4^th Global Summit on Heart Diseases September 14-15, 2018 Singapore

Rojina has completed her B.Sc nursing at the age of 22 from purbanchal university and completed her Masters in Health care management from Pokhara University. She is a registered nurse of Sahid Gangalal national health centre and Assistant Manager (part time) at DI Skin health and Referral centre.

Background: Although the status of health related quality of life (HRQOL) among the post-operative patients after open-heart surgery has been assessed in many developed and developing countries, it has not yet been investigated in Nepalese population. The objective of study was to assess the level of HRQOL after mitral, aortic or both valve replacement surgery; and identify the factors affecting HRQOL of open-heart surgery patients. Methods: Cross sectional study was done among 405 adult patients of age 19 years to 65 years who had undergone aortic, mitral or both valve replacement surgery and attending the follow up visit in Shahid Gangalal National Heart Center. The study was conducted from March to August, 2017. All the eligible patients were recruited and administered the questionnaire by trained field researcher. SF-36v2 questionnaire were adopted and pre- tested prior to final survey. Informed consent was obtained prior to final data collection. Results: The respondents from the valve replacement surgery groups were dominantly female of reproductive age group (mean age: 37.84±13.25), highly literate and married. The mean PCS and MCS scores were (62.90±19.25) and (65.70±20.40) respectively, with better social and mental health including pain perception whose mean scores are (78.51 ±15.71), (87.34 ±23.11) and (79.19 ±32.16) respectively. The study revealed significant association between age, marital status, educational status, occupation, type of valve replaced as well as duration after surgery; and HRQOL (p< 0.05). However, sex of the respondents and classification of valve had no significant impact on HRQOL (p> 0.05). Conclusion and Recommendation: The majority of the patients (65.4%) had average HRQOL after valve replacement surgery. Age, educational status, marital status, major occupation, type of valve replaced and duration after valve replacement surgery had significant impact on their HRQOL (p< 0.05). Mental health was found better than physical health. The recommendations have been made to conduct further studies on HRQOL among Coronary artery bypass surgery, Fontan operation and Bentall’s surgery patients on multi-centered basis.

Currently working as a Professor in Republican Specialized Scientific and Practical Medical Center Therapy And Medical Rehabilitation, Tashkent, Uzbekistan

Purpose. Explore the dynamics of levels of brain natriuretic peptide (BNP), aldosterone (Аl) and norepinephrine (NE) in the serum in patients with II and III functional class (FC) chronic heart failure (CHF) against the background of the treatment of lozartan and lizinopril. Research methods. Were examined 46 patients with coronary heart disease (CHD) with CHF with II-III FC, according to the classification of the New York Association of cardiologists. The first group (1) was 23 patients with II FC (12) and III FC CHF (11 patients), took for 6 months against the background of the standard therapy (bisoprolol, spirinolactone) – losartan; the second group (2) - 23 patients with II FC (12) and III FC CHF (11 patients) – lizinopril, in doses, the average dose lozartan – 69.3±25.8 mg/day, lizinopril – 7.5±3.9 mg/day. All patients were carried out echocardiography, the level of Al, BNP and NE was determined by immunosorbent assay. Results. In CHF there was a significant increase the level of BNP, NE and Al in the blood plasma, correlative with a degree of disease progression, at the same time in patients with II FC is dominated by medium-high levels neurohormones, and in patients with III FC higher levels of these indicators. In patients with CHF II FC there was an increase in the content of BNP, N and Al to 187%, 30% and 36% (p<0.001) and in patients III FC to 330%, 56% and 66.3% (p<0,001), respectively, in comparison with the control group. Installed the dependence of processes remodeling of the level of neurohumoral factors (BNP, Al and NE) in patients with CHF. Revealed association of the level of neurohormones: BNP, Al and NE with the indicators remodeling heart: high inverse correlation with ejection fraction (EF) (r = 0.76, r = 0.70 and r = 0.72, respectively), direct correlation with the final diastolic volume of LV (r = 0.75, r = 0.78 and r = 0.70, respectively). Thus, in patients with CHF significant increase in neurohumoral factors: NE, BNP and Al associated with FC CHF, the degree of systolic dysfunction LV. Analysis of indicators neurohumoral factors in the dynamics of the treatment of showed a significant reduction in the level of BNP, Al and NE in both groups. 6 months treatment in patients with the first group noted reducing BNP, Al and NE in patients with II FC on 43.7%, 21.2%, 22.5%, respectively, in patients with III FC – on 31.7%, 42.6%, 9.9%, respectively, in comparison with the original indicators. 6 months treatment in patients with the 2 group noted reducing BNP, Al and NE: in patients with II FC - by 36.5%, 21.2%, 22.5%, respectively, in patients with III FC - by 35.2%, 31.2%, 8.3%, respectively, in comparison with the original indicators. Conclusion. Thus, six-month therapy by lozartan and lizinopril against the background of the standard therapy (bisoprolol, spirinolactone) allowed achieving significant decrease in BNP, Al and NE, at the same time there were no reliable comparable differences in both groups of patients.

