Cardiovascular disease is the number one killer of death around the world. Most of the cardiovascular diseases are caused by sedentary life style, bad eating habit, tobacco smoking, high alcohol intake, dyslipidemia and genetic factors .Recently the idea of human microbiome science has emerged in diseases pathogenesis .The human gut is a house of trillions of microbial floral. Since a couple of decades ago, there has been interesting insights into the human gut microbiota and have highlighted its increasingly association to cardiovascular (CV) and metabolic diseases.

Background: Vascular anomalies are rare abnormalities which present with inspiratory stridor andrecurrent respiratory tract infection. They are the commonest causes of mortality and morbidity in children due to misdiagnosis. They comprise about less than 4% of congenital heart diseases. The commonest of these anomalies were vascular ring and pulmonary sling.

Background: Vascular anomalies are rare abnormalities which present with inspiratory stridor andrecurrent respiratory tract infection. They are the commonest causes of mortality and morbidity in children due to misdiagnosis. They comprise about less than 4% of congenital heart diseases. The commonest of these anomalies were vascular ring and pulmonary sling.

Introduction: Arrhythmic complications of acute myocardial infarction like ventricular arrhythmias are common and determine the clinical outcome. The associated risk factors like potassium level may help triage the patients to reduce mortality. Objective: Objectives were to determine the frequency of ventricular arrhythmias in acute myocardial infarction and to compare the frequency of ventricular arrhythmias in normokalemic and hypokalemic patients. Study design: Cross-sectional survey Study setting: Study was conducted in Department of Cardiology, Jinnah Hospital, Lahore. Duration of study: Study duration was six months i.e. from 1st February 2018 to 31st July 2018. Subjects & Methods: Using consecutive sampling, 370 patients with acute myocardial infarction were included. Development of ventricular arrhythmias was recorded. Rate of development of arrhythmias among normokalemic (serum potassium levels between 3.5mEq/L to 5.0mEq/L) at presentation and hypokalemic was compared. All enrolled patients received standard medical therapy for MI. History of hypertension and smoking was also elicited. Results: 370 patients were included with mean age of 54.5 ± 9.2 years ranging from 40 to 70 years of age. In our study the frequency of ventricular arrhythmias came out only 16.5%. 21.9% patients with hypokalemia developed ventricular arrhythmias after acute myocardial infarction as compared to 11.4% normokalemic patients (p value< 0.001). There was no significant effect of being older in age, any gender, and hypertensive in our sampled population. Being smoker was significantly associated with development of arrhythmia. Conclusion: It is concluded that patients with hypokalemia are at greater risk of developing ventricular arrhythmias after acute myocardial infarction.

The author describes a simple and inexpensive way to deliver high pressures within an atherosclerotic coronary artery and reports two cases. The technique used two non-compliant (NC) balloons placed in parallel and inflated together within the same coronary segment. The cases illustrate two possible indications for the technique: lesion resistant to one adequately sized NC balloon or not fully expanded coronary stents after high-pressure non-compliant ballooning.

Background: Valsalva maneuver one of the oldest method to diagnose heart failure, it’s cheap ,non-invasive ,bedside tool .Its well-studied in systolic heart failure patients which showed abnormal response either square wave or absent phase IV ,however in diastolic heart failure and diastolic dysfunction were not investigated .

Background and Purpose: The purpose of this study was to assess the correlation of cTn levels in the acute phase of ischemic stroke with the extent of stroke, the degree of disability assessed on the modified Rankin Scale, and their prognostic signifi cance.

Background : Several studies indicate that HRmax estimates using the traditional equation, HRmax = 220 - Age, may represent a regression slope and intercept that does reflect the true relationship between age and maximal cardiac frequency. Meta-analysis of several pertinent studies indicates that 220-Age significantly under-estimates the true HRmax, particularly in older patients. This is a critical issue in the exercise evaluation of pilots with CAD who seek reinstatement of an aviation medical certificate after a cardiac illness because end-points in exercise testing and fitness assessment are based upon the 220--Age method of HRmax estimation.

Background: We compared the angiotensin receptor–neprilysin inhibitor LCZ696 (sacubitril/valsartan) with enalapril in patients who had nonischemic heart failure with a reduced ejection fraction. Methods: In this double-blind trial, we randomly assigned 8442 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either LCZ696 (at a dose of 200 mg twice daily) or enalapril (at a dose of 10 mg twice daily), in addition to recommended therapy. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure, but the trial was designed to detect a difference in the rates of death from cardiovascular causes.

In the recent years, the extensive indications for cardiac electronic device implantation (CIED), has increased the probability to face with device-related complications during clinical practice [1]. Electronic system malfunction (device failure, lead fracture, contact defects), may represent a minor reason for complete or partial revision or replacement of components itself [2]. Nevertheless, large observational studies has shown that the incidence of infection is 1-7 % [3-5], being the most common indication for both device removal and lead extraction [6]. CIED infection significantly increases not only the number of hospitalizations but the risk of in-hospital death by more than 2-folds [7].

Background: Coronary artery disease (CAD) is the most common cause of left ventricular dysfunction (LVD). Confl icting evidence exists with regards to available treatments and patient prognosis. Revascularization may improve ventricular function while coronary artery bypass surgery (CABG) has signifi cantly improved survival. The effectiveness of percutaneous coronary intervention (PCI) has also not been thoroughly investigated to date.

Cardiovascular disease (CVD) is one of the most global threatened diseases; particularly coronary artery disease (CAD) is a major deadly attack around the world. Diabetes mellitus (DM) is associated with a 2 to 4-fold increased mortality risk from heart disease. Diabetes related microvascular complication is seemed to be a hazardous factor for cardiovascular system and likely to cause coronary arteries disease, hypertension, peripheral arteries, and carotid vessels, especially seen in the type 2 DM populations. The severity of cardiovascular complications are related to prolong hyperglycemia and the control of dysglycemia. Thus, effective glycemic control is one of the imperative aspects of the management for the prevention of CVD in diabetes. In addition, different kinds of antidiabetes agents have different mechanism of actions that has impacted to cardiovascular outcome. The benefit and risk of current anti-diabetic agents are needed to define clearly and that is needed to promote effective clinical care between cardiology and diabetology. There are multiple complications and sequelae of diabetes that requires the involvement of cardiologic expertise in the diabetes care setting in heart disease population. Therefore, the close cooperation between the cardiologist and the diabetologist is new perceptive way of care to defeat diabetes related cardiovascular complications.

Background: Coronary artery disease (CAD) is the most common cause of left ventricular dysfunction (LVD). Conflicting evidence exists with regards to available treatments and patient prognosis. Revascularization may improve ventricular function while coronary artery bypass surgery (CABG) has significantly improved survival. The effectiveness of percutaneous coronary intervention (PCI) has also not been thoroughly investigated to date.

The knowledge of the so-called “athlete’s heart”has been linked to the application of diagnostic techniques in cardiology. Perhaps, it is necessary to keep in mind that the “athlete’s heart” is a physiologically “healthy” heart. The figure 1 shows the parameters that determine the mean arterial pressure. Physical exercise is the only physiological circumstance that precedes the regional metabolic demand to the control of the average blood pressure.