Srisakul Chirakarnjanakorn

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Executive Summary Thai Pulmonary Hypertension Guidelines 2020

Journal of the Medical Association of Thailand, Apr 15, 2021

<jats:p>In 2011, the Heart Association of Thailand (HAT) approved the first Thai guideline ... more <jats:p>In 2011, the Heart Association of Thailand (HAT) approved the first Thai guideline for the diagnosis and management of patients with pulmonary hypertension (PH). Since then, significant changes have occurred in the diagnosis and management of patients with PH, such as risk assessment and new strategies for combination therapies based on the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) pulmonary hypertension guidelines. The most recently updated definition of PH was from the Sixth World Symposium on Pulmonary Hypertension in 2018. Hence, HAT has revised the Thai guidelines for the diagnosis and management of patients with PH, which was approved by the Royal College of Physicians of Thailand in 2019. These guidelines are intended for use by 1) general practitioners for preliminary diagnoses and referral to a PH referral center and 2) specialist physicians such as cardiologists and pulmonologists, to collaborate in the caring process and diagnosis and management, including the use of Pulmonary artery hypertension (PAH)-specific drugs. The guidelines were written in Thai language to be easily understood and approved by HAT and the Royal College of Physicians of Thailand in 2019. The current executive summary is aimed to highlight important details of the 2020 Thai Pulmonary Hypertension Guidelines for a broader distribution. This updated version of the executive summary of the guidelines is aimed to achieve three objectives, 1) early diagnosis by using the algorithm, including pathophysiology into one of five PH groups, 2) risk assessment for PAH patients into low, intermediate, or high risk, and 3) sequential combination therapy as indicated by the risk assessment for PAH-specific drugs to maintain PAH patients within the low-risk group as much as possible to improve their long-term survival. Keywords: Guideline, Pulmonary hypertension, Diagnosis, Management</jats:p>

Images in Cardiology: Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Drainage

Sixty-one years old man came to our hospital due to progressive dyspnea. The physical examination... more Sixty-one years old man came to our hospital due to progressive dyspnea. The physical examination revealed left parasternal heaving, loud P2, pansystoic murmur grade III/IV at left lower sternal border with increasing intensity during inspiration, compatible with tricuspid regurgitation (TR) with pulmonary hypertension (PHT). Transthoracic echocardiography (TTE) demonstrated dilated right ventricle (RV) and right atrium (RA), severe TR, RV systolic pressure 70 mmHg. No atrial septal defect (ASD) was detected. TTE findings were compatible with volume overload of right heart. However, sensitivities of

Effects of Buddhist walking meditation on exercise capacity and quality of life of patients with chronic heart failure: A randomized controlled trial

Heart & Lung, 2021

BACKGROUND Buddhist walking meditation (BWM) is widely practiced in many countries. However, ther... more BACKGROUND Buddhist walking meditation (BWM) is widely practiced in many countries. However, there is a lack of evidence relating to its effectiveness for patients with heart failure (HF). PURPOSE To determine the effects of a six-week BWM program on exercise capacity, quality of life, and hemodynamic response in patients with chronic HF. METHODS Patients with HF were randomly assigned to a BWM program or an aerobic exercise program. Each group trained at least three times a week during the six-week study period. The outcome measures included exercise capacity (six-minute walk test), disease-specific quality of life (Minnesota Living with Heart Failure Questionnaire), and hemodynamic response (blood pressure and heart rate) immediately after the six weeks of training. RESULTS The study enrolled 48 patients with a mean age of 65 years and a New York Heart Association functional class of II and III. At baseline, there were no significant differences in their clinical and demographic characteristics or the outcome measures. Although six patients withdrew, all participants were included in the intention-to-treat analysis. There was no statistically significant increase in the functional capacity of the BWM group; however, there was a significant improvement for the aerobic group. With both groups, there was no significant improvement in quality of life or most hemodynamic responses. CONCLUSIONS The six-week BWM program did not improve the functional capacity, quality of life, or hemodynamic characteristics of the HF patients, compared with the values of the patients in the aerobic exercise program.

Non-Bacterial Thrombotic Endocarditis: Always Look Beyond the Heart

Journal of the American College of Cardiology, 2020

Background: Non-bacterial thrombotic endocarditis (NBTE) is an uncommon entity that should be con... more Background: Non-bacterial thrombotic endocarditis (NBTE) is an uncommon entity that should be considered in patients with thromboembolic events. Once suspected, work-up for hypercoagulable state, autoimmune disorders and malignancy are warranted. Case: A 54-year-old woman presented with an acute ischemic stroke in the left middle cerebral and left posterior cerebral artery territories. Echocardiography revealed preserved LV systolic function, apical dyskinesis with an apical thrombus (Figure 1A) and an RV thrombus. There was a 1.3 cm non-oscillating mass attached to the atrial side of the posterior mitral leaflet (Figure 1B, C) and moderate MR (Figure 1D). Decision-making: She refused to undergo a TEE. She was afebrile, antibiotics were started and blood cultures came back negative. NBTE was suspected and enoxaparin was started with subsequent warfarin. Work-up for hypercoagulable state was negative. One month later, she had acute limb ischemia. Lower extremity CTA demonstrated acute occlusion of the right popliteal artery and left tibioperoneal trunk. Incidentally, ovarian cancer with peritoneal metastasis was found. While on enoxaparin, she developed a DVT and pulmonary embolism (Figure 2). She underwent ovarian surgery and chemotherapy. At 3 months, the echocardiogram findings improved. Conclusion: This case highlights the diagnostic challenges of NBTE. Clinical and echocardiographic features in the context of sterile blood cultures are key diagnostic points.

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