This report describes a 61-year-old female with no previous cardiovascular history presented with acute heart failure. Clinical, laboratory, and imaging findings suggested the diagnosis of pneumococcal invasive disease with concomitant purulent pericarditis. Prompt pharmacological and operatory treatment with both pericardiocentesis and further fenestration brought to a complete recovery.

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Objective: Being able to adapt to a changing environment has been associated with better mental and physical health. This adaptivity can be measured by behavioral flexibility assessment tools. However, the mental health consequences of behavioral flexibility have not been examined in patients with cardiovascular disease (CVD). The current study aims to examine if behavioral flexibility is associated with depression and anxiety in patients with CVD. Methods: A total of n = 387 patients with stable CVD were recruited as a part of the Do CHANGE study. At baseline, 3, and 6 months, data were collected. Depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder Scale-7) were assessed at all time points. Results: The mean age of the sample was 61.9 ± 10.23 years, with 274 (71%) being male. An inverse association between behavioral flexibility and depression at baseline, 3, and 6 months was observed. The associations remained significant after adjusting for relevant demographic and medical variables and baseline depression. No longitudinal association between behavioral flexibility and anxiety was found in the multivariate models. Conclusions: Behavioral flexibility is associated with depression in cardiac patients. Future studies should focus on examining the pathways of this association and offering patients with low flexibility levels additional care if needed.

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Background: Due to advances in medical care and treatment of congenital heart disease (CHD), the number of adults with CHD (ACHD) is constantly growing. The psychological situation of ACHD has recently received increasing attention. There is evidence that adaptation to CHD may be affected by psychological factors, especially in how patients integrate their illness into their identities. The present study examined illness identity as a mediator of the association between a self-rated health and emotional distress among ACHD. Materials and Methods: The study used a cross-sectional design. A sample of 229 ACHD (38 ± 12.5 [18–73] years; 45% female) provided background data and completed three questionnaires on self-rated health (EuroQol group's visual analog scale), illness identity (Illness Identity Questionnaire), and emotional distress (Hospital Anxiety and Depression Scale) at the German Heart Center Munich. Serial multiple mediator models were tested using PROCESS macro for SPSS. Results: Perceived health had a direct and indirect effect on emotional distress which was mediated by illness identity (P < 0.05). Compared to all other dimensions of illness identity, engulfment fully mediated the relationship between self-rated health and emotional distress, when adjusted for sociodemographic and clinical confounders. The model explained 42% of variance in total emotional distress (R² = 0.416). The extent of emotional distress did not differ as a function of CHD complexity. Conclusions: Illness identity emerged as a strong mediating factor between a patient's self-rated health and psychological outcomes. More importance needs to be directed toward assessing a patient's health perception and psychological state, independently of cardiac severity. Based on present findings, targeted psychocardiological interventions should include psychoeducational components and emotion-focused strategies.

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India has a high burden of cardiovascular disease, morbidity and mortality due to CVD has been causing a high economic burden and leading to an overall increase in health care cost. Research evidence from different parts of the world indicates that structured approach to secondary prevention such as cardiac rehabilitation (CR) have health-favoring impact. When CR is supplemented with pharmacological interventions and percutaneous coronary intervention (PCI) has shown a significant improvement in quality of life, reduces morbidity, and mortality rate, cardiac-related parameters, depression and minimizes readmission rates among cardiac patients. Primarily, CR is delivered in three phases: Phase – I begin in the hospital, Phase – II outpatient phase, and Phase – III maintenance phase. Various organizations around the world deliver structured home-based and center-based CR program to cardiac patients also provides training and certification courses in CR to healthcare professionals (HCPs). However, in India, no such organization exists; therefore, CR delivery is under prevalent; further, other factors such as lack of skilled task force, adequate infrastructure, education, and training also contribute for suboptimal use of CR in the country. Awareness among HCPs and patients is also considered one of the primary factors to minimize the uptake of CR program in India. Therefore, there is a great need to revisit the CR delivery protocol and develop an evidence-based uniform approach to increase the uptake of the CR program. Government health care agencies should also frame guidelines to facilitating better infrastructure and training to resulting in increased uptake of CR program among cardiac patients. This review article has compiled various international studies to justify the benefits of CR program development necessity and status in India.

