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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 6 | Issue 2
Page Nos. 43-97

Online since Monday, May 16, 2022

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EDITORIALS  

Recognition and treatment of psychosomatic diseases p. 43
Qingshan Geng
DOI:10.4103/hm.hm_8_22  
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Expert consensus on diagnosis and treatment of adult mental stress induced hypertension in China (2022 revision): Part A p. 45
Lin Lu, Qingshan Geng, Meiyan Wang, Chunlin Bai, Gong Cheng, Yinghua Cui, Bo Dong, Jianqun Fang, Feng Gao, Ruowen Huang, Shuwei Huang, Yuming Li, Gang Liu, Yuanyuan Liu, Yan Lu, Yanping Ren, Jialiang Mao, Dazhuo Shi, Huimin Su, Xinyu Sun, Xingguo Sun, Xiangdong Tang, Fengshi Tian, Hong Tu, Hao Wang, Qing Wang, Xiangqun Wang, Junmei Wang, Le Wang, Yibo Wang, Yumei Wang, Zhipeng Wang, Shaojun Wen, Hui Wu, Yanqing Wu, Peng Xiong, Guolong Yu, Ning Yang, Xiaoling Zhao, Haicheng Zhan, Meiyan Liu
DOI:10.4103/hm.hm_4_22  
Mental stress has been recognized as an essential risk factor for hypertension. Therefore, experts specializing in cardiology, psychiatry, and Traditional Chinese Medicine organized by the Psycho-Cardiology Group of College of Cardiovascular Physicians of Chinese Medical Doctor Association and Hypertension Group of Chinese Society of Cardiology proposed the expert consensus on the diagnosis and treatment of adult mental stress-induced hypertension in March 2021, which includes the epidemiology, etiology, diagnosis, and treatment of the mental stress-induced hypertension. This consensus will hopefully facilitate the clinical practice of this disorder. In addition, the COVID-19 pandemic has become one of the primary global sources of psychosocial stressors since the beginning of 2020, and the revision of this expert consensus in 2022 has increased the relevant content. This consensus consists of Part A and Part B. Part A includes (I) Background and epidemiological characteristics, (II) Pathogenesis, and (III) Diagnosis and Part B includes (IV) Treatment recommendations and (V) Prospects. This part presents the content of Part A.
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REVIEW ARTICLE Top

Anxiety in individuals with cardiovascular diseases: A narrative review and expert opinion p. 52
Wei Jiang
DOI:10.4103/hm.hm_5_22  
Anxiety is a commonly prevalent mental problem in patients with cardiovascular diseases (CVD), but its significance and clinical management have been neglected until recently. Similar to depression, anxiety has been demonstrated to be prevalent and hinging the quality of life and optimal outcome of patients with CVD. Although research evidence is still limited, clinical management for depression may be adopted for the care of anxiety in patients with CVD. Special attention needs to be paid when diagnosing anxiety disorder in patients with CVD because the fear may be a normal reaction of these patients and anxiety may manifest somatically.
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ORIGINAL ARTICLES Top

