Editor
Santanu Guha
MD DM FCSI FACC FESC
Professor and Head Department of Cardiology Medical College
President-Elect-CSI 2015 Chairman, Scientific Committee 67th Annual Conference of CSI 2015
Kolkata, West Bengal, India
Associate Editors
S Ramakrishnan
MD DM FACC
Additional Professor of Cardiology All India Institute of Medical Sciences (AIIMS)
Executive Editor, Indian Heart Journal
Secretary, Cardiological Society of India, New Delhi
Secretary, Pediatric Cardiac Society of India (PCSI)
New Delhi, India
Rishi Sethi
MD DM FACC FESC FAPSIC FSCAI MAMS FCSI
Professor Department of Cardiology King George’s Medical University
Lucknow, Uttar Pradesh, India
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CSI: Handbook on Cardiac Critical Care
First Edition: 2016
9789385891076
Printed at
5Dedicated to
Our family, teachers, students, patients and all the members of Cardiological Society of India (CSI)
Contributors
- Ajay Bahl
- Additional Professor
- Department of Cardiology
- Advance Cardiac Center
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh, India
- Ajay Kumar Sinha
- Consultant Interventional
- Cardiologist
- Suraksha Cardiac Care
- PARAS-HMRI Hospital
- Patna, Bihar, India
- Associate Editor
- Indian Heart Journal
- Amit Mittal
- Consultant Cardiologist
- Indraprastha Apollo Hospitals
- New Delhi, India
- Amit Vora
- Consultant Cardiologist and
- Electrophysiologist
- Arrhythmia Associates
- Mumbai, Maharashtra, India
- Anand P
- Senior Resident
- Department of Cardiology
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Anant Mohan
- Professor
- Department of Pulmonary Medicine and Sleep Disorders
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Anitha Sathishkumar
- Department of Cardiac
- Electrophysiology and Pacing
- The Madras Medical Mission
- Chennai, Tamil Nadu, India
- Anoop Mathew
- Assistant Professor
- Department of Cardiology
- Malankara Orthodox Syrian
- Church (MOSC) Medical College
- Hospital
- Kolenchery, Ernakulam, Kerala, India
- Anunay Gupta
- Senior Resident
- Department of Cardiology
- All India Institute of Medical
- Sciences (AIIMS), New Delhi, India
- Aravind Sampath
- Junior Consultant (Cardiology)
- Institute of Cardiovascular Diseases
- The Madras Medical Mission
- Chennai, Tamil Nadu, India
- Archana Saini
- Senior Research Fellow
- Department of Cardiology
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Arindam Maitra
- Resident Medical Officer
- Clinical Tutor
- Institute of Postgraduate Medical
- Education and Research and Seth
- Sukhlal Karnani Memorial Hospital (IPGMER–SSKM)
- Kolkata, West Bengal, India
- Arup Dasbiswas (Retd) Professor and Head
- Department of Cardiology
- Nil Ratan Sircar (NRS) Medical College
- Kolkata, West Bengal, India
- Asit Das
- Resident Medical Officer cum Tutor
- Department of Cardiology
- Institute of Postgraduate Medical
- Education and Research and Seth
- Sukhlal Karnani Memorial Hospital (IPGMER–SSKM)
- Kolkata, West Bengal, India
- Bishav Mohan
- Professor
- Department of Cardiology
- Dayanand Medical College and
- Hospital Unit Hero DMC Heart
- Institute
- Ludhiana, Punjab, India
- Chitra Mehta
- Senior Consultant
- Institute of Critical Care and
- Anesthesiology
- Medanta‒The Medicity
- Gurgaon, Haryana, India
- Debasis Ghosh
- Senior Interventional Cardiologist
- Apollo Gleneagles Hospitals
- Kolkata, West Bengal, India
- Chief Federation Examiner, MRCP (UK)
- Debasri Dasbiswas
- Professor and Head
- Department of Pharmacology
- Calcutta National Medical College
- Kolkata, West Bengal, India
- Deep Chandh Raja S
- Senior Resident
- Department of Cardiology
- Sanjay Gandhi Postgraduate
- Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- G Ashok
- Postgraduate Student of Cardiology
- Madras Medical College and Rajiv
- Gandhi Government General
- Hospital
- Chennai, Tamil Nadu, India
- G Justin Paul
- Professor of Cardiology
- Madras Medical College and Rajiv
- Gandhi Government General
- Hospital
- Chennai, Tamil Nadu, India
- G Sengottuvelu
- Consultant Cardiologist and
- Interventionist
- Apollo Hospitals
- Chennai, Tamil Nadu, India
- Gaurav Chaudhary
- Assistant Professor
- Department of Cardiology
- King George’s Medical University
- Lucknow, Uttar Pradesh, India
- Harikrishnan S
- Additional Professor
- Department of Cardiology
- Sree Chitra Tirunal Institute for
- Medical Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Jabir A
- Senior Consultant Cardiologist
- Lisie Hospital
- Kochi, Kerala, India
