly, postmenopausal women with the diagnosis of ACS or stable CAD. SII, SIRI, MLR, and NLR were significantly higher in women with ACS compared to those with stable CAD (p < 0.05 for all)—the highest values were observed in women with NSTEMI. MLR from new inflammatory markers, HDL, and history of MI turned out to be significant factors associated with ACS. These results suggest that MLR as representative of blood count-derived inflammatory markers may be considered as additional CVD risk factors in women with suspected ACS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies focused on pregnant women with congenital heart disease (CHD)–associated pulmonary hypertension (PH) are scarce and limited by small sample sizes and single-center design. This study sought to describe the pregnancy outcomes in women with CHD with and without PH. METHODS: Outcomes for pregnant women with CHD were evaluated retrospectively from 1993 to 2016 and prospectively from 2017 to 2019 from 7 tertiary hospitals. PH was diagnosed on the basis of echocardiogram or catheterization. The incidence of maternal death, cardiac complications, and obstetric and offspring complications was compared for women with CHD and no PH, mild, and moderate-to-severe PH. RESULTS: A total of 2220 pregnant women with CHD had completed pregnancies. PH associated with CHD was identified in 729 women, including 398 with mild PH (right ventricle to right atrium gradient 30–50 mmHg) and 331 with moderate to-severe PH (right ventricle to right atrium gradient >50 mmHg). Maternal mortality occurred in 1 (0.1%), 0, and 19 (5.7%) women with CHD and no, mild, or moderate-to-severe PH, respectively. Of the 729 patients with PH, 619 (85%) had CHD-associated pulmonary arterial hypertension, and 110 (15%) had other forms of PH. Overall, patients with mild PH had better maternal outcomes than those with moderate-to-severe PH, including the incidence of maternal mortality or heart failure (7.8% versus 39.6%; P<0.001), other cardiac complications (9.0% versus 32.3%; P<0.001), and obstetric complications (5.3% versus 15.7%; P<0.001). Brain natriuretic peptide >100 ng/L (odds ratio, 1.9 [95% CI, 1.0–3.4], P=0.04) and New York Heart Association class III to IV (odds ratio, 2.9 [95% CI, 1.6–5.3], P<0.001) were independently associated with adverse maternal cardiac events in pregnancy with PH, whereas follow-up with a multidisciplinary team (odds ratio, 0.4 [95% CI, 0.2–0.6], P<0.001) and strict antenatal supervision (odds ratio, 0.5 [95% CI, 0.3–0.7], P=0.001) were protective. CONCLUSIONS: Women with CHD-associated mild PH appear to have better outcomes compared with women with CHD-associated moderate-to-severe PH, and with event rates similar for most outcomes with women with CHD and no PH. Multimodality risk assessment, including PH severity, brain natriuretic peptide level, and New York Heart Association class, may be useful in risk stratification in pregnancy with PH. Follow-up with a multidisciplinary team and strict antenatal supervision during pregnancy may also help to mitigate the risk of adverse maternal cardiac events. [ABSTRACT FROM AUTHOR]

This is the first time that a local preliminary document on gender differences in CVDs has been initiated in Pakistan. International forum has been highlighting significant gender and ethnicity in CVDs. So different countries from world took the initiative to develop their local guideline or clinical scientific statements on gender differences with different socio-cultural and educational background for their own countries. GRFW in collaboration with Scientific Council of Women with Heart Disease PCS Pakistan floated this idea to develop a local guideline in various aspects CVDs for our own women population. In this regard different topics were assigned to different groups including mostly female cardiologists, senior gynecologists/obstetricians and radiologist from all over Pakistan. Primary objectives of this write up on Cardiac Imaging in Women is to provide a local clinical practice guideline for the assessment and management of CVD that will improve and standardize the physicians' decision making for Pakistani women population. In the setting of growing awareness of providing personalized precision medicine, addressing sex differences in CVD is a key goal. The intention is to inform cardiologists, non-cardiologist physicians', general practitioners, and, obstetrician/gynecologists about the reasonable use and understanding of technologies to help in proper approach to their treating women with HDs and when to send them for cardiac specialist diagnostic center. As we could not find our own local data on cardiac imaging to report at present, most recommendations on cardiac imaging used has been taken from international