Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
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Saraswati Dental College
On Sep 2018

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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
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On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : March | Volume : 17 | Issue : 3 | Page : OC01 - OC04 Full Version

An Outcome Analysis of Asymptomatic COVID-19 Patients Presenting with Angina- A Retrospective Study

Published: March 1, 2023 | DOI:
Dipankar Ghosh Dastidar, Rakhi Sanyal, Nandita Ghosh Dastidar, Tirna Halder

1. Associate Professor, Department of Cardiology, Burdwan Medical College, Kolkata, West Bengal, India. 2. Associate Professor, Department of Internal Medicine, JIMSH, Kolkata, West Bengal, India. 3. Consultant, Department of Pulmonology, South Eastern Railway Hospital, Kolkata, West Bengal, India. 4. Director, Department of Clinical Operations, OrciVita Sciences and Research Pvt. Ltd., Kolkata, West Bengal, India.

Correspondence Address :
Dipankar Ghosh Datidar,
5/2 Gobindo Auddy Road, Kolkata-700027, West Bengal, India.


Introduction: Cardiovascular disorders have long been considered as one of the leading causes of mortality in India, which when presented with concurrent Coronavirus Disease (COVID-19) infection becomes even more fatal. Evidence suggests that COVID-19 affects the cardiovascular system by causing exuberant cytokinaemia, which results in endothelial inflammation and microvascular thrombosis, leading to multiorgan failure.

Aim: To analyse the outcome of the asymptomatic COVID-19 patients presenting with cardiac angina during the second wave of COVID-19 in India.

Materials and Methods: This is a retrospective data analysis of asymptomatic COVID-19 patients hospitalised with angina was conducted between April 2021 to June 2021 at Bardhhaman Medical College and Hospital located at Bardhdhaman district of West Bengal, India. A total of 1235 patients underwent all regular biochemical, haematological and cardiac investigations after undergoing test for COVID-19 test. Data was retrospectively collected. The outcome of these patients was analysed. Estimation of mean, standard deviation, percentage, p-value (from Pearson’s correlation) was performed to establish the aim of the study.

Results: Seventy six out of 1235 patients tested positive for asymptomatic COVID-19. The mean age of this study population was 55.075±10.95 years, of which were 55 male and 21 female. Hypertension was the most prevalent co-morbidity followed by diabetes, 73 (96%) presented with chest pain. A total of 47(62%) of these 76 patients had ST Elevated Myocardial Infarction (STEMI). Eleven (14.4%) underwent Percutaneous Coronary Intervention (PCI) whereas 36 (47.3%) underwent fibrinolytic therapy with tenecteplase, followed by secondary PCI in 27 (75%) of them. Rest 29 (38%) were medically managed for unstable angina. Mortality rate was as low as 6.5%. Age and comorbidity were the contributing factors for STEMI among asymptomatic COVID-19 patients.

Conclusion: The results indicate that age and comorbidity are the factors, which lead to death or increases the life risk among patients with asymptomatic COVID-19. In this study, we have established that for the current patient population STEMI and age are negatively corelated. Medical management with thrombolytic agent became a lot more accepted in this scenario. PCI still remains the gold standard to treat myocardial infarction. It is recommended that there should be an ICMR guided protocol for the management of such cases with the concurrent COVID-19.


