1. TAKE HOME MESSAGE
FROM
KEY LECTURES JIC 2018

2. INDEX When Friends and Family Ambush-Ask you for Free Medical Advice
DR. 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 Approach
DR. VIVEK PATEL
Autoimmune and Rheumatic Diseases: Myths and Facts
DR. PUJA SRIVASTAVA
Red Eye How to Deal with Them
DR. SMITA DHEER
Case Based Discussion on Physicians Role in High Risk Pregnancy
DR. DEVANG PATEL
A Case of Pulmonary Embolism : Interactive Session
An Approach to Refractory Gastroesophageal Reflux Disease
DR. ABHINAV JAIN
Acid Based Disorder – Step by Step Approach
DR. MANTHAN KANSARA
Differential diagnosis of skin rashes with or without itching
DR. SNEHA GOHIL
A case of Transient LOC
DR. AJAY NAIK
How to Manage Systolic Hypertension in 2018
DR. VIPUL KAPOOR

3. INDEX
Immunotherapy: Role of Physicians in Immunotherapy: What, Who, Where and When
DR. REENA SHARMA
Empirical Antimicrobials in Infectious Diseases
DR. SURABHI MADAN
Salt and Obesity
DR. DHIREN JOSHI
A Case of Massive Iliofemoral DVT Management Strategy
DR. SATYA GUPTA
A Case of Cryptogenic Stroke
DR. TEJAS V. PATEL
SGLT2i and Diabetic Ketoacidosis
DR. VIVEK PATEL
Renal Denervation Rises from the Ashes
DR. KEYUR PARIKH
Efficacy and Safety of Tolvaptan in Hospitalized Patients with Acute Heart Failure
DR. ANISH CHANDARANA
Anti-inflammatory Agent Canakinumab Modestly Reduces Major CVD Events
DR. VIPUL KAPOOR
Therapeutic Fibrinolysis
Triple Challenge of Triple Therapy
DR. VINEET SANKHLA
Evaluating Bleeding Risk with NOACs and Its Management
DR. AJAY NAIK
Improving ACS Outcomes: Acute Treatment and Chronic Management
Clinical Trials of Which Changed My Clinical Practice:
DR. MILAN CHAG
Case of Intermediate Lesions in CAD: What to do?

4. INDEX Tachyarrhythmias in AMI DR. AJAY NAIK
Novel Oral Anticoagulants in CAD
DR. 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?
Management of Pulmonary Embolism
No Mortality Benefit to Supplemental Oxygen in Acute MI – Bye Bye to Oxygen!
Worsening Renal Function in Heart Failure
DR. MANTHAN KANSARA
A Case of HT with DM and CHD : How will I Optimize Therapy?
DR. VIPUL KAPOOR
Diagnosis & Management of Resistant Hypertension
A Case of Middle Aged Hypertensive: How to Apply 2017 New AHA Guidelines
DR. ANISH CHANDARANA
A Case of Statin Intolerance
A Case of Hypertriglyceridemia
DR. TEJAS V. PATEL
CV Risk profiles of Indians
Lessons Learnt: Recent CVOTs of newer Drugs for DM
DR. MILAN CHAG

5. INDEX STEMI: Dual Antiplatelet Treatment: Which Combination and When?
DR. ANISH CHANDARANA
A case of Syncope…
DR. AJAY NAIK
A case of Ventricular Arrhythmia in AMI
Clinical Trials of 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 Guidelines
Left Ventricular Pseudoaneurysm after Myocardial Infarction
DR. DEEPA SHAH /
DR. TEJAS V. PATEL
My Approach 80 Yr. old Patient with Class III Angina Refuses to Undergo PCI CABG
DR. HEMANG BAXI
My Approach: A Patient with Acute Pulmonary Embolism
DR. URMIL SHAH
A Case of Cryptogenic Stroke
Case Presentation Preop Consultation in Diabetes
DR. MANOJ VITHALANI

6. When Friends and Family Ambush-Ask you for Free Medical Advice
- DR. KEYUR PARIKH
TAKE HOME MESSAGE
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.

