In 2019, US-based Multinational technology conglomerate, Cisco Systems Inc. (Cisco) was awarded three Climate Leadership Awards from The Center For Climate and Enerrgy Solutions (C2ES) and The Climate Registry (TCR) . Two of these awards were given the efficiency in greenhouse gas management and one was given for supply chain leadership. Cisco had always believed in the benefits of environmental sustainability for economies as well as human life. The company had continuously incorporated actions into most of the aspects of their business to achieve environmental sustainability.

61 Can carvedilol be used in an elderly patient who developed left ventricular failure after a very recent myocardial infarction, or should it wait until the condition becomes stable?

62 I have seen some patients with chronic rheumatic heart disease with no obvious evidence of rheumatic fever (i.e. they could not recall if there was an episode of severe infection with subsequent fever and joint pain). So, actually, how is chronic rheumatic heart disease diagnosed?

63 If a young patient presents with hemiparesis and rheumatic atrial fibrillation and is already on oral anticoagulant, with an international normalized ratio (INR)

3 and a normal computed tomography (CT) scan done 2 hours after onset, should he receive heparin for prophylaxis against further embolism? Should aspirin be combined with oral anticoagulant later, or should target INR be increased? 64 When treating mitral stenosis using a balloon valvotomy, how come no thrombus develops at the site of the atrial septum or at the separated commissure of the valve leaflets?

65 Why does a mitral stenosis produce a loud S1?

66 Why is the mitral valve more affected than any other valve in the heart in most valvular diseases?

67 What is William's syndrome (supravalvular obstruction)? Why does hypercalcaemia occur with this syndrome?

68 Kindly tell me all the causes postulated for the collapsing pulse seen in aortic regurgitation.

69 Does pulmonary stenosis cause pulmonary hypertension?

70 Under what conditions would a pulsatile liver be found and what is its clinical significance?