Sri Lankan Journal of Cardiology – Volume 1 Issue 1, June 2018

Abstract

Resistant hypertension could be defined as blood pressure that remains elevated despite being treated with 3 anti-hypertensives of which one is a diuretic at maximum tolerable dose. It is an important global health issue associated with morbi dity and mortality. It is a relatively common clinical problem. It is commonly associated with old age, obesity, sleep apnoea, and ch ronic kidney disease.A number of pathophysiological mechanisms are involved in resistant hypertension. Imbalance in sympathetic nervous system and renin-angiotensin system, excess sodium intake, disturbances between vasoconstrictors and vasodilators and wall resistance are other mechanisms involved in the pathogenesis. In the management life style modification such as weight loss, exercise and salt restriction has to be strictly enforced. If underlying cause is found it has to be treated. The initial preferred multidrug regime includes a diuretic,angiotensin – converting enzyme inhibitor or angiotensin II receptor blockers and long-acting calcium channel blockers. If this initialoptimization of drugs is not effective a mineralocorticoid receptor antagonists can be added.Despite the use of several antihypertensive a substantial proportion of patients with resistant hypertension remain uncontrolled. This has necessitated the testing of devices in the treatment of resistant hypertension.  Two new approaches, carotid Baroreflex Activation Therapy and renal sympathetic denervation have shown some promise in the preliminary studies.

Original Articles

  • Anomalous Origin Of Coronary Vessels With Normal Angiographic Appearance- Is It Always Benign ?

    Anomalous Origin Of Coronary Vessels With Normal Angiographic Appearance.Is It Always Benign ?

     

                                             Abstract

    The embryological origin and aberrations in the development of coronary vessels can result in interesting variations which are known as coronary artery anomalies (CAA). The incidence of these anomalies though thought to be low (0.3% to 5.6%,), can have clinically significant implications when present. The scope of understanding the complexity of CAA far exceeds this brief presentation and is better understood by the comprehensive review given by Villa et al.[1]. 2014 ACC/AHA Guideline on NSTEMI /UA

    Author :- Navinan M. R

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  • Sri Lankan Journal of Cardiology

    Sri Lankan Journal of Cardiology

     

     

    Sri Lankan Journal of Cardiology Download | PDF (EN) (496 KB)

  • Liitor atorvastatin calcium tablets

    Liitor atorvastatin calcium tablets

     

                                             Abstract


    The healthy heart. At the end, we are what we eat. An ever changing and rapidly evolving society has made us abandon the healthy dietary practices which was once both tradition and the norm…

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  • SLJC Editorial Board

    SLJC Editorial Board

     

                                             Abstract


    The scope of this journal will be broadly based in order to realize three objectives…

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  • Message from the Team

    Message from the Team

     

     

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  • Diagnosis, evaluation and treatment of resistant hypertension

    Diagnosis, evaluation and treatment of resistant hypertension

     

                                             Abstract


    Resistant hypertension (RHYT) is an important global health problem. It is associated with severe target organ damage. Patients with RHYT usually have a combination of other co-morbid conditions such as obesity, diabetes and chronic kidney disease that further elevate the risks of morbidity and mortality…

    Author :- Constantine G.R.

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  • Outline of Cardiovascular effects of antidiabetic agents from clinical trials and comparative study data

    Outline of Cardiovascular effects of antidiabetic agents from clinical trials and comparative study data

     

                                             Abstract


    One of the major objectives of treating diabetes mellitus would be to prevent life threatening or disabling coronary, cerebral or peripheral vascular disease. Unfortunately the currently available antidiabetic drugs, in the large measure, have sparse evidence of benefit in this regard…

    Author :- Ruvan A.I. Ekanayaka

    Download | PDF (EN) (388 KB)

  • Diagnostic performance of four different screening tools in detecting pre-diabetes and diabetes

    Diagnostic performance of four different screening tools in detecting pre-diabetes and diabetes

     

                                             Abstract


    The pandemic of diabetes is rapidly spreading in South Asia including Sri Lanka [1]. Due to the asymptomatic nature in the early phase of the disease, a substantial majority of individuals affected with type 2 diabetes (T2DM) remain undiagnosed until they develop debilitating and fatal complications such as blindness, end stage renal disease or premature cardiovascular disease…

    Author :- Weerarathna T.P.