Cardiovascular diseases, Myocardial infarction, Thrombolysis

Epidemiological data suggests the global emergence of Non Communicable Diseases (NCD) is a threat to public health (1). Among them, Cardio Vascular Disease (CVD) accounts for 17.9 million deaths worldwide followed by cancers (9.3 million), respiratory diseases (4.1 million) and diabetes (1.5 million) (2). Global disease burden of CVD has significantly increased from 271 million in 1990 to 523 million in 2019 with a near 50% rise in death due to CVD as well from 12.1 million in 1990 to 18.6 million in 2019 (3). The World Health Organisation (WHO)'s statistics suggests that NCDs accounts for 53% of total deaths in India of which 24% is attributed to CVD (4), making it the leading cause of mortality in India (5). Though the mortality rate due to communicable diseases have been on a downward curve over the last 2 decades (6), the global emergence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) infection has rewritten all facts and numbers. As of May 2022, more than 539,795,635 confirmed cases of COVID-19 have been reported with 6,329,853 deaths (7). Evidence suggests that COVID-19 effects the cardiovascular system (8),(9) by causing exuberant cytokinaemia, which results in endothelial inflammation and microvascular thrombosis leading to multiorgan failure (10). Prevalence of comorbidities like hypertension and diabetes raises the risk factor for cardiac involvement among COVID-19 patients (11). The association between systemic viral infection, acute myocardial infection and inflammation is well established (12),(13). Although the pathophysiology of cardiovascular complications due to COVID-19 infection has been established yet there is paucity of data on the characteristics, management and outcomes of asymptomatic COVID-19 patients presenting with cardiovascular complications. The aim of this retrospective study was to analyse the outcome of asymptomatic COVID-19 patients presenting with cardiac angina based on laboratory investigations and medical management provided.

Material and Methods

This is retrospective data analysis of asymptomatic COVID-19 patients hospitalised with cardiac complications (like angina, shortness of breath, dizziness, heaviness in chest) at the Department of Cardiology of Bardhhaman Medical College and Hospital located at Bardhhaman district of West Bengal, India between April to June 2021. The symptoms included severe chest pain, shortness of breath, syncope, nausea and fatigue. Nasopharyngeal sample was collected for real-time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) testing from all patients as they neither had any COVID-19 test report nor showed any symptom of COVID-19. They were also tested for COVID-19 with rapid antigen as the RT-PCR report came after 24 hours of sample collection.

Inclusion criteria: Patients who tested positive for COVID-19 but were symptomatic presenting with cardiac complications aged ≥18 years were included in the study.

Exclusion criteria: COVID-19 negative and or asymptomatic COVID-19 patients, unavailability of complete data set for analysis, patient’s who did not consent were excluded from the study.

Among the 1235 patients who visited the cardiology department of the district superspecialty hospital during the second wave of COVID-19 in India between April to June 2021, 76 patients were found to be asymptomatic COVID-19 positive. As per the inclusion criteria only these 76 patients’ data was included in the study

Study Procedure

Data was retrospectively collected by on duty doctors in the hospitals from patients’ medical notes when the project was conceived. It included demographics, comorbidities, Echocardiography (ECG), laboratory investigations (biochemistry, haematology, serology, urine analysis), diagnosis, management, and outcomes.

The ethics committee of the institute was approached with retrospective study plan. The study received its ethical clearance from the Institutional Ethics Committee of Bardhhaman Medical College. The ethical clearance letter number is BMC/I.E.C/470. Patients were called at site for follow-up after one month of discharge. Consent was obtained from all the participants.

The data was statistically analysed for the demographics (age, sex, ethnicity, marital status) of the study population, diagnosis (myocardial infarction, unstable angina, atrial fibrillation, atherosclerosis) rate of comorbidities present and mortality outcome achieved by the patients.

As per the ICMR guidelines for management of MI (14), patients were managed medically by thrombolysis and/or PCI. When they tested COVID-19 negative or as per Cardiology Society of India guidelines for management of STEMI (15), PCI was performed with all safety measures. ICMR emergency surgical guidelines were followed in case of COVID-19 in patients with higher Thrombolysis In Myocardial Infarction (TIMI) risk score (16). Successful thrombolysis was defined as reduced ST elevation by >50% within 90-120 minutes with relief from chest pain and haemodynamic stability (15). Angiography was performed to assess the TIMI flow grade.

Statistical Analysis

Mean and standard deviation was estimated for quantitative parameters. Percentage was calculated for male, female, comorbidity load and outcomes. Pearson’s correlation test was performed between factors like comorbidity, age, STEMI. Statistical analysis was performed by SPSS Version 28.


