Index

Key LecturesDoctor Name
When Friends and Family Ambush-Ask you for Free Medical AdviceDR. KEYUR PARIKH
Fever of Unknown Origin Still a Puzzle for us!DR. SURABHI MADAN
Whom & When to Always Order Genetic Consult & Testing in Clinical Practice: Need of
the Hour
DR. KRATI SHAH
Hypertension in Pregnancy: How to Manage?DR. ANISH CHANDARANA
Proton Pump Inhibitors in our Daily Life : Too Many ? Too Few ? Never ?DR. BHAVESH THAKKAR
Interpretation of Thyroid Function Tests: Case Based ApproachDR. VIVEK PATEL
Autoimmune and Rheumatic Diseases: Myths and FactsDR. PUJA SRIVASTAVA
Red Eye How to Deal with ThemDR. SMITA DHEER
Case Based Discussion on Physicians Role in High Risk PregnancyDR. DEVANG PATEL
A Case of Pulmonary Embolism : Interactive SessionDR. ANISH CHANDARANA
An Approach to Refractory Gastroesophageal Reflux DiseaseDR. ABHINAV JAIN
Acid Based Disorder – Step by Step ApproachDR. MANTHAN KANSARA
Differential diagnosis of skin rashes with or without itchingDR. SNEHA GOHIL
A case of Transient LOCDR. AJAY NAIK
How to Manage Systolic Hypertension in 2018DR. VIPUL KAPOOR
Immunotherapy: Role of Physicians in Immunotherapy: What, Who, Where and WhenDR. REENA SHARMA
Empirical Antimicrobials in Infectious DiseasesDR. SURABHI MADAN
Salt and ObesityDR. DHIREN JOSHI
A Case of Massive Iliofemoral DVT Management StrategyDR. SATYA GUPTA
A Case of Cryptogenic StrokeDR. TEJAS V. PATEL
SGLT2i and Diabetic KetoacidosisDR. VIVEK PATEL
Renal Denervation Rises from the AshesDR. KEYUR PARIKH
Efficacy and Safety of Tolvaptan in Hospitalized Patients with Acute Heart FailureDR. ANISH CHANDARANA
Anti-inflammatory Agent Canakinumab Modestly Reduces Major CVD EventsDR. VIPUL KAPOOR
Therapeutic FibrinolysisDR. TEJAS V. PATEL
Triple Challenge of Triple TherapyDR. VINEET SANKHLA
Evaluating Bleeding Risk with NOACs and Its ManagementDR. AJAY NAIK
Improving ACS Outcomes: Acute Treatment and Chronic ManagementDR. KEYUR PARIKH
Clinical Trials of 2017 Which Changed My Clinical Practice:DR. MILAN CHAG
Case of Intermediate Lesions in CAD: What to do?DR. VIPUL KAPOOR
Tachyarrhythmias in AMIDR. AJAY NAIK
Novel Oral Anticoagulants in CADDR. VINEET SANKHLA
Case of Acute MI: What went wrong?DR. SATYA GUPTA
Sleep disordered Breathing and Heart Failure : What does the future hold?DR. BHAVIN DALAL
LAA Closure: Here to Stay Why, When – Who?DR. AJAY NAIK
Management of Pulmonary EmbolismDR. BHAVIN DALAL
No Mortality Benefit to Supplemental Oxygen in Acute MI – Bye Bye to Oxygen!DR. BHAVIN DALAL
Worsening Renal Function in Heart FailureDR. MANTHAN KANSARA
A Case of HT with DM and CHD : How will I Optimize Therapy?DR. VIPUL KAPOOR
Diagnosis & Management of Resistant HypertensionDR. SATYA GUPTA
A Case of Middle Aged Hypertensive: How to Apply 2017 New AHA GuidelinesDR. ANISH CHANDARANA
A Case of Statin IntoleranceDR. ANISH CHANDARANA
A Case of HypertriglyceridemiaDR. TEJAS V. PATEL
CV Risk profiles of IndiansDR. VIPUL KAPOOR
Lessons Learnt: Recent CVOTs of newer Drugs for DMDR. MILAN CHAG
STEMI: Dual Antiplatelet Treatment: Which Combination and When?DR. ANISH CHANDARANA
A case of Syncope…DR. AJAY NAIK
A case of Ventricular Arrhythmia in AMIDR. AJAY NAIK
Clinical Trials of 2017 Which Changed My Clinical Practice: Take Home Messages (Part-II)DR. MILAN CHAG
My Approach: A Patient with Hypertension: How to Treat Using New AHA 2017 18
Guidelines
DR. ANISH CHANDARANA
Left Ventricular Pseudoaneurysm after Myocardial InfarctionDR. DEEPA SHAH /
DR. TEJAS V. PATEL
My Approach 80 Yr. old Patient with Class III Angina Refuses to Undergo PCI CABGDR. HEMANG BAXI
My Approach: A Patient with Acute Pulmonary EmbolismDR. URMIL SHAH
A Case of Cryptogenic StrokeDR. TEJAS V. PATEL
Case Presentation Preop Consultation in DiabetesDR. MANOJ VITHALANI