    Download | PDF (EN) (436 KB)

  • Prevalence of resistance to aspirin and clopidogrel in patients

    Prevalence of resistance to aspirin and clopidogrel in patients

     

                                             Abstract


    Atherothrombotic cardiovascular disease is an important category of non-communicable disease which causes significant morbidity and mortality in all societies in the modern world. Antiplatelet therapy, of which aspirin is most widely used, is an essential component of pharmacologic therapy given to patients with atherothrombotic disease. In recent times it has been the practice of many clinicians to use a combination of antiplatelet agents which have different modes of action…

    Author :- Ruvan A.I. Ekanayaka

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  • Correlation of fish consumption and the Omega-3 index in healthy free living Sri Lankan subjects

    Correlation of fish consumption and the Omega-3 index in healthy free living Sri Lankan subjects

     

                                             Abstract


    Atherothrombotic cardiovascular disease is an important category of non-communicable disease which causes significant morbidity and mortality in all societies in the modern world. Antiplatelet therapy, of which aspirin is most widely used, is an essential component of pharmacologic therapy given to patients with atherothrombotic disease. In recent times it has been the practice of many clinicians to use a combination of antiplatelet agents which have different modes of action…

    Author :- Ruvan A.I. Ekanayaka

    Download | PDF (EN) (624 KB)

  • Changing landscape of STEMI care in Sri Lanka

    Changing landscape of STEMI care in Sri Lanka

     

                                             Abstract


    Timely reperfusion therapy is the cornerstone in the management of ST segment elevation myocardial infarction (STEMI). Both European and American guidelines recommend primary percutaneous coronary intervention (PCI) as the preferred method of treatment for STEMI when the anticipated PCI related time delay is less than 120 minutes from the time of STEMI diagnosis…

    Download | PDF (EN) (476 KB)

  • Registry data A preliminary report on Head up Tilt testing

    Registry data A preliminary report on Head up Tilt testing

     

                                             Abstract


    Transient loss of consciousness (TLOC)[1] is a common indication for being referred to Cardiology team. Proper assessment of such a patient encompasses most importantly a detailed history[2] followed by focused examination and relevant investigations to delineate the cause…

    Author :- De Vas Goonewardane A.P.N.

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  • Cardiac rehabilitation in Sri Lanka

    Cardiac rehabilitation in Sri Lanka

     

                                             Abstract


    Sri Lanka is proud to say it has been providing free health care, within a heritage of a national health care system of 150 years. Having a sprawling complex of buildings dedicated to healthcare, cardiology has its own dedicated unit, “The Institute of Cardiology” along with its cardiothoracic wards and theatres. Since becoming functional the objective has been to provide holistic and up-to-date cardiac care…

    Author :- Mendis S.A.E.S.

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  • Rapid scan of scientific papers

    Rapid scan of scientific papers

     

                                             Abstract


    Kwong et al [1]reported in the NEJM Jan 2018 that there was a significant association between respiratory infection and subsequent acute myocardial infarction. This was especially true for influenza. The risk seemed to be restricted to within 7 days of a positive laboratory result for influenza. There was no increased incidence after seventh day…

    Author :- Editorial desk

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  • Practice Points from Late Breaking Clinical trials

    Practice Points from Late Breaking Clinical trials

     

                                             Abstract


    This trial attempts to answer the doubts regarding the safety and efficacy of converting to ticagrelor in patients already on clopidogrel after thrombolysis…

    Author :- Editorial desk

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  • Ten key messages from the 2018 ESC

    Ten key messages from the 2018 ESC

     

                                             Abstract


    The following are key points to remember from the 2018 European Society of Cardiology (ESC) Guidelines for the Diagnosis and Management of Syncope…

    Author :- Editorial desk

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  • Updates from Translational Science

    Updates from Translational Science

     

                                             Abstract


    Histones are proteins which are present in the cell nucleus, helping to package nuclear DNA into nucleosomes. Tails of histones protrude out of the nucleosome core and are susceptible to acetylation and deacetylation. These processes are thought to be important in gene regulation…

    Author :- Editorial desk

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  • NOACs

    NOACs

     

                                             Abstract


    What does NOAC stand for? Non Vitamin K antagonist Oral Anti Coagulants…

    Author :- Editorial desk

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  • Scimitar syndrome: A rare cause of right sided palpitations in an adult

    Scimitar syndrome: A rare cause of right sided palpitations in an adult

     

                                             Abstract


    Scimitar syndrome is a rare, congenital, cardio-pulmonary defect presenting as an anomalous right pulmonary vein draining directly into the IVC, in association with a hypoplastic right lung, a hypoplastic right pulmonary artery, with a resultant shift of the mediastinum into the right hemi thorax, with or without an anomalous systemic arterial supply to the right lung…

    Author :- Perera I.A.