Dr. Queen Gesa T. Mordeno has completed her degree of Doctor of Medicine from Southwestern University, Cebu City Philippines finishing on top of her class. She had her postgraduate internship at Sacred Heart Hospital, Cebu City. She is currently a first year resident physician in the Department of Internal Medicine at Perpetual Succour Hospital, Cebu City, Philippines.

Primary left atrial sarcomas are exceptionally rare. Definitive diagnosis is done through tissue biopsy to differentiate myxomas from highly aggressive sarcomas. Complete surgical resection is still the mainstay treatment for these tumors. However, this becomes less likely as an option in cases where there is local expansion and/or the presence of distant metastases at the time of diagnosis. Use of adjuvant chemotherapy have been reported. However, because of the rarity of primary cardiac sarcomas, the results are speculative and inconclusive. Despite optimal management, the rates of local recurrence and distant metastasis are high. Overall prognosis is poor with a mean survival range from 9.6 to 16.5 months. The author presents a rare case of a recurrent primary cardiac sarcoma of undifferentiated pleomorphic type, its clinical presentation, diagnosis, histopathologic features, management and prognosis. A 39-year old asthmatic Filipino male initially presented with worsening dyspnea. Further work-up revealed an echogenic mass attached to the anterolateral wall of the left atrium oscillating in and out into the left ventricle seen on echicardiography. Surgical resection of the tumor was done. Histopathology confirmed that the mass was a myxoid undifferentiated pleomorphic sarcoma. Fourteen months after resection, he presented with local recurrence. There was also noted bone, lung and lymphatic metastases. Considering the presence of systemic involvement and a broad-base structural anatomy of the mass, repeat tumor resection was not done and the patient was ultimately managed with a single-agent chemotherapy of doxorubicin. Sixteen months from the time of initial diagnosis, the patient eventually succumbed. The management of primary cardiac sarcomas requires a multidisciplinary approach for optimal patient care and survival. Surgical excision is the mainstay of treatment for cardiac sarcomas, however this is dependent with the resectability of the mass and status of distant involvement or metastasis. Because of its rarity, data regarding chemotherapy response is limited and inconclusive. Their aggressive behaviour and current limited therapeutic options contribute to poor prognosis.

Author Luisetto M applied Pharmacologist , European Specilaist laboratory medicine ,Independent Researcher

