Emedinews: Dr Good Dr Bad: A patient with visceral obesity had episodes of night chest burning.

Situation: A patient with visceral obesity had episodes of night chest burning.
Dr Bad: its acidity
Dr Good: Rule out CAD.
Lesson: Nighttime acute coronary syndrome occurs more often in patients with visceral fat accumulation and sleep-disordered breathing
(Nakagawa Y, Kishida K, Mazaki T, et al. Impact of sleep-disordered breathing, visceral fat accumulation and adiponectin levels in patients with night-time onset of acute coronary syndrome. Am J Cardiol 2011; Aug 12. [Epub ahead of print)

#AskDrKK: A patient of CAD with bronchial asthma, how do you treat CAD without aspirin?

#DrKKAnswers: Being bronchial asthma we cannot give beta blockers. Aspirin also needs to be avoided in asthma. But we can give Clopidogrel, diltiazem, amlodipine and nitrates. 

Emedinews Makesure: a patient with suspected heart attack

Situation: A patient with suspected heart attack with blood pressure of 40 mm Hg with warm peripheries died?

Reaction: Oh my God! Why was a diagnosis of anaphylaxis not considered?.

Lesson: Make sure all patients with warm shock are managed on the lines of sepsis or anaphylaxis. Heart attack will present as cold shock.

Dr KK Answers : Can we allow low dose aspirin holidays?

Those at risk of heart attack or other cardiovascular events taking a low dose aspirin holiday can increase their risk of acute heart attack as per a large case-controlled study of 39513 patients aged 50-84 by Dr Luis Garcia Rodriguez, of the Spanish Centre for Pharmacoepidemiologic Research in Madrid and published in British Medical journal.

Compared with those taking aspirin, individuals prescribed aspirin for secondary prevention who had recently discontinued the drug had a significantly increased risk of nonfatal heart attacks or death from coronary heart disease combined and nonfatal heart attacks

Aspirin holiday can cause four more cases of nonfatal heart attacks for every 1,000 patients over a period of one year.

The current American Heart Association/American College of Cardiology practice guidelines recommend 75 mg to 162 mg of aspirin as low dose aspirin per day.

Dr KK Answers: Which is better coronary artery bypass surgery or angioplasty for angina relief?

A prospective quality of life sub study of the SYNTAX trial of patients with three vessel or left main coronary artery blockage compared the relief of angina after the bypass or angioplasty. At 12 months, both interventions were associated with substantial relief of angina, although there was a statistically significant lower angina frequency with bypass surgery. 

Source: N Engl J Med 2011; 364:1016.

Dr KK Answers: Should I opt for surgery of angioplasty in left main lesion?

In patients with left main coronary artery disease bypass surgery is the golf standard. Angioplasty is increasingly being used as an alternative. The PRECOMBAT trial, randomly assigned 600 such patients to either drug-eluting stents or bypass surgery. At one year, the rate of major adverse cardiac or cerebrovascular events (death from any cause, heart attack, paralysis, or ischemia-driven target vessel revascularization) was similar in both groups. 

Source: N Engl J Med 2011; 364:1718.

Being an India a risk factor for diabetes

Regardless of where you live, in India or in the United States, you have the highest chances of getting diabetes, if you were born an Indian, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India.

The same is also true for heart disease. The CADI study has already shown earlier that Indians settled in US are 17 times more likely to get a heart attack than the US natives.

And now a new study published in the June 29 in the journal Diabetes Care has shown that people who immigrated to the United States from India have the highest rate of type 2 diabetes. The study by Leena Gupta and colleagues analyzed data provided by the city's Department of Health and Mental Hygiene of 54,000 people and concluded that 13.6 percent of South Asians born outside of the US had diabetes. In the study, South Asians who were born abroad and had normal body mass index (18.5 to 25) had a rate of diabetes 2.5 times as high as other foreign-born Asians and a five times increased rate than that among US-born non-Hispanic whites.

When the authors adopted WHO BMI categories tailored for specific regions and races to define who was overweight and obese, foreign-born South Asians had a higher rate of diabetes at lower BMI levels than all other racial and ethnic groups.

The study also showed that people from India, Pakistan, Bangladesh, Sri Lanka, Nepal and Bhutan have the highest rate of diabetes of any ethnic group in New York. It is nearly double that of other foreign-born Asians. Hence, it is important for South Asians to be screened for diabetes, regardless of their body weight.

Diabetes has been increasing in India over the last few decades because of consumption of more calories, not exercising regularly and a shift of diet from high complex carbohydrates to high refined carbohydrates.