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  • Device closure of left atrial appendage as a modality for stroke prevention in a patient with atrial fibrillation- the first in Sri Lanka

    Device closure of left atrial appendage as a modality for stroke prevention in a patient with atrial fibrillation- the first in Sri Lanka

     

                                             Abstract


    Atrial fibrillation (AF) is the most common significant cardiac arrhythmia, affecting more than 33 million individuals worldwide [1] with a high prevalence in western populations. It’s prevalence in Asian populations is low (< 1%), although it increases with age [2]. The number of patients with AF is expected to rise 2-5-fold in following decades [3] due to the growing population of older adults…

    Author :- Mendis S.A.E.

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  • Management of a difficult case scenario with left anterior descending artery (LDA) chronic total occlusion (CTO) in the setting of limited resources

    Management of a difficult case scenario with left anterior descending artery (LDA) chronic total occlusion (CTO) in the setting of limited resources

     

                                             Abstract


    A Chronic Total Occlusion (CTO) is defined as a 100% occlusion in a coronary artery with Thrombolysis in Myocardial Infarction (TIMI) 0 flow i.e (no antegrade flow beyond the occlusion) of at least three months duration [1]. Incidence of coronary CTOs are reported to be as high as 20% in usual practice…

    Author :- Amarasekera H.S.U.

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  • Anomalous left main coronary artery (LMCA) arising from right coronary cusp: A case report

    Anomalous left main coronary artery (LMCA) arising from right coronary cusp: A case report

     

                                             Abstract


    Coronary artery anomalies represent a potentially fatal form of congenital cardiac pathology. Although rare in incidence, they constitute a diverse group of anatomic variants with variable presentations and clinical impact. Anomalous origination of a coronary artery from the opposite coronary sinus is a subgroup with high risk for sudden cardiac death…

    Author :- Ranasinghe R.B.D.

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  • Large coronary arteriovenous fistula presenting with infective endocarditis and regurgitation of the aortic valve – an atypical presentation of a rare condition

    Large coronary arteriovenous fistula presenting with infective endocarditis and regurgitation of the aortic valve – an atypical presentation of a rare condition

     

                                             Abstract


    Coronary arteriovenous fistula is a rare anomaly, which by definition involves a sizable communication between a coronary artery and one of the four cardiac chambers or a segment of either the pulmonary or systemic vasculature, bypassing the myocardial capillary bed [1,2]. This usually occurs in isolation and is found in approximately 0.002% of the general population…

    Author :- Bandarage P.

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  • Transcatheter closure of symptomatic aortopulmonary window using an Amplatzer type atrial septal occluder

    Transcatheter closure of symptomatic aortopulmonary window using an Amplatzer type atrial septal occluder

     

                                             Abstract


    Aortopulmonary window (APW) is a communication between ascending aorta and the pulmonary trunk, occurring above the semilunar valves. Isolated APWs account for 0.2% of cases of congenital heart diseases[1] and is associated with other cardiac anomalies in 52% of cases…

    Author :- Sooriyasena J.A.G.P.

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  • Intra ventricular septal haematoma and acquired ventricular septal defect following blunt chest trauma

    Intra ventricular septal haematoma and acquired ventricular septal defect following blunt chest trauma

     

                                             Abstract


    Violent blunt chest trauma is reported to cause a wide range of cardiovascular injuries depending on its mechanism [1]. Septal haematoma and acquired ventricular septal defect (VSD) are rarely reported as complications following blunt chest trauma in survivors following such injuries[2]. It is natural to pay less attention and to concentrate on other more apparent injuries in such a patient [3]. However, early detection and timely planned appropriate intervention are extremely important for the survival of these patients with significant cardiac trauma…

    Author :- Bandara H.G.W.A.P.L.

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  • A case of delayed presentation of post-traumatic mitral regurgitation and VSD following penetrative cardiac injury

    A case of delayed presentation of post-traumatic mitral regurgitation and VSD following penetrative cardiac injury

     

                                             Abstract


    Penetrating cardiac traumata are life threatening injuries in which only a minority of patients will survive to reach the hospital. In the emergency situation the challenge to the surgeon is basically to keep the patient alive following a ‘damage control’ strategy. There can be residual intracardiac injuries, easily overlooked by the operator as these might not be endangering life in the emergency situation…

    Author :- Bandarage P.

