Typical signs of secundum atrial septal defect in a young female.

We report the case of a 25-year-female presented with dyspnea & chest pain on exertion. The ECG showed signs of right ventricular overload. The chest X-ray showed an enlargement of central pulmonary arteries, pulmonary plethora and a small aortic knuckle. Atrial septal defect (ASD) was suspected and transthoracic echocardiography (TTE) subsequently confirmed the presence of a large ostium secundum ASD. A surgical closure with an equine pericardium patch was performed. Two months after the surgical repair, the ECG and TTE showed the regression of signs of right ventricular overload.

Primary Antiphospholipid Antibody Syndrome Presenting as Recurrent Deep Vein Thrombosis.

Aniphospholipid Syndrome also known as sticky blood or Hughes’ syndrome, is an auto immune disease that can cause abnormal blood clotting in any blood vessels- both arteries & veins. As a result it can cause many different problems. These includes clots in the legs known as DVT, miscarriage & dangerous arterial thrombosis resulting in stroke & Heart attacks. Aniphospholipid Syndrome accounts for about one in five DVT & may be to blame in some cases of economy class syndrome, leading to the death of young people traveling on long flight, one in five case of stroke in young people (<45 years) is associated with the condition. APS also accounts for as many as one in five case of miscarriage. Miscarriage is thought to result from disruption of blood flow through small blood vessels of the placenta. The Syndrome has also been linked to pre-eclampsia, placental abruption & intra uterine growth restriction. People with APS are at great risk of - Venus thrombosis in the leg (DVT), arms & internal organ ( kidney, liver, lungs, brain, eye). Arterial thrombosis – which can be lead to recurrent stroke, TIA & Heart attack. Mild thrombocytopenia. Headache- which may be diagnosed as migraine. Multiple sclerosis like episode. Skin rash known as livedo reticularis. Recurrent pregnancy loss. The diagnosis of APS is made by a combination of one clinical criteria plus one laboratory criteria ( Revised Sapporo APS update 2006 ).The clinical criteria are vascular thrombosis & pregnancy events, with evidence from histopathological examination or imaging studies. The laboratory criterion is a medium to high level of anticardiolipin antibody, & beta-2 glycoprotein-1 or a positive lupus anticoagulant antibody 12 weeks apart .