Hyphema: A Rare Complication of Periprocedural Antiplatelets and Anticoagulants Following Percutaneous Coronary Intervention.

Hemorrhagic complications are one of the major complications encountered with reperfusion therapies. However, ocular hemorrhage, especially hyphema, i.e., bleeding into the anterior chamber of the eye is one of the rarest bleeding manifestations. Bleeding manifestations in the periprocedural period can be devastating for the patient as antiplatelets and anticoagulants may need to be stopped and this can lead to stent thrombosis. We present a case of a 55-year-old lady, who was a known diabetic and hypertensive and developed hyphema with periprocedural antiplatelets and anticoagulants following percutaneous coronary intervention (PCI). She was managed medically and the dose of antiplatelets was reduced. She was discharged once there was evidence of a reduction in hyphema. Two weeks post-discharge her hyphema had completely resolved.

Novel Technique of Transfemoral Venous Pacing in a Rare Case of Inferior Vena Cava Stenosis.

Temporary transvenous pacing is a simple and routinely performed invasive procedure for treatment of life threatening bradyarrhythmias. We present a novel technique for transfemoral venous pacing in a patient with rare co-occurrence of inferior vena cava stenosis, rheumatic mitral stenosis, left ventricular dysfunction and digitoxicity.

Congenitally Absent Left Circumflex Artery.

Congenital coronary anomalies are uncommon with rarest being absent left circumflex artery (LCX) having prevalence of 0.003%. We report a case of a 68 year old male having acute coronary syndrome and left ventricular dysfunction whose coronary angiogram showed an absent LCX with super dominant right coronary artery (RCA). Precise morphological evaluation is needed for best suited management strategy.

Massive Hematuria Due to Congenital Renal Arteriovenous Malformation Successfully Treated by Renal Artery Embolization.

Congenital renal arteriovenous malformations (AVMs) are rare benign vascular lesions and a rare cause of massive hematuria in females predominantly involving right kidney. Clinical presentation in a male with involvement of the left kidney is very rare. Only a few case series describing the outcome of congenital renal AVMs have been reported in the literature. We report a challenging case of a male patient with life threatening massive hematuria with congenital renal AVMs in left kidney. Successful embolization was performed using coils and gel foam.

Young Hearts go Ischemic too.

INTRODUCTION: Young presentation of acute coronary syndrome (ACS) has been poorly described in literature. We hereby evaluate patients younger than 30 years. MATERIAL AND METHODS: In this prospective study we enrolled 1377 patients who underwent coronary angiography for symptoms concerning for acute coronary syndrome over a period of one year. RESULTS: Male predominance (100%) was seen among the young patients (less than 30 years) with most common presentation being chest pain. Incidence of ST elevation myocardial infarction (STEMI) was significantly higher (75%) than non-ST elevation myocardial infarction/ unstable angina (NSTEMI/UA). Most common associated risk factor was current smoking (41.6%). As compared to elderly, young patients were seen to have better outcome with percutaneous coronary interventions (PCI) and thrombolysis. CONCLUSIONS: Very young <30 years suffer from ischemia too and may differ in presentation, risk factors and outcome as compared to old. Primary prevention of avoidable risk factors should be aggressively promoted among young.

Long-term Mortality in Patients with Permanent Pacemaker Implantation.

INTRODUCTION: The development of implantable technology for cardiac rhythm management remains one of the seminal achievements of the second half of the 20th century. The development of artificial pacemakers for the electrical control of the cardiac rhythm has greatly enhanced the physician's ability to treat cardiac dysrhythmias. An ageing population and the extension of indications will in all probability result in an increasing number of cardiac device implantations. OBJECTIVE OF STUDY: To study mortality and morbidity in patients with permanent pacemaker implantation at a tertiary care hospital in North India. MATERIAL ANDF METHODS: This was a two year prospective observational study conducted in the Department of Cardiology of Christian Medical College and Hospital, Ludhiana. This included a retrospective period of ten years from 1st July 2002 to 30th June 2012, and a prospective period of two years from 1st July 2012 to 31st July 2014. All patients admitted to Christian Medical College and Hospital, Ludhiana, who received a permanent pacemaker for bradyarrhythmias were included in the study. A detailed analysis of demographic profile, indications, complications and mortality data was performed. RESULTS: A total of 323 patients were included in the study of which more than 75% of the patients receiving the pacemaker were in the age group 56-85 yrs. Males received more pacemakers than females. The commonest presenting symptom was syncope. Complete heart block was the commonest ECG finding. Acquired A-V block was the most common indication of pacing. VVI was the commonest mode of pacemaker implantation. Complications were seen in 3.72% patients. During the entire study period death occurred in 7.1% patients. CONCLUSIONS: Permanent pacemaker implantation is a relatively safe procedure with low complication rates and low mortality particularly in patients who have been on a regular follow up.

