A Case of 2:1 Atrio-Ventricular Block- Unravelled by Exercise Testing

: We present a case of 75-year-old lady with effort intolerance and baseline ECG showing 2:1 atrio-ventricular block, in whom it was unclear as to requirement of permanent pacing, even after long term ECG monitoring. She underwent a tread mill test during which her QRS became wide and developed complete heart block within 2 minutes of the test. Thus, a simple exercise test helped in confirming level of block to be infra nodal without need for invasive study. In patients with exertional symptoms, even in elderly, and in those where ECG masquerades as a benign entity, exercise testing is useful to differentiate benign cases of atrio-ventricular block from the more serious cases that mandate a pacemaker implantation.

Cardiovascular changes in newly detected hypothyroid patients in Eastern India

Background: Present study was carried out with an objective to study all the cardiovascular changes associated with newly detected hypothyroidism, and to know the cardiovascular involvement in sub-clinical hypothyroidism.Methods: A total number of 60 newly detected hypothyroid patients, diagnosed by clinical evaluation and confirmed by thyroid hormone assay by chemiluminescence immunoassay (CLIA) method, were subjected to cardiovascular examination, electrocardiograph, echocardiography and Tread mill test. It was cross sectional study design based on random sampling method which was conducted for 2 years in the department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. The work was carried out after approval from the Institutional Ethics Committee of MKCG Medical College Hospital, Berhampur, Odisha. Patients were investigated before thyroid hormone replacement therapy. Statistical data analysis was made on basis of deviation, standard error, t-test and the proportion test. P value of < 0.05 was considered statistically significant.Results: Out of 60 patients studied 14 were males and 46 were females. Hypothyroidism was newly diagnosed more in females and maximum in age group of 17-47 years (69.9%). Out of 60 patients, 63.3% had symptoms less than 3 months duration. Cardiovascular symptoms were present in 12 (20%) patients. Bradycardia was observed in 7% patients. Stage 1 hypertension was noticed in 13.3% (diastolic high blood pressure). Low voltage complexes in electrocardiogram was present in 40% study group. Pericardial effusion was present in 26.7% patients. Tread mill test was positive for inducible ischaemia in 2 patients. Diastolic dysfunction was noticed in 26.6% study group. Altered lipid profile was present in 16.7% (S. cholesterol) and 53.4% (S. Triglycerides).Conclusions: Hypothyroidism is common in female, maximum between 17-47 years age group. Majority of the patients did not have any cardiovascular changes. Observed cardiovascular changes were ECG abnormalities, pericardial effusion, diastolic hypertension and diastolic dysfunction. Systematic study was done to know the early effects of hypothyroidism on cardiovascular system. The identification of patients with hypothyroidism is an important individual as well as public health issue. Hence, early detection and initiation of hormone replacement therapy can minimize associated cardiovascular changes.

Coronary angiography finding of exercise tread mill test positive patients in a tertiary care center

Background and Aims: The use of coronary angiography in diagnosing coronary artery disease is limited by its invasive property. In the other hand correct interpretation of tread mill test data and its use as a key diagnostic modality also has been a problem. The study was thus aimed to see the diagnostic accuracy of treadmill test to rule out coronary artery disease.Methods: We included all the patients who had positive tread mill stress test and underwent coronary angiography and were subsequently analyzed for presence of coronary artery disease.Results: A total of 303 patients were included with 119 males and 184 females with mean age of 53.6±10.5 yrs and 51.7±8.6 yrs respectively. Normal coronaries was seen in 114(54.0%), borderline lesion in 29 (13.7%) and significant lesion in 68 (32.2%) with 48(22.7%) having single vessel disease, 29(13.7%) double vessel disease and 14(6.6%) triple vessel disease. Coronary artery diseases was highest among diabetics (57.7%, OR 1.72 (95 % CI: 0.92 to 3.20), p value-0.08).Similarly the risk of coronary artery disease was significantly highest among patient with ≥2 risk factor (OR: 8.10,95 % CI: 4.96 to 13.24, P < 0.0001). Gender distribution showed that coronary artery disease was significantly higher in males than females (53% vs 35% respectively, OR: 2.08, 95 % CI: 1.30 to 3.32, p value-0.002).Conclusion: The value of tread mill test to predict coronary artery disease is highest in patients with two or more risk factor especially in those with diabetes with significance increased among males.

Reducing the Integrated Harrington Seed Destructor Power Requirements through Chaff Fraction Optimization

Mechanical weed seed destruction during harvest is an effective method of reducing viable weed seed inputs to the seedbank. The commercialized Integrated Harrington Seed Destructor (iHSD) was developed for destroying weed seeds contained in the chaff residue exiting the harvester. Considered state-of-the-art in harvest weed seed control (HWSC), weed seed destruction is achieved without crop residue loss (burning or removal) and therefore, the iHSD is well suited to use in conservation cropping systems. However, as the iHSD is powered directly by the harvester its power draw impacts harvester performance. The objectives of this study were to determine the iHSD mill power requirements for effective weed seed destruction and to identify opportunities for decreasing these requirements. Using a torque-arm arrangement, the power requirements of an iHSD mill test rig powered by a PTO drive were measured. Wheat chaff containing a known amount of annual ryegrass () seed was passed through decreasing aperture sized sieves to obtain chaff size and seed distributions. The standard power demand to process chaff was ~54 kW, restricting the use of this system to large capacity harvesters. It was found that annual ryegrass seeds were concentrated in the chaff fraction passing through a 3 mm sieve. The power demand for processing this refined fraction was reduced by approximately a third to ~36kW. Efficient mechanical means to refine the chaff fraction to focus on the weed seed portion should be investigated. Keywords: Agricultural engineering, Conservation cropping, Efficiency, Harvest weed seed control, Herbicide resistance, Mechanical weed seed destruction,