7. When Friends and Family Ambush-Ask you for Free Medical Advice
- DR. KEYUR PARIKH
TAKE HOME MESSAGE
Ethical and Professional Issues include, but are not limited to:
Inappropriate Influence of Subjective Evaluations and Judgments
Potential for Failure to Provide thorough Medical Care including follow-up
Potential for Conflict in Personal Relationships.
Potential for Treatment of Conditions beyond the Expertise and Training of the Physician/Health Care Provider
Absence of Standard Provider-Patient Relationship Leading to Poor or lack of Documentation of Care and follow-up Practical Issues
Lack of Appropriate Documentation
Billing/Reimbursement Issues
Malpractice Issues
Potential for Lack of Informed Consent
Potential Conflict of Interest and Attention in Mediating Roles as Family Member and Provider.

8. TAKE HOME MESSAGE FEVER Of Unknown origin - Still a puzzle for us!
- DR. SURABHI MADAN
TAKE HOME MESSAGE
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

9. Whom & When to Always Order Genetic Consult & Testing in Clinical Practice: Need of the Hour
- DR. KRATI SHAH
TAKE HOME MESSAGE
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.

10. TAKE HOME MESSAGE Hypertension in Pregnancy: How to Manage?
- DR ANISH CHANDARANA
TAKE HOME MESSAGE
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
and 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-dopa, Labetalol, NF CR

11. Proton Pump Inhibitors in our Daily Life : Too Many ? Too Few ? Never ?
- DR BHAVESH THAKKAR
TAKE HOME MESSAGE
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.

12. Interpretation of Thyroid Function Tests: Case Based Approach
- DR. VIVEK PATEL
TAKE HOME MESSAGE
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

13. TAKE HOME MESSAGE Autoimmune and Rheumatic Diseases: Myths and Facts
- DR. PUJA SRIVASTAVA
TAKE HOME MESSAGE
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

14. 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 mg stat
Red Eyes with diminution of vision –
Caution could be Serious
Flourescein Stain Positive : antibiotic + cycloplegic ,
Stain Negative : Steroid + antibiotic and cycloplegic

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

16. TAKE HOME MESSAGE A Case of Pulmonary Embolism : Interactive Session
- DR. ANISH CHANDARANA
TAKE HOME MESSAGE
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

17. An Approach to Refractory Gastroesophageal Reflux Disease
- DR. ABHINAV JAIN
TAKE HOME MESSAGE

18. TAKE HOME MESSAGE Acid-Based Disorder – Step by Step Approach
- DR. MANTHAN KANSARA
TAKE HOME MESSAGE
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

19. Differential diagnosis of skin rashes with or without itching
- DR. SNEHA GOHIL
TAKE HOME MESSAGE
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

20. 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.

21. TAKE HOME MESSAGE A case of Transient LOC - DR. AJAY NAIK
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.

22. TAKE HOME MESSAGE How to Manage Systolic Hypertension in 2018
- DR. VIPUL KAPOOR
TAKE HOME MESSAGE
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.

23. 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

24. TAKE HOME MESSAGE Empirical Antimicrobials in Infectious diseases
- DR. SURABHI MADAN
TAKE HOME MESSAGE
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

25. 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

26. A Case of Massive Iliofemoral DVT Management strategy
- DR. SATYA GUPTA
TAKE HOME MESSAGE
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

27. 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.

28. 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 suspicion and early assessment are the key
AVOIDE IN T1DM

29. TAKE HOME MESSAGE Renal Denervation Rises from the Ashes
- DR. KEYUR PARIKH
TAKE HOME MESSAGE
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

30. Efficacy and Safety of Tolvaptan in Hospitalized Patients with Acute Heart Failure
- DR. ANISH CHANDARANA
TAKE HOME MESSAGE
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

31. Anti-inflammatory Agent Canakinumab Modestly Reduces Major CVD Events
- DR. VIPUL KAPOOR
TAKE HOME MESSAGE
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.