Functional (psychogenic) seizures are associated with thyroid disorders p. 58
Ali A Asadi-Pooya, Mohsen Farazdaghi
DOI:10.4103/hm.hm_37_21  
Objective: We investigated medical comorbidities in patients with functional seizures (FS) and those with epilepsy (idiopathic generalized epilepsies [IGEs] or temporal lobe epilepsy [TLE]). We hypothesized that the nature of medical comorbidities differs between these three groups. This might be helpful to postulate on the pathophysiology of FS. Materials and Methods: In a retrospective study, all adult patients with a diagnosis of IGE, TLE, or FS were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Iran, from 2008 until 2020. The three groups of patients were matched with regard to their age. Age, sex, and medical comorbidities were registered routinely for all patients at the time of the first visit. Results: Nine hundred and sixty-six patients were studied (254 patients with IGE, 467 persons with TLE, and 245 individuals with FS). The groups differed significantly with regard to having medical comorbidities. The most striking difference was comorbid thyroid disorders; this was more common among patients with FS. The diagnosis of FS was independently significantly associated with thyroid disorder comorbidity (odds ratio: 2.77, 95% confidence interval: 1.06–7.23; P = 0.038). Conclusion: Thyroid disorders are significantly associated with FS. We can make the following suggestions to advance the field: a. It is necessary to reproduce this observation in larger multicenter studies; b. We recommend to evaluate thyroid function in all patients with FS; c. It might be helpful to design clinical trials to investigate whether correction of any clinical or subclinical thyroid disorders changes the treatment outcome in patients with FS.
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Trends and outcomes of coronary artery bypass grafting in patients with major depressive disorder: A perspective from the national inpatient sample Highly accessed article p. 62
Andrew Del Re, Krissia M Rivera Perla, Ghazal Aghagoli, Krishna Bellam, Frank W Sellke, Afshin Ehsan
DOI:10.4103/hm.hm_62_21  
Purpose: Coronary artery disease is a major cause of morbidity and mortality in the United States, representing the highest proportion of deaths due to cardiovascular disease. Treatment of coronary artery disease ranges from prevention to intervention, with the latter warranting a decision between surgical versus percutaneous revascularization. Medical optimization before coronary artery bypass grafting (CABG) is an important step in the care continuum. While the optimization of many risk factors such as smoking has been studied extensively, the inclusion of mental health conditions in preoperative health assessment is not yet standard of care. Major depressive disorder (MDD) is the most prevalent mental health disorder and has been shown to affect physiological processes that are critical in recovery after cardiac surgery. Methods: We queried the national inpatient sample from 2000 to 2017 for patients ≥18 years undergoing CABG with and without MDD. Patients who left against medical advice were excluded. Patients with a diagnosis of MDD were compared against those without. Our primary outcomes were in-hospital mortality, favorable discharge (home or home with services), and length of stay. Multivariable models were used for the various outcomes and each model adjusted for confounding variables. Results: A total of 2,988,997 met clinical criteria for inclusion including 108,782 with an MDD diagnosis. Most patients were male (n = 2,135,804, 71.46%), White (n = 2,417,216, 80.87%), and the average age was 66.3 years (standard deviation = 10.8 years). After adjustment, patients with a diagnosis of MDD were found to have lower odds of in-hospital mortality (odds ratio [OR] [95% confidence interval {CI}] 0.64 [0.56–0.73], P < 0.001) and had decreased odds of home discharge (OR = 0.66 [0.63–0.69], P < 0.001) after CABG. Overall, length of stay was similar between the groups, with MDD patients having a slightly longer length of stay (β-coefficient = 1.03 [1.03–1.04], P < 0.001). Patients with a diagnosis of MDD were also found to have lower odds of acute kidney injury (OR = 0.70 [0.61–0.81], P < 0.001), cardiogenic shock (OR = 0.75 [0.68–0.83], P < 0.001), infection (OR = 0.78 [0.69–0.89], P < 0.001), transient ischemic attack/stroke (OR = 0.75 [0.63–0.89], P = 0.001), acute liver injury (OR = 0.45 [0.34–0.61], P < 0.001), and acute limb ischemia (OR = 0.57 [0.40–0.82], P = 0.003). Conclusions: Patients with a diagnosis of MDD have decreased odds of postoperative morbidity and mortality after CABG in addition to having lower odds of home discharge. The present study suggests a need for prospective investigations on the impact of MDD diagnosis and outcomes after CABG to further understand this relationship.
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Mental status in patients with cerebral infarction in central China at the early stage of coronavirus disease-19 pandemic p. 70
Yuping Wu, Sha Ma, Hong Zhang, Xiaoqian Huang, Yi Shu
DOI:10.4103/hm.hm_40_21  
Aims: The study aimed to analyze the changes in mental health and social support in patients with cerebral infarction during the recovery period at the early stage of coronavirus disease pandemic. Subjects and Methods: During January–March 2020, 98 patients with cerebral infarction during the recovery period were selected from Wuhan city. Among them, 42 patients were living alone (called the solitary group) and 56 patients lived with their spouses (called the spouse group). The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate anxiety and depression, respectively, and Multi-Dimensional Scale of Perceived Social Support (MSPSS), social support for patients. Statistical Analysis Used: The statistical calculations were carried out using GraphPad Prism 5.01 software (GraphPad, San Diego, California, USA). Results: At the early stage of the pandemic, patients with cerebral infarction in the solitary group and the spouse group experienced varying degrees of anxiety and depression. The SAS and SDS scores in the solitary group were significantly higher than those in the spouse group (P < 0.01). The subscale scores of MSPSS in the solitary group were lower than those in the spouse group (P < 0.01). Conclusions: It is necessary for medical staff to help the patients to overcome anxiety and depression and provide more social support to patients, especially for those patients living alone.
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Developmental Pb2+-Exposure induces cardiovascular pathologies in adult male rats p. 75
Evelyn Okeke, Lorenz S Neuwirth, Abdeslem El Idrissi
DOI:10.4103/hm.hm_73_21  
Background: Developmental lead (Pb2+) exposure has been historically shown to alter the pathological functions of the cardiovascular system at high blood lead levels (i.e.,>15 μg/dL). However, given the time that has elapsed in the field (i.e., some 30 years), there is a great need for less clinical and more basic research on the cardiopathology of low blood lead levels (lBLLs; i.e.,<10 μg/dL). Further, most of the prior literature had focused solely on males as they had been reported to be more vulnerable to Pb2+ induced cardiovascular pathology. Aims and Objectives: To generate a model system of Pb2+-induced cardiovascular pathology that would be consistent with past reports, the present study examined male Long–Evans Hooded rats that were perinatally Pb2+ exposed (i.e., via their food with 996 ppm lead acetate in the rat chow) up until weaning (i.e., postnatal day 22; blood lead levels [BLLs]: 10–15 μg/dL) and were then removed from Pb2+ exposure for nearly 1.5 months (i.e., BLLs >3.33 μg/dL). Materials and Methods: Rats were then subjected to cardiovascular measures of systolic and diastolic blood pressures (SBP and DBP) and heart rates. Rats were sacrificed and their hearts were weighed; their thoracic aortas were collected and examined for microstructural and morphological changes through a scanning electron micrograph. Results: The data showed that compared to age matched control rats, the Pb2+ exposed rats have increased SBP, DBP, and heart rate with no differences in heart weight. These data show that early developmental Pb2+ exposure comprising lBLLs can cause significant cardiovascular pathological changes in rats. Conclusion: The present model of developmental Pb2+-exposure occurring early in life caused Pb2+-induced cardiopathology later in life through increased hypertension and reduced elasticity of the aorta media. These cardiovascular pathologies could further increase the likelihood of accelerated fronto executive dysfunctions due to the direct action of Pb2+ on neurons through inhibition of calcium dependent processes and might also contribute to vascular dementias.
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Internet addiction predicted insomnia among bangladeshi undergraduate students at the time of the COVID-19 pandemic p. 82
Mohammad Ali, Zarin Tasnim, Gias Uddin Ahsan
DOI:10.4103/hm.hm_66_21  
Objective: The prevalence of Internet addiction (IA) and insomnia among the student cohort was high. The COVID-19 pandemic adversely influenced both critical emerging public health concerns. Our study aimed to determine the prevalence of IA and insomnia and assess the relationship among the problems at the crucial time of the COVID-19 pandemic. Methods: A pilot survey was conducted among undergraduate students of an educational institute by inviting participants to use an electronically randomly selected e-mail address provided by the affiliated institute. Descriptive analysis was conducted to identify the student subgroups with a higher prevalence of insomnia; however, a multiple regression analysis was employed to identify the predictors of insomnia. Results: Insomnia and IA prevalence was 49.4% and 81.7%, respectively. Age group, gender, relationship status, family income, family type, living location, tobacco use, and exercise habits and physical illness history were associated with insomnia. However, regression analysis suggested that maintaining a relationship, being physically ill in the last year, and IA could predict insomnia independently. Conclusion: Institutional initiatives are recommended to reduce the high burden of insomnia and IA. A large sample size cross-sectional and longitudinal study is warranted to generalize these findings and determine the in-depth relationship between IA and insomnia.
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CASE REPORTS Top

