Atrioventricular and interventricular groove and septal extension of right sinus of Valsalva aneurysm: a rare cause of complete heart block

A 26 years old male presented with vertigo and history of fall. The electrocardiogram revealed 2:1 second-degree heart block and later progression to complete heart block. Transthoracic echocardiography revealed aneurysm at the site of ascending aorta and computed tomographic scan showed an aneurysm of right sinsus of Valsalva extending into right atrioventricular and interventricular groove and causing complete heart block by compression on the conduction system. He also suffered from lymph node tuberculosis. This case report is unique because of rare presentation as complete heart block

Bidirectional ventricular tachycardia of unknown etiology

A 45 years old male presented to the emergency department with palpitations, headache and apprehension. Hiselectrocardiogram revealed bidirectional ventricular tachycardia. He remained vitally stable and responded to intravenous beta-blocker. Initially digitalis toxicity was suspected but history was negative for digitalis intake. The cause remained unidentified in patient despite detailed investigations. During a short follow-up [of 6 months] he remained asymptomatic and no cause was further identified during this period. Some other unseen causes of bidirectional ventricular tachycardia need to be explored

Adult basic life support: update from the recent guidelines on cardiopulmonary resuscitation

Sudden cardiac death is the most prevalent yet preventable clinical problem. It is estimated that about 300,000 to 400,000 deaths occur annually due to cardiovascular causes with 63% occurring due to sudden cardiac deaths. The most important determinant of survival among these patients is the prompt and effective delivery of basic life support at the site or by the first bystander. Although there has been a decline in overall cardiovascular morbidity and mortality but the incidence of sudden deaths from cardiovascular causes has remained constant. Currently the basic life support not only includes cardiopulmonary resuscitation but also defibrillation using automated external defibrillators. The latest guidelines for cardiopulmonary resuscitation published in 2010 by the American Heart Association [AHA] have made substantial changes to the basic life support strategy. The conventional stepwise approach A-B-C has been changed to C-A-B. This mandates the decrease in time to deliver first compression. Look, listen and feel has been omitted to avoid unnecessary delay of the chest compressions. The pulse check parameter has also been diminished for healthcare providers. This review covers the management of cardiopulmonary resuscitation, and scrutinizes current practices and data supporting the use of CPR

Nephrotic syndrome: a rare cause of acute coronary syndrome in a child

Patients with nephrotic syndrome are at risk of developing thrombosis in both veins and arteries. Various manifestations in different organs have been reported. Thrombi in heart seen, associated with multiorgan thrombosis have been reported on autopsy earlier, but only once in a living patient with nephrotic syndrome. Here, we report a 13 years old boy with steroid-resistant nephrotic syndrome, who developed an asymptomatic but potentially hazardous large intracardiac thrombus. The child developed nephrotic syndrome at the age of 9 years and had multiple recurrences. At the age of 13 years, he developed myocardial infarction [MI] due to embolism from a large intracardiac thrombus. Later on, he was treated with heparin and warfarin anticoagulation

Adult basic life support: an updated summary from the recent guidelines on cardiopulmonary resuscitation [CPR]

Sudden cardiac death is the most prevalent yet preventable clinical problem. It is estimated to cause 300,000 to 400,000 deaths annually with 63% cardiac deaths. The most important determinant of survival among these patients is the prompt and effective delivery of basic life support at the site or by the first bystander. Although there has been a decline in overall cardiovascular morbidity and mortality but the incidence of sudden deaths from cardiovascular causes has remained constant. In the current era the basic life support not only includes cardiopulmonary resuscitation [CPR] but defibrillation has also been added by using automated external defibrillators. The latest guidelines for CPR published in 2010 by the American Heart Association [AHA] have made substantial changes to the basic life support strategy. The conventional stepwise approach A-B-C has been changed to C-A-B. This mandates the decrease in time to deliver first compression. Look, listen and feel has been omitted to avoid unnecessary delay of the chest compressions. The pulse check parameter has also been diminished for healthcare providers. This article is a review of management of CPR. It scrutinizes current practices and data supporting the use of CPR.

Infective endocarditis: a rare cause of acute coronary syndrome

This is a case report of a 26 years old female who presented in emergency with sudden onset of chest heaviness and dyspnoea. She had suffered a stroke in the past and was treated with anti-tuberculous medication. Her ECG revealed STelevation myocardial infarction and thrombolysis was performed but was unsuccessful. Further workup during in-hospital stay revealed evidence of infective endocarditis and Streptococcus species were isolated. She was started on penicillin and gentamycin with good recovery. This case presented a management problem during initial presentation as there was insufficient data on thrombolysis during such situation. It is also a diagnostic problem as the initial picture was dominated by acute coronary syndrome. There is need to develop consensus based on expert opinion about management in such situations

Salmonella typhi infection: a rare cause of endocarditis

A 21 years old male with a history of mitral valve repair for mitral regurgitation is discussed. He was presented with a history of fever and loose motions for one month and shortness of breath for 03 days. Chest radiograph and ECG was within normal limits. Total leukocyte count was elevated and antibodies to salmonella typhi were positive. Blood culture revealed Salmonella typhi growth. Echocardiography revealed small echogenic masses on mitral valve. He responded to treatment with ceftriaxone given for 4 weeks. This is a rare case where Somonella typhi was isolated from blood of a patient with echocardiographic evidence of documented mitral valve disease and endcarditis

Device entrapment: a rare complication of percutaneous coronary intervention

Device entrapment is a rare complication of percutaneous coronary intervention. It has hazardous potentials for the patient. Emergent cardiac surgery is the only option after failure of retrieval devices. We have described here a case of a 55 years old male. During percutaneous coronary intervention, the balloon inflated only partially at its ends and entrapped in the lesion along with the stent. Multiple attempts at inflation failed and the patient developed severe chest pain for few minutes. Surgery was contemplated but final attempt at inflation was successful and the patient stabilized. It was an emergent situation and could have led to fatal outcome, although this patient escaped narrowly from any fatal outcome

Basic life support skills: assessment and education of spouse and first degree relatives of patients with coronary disease

To assess the knowledge of basic cardiac life support [BCLS] before and after the institution of training among first degree relatives and spouses of patients with coronary disease. Quasi-experimental study. National Institute of Cardiovascular Diseases, Karachi, from April 2007 to May 2008. A total of 300 relatives of patients with coronary heart disease undertook a one day CPR course. Questionnaire assessing knowledge of CPR was administered before and after the course. Patients were studied in groups of 10-20 at a time. Proportion of correct knowledge was compared using chi-square test with significance at p < 0.05. Mean age of participants was 31.08 +/- 10.53 years. Two hundred and twenty [73.34%] were males. On the average of all 31 questions, 37.09% of participants had correct responses before the training and 68.16% after the training of BCLS [p < 0.001]. There was statistically significant improvement across all age groups, gender and educational levels [p < 0.01]. There was significant improvement in relatives' knowledge of BCLS after training. Different age groups, both genders and all educational groups shoed equal learning abilities