Take Home Message

When Friends and Family Ambush-Ask you for Free Medical Advice
– DR. KEYUR PARIKH
• The ethical issues that are involved in treating friends and family are numerous and   become increasingly problematic as the closeness of the relationship increases.

 

• Physicians who are also a family member of the patient face numerous conflicts of      interest between their dual roles.
• Although physicians may see themselves as the best advocate for their family, it is        easy to lose perspective when one has emotional investment, and informal care may    even pose a risk or be detrimental to the patient.
 

Take Home Message

FEVER Of Unknown origin – Still a puzzle for us!
– DR. SURABHI MADAN
• Active search for Diagnosis with the Right Diagnostic Tests

 

• Avoid empirical Rx – Ab/ AKT/ Steroids
• Avoid misleading tests – TB serology, TB PCR, S Widal, TB Gold, Throat Swab Culture    etc
 

Take Home Message

Whom & When to Always Order Genetic Consult & Testing in Clinical Practice: Need of the Hour
– DR. KRATI SHAH
• When Multiple Organ Systems in the Family History/Personal History are Involved,        take a Deep Breath and Think Twice if it is some how Related to Genetics.
 

Take Home Message

Hypertension in Pregnancy: How to Manage?
– DR. ANISH CHANDARANA
• Discrepancies exist for Threshold and Target: Lack of data
• Considerations:
        – Benefits vs harms of Lowered BP to Mother and Fetus 
        – Potential A/E of Medicines to the Fetus 
• > 160/110 mm Hg : No doubt, Prevents Stroke to Mother 
• 140-160 and 90-110 mm Hg : Grey Zone 
        – Chronic HT: > 150/95, as it would Run through 9 months Careful during 2nd                      trimester for Hypotension
        – Gestational HT – Early or TOD : Treat at lower thresholds 
        – Gestational HT – Late: For a Shorter Duration. Benefits to Mother/Child not                      proven for Lower threshold. 
• M-dopaLabetalolNF CR
 

Take Home Message

Proton Pump Inhibitors in our Daily 
Life : Too Many ? Too Few ? Never ?
– DR. BHAVESH THAKKAR
• PPIs should be used in lowest possible dose and for shortest possible duration.
• PPIs are safe medications and when indicated can be used for long term without          any risk or need of special monitoring.
• We need to review the dose and indication for continuation of PPI for patients who      need for long term.
 

Take Home Message

Interpretation of Thyroid Function Tests: Case Based Approach
– DR. VIVEK PATEL
• In case of “Weird TFTs”;
      – Reappraisal of the clinical context: physiological, pregnancy, NTI 
      – Medication usage
      – Reassessment of thyroid status
      – Exclusion of assay interference/assay artifact 

 

      – Disorders of the HPT axis are rare, but should be considered
 

Take Home Message

Autoimmune and Rheumatic Diseases: Myths and Facts
– DR. PUJA SRIVASTAVA
• Positive autoimmune serology AI disease. 
• RF / ANA titres do not correlate with disease activity. 
• Dx Rheumatic / AI Diseases: clinical pattern recognition. 
• Juvenile Idiopathic Arthritis (JIA): most common cause of arthritis in children.
 
