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Ramayana and Other Poems is a beautiful collection of poems that brings the story of India's great epic Ramayana in wonderfully woven poetic verses. The narrative is visually impacting and takes you through the journey of Lord Rama in a mesmerizing way. There are other poems that depict the beauty of nature around us and also touch upon some divine aspects of existence.
There is a hypothesis that a subgroup of patients with reversal of systolic dysfunction following hemodialysis have fluid overload. However, the underlying pathology has not been understood in those patients without significant fluid overload. Inflammatory markers have been found to be raised in chronic kidney disease, which prompts the theory for an underlying inflammatory pathology as a cause of reversible cardiac dysfunction in this group of patients. We studied 52 patients with chronic kidney disease. There were 29 patients with systolic dysfunction. Twenty three patients with preserved systolic function, had diastolic dysfunction. Of the 29 patients with systolic dysfunction, 10 patients had significant improvement in NYHA functional class, left ventricular dimensions, left ventricular ejection fraction . None of the patients had significant changes in dry weight. These patients had the highest baseline serum levels of troponin I which decreased significantly with recovery of cardiac function along with the c reactive protein levels. Those patients with C reactive protein greater than median change had significant improvements in LVIDs and EF.
The topic of heart failure although extensively researched and reported, has several gray areas. This is especially seen in determining strategies for combating advanced heart failure. The global burden of ischemic heart disease is increasing at an alarming rate to almost pandemic proportions. Even in the presence of state-of the art technology for prompt and successful coronary reperfusion, the population progressing to ischemic cardiomyopathy is substantial. The treatment strategies for ischemic cardiomyopathy do not always ensure optimal clinical results, the reasons for which are varied. The proper patient selection is vital as is the tailoring of suitable therapy. The approach is thus multi-pronged, of which surgical ventricular restoration (SVR) has a definite role. Despite various randomized studies like the STICH-hypothesis 2, where there was a huge selection bias, with patients subjected to an erroneous technique of SVR, with inadequate ventricular remodelling assessment. The present need is to understand the unique anatomy of the left ventricle, its function and perturbations with the onset of heart failure, in order to plan therapeutic strategies to restore near normal anatomy and function. A study of the hemodynamics in ischemic cardiomyopathy is essential, as it differs in certain aspects from other causes of heart failure like idiopathic dilated cardiomyopathy and valvular heart diseases. Since information on these aspects are scattered in various scholarly articles, a concise source in the form of a book would be appropriate and useful for both cardiologists and cardiac surgeons. This project represents a concise review of normal and abnormal cardiac anatomy and physiology, the evolution of SVR to EVLPP with validation of near normal ventricular restoration, plus act as a reference guide for cardiac surgeons with interest in SVR.
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