Role of serum troponin-l in identifying left ventricular ejection fraction of

To determine the serum levels of troponin-l in identifying left ventricular ejection fraction [LVEF] of 63.5 ng/ml predicted LVEF of <40% with a sensitivity of 94% and specificity of 97% in patients receiving streptokinase, whereas in patients undergoing primary PCI, troponin-l levels of > 87.5 ng/ml predicted LVEF < /=40% with a sensitivity of 86% and specificity of 100%. Troponin-l concentration of > 63.5 ng/ml and > 87.5 ng/ml can predict LVEF

Primary percutaneous coronary aspiration of thrombus from infarct related artery

We are reporting the case of a 48-year-old man hypertensive, and smoker presenting with acute inferoposterior ST elevation myocardial infarction [STEMI] with right ventricular infarction. He underwent diagnostic angiogram which revealed total occlusion of mid right coronary artery [RCA] by thrombus. Multiple runs of aspiration were performed using Export Aspiration Catheter-6F and thrombus was aspirated from RCA. Postaspiration stenting was deferred due to absence of any significant obstructive lesion. Some thrombus had migrated to distal right posteriolateral branch [RPLB]. He was started on glycoprotein [GP] IIb IIIa inhibitors which had to stopped after a few hours due to upper gastrointestinal bleed. After 48 hours a re-look angiogram demonstrated good flow in RCA with resolution of the residual thrombus

Biatrial myxoma

A female, 32 years of age, presented with complaint of easy fatigability and exertional dyspnoea for the last one year. She had no previous history of cardiac disease. On clinical examination, there was a diastolic murmur at apex. Transthoracic echocardiography and subsequently a transesophageal echocardiogram was performed, which showed biatrial pedunculated masses, suggestive of cardiac myxoma. The left atrial mass was 28 x 15 mm and right atrial mass was 35 x 25 mm in dimension and both appeared attached with interatrial septum. On surgical excision and histopathological examination, findings were consistent with cardiac myxoma

Acute myocardial infarction with left bundle branch block [LBBB]: significance of sgarbossa criteria

A middle aged female presented in emergency department with chest discomfort. Her old electrocardiogram [EKG] showed left bundle branch block [LBBB] signs. EKG performed in the emergency room revealed left bundle branch block with 4-6 mm discordant ST segment elevation in leads VI-V3 and 1mm concordant ST segment elevation in lead V4. Diagnosis of acute anterior wall STEMI was made based on Sgarbossa criteria. She underwent angiography which showed total occlusion of proximal left anterior descending artery which was stented. She had uneventful post-stenting course in hospital and was discharged. The case highlights the significance of Sgarbossa criteria which can be applied to diagnose acute myocardial infarction in the presence of LBBB so that prompt thrombolytic or primary angioplasty can be preformed