• Normal SI joint Imaging does not rule out SpA. 
• Don’t let myths prevent your patients from eating otherwise healthy foods

Take Home Message

Red Eye How to Deal with Them
– DR. SMITA DHEER
• A. Red eyes without pain : LUBRICANT EYE DROPS 
• B. Red eyes with pain
                               ‘Do Flourescein Staining’
                                                           
• ‘STAIN POSITIVE’                               ‘STAIN NEGATIVE’ 
    Antibiotic eye drops  Lubricants with mild steroids 

 

• HARD eye ball – TAB acetazolamide 1000 mg stat 
• Red Eyes with diminution of vision – 
                                      Caution could be Serious 
Flourescein Stain Positive :   antibiotic  +  cycloplegic ,
                         Stain Negative :  Steroid  +  antibiotic and cycloplegic
 

Take Home Message

Case-Based Discussion on Physicians Role in High Risk Pregnancy
– DR. DEVANG PATEL
• Physiological changes 
• Pregnancy specific and aggravated disorder need to be kept in mind
• Medical management of medical disorder is different in pregnancy
 

Take Home Message

A Case of Pulmonary Embolism : Interactive Session
– DR. ANISH CHANDARANA
• Diagnosis: D-dimer, ECG, Echo, CTPA 

 

• Prognosis: sPESI, CT/Echo, Trop/BNP 

 

• Thrombolysis:

 

             – Shock / Hypotension 
 
             – sPESI>/=1, RV Dilatation, Marker Positive 
 
• Half dose / Cath Directed Thrombolysis:

 

             – Increasingly used 
 
             – Less bleeding risk, almost equal efficacy 
 
• All patients need anticoagulation: >/= 3 months 

 

• NOACs highly promising alternatives; Warfarin still on
 

Take Home Message

An Approach to Refractory Gastroesophageal Reflux Disease
– DR. ABHINAV JAIN

Take Home Message

Acid-Based Disorder – Step by Step Approach
– DR. MANTHAN KANSARA
• Development of acute lactic acidosis in patient with sepsis and shock is associated      with increase in mortality. 
 
• Aggressive resuscitation and elimination of triggering conditions are mainstay of           treatment.
• Administration of bicarbonate doesn’t reduce mortality or hemodynamic, even               when blood pH is increased
• Control of blood calcium level and reduction of PaCO2 during bicarbonate                       administration may enhance any benefit of bicarbonate.
 

Take Home Message

Differential diagnosis of skin rashes with or without itching
– DR. SNEHA GOHIL
• Skin lesions occur in multiple infections,     allergic conditions as well as internal           diseases. 
• Knowledge of different patterns and           shapes of these lesions help come to           diagnosis
• Dermatology is beyond rashes

Take Home Message

A case of Transient LOC
– DR. AJAY NAIK
• Important to identify every problem
• Treat the patient as a whole, tackle each issue
• Holistic view, long term approach.
• LAA appendage occlusion is an important addition to our armamentarium against      Cardioembolic strokes.
• AF ablation and LAA closure may become tandem procedures in the future

Take Home Message

How to Manage Systolic Hypertension in 2018
– DR. VIPUL KAPOOR
• Thresholds for diagnosis and treatment goals for hypertension are lowered in new         AHA guidelines (mainly due to SPRINT and some large meta analyses) 
• Measurement of BP outside the clinic (Ambulatory and self monitoring) is                        important  to manage hypertension 
• Beta blockers are not 1st line drugs for non-complicated HTN, should be used only in     compelling indications, Atenolol should not be used in IHD patients. 
• MRAs constitute an important class of drugs in patients with resistant Hypertension.

Take Home Message

Immunotherapy: Role of physicians in immunotherapy: what ,who, where and                                  when
– DR. REENA SHARMA
  • Proper history is the key to the diagnosis
  • Early diagnosis and early treatment is the key to successful treatment
  • Young females of reproductive age group presenting with hyperuricemia- always look for secondary causes
  • All hyperuricemias are not gout and vice a versa
  • Keep track of the case as symptoms may evolve over a period of time- months to years
  • Last but not the least all joint pains may not be due to rheumatological diseaseS

Take Home Message

Empirical Antimicrobials in Infectious diseases
– DR. SURABHI MADAN
• Empirical Rx should always be started after obtaining appropriate cultures

 

• It is a bridge to Targeted Rx, which is based on the culture results 
• Avoid empirical Rx in stable and immnocompromised patients
• Designing of an empirical regimen – history, investigations, host and microbial               factors and  various epidemiological features

