Multiple mobile clots in right atrium and ventricle following insertion of temporary pace maker :a case report

Temporary pace marker [TPM] usually has been used in emergency conditions. Insertion of TPM is accompanied with vein thrombosis and pulmonary Emboli. TPM was inserted via right femoral vein in 73 years male due to complete heart block. Thereafter, he was suffered from deep vein thrombosis. Echocardiography revealed multiple mobile clots in right atrium, ventricle and impending pulmonary thromboemboli following insertion of permanent pacemaker. Despite of contraindication for the application of thrombolytic agents due to surgical incision for permanent pacemaker and presence of patent foramen oval, the patient survived from massive pulmonary thromboemboli and death due to rapid diagnosis and on time treatment with anticoagulation agents without performing surgery

[Origin of left coronary artery arising from the right coronary cusp]

Anomalous coronary artery origin is a rare clinical entity with varied clinical outcomes ranging from asymptomatic to sudden cardiac death. The incidence of anomalous origin of left coronary artery arising from the right coronary cusp is 0.3-1%. CT angiography is the choice method for coronary anomalies, but often coronary angiography in RAO [right anterior oblique] view shows the coronary course. We present a case that referred to our hospital with post myocardial infarction angina for coronary angiography. A resting 12-lead electrocardiogram showed ST-segment elevation in leads v2, v3, v4. A transthoracic echocardiogram indicated LVEF 25% [Left ventricular ejection fraction], septal akinesia and apical dyskinesia. Coronary Angiography showed an anomalous origin of the left coronary artery from the right coronary cusp and significant stenosis in LAD [left anterior descending] and LCX [left circumflex] arteries with poor run off

[ study of the efficacy of N-acetylcysteine for the prevention of contrast induced nephropathy in normal renal functioning patients undergoing coronary angiography]

N-Acetylcysteine [NAC] has been found to reduce the risk of Contrast Induced Nephropathy [CIN] in chronic renal insufficiency after CT imaging with contrast enhancement. The purpose of the current study was to evaluate the efficacy of NAC, for the prevention of CIN in normal renal functioning patients undergoing coronary angiography. We prospectively studied 100 patients, who were undergoing coronary angiography with meglumin compound 76% [Urografin], Patients were randomized one to two groups. Group one, IV hydration and NAC 600 mg PO were administered twice daily for 2 days [on the day prior to and on the day of coronary angiography]. Group two, was administered IV hydration alone [Control Group]. One hundred patients completed the study. There was no significant difference between the group in baseline characteristics, duration of angiography, mean volume of contrast agent infused or in mean IV hydration. Contrast nephropathy developed in 30% of subjects. 11/50 [22%] in NAC group and 19/50 [38%] in control group [P= 0.12]. In control group, the mean of Createnin Serum Level significantly increased 48 hours after administration of the contrast agent [P=0.001]. Our findings do not support routine prophylactic administration of oral NAC as an adjunct to saline hydration for prevention of contrast induced nephropathy, in patients with normal kidney, undergoing coronary angiography