Situs ambiguous in an adult with congenital cardiovascular and musculoskeletal defect

Situs ambiguous [SA] is an abnormality in which the thoracic and abdominal organs are not clearly lateralized. Situs ambiguous with polysplenia is usually associated with complex cardiovascular abnormalities and rarely found among adults due to high mortality at younger age. We are reporting a rare cluster of Situs ambiguous with polysplenia [left isomerism] in an adult with congenital hand deformity and cardiovascular pathology, who presented with ascites and decompensated congestive cardiac failure due to dilated cardiomyopathy. He had congenital agenesis of left hand fingers and hypoplastic left thumb. Electrocardiogram and imaging findings were consistent with dextrocardia, Situs inversus and features of left isomerism. Echocardiography showed severe biventricular failure with prominent coronary sinus. Such a combination of musculoskeletal and cardiovascular pathologies was not reported in the literature. His coronary arteries were normal. He had successful single chamber Implantable Cadioverter Defibrillator [ICD] insertion

Prediction of 10-year risk of hard coronary events among Saudi adults based on prevalence of heart disease risk factors

Cardiovascular disease is becoming the lead cause of mortality and morbidity worldwide, and developing countries are the main contributors to this trend. Saudi Arabia, which is considered a rapidly developing country, faces progressive urbanization and the adoption of a westernized lifestyle, factors which contribute to the rising burden of cardiovascular disease. Our study evaluates the prevalence of coronary risk factors and predicts hard coronary artery events over 10 years in an urban Saudi cohort. A cross-sectional observational study was conducted on a Saudi population. The study involved Saudi subjects aged more than 20 years without a history of coronary heart disease. Demographic variables and hard coronary events [HCE] risk factors were measured. Each subject's 10-year HCE risk was estimated by means of the Framingham Risk Score [FRS]. A total of 4932 subjects [2215 men and 2717 women] were examined, the majority [85%] of whom were less than 40 years old. The risk of developing HCE within the next 10 years was low in 92.6% of subjects, intermediate in 3.2% and high in 4.1%. On considering diabetes as coronary heart disease [CHD] risk-equivalent, 26% of subjects were at high risk for hard coronary events in 10 years. The HCE risk progressively increased with age and was higher in men. Our study, the first to estimate the 10-year risk of HCE among adults in an emerging country, deter-mined that a significant proportion of a younger aged population is at risk for the development of hard coronary events. Public awareness programs to control risk factors are warranted

Frequency of acute renal failure after cardiac catheterization and percutaneous intervention

To observe the frequency of acute renal failure after percutaneous coronary intervention and cardiac catheterization. This is a retrospective study, comprising 200 patients undergoing cardiac catheterization and percutaneous coronary intervention at Aga Khan University Hospital. Patient aged above 18 years and not on regular dialysis was included in the study. Proper history and physical examination was carried out on every properly hydrated with 50 ml/hr of normal saline except in-patient with congestive cardiac failure. Serum creatinine and blood urea nitrogen was checked before procedure and 24 hrs after procedure. Amount and type of contrast media was noted. Serum creatinine after 24 hrs is compared with base line creatinine. Rise in serum creatinine of >0.5 mg/dl, is labeled as contrast induced nephropathy. Out of a total 199 patients [1 was excluded as he was on regular dialysis] 16 [8%] were found to have contrast induced nephropathy. Congestive cardiac failure and renal insufficiency were found to have significant association for development of contrast induced nephropathy. Contrast induced nephropathy is not a frequent complication. Contrast [ionic or nonionic] is safe to use in patients undergoing percutaneous coronary intervention and cardiac catheterization even in presence of risk factors. However caution should be used in patient with congestive cardiac failure and antecedent renal insufficiency