Take Home Message

Salt and Obesity
– DR. DHIREN JOSHI
• Obesity is a complex syndrome having multiple factors contributing to it, SALT               being one of the important factor. 
• Calories restriction and exercise are the main tools to curtail Obesity.
• But we should give equal emphasis to SALT consumption. 
• Restriction of SALT intake even in non hypertensive and non cardiac Obese people       can give good and fast reduction of weight reduction

Take Home Message

A Case of Massive Iliofemoral DVT Management strategy
– DR. SATYA GUPTA
• Proximal DVT is a highly morbid clinical scenario
• Pharmaco-invasive approach can lead to early recovery and less chronic venous             complications
• PE can lead to sudden death
 
• Judicious use of IVC filter is recommended 
• Early CDT reduces clot burden and preserves valve function 
• Post thrombotic syndrome can be avoided

Take Home Message

A Case of Cryptogenic Stroke
– DR. TEJAS V. PATEL
• Cryptogenic stroke accounts for 25-40% of ischemic stroke 
• Cryptogenic stroke is a diagnosis of exclusion 
• Look for 2 most imp cardiac causes: 
       – occult paroxysmal atrial fibrillation 
       – paradoxical embolism via PFO 
• Taken together, the 5 clinical trials have provided the evidence that trans-catheter         PFO closure is effective in reducing the risk of recurrent stroke in young patients           (age <60 years) suffering with cryptogenic stroke

Take Home Message

SGLT2i and Diabetic Ketoacidosis
– DR. VIVEK PATEL
• SGLT2i are wonderful drugs with multiple benefits

• Choosing the right candidate for the drug

• High degree of suspi c ion and early  assessment are the key
• AVOIDE IN T1DM

Take Home Message

Renal Denervation Rises from the Ashes
– DR. KEYUR PARIKH
• Renal Denervation is not dead and it is coming back 
• As newer guidelines mandate lower BP thresholds, it will get tougher to manage that 
• Early Studies and Devices were premature 

 

• New RDN Technologies are promising and may deliver the proper treatment 
• Large scale trials with “Sham” controls will give us the answer in next 2 years

Take Home Message

Efficacy and Safety of Tolvaptan in Hospitalized Patients with Acute Heart Failure
– DR. ANISH CHANDARANA
• Improves hyponatremia in patients with

 

        – Hypervolemic / Euvolemic Hyponatremia
        – No effects on BP, Heart Rhythm, Kidney Function and S K+   

 

• In well-treated patients hospitalized with HF, oral tolvaptan 30 mg daily, facilitates      management of volume overload with 

 

       – Early and sustained weight reduction 

 

       – Borderline Improvement in dyspnea (d1 and 3) 

 

       – No effect on global clinical status (VAS) at d7/DC

 

• Long-term treatment: No effect on long-term mortality or HF morbidity. 

 

• Currently indicated for CHF / AHF with Hyponatremia

Take Home Message

Anti-inflammatory Agent Canakinumab Modestly Reduces Major CVD Events
– DR. VIPUL KAPOOR
• CANTOS Demonstrates that Canakinumab Reduces Cardiovascular event rates in         High Risk Patients

 

  • The magnitude of hsCRP Reduction Following a single dose of Canakinumab may         provide a simple Clinical Method to Identify Individuals Most likely to accrue the             Largest Cardiovascular Benefits from Continued Treatment
• For example, among those who Achieved Levels of hsCRP <2mg/L after a Single             Dose of Canakinumab, Continued Long-Term Treatment was associated with a 25%     Reduction in MACE (P<0.0001), a 31% Reduction in Cardiovascular Mortality                       (P=0.0004) and a 31% Reduction in all-cause Mortality (P<0.0001). 
• By Contrast, Effects were smaller in Magnitude and Non-significant for all of these        endpoints among those with a less Profound Inflammatory Response.