The number of male patients in the study population was 55 and that of female was 21. The mean age of the study patients was 55.075±10.95 years.

(Table/Fig 1) enlists the characteristics of 76 asymptomatic COVID-19 positive patients presenting with angina. Co-morbidity load of the study patients was high with 73.7% having at least one co-morbidity or more. Hypertension (HTN) (19, 25%) was the most common comorbidity observed among the study patients, followed by Diabetes Mellitus (DM) (15,19.73%). Both DM and HTN were present among 14.47% of the study population. Strikingly 20 i.e., 26.31% patients did not have any known co-morbidity (Table/Fig 2).

ECG was performed as primary investigation for all 76 patients and ST elevation was observed among 47 patients i.e., 61.8%. Non ST elevation patients, 29 (38.15%) were treated for unstable angina, atrial fibrillation, hypertropic cardiomyopathy, atherosclerosis and managed medically but had a mean hospital stay of 5±1.2 days. Laboratory investigations such as sodium (136-145 mEq/l), potassium (3.5-5.1 mEq/l), liver function test (AST and ALT <32U/l), urea (21-43 mg/dL), creatinine (<1.2 mg/dL), lipid profile, complete blood culture, thyroid profile, urine analysis of patients in all subgroups (death, PCI and medical management) based on their outcomes showed similar characteristics with a p-value which was not statistically significant.

Out of 76, 73 (96%) presented with chest pain and 3(4%) presented with shortness of breath. The ECG conducted confirmed 47 patients of having ST elevation. Among these 47 patients, 37 patients underwent PCI, either primary or secondary. As the hospital was in a rural setting, only 11 patients underwent primary PCI as their door to balloon time was less than 120 minutes. Others (36) underwent thrombolysis with hospital supplied Tenecteplase of which 27 underwent secondary PCI after recovering from COVID-19. The dose of thrombolytic agent Tenecteplase was calculated based on the body weight of the patients.

Out of 76, 71 patients reported recovered either with medicine, thrombolysis or PCI. Death was the outcome for 5 patients whose mean age was 75.60±16.22 and strikingly all of them were male with more than 2 comorbidities. The mean hospital stay was 7.8±2.3 and 10.32±3.68 days for patients undergoing thrombolysis and PCI, respectively. Mechanical ventilation was given to two patients who underwent primary PCI but ultimately resulted in death. (Table/Fig 3) graphically represents the final outcome of the study population.

Statistically significant correlation was found to exist between comorbidity, age and STEMI as represented in (Table/Fig 4),(Table/Fig 5).


Management of any coronary disease or event presents a great challenge as it can be fatal if not addressed in time. When such events are added with concurrent asymptomatic COVID-19, it presents an even greater threat than the pre-pandemic management of such events. In this scenario, the use of fibrinolytic therapy has gained momentum (17). Stable patients who report at hospital within 12 hours of experiencing STEMI can be administered with this therapy. In COVID-19 patients’, fibrinolytic therapy is chosen over primary PCI by experts in China (18) if the patient is stable and presents within 12 hours of experiencing angina or cardiac complications which can fall under this category of coronary events. Though patients are successfully being managed with fibrinolytic therapy, many questions still remain unanswered and unaddressed. The guidelines available for management of coronary events in COVID-19 patients are still not enough to address various situations encountered in real life settings. Different hospitals have different SOP based on the country’s medical guidelines for such scenarios. The mortality rates vary across different populations, such as a 19 patient case series in New York (19) and a 28 patient case series in Italy (20) reported much higher mortality rates than observed in the study population of 76 patients. However, the long term follow-up of the cases may report differently as the far-fetched effects of the pandemic are still unknown. Coronary diseases or events are categorised as highly morbid and there is a plethora of condition which influences mortality. In this study, death was the outcome for patients who were male and their average age was 75.60±19.28. Patients without any comorbidity recovered faster than patients with one or more comorbidity. It can be concluded that presence or absence of comorbidity influenced the patient outcome in case of this study as all patients who experienced death had two or more comorbidities, whereas 13 of 20 patients with no comorbidity could be medically managed with thrombolysis.

