The Indian Practitioner

Sunil Thanvi ¹

Affiliations
1 Ahmedabad, Gujarat, IN

Abstract

Hypertensive Urgencies and Emergencies occur with severe elevations in BP. The presence of Target organ damage as a consequence of this raised BP differentiates Emergency from Urgency. While Hypertensive emergencies require admission and in some instances rapid control of BP, to prevent acute complications, Hypertensive urgencies can be managed on outpatient basis with slow reduction in BP. Clinical experience indicates that excessive reduction of BP may cause or contribute to renal, cerebral, or coronary ischemia and should be avoided. As autoregulation of tissue perfusion is disturbed in hypertensive emergencies, continuous infusion of short-acting titratable antihypertensive agents is preferred . Patients without chronic HT generally develop hypertensive crises at a lower BP than those with chronic HT. Situations like stroke and Eclampsia need specific considerations.

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Sunil Thanvi ¹

Affiliations
1 Gujarat, IN

Abstract

Acute Coronary Syndrome accounts for a majority of morbidity and mortality related to Coronary Artery Disease (CAD). As compared to west, more number of ACS patients in India present with STEMI than NSTEMI with a high rate of mortality. The hallmark of ACS is a sudden imbalance between the amount of myocardial oxygen consumption and the oxygen demand. ACS is commonly associated with three clinical manifestations: ST elevation myocardial infarction, Non ST elevation myocardial infarction or Unstable angina. The 12-lead ECG is at the heart of the decision pathway in the management of ischemic chest pain and is the only means of identifying STEMI. In NSTEMI, determination of the preferred management strategy depends on the patient's clinical characteristics and clinical risk. STEMI patients require immediate reperfusion either by Fibrinolysis, Primary PCI or a combination of the two (Pharmaco-invasive approach). Primary PCI is the therapy of choice in STEMI if delivered in less than 120 mins. Fibrinolysis remains a valuable alternative in some clinical situations. Given the dearth of Interventional Cardiologists, PCI capable hospitals and various patient logistic issues, Pharmaco-invasive approach looks the most appropriate option for Indian scenario.

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Sunil Thanvi ¹

Affiliations
1 Department of Cardiology, Zydus Hospitals & Healthcare Research Pvt Ltd, Ahmedabad, Gujarat, IN

Abstract

Atrial Fibrillation (AF) is a common cardiac rhythm disturbance that increases in prevalence with advancing age. The mechanisms causing and sustaining AF are multifactorial. AF can be complex and difficult for clinicians to manage. Symptoms of AF range from non-existent to severe. Frequent hospitalizations, hemodynamic abnormalities, and thromboembolic events related to AF result in significant morbidity and mortality. AF is associated with a 5-fold increased risk of stroke and/or peripheral thromboembolism owing to the formation of atrial thrombi, usually in the left atrial appendage (LAA). The appearance of AF is often associated with exacerbation of underlying heart disease. The past decade has seen substantial progress in the understanding of mechanisms of AF, clinical implementation of ablation for maintaining sinus rhythm, LAA occlusion and new drugs for stroke prevention.

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