- Jacob Jose
- Professor
- Department of Cardiology
- Chirstian Medical College
- Vellore, Tamil Nadu, India
- Kapil Rangan
- Associate Professor
- Department of Cardiology
- Sri Jayadeva Institute of
- Cardiovascular Sciences and
- Research
- Bengaluru, Karnataka, India
- Krishnan MN
- Professor and Head
- Department of Cardiology
- Government Medical College
- Kozhikode, Kerala, India
- Manbir Singh Khurana
- Senior Resident
- Dayanand Medical College and
- Hospital Unit
- Hero DMC Heart Institute
- Ludhiana, Punjab, India
- Manish Gunjan
- Consultant Cardiologist
- PARAS-HMRI Hospital
- Patna, Bihar, India
- Mayank Singhal
- Senior resident
- Department of Cardiology
- Advance Cardiac Center
- Postgraduate Institute of Medical
- Education and Research (PGIMER)
- Chandigarh, India
- Mridubhashini Sinha
- PhD Student
- Department of Bio-Engineering
- University of California
- San Diego, USA
- Mullasari Ajit Sankardas
- Director (Cardiology)
- Institute of Cardiovascular Diseases
- The Madras Medical Mission
- Chennai, Tamil Nadu, India
- Munna Das
- Consultant of Cardiology
- NH Network
- Kolkata, West Bengal, India
- Nagendra S Chouhan
- Senior Consultant
- Interventional Cardiology and
- Electrophysiology
- Medanta Heart institute
- Medanta‒The Medicity
- Gurgaon, Haryana, India
- Nair Anishkumar
- Senior Resident
- Department of Cardiology
- Government Medical College
- Kozhikode, Kerala, India
- Neil Bardoloi
- Consultant Interventional
- Cardiologist
- International Hospital
- Director, Excelcare Hospitals
- Guwahati, Assam, India
- Nitish Naik
- Professor
- Department of Cardiology
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- NN Khanna
- Chairman, Asia Pacific Vascular
- Society
- Senior Consultant Interventional
- Cardiology
- Senior Consultant Vascular
- Interventions
- Indraprastha Apollo Hospitals
- New Delhi, India
- P Anandharaj
- Postgraduate Student of Cardiology
- Madras Medical College and
- Rajiv Gandhi Government General
- Hospital
- Chennai, Tamil Nadu, India
- Parag Barwad
- Assistant Professor
- Department of Cardiology
- Advance Cardiac Center
- Postgraduate Institute of Medical
- Education and Research (PGIMER)
- Chandigarh, India
- PC Mondal
- Consultant Interventional
- Cardiologist
- Apollo Gleneagles Hospitals
- Kolkata, Tamil Nadu, India
- Poonam Malhotra Kapoor
- Professor
- Department of Cardiac Anesthesia
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Prafulla Kerkar
- Professor and Head
- Department of Cardiology
- King Edward Memorial Hospital and
- Seth GS Medical College
- Mumbai, Maharashtra, India
- Pramod Kumar
- Consultant Cardiologist
- PARAS-HMRI Hospital
- Patna, Bihar, India
- Praveen Chandra
- Chairman
- Division of Interventional
- Cardiology
- Medanta Heart Institute
- Medanta‒The Medicity
- Gurgaon, Haryana, India
- Pritish Bagul
- Superspecialty Medical Officer
- Department of Cardiology
- King Edward Memorial Hospital and
- Seth GS Medical College
- Mumbai, Maharashtra, India
- Rajiv Ananthakrishna
- Assistant Professor
- Department of Cardiology
- Sri Jayadeva Institute of
- Cardiovascular Sciences and Research
- Bengaluru, Karnataka, India
- Rakesh Yadav
- Professor
- Department of Cardiology
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Randeep Guleria
- Professor and Head
- Department of Pulmonary Medicine and Sleep Disorders
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Rishi Sethi
- Professor
- Department of Cardiology
- King George’s Medical University
- Lucknow, Uttar Pradesh, India
- Rituparna Baruah
- Consultant Interventional
- Cardiologist
- International Hospital
- Guwahati, Assam, India
- Rohit MK
- Additional Professor
- Department of Cardiology
- Advance Cardiac Center
- Postgraduate Institute of Medical
- Education and Research (PGIMER)
- Chandigarh, India
- SS Kothari
- Professor
- Department of Cardiology
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Sameer Taneja
- Senior Resident
- Department of Cardiac Anesthesia
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Sandeep Seth
- Professor
- Department of Cardiology
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Sanjay Tyagi
- Director Professor
- Department of Cardiology
- Maulana Azad Medical College
- Director, GB Pant Institute of
- Postgraduate Medical Education and Research
- New Delhi, India
- Sanjeev Kumar
- Assistant Professor
- Department of Cardiothoracic and
- Vascular Surgery
- All India Institute of Medical
- Sciences (AIIMS)
