Spontaneous multivessel coronary artery dissection associated with elevated homocysteine levels

A case of spontaneous multi-vessel coronary artery dissection in a young man, with markedly elevated serum homocysteine levels, is reported. The effects of elevated homocysteine levels on arterial endothelial function and possible plaque rupture leading to coronary dissection and acute coronary syndrome and / or sudden cardiac death are also discussed

Clinical and echocardiographic characteristics of patients with significant pericardial effusion requiring pericardiocentesis

Clinical and echocardiographic features of significant pericardial effusion [PE] have been reported from the west. Currently there is lack of published data from this part of the world, we reviewed all consecutive cases of significant PE requiring echocardiographic assisted pericardiocentesis to analyze the clinical and echocardiographic features of these patients. Forty four consecutive patients who underwent echocardiography assisted pericardiocentesis at the Aga Khan University Hospital [AKUH] between January 1988 and May 2001 are included in this review. Most common presenting symptoms were dyspnea [89%] and fever [36%]. Elevated JVP and pulsus paradoxus were documented in 59% and 41% of patients respectively. Sinus tachycardia [75%] and low voltage [34%] were the most common ECG findings. Malignancy [45-51%] and tuberculosis [27%] were among the most frequent causes of PE. One patient died during echocardiography-assisted pericardiocentesis. Majority of the pregnant females delivering at Aga Khan University Hospital were aware of epidural analgesia for labour. However, only a small proportion are availing this service, due to fears and misconceptions [JPMA 55:63;2005]. The symptoms and physical findings of haemodynamically significant PE are frequently nonspecific. Transthoracic echocardiography is the gold standard for rapid and confirmatory diagnosis of PE and cardiac tamponade. The most common cause of PE was malignancy followed by tuberculosis. Pericardiocentesis under echocardiographic guidance is a safe and effective treatment for significant PE