Fibrinolytic therapy has been recommended as the first line of treatment for stable patients with myocardial infarction and COVID-19 infections by many experts from USA and China (18), however, no such ICMR guideline is available yet for the same. Also, it is reported that since COVID-19 has approximately 31% (21) thrombotic complications, fibrinolytic therapy and anticoagulants can improve outcomes in patients who have high levels of D-dimer. Elevated level of cytokines and D-dimer is a result of COVID-10 infection which in turn increases the prothrombin time (22). This can also lead to endothelial damage, thus exposing the patient to a hypercoagulable state (23). It is suggested by Schoenhagen P et al., that change in the couagulable state may result in the plaques to weaken, rupture and finally lead to thrombosis (24). Kumar N et al., also suggests the use of anticoagulant therapy in such cases (22). There are also several studies suggesting that COVID-19 patients are prone to thrombosis or thrombotic events and comorbidities like diabetes and hypertension can act as a prognostic factor (25),(26),(27). The present study also reports the same. Several protocol changes can be suggested to treat patients in such scenarios but we are yet to appear at a structured guideline to counter such situations. The research available on COVID-19 and its cardiac manifestation is very less to understand and manage patients in such emergency conditions.


Due to the rural setting, it is one of the limitations that the D-dimer of the patient population could not be estimated. The other limitations include the fact that this study was performed retrospectively during the second wave of COVID-19 so it was not possible to collect more data from patients due to the shortage of staff and facilities in our settings. Second, patients in cardiogenic shock could not be taken to OT due to the unavailability of ventricular assist device and Intra-Aortic Balloon Pump at the hospital. The study population is very small which limits us from performing many relevant statistical analyses. Lastly, there was no control group to match the data and perform case control analysis at the then emergency situation along with the dearth of proper guidelines to treat patients in the pandemic scenario.


The present study concludes that there is a positive correlation between STEMI and comorbidities. This study also shows multiple outcomes in case of asymptomatic COVID-19 patients. The analysis of the outcome reports the mortality rate to be low and concludes that patients can be saved if diagnosed in time but the unavailability of proper guidelines had worsened the situation during the second wave. The results establish the need for proper guidelines from ICMR and cardiology society of India in such emergency situation.