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Background: Hypnotic communication is a validated technique for reducing procedural anxiety and pain. The aim of our work was to evaluate the additional utility of hypnotic communication during catheter ablation procedures in the COVID-19 period. Materials and Methods: Sixteen consecutive patients undergoing electrophysiological study and catheter ablation underwent: 8 to standard sedation procedure (Group B) and 8 to this with the addition of hypnotic communication (Group A). In these two groups, we measured and compared preprocedure and intraprocedure anxiety, compliance to the procedure, perceived pain, use of drugs, the procedural time perceived by the patient compared to real time in minutes, and radiological exposure, using validated scales. Results: Hypnotic communication resulted in a significant reduction in anxiety during the procedure (Group A: 1.1 ± 0.6 vs. Group B: 3.4 ± 2; P = 0.003); better procedural compliance (Group A: 4.8 ± 0.5 vs. Group B: 3.7 ± 0.8; P = 0.002) and showed a trend toward a reduction in procedural pain (Group A: 2.4 ± 2 vs. Group B: 4.3 ± 1.8; P = 0.08) compared to standard sedation. Midazolam was not used in Group A, while an average of 3 ± 1.3 mg was used in Group B. The use of local anesthetic and Fentanest was comparable. The real procedural durations (Group A: 167.5 ± 30.1 vs. Group B: 150 ± 27.8 min; P = not significant) and perceived (Group A: 78.8 ± 15.5 vs. Group B: 86.3 ± 29.9 min; P = not significant) and the difference between these was also comparable. The radiological exposure was 74.4 ± 65.5 s in Group A and 118 ± 119 s in Group B (P = not significant). There were no complications in the two groups. Conclusions: Hypnotic communication as an additional strategy during electrophysiological interventional procedures has made possible to eliminate the use of midazolam and reduce anxiety during the procedure, but above all, it has improved the patient's compliance with the procedure compared to traditional sedation approach.

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Preexcitation symptom presents morbidity of 0.1% to 0.3% in the general population, which could lead to deadly events while accompanying arrhythmia. The classical type is Wolff-Parkinson-White (WPW) syndrome characterized as a shorter PR period, longer QRS duration, and δ wave. Radiofrequency catheter ablation (RCA) takes a vital role in treating WPW and has a high success rate. While some patients complain of consecutive chest pain after RCA, which influence their daily life severely. A 45-year-old man went to a hospital for examination because of uncomfortable palpitation. The electrocardiogram (ECG) presenting WPW syndrome (left free wall accessory pathway), then he was admitted to the hospital and scheduled for RCA. The RCA was very successful and the ECG became normal. However, after ablation, he reported consecutive chest pain, accompanied by insomnia and hypertension. No abnormal elevations of cardiac-Troponin I, myoglobin, cytokeratin, creatine kinase MB were found, and the left ventricular ejection fraction was 60%. His mental status was measured by Patient-Health Questionnaire-9, 7-item Generalized Anxiety Disorder Scale-7, Athens Insomnia Scale, indicating depressive status and anxiety status. The predominant managements involved flupentixol-melitracen and duloxetine. His chest pain, depressive, and anxiety symptoms were gradually relieved after 3-month treatment, and the drugs were slowly tapered in the 1½ years' follow-up period. Ultimately, he recovered and worked as before. This case highlights the importance of evaluating psychological status in patients with unexplained chest pain resulting from RCA and adopting antidepressants in those patients that coexist with definite depression or anxiety.

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A 65-year-old female presented with 2 weeks of dyspnoea, associated with orthopnoea and lower limb pitting edema. There were no prior major physical or emotional stressors. Initial investigations showed elevated N-terminal pro-B-type natriuretic peptide (NT-ProBNP), Troponin-I and dynamic ST-T changes on electrocardiogram. Coronary angiography was normal and echocardiography demonstrated apical akinesis and ballooning with normokinesis of the base of the left ventricle. A diagnosis of Takotsubo cardiomyopathy (TC) was made. The patient was initially treated for heart failure as well but a thoracentesis of pleural fluid demonstrated adenocarcinoma. Computed tomography revealed newly diagnosed metastatic ovarian adenocarcinoma. To our knowledge, TC as a presentation of undiagnosed metastatic ovarian cancer has not been reported before and we believe that this case adds to the growing literature of the link between TC and cancer.

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