Malignant multivessel coronary spasm complicated by myocardial infarction, transient complete heart block, ventricular fibrillation, cardiogenic shock and ischemic stroke

Multivessel coronary spasm resulting to cardiogenic shock and malignant ventricular arrhythmias though rare has been reported in the literature. The disease seems to be more prevalent in Asians. There have been isolated reports of coronary spasm in patients with reactive airway disease. We report the first case of spontaneous multivessel spasm in a male patient with bronchial asthma of Arab ethnicity resulting in acute myocardial infarction complicated by cardiogenic shock, recurrent ventricular arrhythmias, and transient complete heart block. Literature review of similar cases suggests a strong association with bronchial asthma and a more malignant course in patients with reactive airway disease. The role of intracoronary nitroglycerin in proving the diagnosis even in patients in shock on maximal inotropic supports and intra-aortic balloon pump is highlighted and the importance of considering multivessel coronary spasm as a cause for acute coronary syndrome even in patients with conventional risk factors for atherosclerotic coronary artery disease is reinforced in the discussion of this case

Mycotic aortic aneurysm treated by endovascular aneurysmal repair [EVAR] [first case report from Oman]

Mycotic aortic aneurysm is rare but life threatening disease. Endovascular aneurysm repair [EVAR] has become an established procedure for the treatment of many infrarenal aortic aneurysms

Although EVAR is obviously less invasive than open surgical repair but it is not without complications. Lower extremity ischemia is a known complication of endovascular abdominal aortic aneurysm repair [EVAR]. Limb occlusion, embolism or access related problems are the main causes. We hereby describe the first case of EVAR of infra renalmycotic aortic aneurysm in the history of Sultan Qaboos University Hospital Oman. A 67 years old lady known to have diabetes mellitus and hypertension admitted with fever and abdominal pain. On further evaluation found to have 4 cms infra-renal mycotic abdominal aortic aneurysm treated by EVAR but procedure was complicated by lower limb ischemia due to thrombosis at the puncture site which was successfully treated by aspirating thrombus and ischemia was relieved

Pheochromocytoma with uncommon ECG presentation

Pheochromocytoma is a rare neuroendocrine tumour with a highly variable clinical presentation.

It may present with unusual presentation and these tend to mislead the physician into a delayed diagnosis. Typical cardiac manifestations include ST-segment deviations mimicking myocardial infarction, QT interval prolongation, blood pressure fluctuations, arrythmias mostly tachycardia but rarely may present with bradyarrythmia. We describe a case of pheochromocytoma with rare findings of Intermittent AV dissociation associated with Junctional and ventricular ectopic rhythm

Tumour lysis syndrome in haematological malignancies

Objectives: this study was conducted to determine the frequency of tumor lysis syndrome [TLS] in hematological malignancies

Materials and methods: this descriptive study was conducted at Liquate National Postgraduate Medical Centre from October 2005 to April 2006 over a period of six months. Total 50 patients with diagnosed hematological malignancies were included in the study and data were collected by non-probability convenient sampling. Patients pretreated for their malignancy were excluded from the study. Venous samples for serum uric acid, LDH, phosphorus, calcium, potassium and creatinine were collected on admission, before starting chemotherapy and then for four days after starting the chemotherapy. All patients received adequate hydration, allopurinol and induction chemotherapy. Data were analyzed by statistical package for social sciences [SPSS] version16.0

Results: out of 50 patients 10 fulfilled the criteria for TLS. Six patients developed laboratory tumor lysis syndrome [LTLS], whereas 4 developed clinical tumourlysis syndrome. Acute renal failure was observed in 4 out of 10 patients. Overall 3 patients died because of TLS. Hyperuricemia and lactate dehydrogenase above 2000 IU were the most prominent findings in patients with TLS

Conclusion: it is concluded that 20% of the patients developed TLS [including both laboratory and clinical TLS and despite all measures of prevention it can occur and result in devastating clinical effects