Take Home Message

Therapeutic Fibrinolysis
– DR. TEJAS V. PATEL
• Thrombolytic Therapy [TLT] is the Main Reperfusion Strategy in STEMI where                   Primary PCI Facility is not Available 
• TLT has Excellent Result if given Timely [D-to-B time <30min] in initial few Hours of         Symptoms onset 
• In Delayed Presentation, the Efficacy of TLT Reduces Drastically at the Expense of          Bleeding Complications 
• New Generation agents are more Efficacious, but costlier

Take Home Message

Therapeutic Fibrinolysis
– DR. TEJAS V. PATEL
• Thrombolytic Therapy [TLT] is the Main Reperfusion Strategy in STEMI where                  Primary PCI Facility is not Available 
• TLT has Excellent Result if given Timely [D-to-B time <30min] in initial few Hours of         Symptoms onset 
• In Delayed Presentation, the Efficacy of TLT Reduces Drastically at the Expense of           Bleeding Complications 
• New Generation agents are more Efficacious, but costlier

Take Home Message

Triple Challenge of Triple Therapy
– DR. VINEET SANKHLA
• LEADERS FREE is the First Randomized Clinical Trial dedicated to HBR patients 
• Such patients are often excluded from stent and drug trials, constitute a rapidly            growing proportion of PCI candidates and suffer high event rates 
• Together with a one-month only DAPT course, the use of a BA9-DCS was both                 significantly safer and more effective than a control BMS in HBR patients

Take Home Message

Evaluating bleeding risk with NOACs and its management
– DR. AJAY NAIK
• NOACs provide opportunity to minimize growing burden of potentially preventable       thromboembolism (especially AF)
• Reductions in both stroke and bleeding translate into important benefits for                   patients
• Most bleeding can be managed without specific antidotes
• Specific antidotes will provide reassurance to physicians 
• Education to overcome the fear of bleeding as a barrier to appropriate                              anticoagulant use important

Take Home Message

Improving ACS Outcomes: Acute Treatment and Chronic Management
– DR. KEYUR PARIKH
• Evaluation and Management of Non-ST Management of Non-ST 10 points to                   remember
• 10 points to remember on the management of patients with non–ST-elevation acute     coronary syndromes (NSTE-ACS)

Take Home Message

Clinical Trials of 2017 – Which Changed My Clinical Practice:
– DR. MILAN CHAG
• FOURIER: Evolocumab, on top of Statin therapy, reduces LDL-C to <30 mg/dL and         further reduces CV events.
• EBBINGHAUS: Evolocumab, on top of Statin therapy, reduces LDL-C to <30 mg/dL      and does not cause cognitive dysfunction at 19 months follow up. 
• CANTOS: Canakinumab, an IL-1 ß inhibitor, by reducing inflammation, reduces 3-         pont MACE, mainly driven by reduction in MI, especially in subgroup of hs-CRP               responders.
 • HPS3/TIMI 55/REVEAL: Among patients with ASCVD on statin, addition of                        Anacetrapib reduced CV events further. 
• COMPASS: Among patients with stable ASCVD, addition of rivaroxaban (2.5 mg           twice daily) to aspirin (100 mg) reduces CV death, MI or stroke 
• RE-DUAL PCI: Among patients with NVAF needing PCI, Dual Therapy with                  Dabigatran plus P2Y12 i is safer and equally effective compared to triple therapy of      Warfarin and DAPT.
• DETO2X SWEDEHEART: Routine use of supplemental O2 in absence of hypoxia in      patients with suspected acute MI is not useful and does not reduce 1 year mortality

Take Home Message

Case of Intermediate Lesions in CAD: What to Do?
– DR. VIPUL KAPOOR
• FFR remains the reference standard for physiological assessment of intermediate lesion severity. 
• iFR is an adenosine independent index of coronary stenosis severity utilised either alone or in combination with FFR.
• These indices form the backbone of functional assessment of intermediate coronary lesions (clinically, non-invasively and angiographically).

Take Home Message

Tachyarrhythmias in AMI
– DR. AJAY NAIK
• Presence of VA could independently influence mortality in patients recovering from MI.
• Appropriate risk assessment and subsequent treatment is warranted in these pts.
• The prevention and treatment of hemodynamically significant VAs in the post- infarct period and of SCD remote from the event are under study.