32. 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

33. TAKE HOME MESSAGE Triple Challenge of Triple Therapy
- DR. VINEET SANKHLA
TAKE HOME MESSAGE
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

34. Evaluating bleeding risk with NOACs and its management
- DR. AJAY NAIK
TAKE HOME MESSAGE
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

35. Improving ACS Outcomes: Acute Treatment and Chronic Management
- DR. KEYUR PARIKH
TAKE HOME MESSAGE
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) 35

36. Clinical Trials of 2017 - Which Changed My Clinical Practice:
- DR. MILAN CHAG
TAKE HOME MESSAGE
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

37. TAKE HOME MESSAGE Case of Intermediate Lesions in CAD: What to Do?
- DR. VIPUL KAPOOR
TAKE HOME MESSAGE
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).

38. 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.

39. TAKE HOME MESSAGE Novel Oral Anticoagulants in CAD
- DR. VINEET SANKHLA
TAKE HOME MESSAGE
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

40. 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

41. “Don’t ever go to sleep. Too many people die there.”
Sleep disordered Breathing and Heart Failure : What does the future hold?
- DR. BHAVIN DALAL
TAKE HOME MESSAGE
“Don’t ever go to sleep. Too many people die there.”
Mark Twain
Was Mark Twain Right??

42. TAKE HOME MESSAGE CONCLUSION
LAA Closure: Here to Stay - Why - When – Who?
- DR. AJAY NAIK
TAKE HOME MESSAGE
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.

43. 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.

44. No Mortality Benefit to supplemental Oxygen in acute MI – Bye Bye to Oxygen!
- DR. BHAVIN DALAL
TAKE HOME MESSAGE
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!

45. TAKE HOME MESSAGE Worsening Renal Function in Heart Failure
- DR. MANTHAN KANSARA
TAKE HOME MESSAGE
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

46. A Case of HT with DM and CHD : How will I Optimize Therapy?
- DR. VIPUL KAPOOR
TAKE HOME MESSAGE
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

47. TAKE HOME MESSAGE Diagnosis & Management of Resistant Hypertension
- DR. SATYA GUPTA
TAKE HOME MESSAGE
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.

48. A Case of Middle Aged Hypertensive: How to Apply 2017 New AHA Guidelines
- DR. ANISH CHANDARANA
TAKE HOME MESSAGE
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.

49. 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

50. 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

51. 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.

52. Take-Home Points TAKE HOME MESSAGE
Lessons Learnt: Recent CVOTs of Newer Drugs For DM
Take-Home Points
- DR. MILAN CHAG
TAKE HOME MESSAGE
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

53. STEMI: Dual Antiplatelet Treatment: Which Combination and When?
- DR. ANISH CHANDARANA
TAKE HOME MESSAGE
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)

54. TAKE HOME MESSAGE Conclusion
A case of Syncope…
- DR. AJAY NAIK
TAKE HOME MESSAGE
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”

55. TAKE HOME MESSAGE Conclusion
A Case of Ventricular Arrhythmia in AMI
- DR. AJAY NAIK
TAKE HOME MESSAGE
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.

56. Clinical Trials of 2017 - Which Changed My Clinical Practice: Take Home Messages (Part-II)
- DR. MILAN CHAG
TAKE HOME MESSAGE
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, hyperglycaemia.

57. TAKE HOME MESSAGE My Approach: A Patient with Hypertension:
How to Treat Using New AHA Guidelines
- DR. ANISH CHANDARANA
TAKE HOME MESSAGE
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.

58. LEFT VENTRICULAR PSEUDOANEURYSM AFTER MYOCARDIAL INFARCTION
- DR. DEEPA SHAH / DR. TEJAS V. PATEL
TAKE HOME MESSAGE
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 Radiology.

59. My Approach 80 Yr. Old Patient with Class-III Angina Refuses to Undergo PCI CABG
- DR. HEMANG BAXI
TAKE HOME MESSAGE
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.

60. Take-Home Messages TAKE HOME MESSAGE
My Approach: A Patient with Acute Pulmonary Embolism
Take-Home Messages
- DR. URMIL SHAH
TAKE HOME MESSAGE
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

61. 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.

62. TAKE HOME MESSAGE Case Presentation Preop Consultation in Diabetes
- DR. MANOJ VITHALANI
TAKE HOME MESSAGE
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