Introduction Today we need to introduce new approach in some cardiovascular pathology and to do this we think is useful to Use a toxicological approach and new delivery systems. (This paper is produced under a pharmaceutical-toxicological approach.) Material and methods With a review method observing some literature in biomedical database we try to produce new approach in pharmacological strategies in some heart diseases. Results From literature: “Related to our consideration we can think a new method in heart disease staging strategy. New tests that can make possible to stress cardiac metabolism in normal, lowland high working conditions or in para-physio-pathological conditions but in local place (heart situation and not in plasma in example). We think that this new methods can be useful in much heart disease and condition to prevent some events. (Heart attacks, ischemic disease, atria, heart failure, transplants, sports and so on). Every bio-medical discipline has specific diagnostic discipline, but it can be useful to translate the various diagnostic system strategies from a discipline to other: this make possible to observe phenomena with.” (1)“We must consider an endogenus intra-local toxicology aspect time related to better verify some pathologic process under a new light. In some time related cardiovascular local metabolic-catabolic-toxic status we can observe some cellular effect resulting in global organ failure. The time involved and kinetics aspect in resolve some temporary methabolic-catabolic gradients or the velocity involved in this process can be fundamental. The same effect related to too much rapid evolution or too slow reduction (kinetics) in balancing equilibrates some physiologic systems” (2)“In example what happen in sudden death heart syndrome in untrained? Why in this condition physical training can reduce this event? We can think a condition of intra- toxicity time related. Other example can be some immune shock or what happen in septic shock. We think in this condition is relevant observe the time related intra- toxicity situation involved in some Metabolic- catabolic –electrical cell membrane - immune status and other. In example involved in some heart aritmia, epilectic status, septic shock and other situation high time related (ischemic coronaric spasm etc). In embryology, oncology, toxicology, some heart and brain pathologies time is relevant added to local micro environment and inters cellular communication (crisis). We can consider an intra- local toxicology aspect time related to better verify some pathologic process under a new light.” (3)“In actual pharmacological therapy we can see that some drugs can be added to other medical instruments to improve their activity: in example we can see medicated stent for some coronary disease, or hormonal medical devices used in pregnancy prevention, but other example are known today. In example Carmustine wafer is delivered by delivery systems in some brain cancer and radioactive seed implants in prostatic cancer. Ocular intra vitreal implants for some macular degenerations (MABS or cortisones) other implants delivery systems drugs, naltrexone implant for opiate dependence. Other strategies imply carrier use to deliver the drugs in the site of action: In example MABS linked to radioactive isotopes in some relapse of severe Hodgkin disease but many other examples we can see in therapy used today. So we can think that other chronic conditions can be treated using a combination of drugs with other instrument to improve the clinical outcomes. This to make possible that the ERLICH MUGIC BULLETS can act in the right site reducing the side effect. In example today we can see various medical interventional radiological strategy to treat in coronary and hearth disease with medicate stents positioning or to local use of contrast agents or other valve surgery procedures with global good clinical results.” (4)“The causes and the mechanisms underlying the development of CAS are still poorly defined and are likely multifactorial . In the 1980s, the autonomic nervous system was found to play an important role in the pathophysiology of CAS in the 1990s; inflammation, endothelial dysfunction, oxidative stress, respiratory alkalosis and magnesium deficiency were identified as predisposing factors. In the late 1990s and early 2000s, genetic mutations were found to be associated with CAS. Nonetheless, coronary vascular smooth muscle cell hyper reactivity seems to constitute the substrate for CAS.” (6)“Sudden death is an important but widely under-recognised consequence of stroke. Acute stroke can disturb central autonomic control, resulting in myocardial injury, electrocardiographic abnormalities, cardiac arrhythmias, and ultimately sudden death. Experimental and clinical evidence suggests that autonomic imbalance is more frequent after infarcts involving the insular cortex, a crucial region for the control of sympathetic and parasympathetic autonomic functions. Cardiovascular comorbidities increase the risk of cardiac morbidity and mortality after stroke. Thus, many sudden deaths and serious non-fatal cardiac events after stroke are probably due to an interaction between cardiovascular and neurological causes. The exact mechanisms leading to sudden death remain incompletely understood. Further research is needed to investigate the autonomic consequences of acute stroke and to identify patients at high risk of sudden death.” (8)Results of the first large-scale randomized trial of this treatment. “TACT, the first large-scale trial of chelation therapy for atherosclerotic coronary disease, found that EDTA chelation therapy reduced the risk of a composite of adverse cardiovascular outcomes, particularly among patients with diabetes. Before disodium EDTA chelation can take its place among other accepted therapies in the routine care of post-MI patients, however, it is important that further replicative and mechanistic clinical trials be performed” (9). Discussion conclusion Observing the reported literature In some heart disease we have see that some phenomena are deeply involved :Kinetics and gradients in metabolism , catabolism , time related , toxic like effect , electrical cell membrane status, smooth vascular muscle cell hyper-reactivity , platelet iperactivations, central autonomic control after acute stroke , great electrolites umbalances et other We think that using and antidothes- toxicological approach and new delivery systems we can obtain new Pharmacological strategies useful in some cardiovascular conditions. Clarification This paper has not any diagnostics or therapy intent only to produce new research hypothesis.