Bilateral Coronary Artery Fistula.

Coronary artery anomalies include anomalies of origin, termination, structure or course. Coronary artery fistulae (CAF) are classified as abnormalities of termination and are considered a major congenital anomaly. A coronary artery fistula involves a sizable communication between a coronary artery, bypassing the myocardial capillary bed and entering either a chamber of the heart (coronary-cameral fistula) or a great vessel. Bilateral coronary artery fistula, are a rare variant. We describe a bilateral CAF with angina and significant coronary artery disease requiring percutaneous coronary intervention.

A Clinical and Angiographic Profile and Assessment of Outcomes in Coronary Artery Ectasias: Single Centre Experience.

OBJECTIVE: To assess the clinical and angiographic profile of patients with coronary artery ectasias (CAE) and assess their outcomes. METHODS: One year retrospective and one year prospective study was carried out in the Department of Cardiology in CMC, Ludhiana from January 2011 to December 2012 on all patients undergoing coronary angiographies and each patient was followed up for 1 year. Their outcomes were noted and statistical analysis carried out. RESULTS: There were a total of 327 males (66.3%) and 166 females (33.7%) in the study. Mean age of patients were 51 to 60. The incidence of CAE was 79 (16.02%). 6.9% patients had pure ectasia without CAD. The distribution of CAE according to Markis classification was, Type 1 in 21 (26.5%), Type 2 in18 (22.7%) and Type 3 in 28 (35.44%) and Type 4 comprised of 12 (15.18%). Among all 3 categories UA was the commonest presentation (p=0.004). Hypertension was the commonest risk factor in both patients with CAE (44 patients, 55.7%) and CAD (167 patients, 52.6%) but not statistically significant. Regarding outcomes among Type 1, 84% patients remained asymptomatic, while 8.8% of patients were symptomatic with UA episodes. 4% were lost to follow up. Among Type 2, 68.8% remained asymptomatic while 24.4% had recurrence of symptoms. 6.6% were lost to follow up. Among the Type 3, 70.12% of patients remained asymptomatic while 20.12 % had recurrence of symptoms, 8.17% were lost to follow up. Five patients (1.57%) expired, all of whom were from Type 3. Most patients improved with the treatment opted by them over a 1 year period however the patients that remained symptomatic on treatment were three (8.8%) in category 1, 12 (24.4%) in category II and 55 (20.12%) in category III. Four in Category II required repeated hospitalization while 16 in category III required rehospitalizations. CONCLUSIONS: CAE is not an uncommon finding among patients presenting with acute coronary syndromes requiring invasive evaluation to confirm disease severity and decide management. However it is a benign entity requiring optimal medical management.

Gel Foam Renal Artery Embolization for Life-threatening Renal Haemorrhage.

INTRODUCTION: Renal artery embolization (RAE) is an important treatment option for patients with acute renal haemorrhage. Many types of embolic agents are presently available. We describe here the use of gel foam embolization for the treatment of acute renal haemorrhage. MATERIAL AND METHODS: A total of 12 patients (10 males and 2 females) underwent RAE. The indications in all cases were persistent renal haemorrhage which was secondary to renal biopsy (10 cases), blunt trauma to abdomen (1 case) and percutaneous nephrostomy (1 case). Embolic agent used was gel foam in all but one case. Embolization was done by selective catheterization of the feeding segmental / lobar renal artery branches. RESULTS: Successful obliteration of the vascular malformation with no post-procedure complications were achieved in all cases. CONCLUSION: RAE with gel foam is a relatively inexpensive, safe, effective and minimally invasive procedure for the treatment of life-threatening renal haemorrhage, preserving healthy renal parenchyma and renal function.

A case of mixed type of paroxysmal dyskinesia: is there an overlap between two clinical categories of paroxysmal dyskinesia?

We report a sporadic case of paroxysmal dyskinesia of predominantly choreic and ballistic movements of 10 years duration in a 22-year-old male. The movement starts after exercise for certain period. However, for the next 5-15 min, the movements are triggered by sudden voluntary activity. These dyskinesias persist for about 10-30 s after sudden voluntary activity. Patient has to be immobile once symptoms start after the exercise to prevent the kinesigenic involuntary movements. Involuntary movements could be induced in the lower limbs, upper limbs, facial and jaw muscle by local exercise. Overtime symptoms occurred with minimal exercise. Secondary dyskinesia was ruled out by investigations. Patient responded well to Carbamazepine, relapsed when stopped taking it.