RESUMEN
Complete heart block comprises complete absence of AV conduction - none of the supraventricular impulses are conducted to the ventricles. Perfusing rhythm is maintained by a junctional or ventricular escape rhythm. Typically, the patient will have severe bradycardia with independent atrial and ventricular rates. The incidence is 1 in 15,000 to 20,000 live births. Authors present the case report of a primigravida, aged 30 years who presented with amenorrhoea of 35 weeks. She was diagnosed as complete heart block by cardiologist. She had no history of syncopal attacks during childhood or antenatal period. She had a heart rate of 50-52 bpm. ECG showed ventricular escape rhythm with narrow QRS complexes. Echocardiography showed no structural defects. Her elective LSCS was done at 39 weeks after consultation with cardiologist. Patient underwent temporary pacemaker insertion just prior to surgery and she delivered a healthy female baby of weight 3 kg with Apgar 9/10 at 5 mins. She remained asymptomatic during the postoperative period and pacemaker was removed after 30 hours. She was discharged under satisfactory condition on day 6. Patient was counselled for follow up with cardiologist. This case lays emphasis on proper history taking, vitals monitoring, early recognition of undiagnosed cardiac disorders and team work for good maternal and fetal outcome.
RESUMEN
Background: To study the prevalence and pattern of iron de?ciency (ID)in heart failure (HF) patients with or without anaemia.Methods: This is a single-centre observational study, conducted at a tertiary care hospital of Punjab. Patients were selected based on validated clinical criteria-Framingham criteria. The iron parameters were done during the study including serum iron, serum ferritin, total iron binding capacity, and transferrin saturation (TSAT), to diagnose iron deficiency anaemia. Anaemia was defined as haemoglobin (Hb) < 13g/dl in males and <12 g/dL in females, based on WHO definition. Absolute iron deficiency is defined as serum ferritin < 100 mg/L and functional ID was defined as normal serum ferritin (100�0 mg/L) with low TSAT (<20%).Results: A total of 120 patients of Heart Failure (54% males and 46% females) were studied. Most of the patients were of high-functional NYHA class (Class IV NYHA n=45). Iron Deficiency was present in 60% patients with 31.66% patients having absolute and 28.33% patients having functional ID. Nearly one-fifth of the patients were having ID but without anemia, signifying importance of workup of Iron deficiency other than haemoglobin levels.Conclusions: Study highlights the neglected burden of ID in HF patients in India. This study suggests further large-scale studies to better characterize this easily treatable condition and considering routine testing in future Indian guidelines.