literatures (which we have found feasible, readily available, and some cost effective approach in our money constraint society which can be followed in our population) and also which were published within the past decade were given priority. In this document, we discuss the role of using different cardiac imaging modalities, with a focus on diseases which are unique/or occur more in women. So, five women specific topics more commonly seen in our population were selected currently, which are (stable/unstable angina and ACS, MINOCA), non-ischemic CMP, HD during pregnancy, cardio-oncology, and connective tissue diseases (CTD). In these topics we have tried to used our own local incidences and prevalence of these diseases in our community/internationally on gender basis and have highlighted the availability/limitations of cardiac imaging in our society. The updated recommendations in women have been taken from international guidelines. Graphs and tables layout has been taken from abroad literatures and made some few changes according to its use in our population. You will find this a preliminary review document which will be simple to read, have updated approach in evaluating the diagnosis of HD in women easily. For current cost effectiveness issues for our population will be taken up by PCS to Health ministries of Pakistan for its making it easily availability with cheap cost so to benefit our female (very neglected and ill informed) with CVD population. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular disease is the main cause of general and premature death of adults aged 30-69 years in Brazil and around the world. Unhealthy food environments have been implicated as one of the factors associated with cardiovascular disease morbimortality because they affect people's health conditions and nutrition. This study aims to explore the association between unhealthy food environments (deserts/swamps) and premature cardiovascular disease mortality in the Brazilian population.Methods: This is an ecologic study using data from 5,558 Brazilian municipalities in 2016. The cardiovascular disease mortality data were obtained from the Mortality Information System of the Ministry of Health. The study on mapping food deserts in Brazil, developed by the Interministerial Chamber of Food and Nutrition Security, was used to evaluate the physical dimension of food access. The authors calculated the standardized rates of premature general and specific cardiovascular disease (stroke and ischemic heart disease) causes of death in the same period. To characterize food environments, the density of unprocessed and ultraprocessed foods per 10,000 population in tertiles was used. Crude and adjusted negative binomial regression models were used to study the associations of interest.Results: After the necessary adjustments (human development index, gross domestic product per capita, unemployment rate, Gini index and Family Health Strategy coverage), it was found that municipalities with low unprocessed food supply were at the highest risk of increased mortality among women with ischemic heart disease (rate ratio first tertile: 1.08 [95% CI=1.01, 1.15]). Conversely, the municipalities where there was a greater offer of ultraprocessed foods showed a higher risk of death from cardiovascular diseases (rate ratio second tertile: 1.17 [95% CI=1.12, 1.22]; rate ratio third tertile: 1.20 [95% CI=1.14, 1.26]), from strokes (rate ratio second tertile: 1.19 [95% CI=1.13, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.15, 1.30]), and ischemic heart disease (rate ratio second tertile: 1.19 [95% CI=1.12, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.13, 1.29]).Conclusions: This study's findings show an increase in the risk of cardiovascular disease, stroke, and ischemic heart disease mortality, especially in the municipalities where there was a greater offer of ultraprocessed foods. Initiatives aiming to minimize the effects of these food environments are urgently needed in the Brazilian context. [ABSTRACT FROM AUTHOR]

HighlightsFasting glucose‐defined prediabetes and undiagnosed diabetes based on the American Diabetes Association criteria were associated with a greater risk of coronary heart disease, stroke, and composite atherosclerotic cardiovascular disease in women. In contrast, oral glucose tolerance‐defined prediabetes and undiagnosed diabetes were associated with a greater risk of all cardiovascular outcomes in men.Intermediate A1c was associated with a more pronounced effect on the risk of coronary heart disease and stroke in women, whereas the above diagnostic level of A1c was associated with a higher magnitude of coronary heart risk in undiagnosed men but a higher magnitude of stroke risk in undiagnosed women. [ABSTRACT FROM AUTHOR]