Transvenous Permanent Pacemaker Implantation in 14 Month Old baby with Congenital Complete Heart Block.

Congenital Complete Heart Block in utero has been diagnosed more frequently with the clinical use of fetal echocardiography. The fetus with complete heart block may remain asymptomatic or develop congestive heart failure. Pacemaker therapy in children involves unique issues regarding patient size, growth, development and possible presence of congenital heart disease. Historically, epicardial pacing was more common in children. As technology has improved, generators and leads have become smaller and more advanced, allowing transvenous pacing system in children. Pacemaker therapy is even technically feasible in infants and neonates. We present a 14mth old baby of just 7.5kg who presented to us with Adams Stokes and subtle signs of congestive heart failure that after stabilization was implanted a transvenous MRI compatible permanent pacemaker (VVIR).

Hyponatremia Presenting as Cardiac Conduction Defect.

Hyponatremia, the most common electrolyte disorder in hospitalized patients is usually asymptomatic. Clinical cardiac toxicity associated with hyponatremia has not been previously described, Although it is usually difficult to single out hyponatremia as the cause of conduction defects thus,we describe a case that developed reversible cardiac conduction defect temporally associated with hyponatremia.

Correlation of hepatic venous pressure gradient with variceal bleeding, size of esophageal varices, etiology, ascites and degree of liver dysfunction in cirrhosis of liver.

An elevated hepatic venous pressure gradient (HVPG) has been associated with risk of variceal bleeding, and outcome and survival after variceal bleeding. In this pilot study, we measured HVPG in 40 patients with liver cirrhosis and studied its relationship with etiology of liver disease, esophageal variceal size, history of variceal bleeding or ascites, biochemical liver tests and Child-Pugh class. There was no procedurerelated complication. The mean (SD) HVPG was similar in patients who had history of variceal bleeding as compared to those who did not (15.4 [2.8] mmHg vs. 13.9 [2.7] mmHg, p=0.1); HVPG had no significant association with etiology of cirrhosis (p=0.4). HVPG levels were significantly higher in patients with larger esophageal varices (grade III/IV vs. I/II: 15.2 [2.7] mmHg vs.13.1 [2.8] mmHg, p=0.04), poorer Child- Pugh class (B or C versus A), and presence of ascites (p=0.04). Thus, HVPG correlated with variceal size, Child-Pugh class, and presence of ascites, but not with variceal bleeding status.

Complete Heart Block In Mumps Myocarditis.

Myocarditis is a relatively common complication occurring in Mumps (epidemic parotitis). Inflammation of the myocardium causes complications in some of these cases. Observation of complete heart block in patients of acute mumps myocarditis is a rare instance. We report a case of complete heart block in a patient suffering from mumps.

Brugada syndrome.

The syndrome of right bundle branch block, ST segment elevation from VI-V3 and syncopal episodes and/or sudden death in a patient with structurally normal heart is a new entity, named Brugada syndrome in 1992. In some individuals, the presentation may be asymptomatic with only abnormal electrocardographs while in others a history of sudden death in the family and electrocardiographic criteria are observed. This disease is genetically determined caused by a defect in the myocardial sodium channel (SCN5A). Sudden death in individuals with this syndrome can only be prevented by implanting a cardioverter-defibrillator.

Reflex Sympathetic Dystrophy Syndrome

Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndome Type-I (CRPS-I), a disease of unknown prevalance, complicates any minor trauma, stroke, myocardial infection, colle’s fracture, peripheral nerve injury and in one-fourth of cases without any precipitant factor. An awareness of RSD and the injuries, illnesses and drugs that can provoke it is the first step to learn for an early treatment and better outcome. Here we present a neglected case of RSD following minor trauma who presented to us after 6-7 months of onset of disease. Delay in treatment resulted in partial recovery of the patient.

Gouty Polyarthritis-An Uncommon Presentation

Crystal arthropathies are a group of disorders produced due to deposition of crystals in and around joints. These are usually monoarticular, but some 10% of the patients with mono sodium urate crystal arthropathy (Gout) can be polyarticular. However, in present set up with much advancement in diagnostic and therapeutic modalities, the number of patients of gout with polyarticular involvement is less common. Here we present a case of gouty polyarthritis with a prolonged intercritical period.