Take Home Message

Novel Oral Anticoagulants in CAD
– DR. VINEET SANKHLA
• COMPASS trial represents a imp step forward in thrombo-cardiology.
• Likely to change guidelines with important role of NOACs in CAD in both ACS and stable CAD population

Take Home Message

Case of Acute MI: what went wrong?
– DR. SATYA GUPTA
• Mechanical /structural complication during management of MI are rare but not uncommon 
• Elderly hypertensive patients with MI has high risk of mechanical complication 
• Clinical findings, symptoms , investigational findings should always be correlated 
• If picked up at appropriate time, can be life saving and rewarding

Take Home Message

Sleep disordered Breathing and Heart Failure :
What does the future hold?
– DR. BHAVIN DALAL

 
 
“Don’t ever go to sleep. Too many people die there.”
                     – Mark Twain
 
         Was Mark Twain Right

Take Home Message

LAA Closure: Here to Stay – Why – When – Who?
– DR. AJAY NAIK
 
• Important to identify every problem

 

• Treat the patient as a whole, tackle each issue 
• Holistic view, long term approach.

 

 CONCLUSION
• LAA appendage occlusion is an important addition to our armamentarium against Cardioembolic strokes
• AF ablation and LAA closure may become tandem procedures in the future.

                                                      

Take Home Message

Management of Pulmonary Embolism
– DR. BHAVIN DALAL
• Patient with low risk PE can be started on LMWH or NOACs
• Patient wit high risk PE with hypotension, requires systemic t-PA 
• Patient with intermediate risk PE requires close monitoring and serial       measurements of several parameters like Trop-t, BNP, s-PESI scores etc.
                                                       

Take Home Message

No Mortality Benefit to supplemental Oxygen in acute MI – Bye Bye to Oxygen!
– DR. BHAVIN DALAL
• Don’t give supplemental oxygen for suspected or proven patient of MI if they are not hypoxic 
• Although definition of hypoxia is variable
• Bye Bye Oxygen!
                                                       

Take Home Message

Worsening Renal Function in Heart Failure
– DR. MANTHAN KANSARA
• CVP and not the cardiac index is a predictor of worsening renal function 
• CRS 2 may lead to CKD and progressive kidney dysfunction 
• Combine cardiac and renal dysfunction is attributed for diuretic resistance in HF patient
                                                       

Take Home Message

A Case of HT with DM and CHD : How will I Optimize Therapy?
– DR. VIPUL KAPOOR
• As per new 2017 guidelines, BP target in DM + HT patients is < 130/80 mm Hg
• For DM and IHD patients, ARBs/ACEIs are most preferred antihypertensive drugs
• SGLT-2 inhibitors (an anti-diabetic drugs group) have modest BP lowering effect in addition to reduction in CV events
• Metformin, SGLT-2 inhibitors and GLP-1 analogues are only antidiabetic drugs which reduces CV end points in DM + CHD patients in long term treatment
                                                       

Take Home Message

Diagnosis & Management of Resistant Hypertension
– DR. SATYA GUPTA
• RHTN, a common problem, in a subset of patients. 
• Pseudo resistance needs to be rules out. 
• ABPM a very helpful tool. 
• Secondary causes must be rules out & treated appropriately.
• Judicious up-titration of single / or appropriate combination of drugs overcomes this problem.
• Diuretics, cornerstone of therapy of RHTN. • Stenting Renal artery in RAS may be useful in selected population.
• Newer drugs & interventions holds promise for the future.                                  

Take Home Message

A Case of Middle Aged Hypertensive: How to Apply 2017 New AHA Guidelines
– DR. ANISH CHANDARANA
• Do not be satisfied when patient is not at Goal
• Ask leading questions about concomitant medicines 
• “Nobody lives good lifestyle”
• Rationalize therapy and don’t hesitate to use multiple drugs : 
• Goal: < 130/80 A, C, D……. B only for Right Indications
• Think secondary cause in each patient, Evaluate only few 
• Intervening with SNS is on the horizon….RDN
• Comprehensive risk management : HT, DM, Lipids etc.                                                       

Take Home Message

A Case of Statin Intolerance
– DR. ANISH CHANDARANA
• Inability to tolerate optimum dose of statin

 

            – Mostly due to Muscle symptoms (CK +/-), Liver enzymes

 

• Prove it by challenge and re-challenge, using different statin….Prava, Fluva, Rosuva

 

            – Check coexisting conditions, drug interactions

 

• Take your time…Counsel benefits of statin

            – 90% would tolerate some dose of one or other statin

 

• If associated with CK elevations + clinical myonecrosis/ myoglobinuria/ARF and no      “cause” is found: Not restart

 

