A case of resolution of inferior wall myocardial infarction and varying degrees of atrioventricular block: a case report.

Inferior wall myocardial infarction (IWMI) complicating with high degree atrioventricular (AV) block had been a subject of discussion for a long time. Also the transient nature of these AV blocks in the presence of IWMI is well known to us. However our case presented with IWMI with right ventricular MI (RVMI) and in complete heart block and subsequently post thrombolysis developed varying degrees of AV block and reverted back to sinus rhythm. We found it as an incidence not much reported and thus reporting the case herewith.

Atrial fibrillation associated with high voltage electric shock in a young healthy female: a case report.

Atrial fibrillation is amongst the various arrhythmias resulting after electrical injury but its incidence has been reported to be extremely rare. Here we are reporting a case of 35 years old lady presenting to our Emergency department with atrial fibrillation with fast ventricular rate after accidentally being injured by high voltage electrical current. She was managed successfully with pharmacological cardioversion followed by a period of observation. The rhythm reverted back to normal sinus rhythm on 3rd day. This approach of management is amongst one of the few published cases where patient was managed conservatively.

Miller Fisher syndrome/acute motor axonal neuronopathy overlap an atypical manifestation of malaria: a case report.

Various types of neurological manifestations are described in P. falciparum/vivax malaria of which Guillian Barre syndrome and its variant like Miller Fisher Syndrome (MFS) and Acute Motor Axonal Neuronopathy (AMAN). We are reporting such an unusual case who presented with five days history of fever and weakness of three days duration. On investigations it turned out to be acute MFS/AMAN overlap with peripheral blood showing mixed infection having heavy parasitaemia of P. falciparum and P. vivax combine. All other causes of acute polyneuropathy were ruled out by history and relevant examination. Patient improved with Artemisinin based Combination Therapy (ACT) and other supportive measures.

Staphylococcus aureus septicemia presenting as disseminated intravascular coagulation - thrombotic thrombocytopenic purpura overlap and thrombus in inferior vena cava, right atrium and right ventricle: a case report.

Staphylococcal sepsis following furunculosis and complicated by suspected deep vein thrombosis and septic inferior vena caval, right atrium, right ventricle emboli accompanied by disseminated intravascular coagulation (DIC) - thrombotic thrombocytopenic overlap in a 65 years old lady is presented. She was managed successfully with antibiotics and anticoagulation. The case is reported for its rarity and brings to light the vivid manifestations of septicemia specially staphylococcal.

Hemichorea as a presentation of acute rheumatic fever: a case report.

Chorea is a major manifestation of acute RF and is the only evidence of RF in approximately 20% of cases. We report on a 15-year-old boy who presented with transient right side involuntary jerky movements, apical systolic murmur, sinus bradycardia, arthralgia, elevated antistreptolysin O titer and ESR, who was diagnosed with acute rheumatic fever and improved with haloperidol, prednisolone, digoxin, aspirin and furosemide and was given benzathine penicillin prophylaxis for future RF. Patient is faring well in follow up visits. We present our case because of its rarity.

Endothelial dysfunction in patients with metabolic syndrome: a prospective study in a rural institute in India.

Background: The objective was to evaluate endothelial dysfunction in patients with metabolic syndrome. Methods: This prospective, cross-sectional, hospital based observational study included 45 patients with metabolic syndrome and 20 age and sex matched controls who attended hypertension clinic, diabetes clinic, general medicine OPD and patients admitted in wards department of medicine, UPRIMS&R, Saifai, Etawah, UP, India. All patients who fulfilled inclusion criteria were subjected to the color Doppler of the brachial artery in the department of radio-diagnosis of the same institute. Results: Of the 45 patients with metabolic syndrome included in the study, 22 patients (48.9%) were males and 23 patients (51.1%) were females. Ten males (45.5%) had a waist circumference of >90 cm whereas 20 females (87%) had waist circumference of >80 cm. 9 males (40.9%) had abnormal waist hip ratio whereas 22 females (95.7%) had abnormal waist hip ratio. 43 patients (95.6%) had a SBP >130 mm of Hg whereas 39 patients (86.7%) had a DBP >85 mm of Hg. 24 patients (53.3%) had impaired fasting blood sugar i.e. >100 mg/dl ,25 patients (55.6%) had a TGL level >150 mg/dl, and 9 males (40.0%) had HDL < 40 mg/dl whereas 18 females (78.3%) had HDL value < 50 mg/dl respectively. The mean brachial artery baseline diameter were 3.50 ± 0.39 mm in males and 3.25  0.29 mm in females respectively, FMD percentage was 14.91  3.56 in females and 14.53  4.02 in males, and GTN mediated dilatation were 27.67  9.83% in females and 27.62  6.85% in males respectively. Conclusion: Estimation of Endothelial Dysfunction in patients at risk of developing full blown Metabolic Syndrome may predict the cardiovascular morbidity and mortality in these individuals even before fulfilling the 3/5 criteria of NCEP/ATP III Guidelines for the diagnosis of metabolic syndrome.

Tropical endomyocardial fibrosis: an overview.

Tropical endomyocardial fibrosis is the commonest form of endemic restrictive cardiomyopathy that affects mainly children and adolescents, and is geographically restricted to some poor areas in the tropical and subtropical regions of the world such as Africa, Latin America and Asia including southern districts of India especially in the coastal belt of Kerala state. Sub-endocardial fibrosis affecting the apices and the inflow tracts of the right or left ventricle, or both; and varying degree of atrioventricular valve regurgitation defines the disease. Chronic systemic venous hypertension and severe pulmonary hypertension are characteristic features of right ventricular and Left ventricular endomyocardial fibrosis respectively. Due to lack of resources for research in the disease endemic areas, the exact epidemiology, etiology and pathogenesis remain unknown, and the natural history is incompletely understood. Various infections and toxic factors were postulated regarding its etiology. During the last few years, incidence of the disease has decreased considerably because of the significant improvement in the living standards of the people with the corresponding decline in the childhood malnutrition, infections, worm infestations and associated eosinophilia. It is a condition with high morbidity and mortality, for which no effective therapy is available. However, surgical management improves the natural history of this disease to some extent. We have conducted a systematic review of the most intriguing aspects of epidemiology, natural history, clinical picture and management of endomyocardial fibrosis, proposing new ways to increase research into this challenging and neglected cardiovascular disease. We relied primarily on articles in the MEDLINE database with either ‘‘endomyocardial fibrosis’’ or ‘‘endomyocardial sclerosis’’ in the title.