Late in-stent restenosis in a patient with drug-eluting stent

Drug coated stents have reduced the incidence of in-stent restenosis with coronary intervention. whether this effect is long lasting or just delaying the process is not clear. We report here a case of late in-stent restenosis with Raoamycin drug eluting stent.

Spontaneous multivessel coronary artery dissection associated with elevated homocysteine levels

A case of spontaneous multi-vessel coronary artery dissection in a young man, with markedly elevated serum homocysteine levels, is reported. The effects of elevated homocysteine levels on arterial endothelial function and possible plaque rupture leading to coronary dissection and acute coronary syndrome and / or sudden cardiac death are also discussed

Clinical and echocardiographic characteristics of patients with significant pericardial effusion requiring pericardiocentesis

Clinical and echocardiographic features of significant pericardial effusion [PE] have been reported from the west. Currently there is lack of published data from this part of the world, we reviewed all consecutive cases of significant PE requiring echocardiographic assisted pericardiocentesis to analyze the clinical and echocardiographic features of these patients. Forty four consecutive patients who underwent echocardiography assisted pericardiocentesis at the Aga Khan University Hospital [AKUH] between January 1988 and May 2001 are included in this review. Most common presenting symptoms were dyspnea [89%] and fever [36%]. Elevated JVP and pulsus paradoxus were documented in 59% and 41% of patients respectively. Sinus tachycardia [75%] and low voltage [34%] were the most common ECG findings. Malignancy [45-51%] and tuberculosis [27%] were among the most frequent causes of PE. One patient died during echocardiography-assisted pericardiocentesis. Majority of the pregnant females delivering at Aga Khan University Hospital were aware of epidural analgesia for labour. However, only a small proportion are availing this service, due to fears and misconceptions [JPMA 55:63;2005]. The symptoms and physical findings of haemodynamically significant PE are frequently nonspecific. Transthoracic echocardiography is the gold standard for rapid and confirmatory diagnosis of PE and cardiac tamponade. The most common cause of PE was malignancy followed by tuberculosis. Pericardiocentesis under echocardiographic guidance is a safe and effective treatment for significant PE

Acute myocardial infarction in a young patient

Myocardial infarction [MI] is considered to be the disease of the fifth and sixth decade as seen in the West but an earlier age incidence is not infrequently encountered in the South Asian population. However, occurrence of MI in the teen-age still remains a rare happening. We are reporting a case of a teenager, who suffered a myocardial infarction with cardiogenic shock and pulmonary edema on two separate occasions with ECG and biochemical evidence of myocardial infarction. An exercise stress test done in between the two episodes was negative at a workload of 13.5 METs. A coronary angiogram done after the second event revealed normal coronary arteries and a preserved left ventricular systolic and segmental function. Except for low HDL [high density lipoprotein] and mildly raised homocysteine levels, the patient did not have other conventional or novel risk factors for coronary artery disease