• Reduced dose, + Ezitimibe, PCSK9 Inh are main options                                                      

Take Home Message

A Case of Hypertriglyceridemia
– DR. TEJAS V. PATEL
• Evidence for hypertriglyceridaemia as an independent risk factor for CVD is increasing
• There is increasing evidence that suggest that targeting hyperTG may improve atherosclerotic    CVD (ASCVD) outcomes 
• Currently, in addition to lifestyle changes, Fenofibrate is one of the options for treatment of hypertriglyceridaemia 
• Niacin and Omega 3 Fatty acids are also used but have inconsistent data
• In diabetic patients, Saroglitazar is an option                                               

Take Home Message

CV Risk profiles of Indians
– DR. VIPUL KAPOOR
• Indians have more atherogenic dyslipidemia (lower HDL-C, Higher TG) than western population
• Fibrates remain important drugs for Indian dyslipidemia in appropriately selected patients
• LDL-C, non-HDL-C goals are still relevant in Indian population 
• JBS risk score is most accurate compared to any other risk score to predict CV risk in    Indian population.                                                    

Take Home Message

Lessons Learnt: Recent CVOTs of Newer Drugs For DM
– DR. MILAN CHAG
• Diabetes is a major risk factor for HF; prevalence of both is increasing 
• Prognosis of patients with diabetes is ominous once HF develops 
• Glucose lowering by itself is not helpful as a strategy to prevent/treat HF 
• Several classes of diabetes medications with questionable HF safety 
• TZDs; possibly some DPP-4 inhibitors
 
• SU and insulin with limited data 
• SGLT2 inhibitors appear to prevent HF and reduce CV death 
• SGLT2 inhibitors may provide unique benefit in established HF: being investigated in clinical trials 
• T2D therapies that provide upfront benefit – survival and prevent important complications (such as HF) – should be prioritied

Take Home Message

STEMI: Dual Antiplatelet Treatment: Which Combination and When?
– DR. ANISH CHANDARANA
• In all patients of ACS, DAPT is must. 
• Lower dose of Aspirin preferred. 
• Clopidogrel : Only STEMI patients undergoing TLT. 
• Ticagrelor : All other ACS patients : NSTEMI, STEMI with PPCI, STEMI with late presentation not undergoing TLT. 
• Prasugrel : Not a drug for clinicians 
• DAPT for 12 months. Consider shorter (3-6 m) or longer (up to 30 m): ischemic vs bleeding risk. 
• Triple therapy for only 6 weeks when must. 
• Do not operate NCS < 1 mo (BMS) and <3-6 mo (DES)

Take Home Message

A case of Syncope…

– DR. AJAY NAIK
                                                      Do NOT believe these Myths
• If patient is stable, it is SVT 
• Tachycardia in young patient is SVT 
• SVT does not cause hemodynamic instability 
• After delivering a shock, patient may not have any rhythm / BP 
• There is no harm in giving escalating doses of Verapamil / Diltiazem
                                                                 Conclusion
• All patients and issues need to be approached with an open mind, without prejudice and premeditated diagnosis. 
• Do not mitigate your responsibility by choosing an easier option when the need is to opt for the “tougher one”

Take Home Message

A Case of Ventricular Arrhythmia in AMI
– DR. AJAY NAIK
• Presence of VA could independently influence mortality in patients recovering from MI.  
• Appropriate risk assessment and subsequent treatment is warranted in these patients. 
• The prevention and treatment of hemodynamically significant VAs in the post- infarct period and of SCD remote from the event is crucial.
                                                                 Conclusion

 

• Team- based approach including specialists in acute cardiac care, interventional cardiology, and electrophysiology is needed for …. 
• Acute care and mgt of VA, AF, Bradyarrhythmias, and prevention of stroke and embolism in Pts with ACS.

Take Home Message

Clinical Trials of 2017 – Which Changed My Clinical Practice: Take Home Messages (Part-II)
– DR. MILAN CHAG
                                                     
• CANVAS: Canagliflozin reduces 3-point MACE and HHF. There is increased incidence of  amputation. 
 
• CVD-REAL: In this real world large observational study in type 2 diabetes, SGLT2i reduced all- cause mortality and HHF. 87% of these patients were free of any established CVD.
 
• LEADER-Renal outcome: Liraglutide slowed down the development and progression of Diabetic kidney disease, primarily owing to a lower rate of new-onset persistent Macro- albuminuria 
 
• EXSCEL: Among patients with type 2 diabetes with or without previous CV disease, exenatide (long acting GLP1 RA) did not cause significant reduction in 3-point MACE.
 