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  • Where is the culprit A case of infero-posterior STEMI due to occlusion of a dominant circumflex artery of anomalous origin

    Where is the culprit A case of infero-posterior STEMI due to occlusion of a dominant circumflex artery of anomalous origin

     

                                             Abstract


    Anomalous origin of the circumflex artery from the right sinus of Valsalva or right coronary artery is one of the commonest coronary artery anomalies. It may be missed on the coronary angiogram unless carefully looked for, bearing in mind the clinical profile of the patient. In performing coronary angioplasty in such a vessel, numerous technical obstacles may need to be overcome to achieve a successful result…

    Author :- Colombage D.D.E.

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  • Management of a case of dynamic (intermittent) severe ischaemic mitral regurgitation

    Management of a case of dynamic (intermittent) severe ischaemic mitral regurgitation

     

                                             Abstract


    Mitral regurgitation (MR) can be classified as primary and secondary. Primary MR is usually due to an organic disease of the mitral valve (MV) itself especially involving the mitral valve leaflets. Secondary MR is usually due to dilatation of the mitral annular ring following LV remodeling in cases of cardiomyopathy or myocardial ischaemia affecting the functionality of the MV. The mechanism of ischaemic MR(IMR) is a complex phenomenon…

    Author :- Amarasekera H.S.U.

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  • A challenging case of heavily calcified unprotected left main coronary artery (LMCA) distal critical stenosis treated with rotational atherectomy and drug eluting stent (DES) placement

    A challenging case of heavily calcified unprotected left main coronary artery (LMCA) distal critical stenosis treated with rotational atherectomy and drug eluting stent (DES) placement

     

                                             Abstract


    LMCA disease accounts for 5-10% of angiographic results and unprotected LMCA disease treated medically has a 3 year mortality rate of 50%. Coronary artery bypass grafting (CABG) is considered the gold standard therapy for LMCA disease. The development of coronary stents, particularly drug eluting stents, with their dramatic patency improvement powered by antiplatelet regimens warrants reconsideration of Percutaneous coronary intervention (PCI) as a successful treatment option for LMCA disease…

    Author :- Amarasekera H.S.U.

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  • A Project by the Community to Save the Children of Sri Lanka

    A Project by the Community to Save the Children of Sri Lanka

     

                                             Abstract


    Paediatric cardiac services have rapidly advanced in Sri Lanka over a period of a few years. At the beginning of this millennium, facilities for treatment of children with Congenital Heart Disease (CHD) were limited and most of the patients succumbed to their illness or became inoperable due to development of pulmonary hypertension. A dedicated paediatric cardiac clinic was established in 1998 with the appointment of Dr. S. Narenthiran as the Cardiologist at Lady Ridgeway Hospital (LRH) which is the tertiary care referral centre for children…

    Author :- Samarasinghe D.

    Download 1 | PDF (EN) (344 KB)     Download 2 | PDF (EN) (340 KB)

  • A Stroke of bad luck – Atrial Myxoma

    A Stroke of bad luck – Atrial Myxoma

     

                                             Abstract


    A 57 year old Sri Lankan female, presented to a medical ward for further management following left sided weakness of both the upper and lower limbs with headache, suggestive of a stroke. She otherwise had a preserved sensorium. She was a diagnosed type II diabetic for two years and hypertensive patient for 10 years on treatment and regular follow up…

    Author :- Rathnayake W.

    Download | PDF (EN) (392 KB)

  • Anomalous origin of coronary vessels with normal angiographic appearance – Is it always benign?

    Anomalous origin of coronary vessels with normal angiographic appearance – Is it always benign?

     

                                             Abstract


    The embryological origin and aberrations in the development of coronary vessels can result in interesting variations which are known as coronary artery anomalies (CAA). The incidence of these anomalies though thought to be low (0.3% to 5.6%,), can have clinically significant implications when present…

    Author :- Navinan M.R.

    Download | PDF (EN) (340 KB)

  • Study findings suggest fewer heart attack patients die when top cardiologists are away at conferences

    Study findings suggest fewer heart attack patients die when top cardiologists are away at conferences

     

                                             Abstract


    Heart attack patients are more likely to survive when top cardiologists are not in the hospital, a new study suggests…

    Author :-  

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  • Submitting a manuscript to the journal

    Submitting a manuscript to the journal

     

                                             Abstract


    Congratulations!, You have reached the most important page of the journal. This section will provide all the necessary instructions to ensure your submission to the SLJC conforms to the standards and format applicable to the journal…

    Author :- Editorial Desk

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