Adenosine-Induced Myocardial Ischemia in a Patient with Myocardial Bridge: A Case Report p. 87
Bingqing Bai, Huan Ma, Lan Guo, Xueju Yu, Haochen Wang, Yuting Liu, Ha Yin, Fengyao Liu, Qingshan Geng
DOI:10.4103/hm.hm_33_21  
The adenosine stress test and exercise stress test have been widely used in the diagnosis of coronary heart disease, which has high sensitivity and specificity for diagnosis of coronary heart disease. The myocardial bridge is a congenital dysplasia of the coronary artery which may cause severe myocardial ischemia, acute myocardial infarction, arrhythmia, and sudden death. Although drug therapy for this disease is clear and widely used, indication for open-chest surgery is still vague. This case shows a patient with long-term chest pain undergoing the coronary computed tomographic angiography in our hospital 1 month ago, which showed the mild myocardial bridge in the left anterior descending (LAD) branch. Then, she did the mental stress-induced myocardial ischemia and cardiopulmonary exercise test which the results were negative. After the informed consent, the patient took the adenosine stress test and severe angina occurred during the test. Later, coronary angiography showed that the myocardial bridge caused 70% contraction of the middle segment of the LAD branch. In the case of long-term ineffective drug treatment, the patient underwent a open-chest surgery called coronary artery myotomy and her chest discomfort eventually recovered. To a degree, adenosine stress test may be more sensitive than exercise stress test in predicting the severity of coronary artery stenosis. Moreover, we may provide a unique direction of indication for surgeons to operate open-chest surgery on the myocardial bridge.
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An unusual case of dense mitral annular calcification in a young with plethora of mitral annular premature ventricular complexes p. 92
Debasish Das, Tutan Das, Subhas Pramanik
DOI:10.4103/hm.hm_57_21  
We report a rare case of dense mitral annular calcification in a 26-year-old male presenting with recurrent palpitation for the last year with a plethora of mitral annular premature ventricular complexes (PVCs). PVCs had right bundle branch block morphology, were notched in inferior leads with negative QRS complexes in aVL suggestive of likely origin from the lateral mitral annulus. Patients with PVCs from mitral annulus are usually advised to undergo cardiac magnetic resonance imaging to localize the site of subtle mitral annular calcification and plan subsequent delivery of radiofrequency lesions at the same site during radiofrequency ablation. Dense calcification of the lateral mitral annulus is extremely rare to encounter in such a young age of below 30 years without the presence of any predisposing risk factors for calcification. Our case is the first illustration of dense mitral annular calcification secondary to the plethora of mitral annular PVCs in a symptomatic young person below the age of 30 years. PVCs-induced excessive local excursion with wear and tear phenomenon and secondary dystrophic calcification may be the plausible explanation behind this interesting presentation.
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LETTER TO THE EDITOR Top

Nurses in cardiac catheterization laboratory: An important pillar of “heart team” p. 96
Surender Deora, Nipin Kalal, Kuldeep Singh
DOI:10.4103/hm.hm_75_21  
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