• DEVOTE: Among patients with type 2 DM, Degludec is non-inferior to basal insulin Glargine for incidence of CV events and is superior to it for prevention of severe and nocturnal hypoglycaemia.
 
• EINSTEIN CHOICE: Among patients with DVT and PTE on intensive OAC for 6-12 months, continued 10 or 20 mg Rivaroxaban for extended period was better than Aspirin for prevention of recurrent events, without additional significant bleeding risk. 
 
• STAMPEDE: Bariatric surgery plus intensive medical therapy was more effective in decreasing, or in some cases resolving, hyperglycaem

Take Home Message

My Approach: A Patient with Hypertension: How to Treat Using New AHA 2017-18 Guidelines
– DR. ANISH CHANDARANA
                                                     
• Do not be satisfied when patient is not at Goal 

 

• Ask leading questions about concomitant medicines 

 

• “Nobody lives good lifestyle” 

 

• Rationalize therapy and don’t hesitate to use multiple drugs : 

 

• Goal: < 130/80 A, C, D……. B only for Right Indications 

 

• Think secondary cause in each patient, Evaluate only few 

 

• Intervening with SNS is on the horizon….RDN 

 

• Comprehensive risk management : HT, DM, Lipids etc.

Take Home Message

LEFT VENTRICULAR PSEUDOANEURYSM AFTER MYOCARDIAL INFARCTION
– DR. DEEPA SHAH / DR. TEJAS V. PATEL
• So, In Today’s World Of Evidence Based Medicine, Every Clinical Decision Has To Be backed Up With A Concrete Evidence, Both Guideline And Investigation Based.
 
• Cardiac MRI(CMRI), Fits The Bill Perfectly In View Of Its Numerous Clinical  Applications And Obvious Advantages Over Similar Contemporize Investigations. 
• CIMS Hospital Offers The Latest Cutting –Edge Technology In Cardiac MRI(CMRI) backed Up With Perfect Mixture Of Experience And Expertise In The Field Of Cardiology And Radiol
 

Take Home Message

My Approach 80 Yr. Old Patient with Class-III Angina Refuses to Undergo PCI CABG
– DR. HEMANG BAXI
                                                     
• Significant proportion of elderly CAD patients may not agree to undergo revascularization in India (socio-economical reasons) 

 

• Optimal control of CV risk factors (BP, lipid and sugar levels) and symptomatic therapy to reduce anginal pain are primary approach in such a patients 

 

• Use of 2nd line antianginals, Chelation therapy, EECP, Spinal cord stiimulation are  important to manage such patients in clinical practice.

Take Home Message

My Approach: A Patient with Acute Pulmonary Embolism
 – DR. URMIL SHAH
• Data from ULTIMA, SEATTLE 2 and OPTALYSE PE now support Ultrasound-assisted  or UDT for treatment of PE in 2017

 

• Consistent decrease in the RV/LV ratio is seen, with improved outcomes
 
• Working together for patient care  
              
               –  PE Response Team 
               –  Multidisciplinary Group of Clinicians with expertise in PE 
               –  Start integrating data from these studies at the bedside for direct patient                        care 
               –  Patient Selection 
               –  Using Lower amounts of TPA 
               –  Shorter duration of treatment

Take Home Message

A Case of Cryptogenic Stroke
 – DR. TEJAS V. PATEL
                                                     
• Cryptogenic stroke accounts for 25-40% of ischemic stroke 

 

• Cryptogenic stroke is a diagnosis of exclusion 

 

• Look for 2 most imp cardiac causes:

 

              – occult paroxysmal atrial fibrillation 
              – paradoxical embolism via PFO
 
• Taken together, the 5 clinical trials have provided the evidence that trans-catheter  PFO closure is effective in reducing the risk of recurrent stroke in young patients (age <60 years) suffering with cryptogenic stroke.

Take Home Message

Case Presentation Preop Consultation in Diabetes
 – DR. MANOJ VITHALANI
                                                     
• Pre operative consultation is clinical art

 

• Never consider lightly 

 

• Clinicians are risk stratifiers 

 

• When surgery is indicated , there is no contraindication weigh benefit versus risk 

 

• Coordination between surgeon, Anaesthetist and physician are vital