Persistent junctional reciprocating tachycardia [PJRT]

Persistent Junctional reciprocating tachycardia [PJRT] is an arrhythmia mostly seen in infants and children, but is reported in the older age group as well. It is an easy diagnosis with [awareness of the mind]. Once confirmed by electro-physiological study, the management is simplified. Radiofrequency ablation of the accessory pathway gives complete cure in almost all cases, especially so, for those with the persistent form. The tachycardia when untreated could induce the so called Tachycardia Induced Cardiomyopathy [TIC] which is reversible. We report the case of a 64-year-old lady with spontaneously relapsing and remitting PJRT which remained undiagnosed. Ultimately, a complete cure was achieved with the help of electro-physiology study and radiofrequency ablation

Kuwait acute coronary syndromes registry: baseline characteristics, management practices and in-hospital outcomes of patients hospitalized with acute coronary syndromes in Kuwait

To identify the characteristics of patients with acute coronary syndromes [ACS], their hospital management and in-hospital outcomes, through a prospective registry system in Kuwait. A registry involving all 7 general hospitals in Kuwait was set up. Consecutive patients diagnosed as having ACS over a period of 6 months were enrolled. Of 2,129 patients enrolled, 718 [34%] had ST segment elevation myocardial infarction [STEMI], 576 [27%] non-ST segment elevation myocardial infarction [NSTEMI] and 835 [39%] unstable angina [UA]. Thrombolytic therapy was used in 556 [77%] patients with STEMI. The median time from diagnostic electrocardiogram to administration of thrombolytic therapy was 38 min. Almost all patients with ACS [2,050, 96%] received aspirin during hospitalization. Only a minority received clopidogrel, 18 [3%] STEMI, 36 [6%] NSTEMI and 96 [12%] UA patients. The use of glycoprotein llb/llla antagonists was minimal [38 patients, 2%]. beta-blockers were used in 1,473 [69%] patients, while 982 [46%] received angiotensin-converting enzyme inhibitors. Coronary angiography during hospitalization was performed in 119 [17%], 120 [21%] and 126 [15%] patients with STEMI, NSTEMI and UA, respectively. In-hospital mortality occurred in 31 [4%] myocardial infarction patients and 4 [0.5%] UA patients [p < 0.0001]. This registry has enabled us to determine the incidence and characteristics of ACS patients in Kuwait. It has also enabled us to identify some barriers that we need to overcome for the full implementation of published guidelines for the management of patients with ACS

Infective endocarditis in the elderly: severe mitral regurgitation in acute coronary syndrome. A case report highlighting the changing patterns of endocarditis

Endocarditis is increasingly becoming a disease of the elderly. We report a case of a 70 year old man with coronary artery disease, who presented with chest pain and fever. His cardiac markers were elevated and an echocardiogram revealed large vegetation on the anterior leaflet of the mitral valve. He also had severe mitral regurgitation and hypokinesia of the posterior and inferior wall. The association of a mitral regurgitant valve secondary to myocardial infarction and bacterial endocarditis has not been reported in the literature making this case unique and interesting. A discussion on the changing patterns of infective endocarditis reveals interesting facts which are useful in the management of such cases