- Patna, Bihar, India
- Satyendra Tewari
- Professor
- Department of Cardiology
- Sanjay Gandhi Postgraduate
- Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Saurabh Kumar Gupta
- Assistant Professor
- Department of Cardiology
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Saurabh Mittal
- Senior Resident
- Department of Pulmonary Medicine and Sleep Disorders
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Srinivas BC
- Professor
- Department of Cardiology
- Sri Jayadeva Institute of
- Cardiovascular Sciences and
- Research
- Bengaluru, Karnataka, India
- Srinivasa KH
- Professor
- Department of Cardiology
- Sri Jayadeva Institute of
- Cardiovascular Sciences and
- Research
- Bengaluru, Karnataka, India
- SS Islam
- Associate Professor of Cardiology
- Institute of Postgraduate Medical
- Education and Research and Seth
- Sukhlal Karnani Memorial Hospital (IPGMER–SSKM)
- Kolkata, West Bengal, India
- SS Iyengar
- Consultant Cardiologist
- Manipal Hospital
- Bengaluru, Karnataka, India
- Sundeep Mishra
- Professor
- Department of Cardiology
- All India Institute of Medical
- Sciences (AIIMS)
- New Delhi, India
- Hon Editor
- Indian Heart Journal
- Suparna Rao
- Associate Consultant (Cardiology)
- Indraprastha Apollo Hospitals
- New Delhi, India
- Swapnil Mate
- Senior Resident
- Department of Cardiology
- King Edward Memorial Hospital and
- Seth GS Medical College
- Mumbai, Maharashtra, India
- Swati Tyagi
- Resident of Cardiology
- Govind Ballabh Pant Institute of
- Postgraduate Medical Education and Research and
- Maulana Azad Medical College
- New Delhi, India
- Ulhas M Pandurangi
- Senior Consultant
- Department of Cardiac
- Electrophysiology and Pacing
- The Madras Medical Mission
- Chennai, Tamil Nadu, India
- Upendra Kaul
- Executive Director and Dean (Cardiology)
- Fortis Escorts Heart Institute
- New Delhi, India
- Vijayakumar Subban
- Senior Consultant (Cardiology)
- Institute of Cardiovascular Diseases
- The Madras Medical Mission
- Chennai, Tamil Nadu, India
- Vineet Bhatia
- Principal Consultant (Cardiology)
- Fortis Hospital, Noida, Gautam
- Budh Nagar, Uttar Pradesh, India
- Vishal Batra
- Resident
- Department of Cardiology
- Instittute of Postgraduate Medical
- Education and Research and Seth
- Sukhlal Karnani Memorial Hospital (IPGMER–SSKM)
- Kolkata, West Bengal, India
- Yash Lokhandwala
- Department of Cardiology
- Lokmanya Tilak Municipal General (LTMG) Hospital, Sion
- Mumbai, Maharashtra, India
- Yatin Mehta
- Chairman
- Institute of Critical Care and
- Anesthesiology
- Medanta‒The Medicity
- Gurgaon, Haryana, India
- Zohaib Shaikh
- Department of Cardiology
- Lokmanya Tilak Municipal General (LTMG) Hospital, Sion
- Mumbai, Maharashtra, India
When written in Chinese, the word ‘crisis’ is composed of two characters, one represents danger and the other represents opportunity. That defines the practice of critical care cardiology where high-risk disease represents the danger and good longterm outcome with minimal morbidity in most patients who tide over the acute insult‒represents the opportunity.
Cardiac care has changed significantly over the last two decades and great progress has been made in the management of cardiac diseases. Integration of technology with clinical wisdom has led to better management of cardiac disease in hospital setting and this has resulted in overall better clinical outcomes for the patients in long term.
In the present scenario, a lot of literature is available in the field of cardiology. However, we were realizing the lack of consolidated literature for management of cardiac conditions in acute critical care setting. Therefore, our goal was to create an academic resource to address the issues of critical care cardiology and accumulate the views and ideas from experts in this field.
The problems we encounter in India are at times unique and offer specific challenges. Cost optimization remains a priority. Hence, this book focuses on specific issues faced by Indian physicians managing Indian patients.
We hope that you will appreciate our small efforts and be gracious to forgive any oversight on our part. We would look forward for your comments and suggestions so as to improve this resource in future.
Santanu Guha
S Ramakrishnan
Rishi Sethi
Acknowledgments
The Scientific Committee of the 67th Annual Conference of the Cardiological Society of India (CSI) sincerely acknowledges the contribution of Torrent Pharmaceuticals Limited toward the publication of this book.