Kundu J, Kundu S. Cardiovascular disease (CVD) and its associated risk factors among older adults in India: Evidence from LASI Wave 1. Clin Epidemiol Global Health. 2022;13:100937. [crossref]
World Health Organization (2021). Noncommunicable Diseases. Retrieved September 2, 2021, from WHO website: -sheets/detail/noncommunicable-diseases.
Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982-3021. [crossref] [PubMed]
WHO. Non Communicable Diseases Country Profile: India. 2010.
Reddy KS, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet. 2005;366(9498):1744-49. [crossref] [PubMed]
Giustino G, Pinney SP, Lala A, Reddy VY, Johnston-Cox HA, Mechanick JI, et al. Coronavirus and cardiovascular disease, myocardial injury, and arrhythmia. J Am Coll Cardiol. 2020;76(17):2011-23. [crossref] [PubMed]
COVID Live- Coronavirus statistics- Worldometer. https://www.worldometers. info/coronavirus/ Last accessed on 07/11/2022
Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalised patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;25:802-10. [crossref] [PubMed]
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62. [crossref] [PubMed]
Fauci AS, Lane HC, Redfield RR. Covid-19- navigating the uncharted. N Engl J Med. 2020;382 1268-69. [crossref] [PubMed]
The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Coronavirus COVID-19 global cases. Accessed May 20, 2020.
Warren-Gash C, Hayward AC, Hemingway H, Denaxas S, Thomas SL, Timmis AD, et al., Influenza infection and risk of acute myocardial infarction in England and Wales: a CALIBER self-controlled case series study. J Infect Dis. 2012;206(11):1652-59. [crossref] [PubMed]
Claeys MJ, Coenen S, Colpaert C, Bilcke J, Beutels P, Wouters K, et al., Environmental triggers of acute myocardial infarction: results of a nationwide multiple-factorial population study. Acta Cardiol. 2015;70(6):693-701. [crossref] [PubMed]
Harikrishnan S, Mohanan PP, Chopra VK, Ambuj R, Sanjay G, Bansal M, et al. Cardiological society of India position statement on COVID-19 and heart failure. Indian Heart J. 2020;72(2):75-81. [crossref] [PubMed]
Guha S, Sethi R, Ray S, Bahl VK, Shanmugasundaram S, Kerkar P, et al., Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India. Indian Heart J. 2017;69:S63-S97. [crossref] [PubMed]
Ralhan S, Arya RC, Gupta R, Wander GS, Gupta RK, Gupta VK, et al. Cardiothoracic surgery during COVID-19: Our experience with different strategies. Ann Card Anaesth. 2020;23:485-92. [crossref] [PubMed]
Zeng J, Huang J, Pan L. How to balance acute myocardial infarction and COVID- 19: the protocols from Sichuan Provincial People’s Hospital [published online ahead of print, 2020 Mar 11]. Intensive Care Med. 2020;46(6):1111-13. [crossref] [PubMed]
Jing ZC, Zhu HD, Yan XW, Chai WZ, Zhang S. Recommendations from the Peking Union Medical College Hospital for the management of acute myocardial infarction during the COVID-19 outbreak [published online ahead of print, 2020 Mar 31]. Eur Heart J. 2020. [crossref] [PubMed]
Bangalore S, Sharma A, Slotwiner A, Yatskar L, Harari R, Shah B, et al. ST- Segment elevation in patients with Covid-19- a case series [published online ahead of print, 2020 Apr 17]. N Engl J Med. 2020;NEJMc2009020. [crossref] [PubMed]
Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, et al. ST-Elevation Myocardial Infarction in Patients with COVID-19: Clinical and Angiographic Outcomes [published online ahead of print, 2020 Apr 30]. Circulation. 2020;141(25):2113-16. [crossref] [PubMed]
Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al., Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-47. [crossref] [PubMed]
Kumar N, Verma R, Lohana P, Lohana A, Ramphul K. Acute myocardial infarction in COVID-19 patients. A review of cases in the literature. Arch Med Sci Atheroscler Dis. 2021;6:e169-75. Published 2021 Sep 20. Doi:10.5114/ amsad.2021.109287. [crossref] [PubMed]
Cardiac Manifestations of Coronavirus (COVID-19 Available at: https://www. campaign=CME&utm_content=95199 Accessed date: 10 June 2021.
Schoenhagen P, Tuzcu EM, Ellis SG. Plaque vulnerability, plaque rupture, and acute coronary syndromes: (multi)-focal manifestation of a systemic disease process. Circulation. 2002;106:760-62. [crossref] [PubMed]
Ramphul K, Ramphul Y, Park Y, Lohana P, Kaur Dhillon B, Sombans S. A comprehensive review and update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Coronavirus disease 2019 (COVID-19): what do we know now in 2021? Arch Med Sci Atheroscler Dis. 2021;6:05-13. [crossref] [PubMed]
Lippi G, Sanchis-Gomar F, Henry BM. Active smoking and COVID-19: a double- edged sword. Eur J Intern Med. 2020;77:123-24. [crossref] [PubMed]
Ramphul K, Lohana P, Ramphul Y, Park Y, Mejias S, Dhillon BK, et al. Hypertension, diabetes mellitus, and cerebrovascular disease predispose to a more severe outcome of COVID-19. Arch Med Sci Atheroscler Dis. 2021;6:e30-e39. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/59103.17577

Date of Submission: Jul 15, 2022
Date of Peer Review: Sep 10, 2022
Date of Acceptance: Feb 09, 2023
Date of Publishing: Mar 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jul 17, 2022
• Manual Googling: Jul 24, 2022
• iThenticate Software: Feb 08, 2023 (6%)

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