Reverse Takotsubo Cardiomyopathy Following COVISHIELD Vaccination: A Rare Case of an Anaphylactic Reaction.

This case report describes a 47-year-old female healthcare worker who developed reverse takotsubo cardiomyopathy (TTC) following the administration of the COVISHIELD COVID-19 vaccine. Within minutes of receiving the vaccine, she experienced acute shortness of breath, nausea, and restlessness, along with a significant drop in blood pressure. She was diagnosed with an anaphylactic reaction and promptly treated with adrenaline and fluids. In the intensive cardiac care unit, she exhibited hypotension, had vision loss, and developed pulmonary edema. Further evaluation revealed abnormal ECG findings, elevated troponin levels, and reduced left ventricular ejection fraction (LVEF). Coronary angiography ruled out obstructive coronary artery disease. The patient gradually improved over several days and was discharged with a recovered left ventricular function. This case highlights the occurrence of TTC triggered by anaphylaxis to the COVID-19 vaccine and emphasizes the need for preparedness to manage such emergencies in vaccination centers.

A case of "very" very late stent thrombosis: More than 12 years after DES.

A rare but possibly catastrophic consequence of drug-eluting stents (DES) is very late stent thrombosis. We report a case of 74-year-old male who sustained a ST elevation myocardial infarction (STEMI) 12 years after initial Paclitaxel eluting stent implantation (PES). This is the longest time between stent placement and the development of an acute coronary event due to very late stent thrombosis that we are aware of (VLST). The implications for prognosis and therapy are significant because they highlight the uncertainty around the recommended duration of antiplatelet medication in patients with DES. Clinicians face challenges in treating those patients particularly when competing medical conditions demand the discontinuation of antiplatelet therapy. VLST is concerning since the underlying pathophysiology is unknown, and the best preventive treatments and duration of antiplatelet medication after stent implantation are unknown.

Reducing the Wire Crossing Time in Primary Percutaneous Coronary Angioplasty: A Study From a Tier II City in India.

Acute coronary syndrome is a major cause of morbidity and mortality all over the world. Timely intervention in ST-elevation myocardial infarction (STEMI) in the form of primary angioplasty is the gold standard of treatment to reduce mortality and morbidity. "Time is muscle" is the phrase to impress upon the importance of time in treating patients with STEMI. Traditional treatment target included "door to balloon time" of 90 min or less. This "door to balloon time" is now rephrased as the "wire crossing time" (WCT). The European Society of Cardiology (ESC) updated its guidelines further, reducing the target of wire crossing time to 60 min. The present study is a brief report on the door to wire crossing time status in one of the tertiary care centers of a nonmetro city. Retrospective analysis of case records was done for 79 patients admitted with acute MI who underwent primary angioplasty between November 2018 and June 2019 (pre-corrective action group). Various reasons for the delay, right from the time of the patient reaching the emergency room (ER) to the time of wire crossing, were analysed and measures were taken to reduce the delay. The post-corrective action group comprised 77 patients. The major causes of a prolonged WCT in our setup were delayed diagnosis of STEMI in ER, delay in giving consent by the patient's relatives, financial issues, and availability of cath lab technicians during the off-duty hour. The delay in WCT in our center was 121 min. Remedial actions were taken to mitigate the problems at each step, which resulted in a reduction of delay by 20 min, i.e., to 101 min leading to a significant difference in the outcome in view of morbidity and mortality.

Radial Artery Pseudoaneurysm Following Cardiac Catheterization: A Case Report.

The transradial approach is the most preferred method for cardiac catheterization. The radial route approach has many advantages, including fewer puncture site-related complications and early mobility and discharge. The vascular complications include radial artery spasms, occlusions, dissections, perforations, and compartment syndrome. Although pseudoaneurysms are a well-known complication of femoral access (0.2%-3%), pseudoaneurysms are very infrequent (0.05%) after radial artery access. Very few cases of radial pseudoaneurysms have been reported to date. We present a rare case of an 82-year-old man on dual antiplatelet and anticoagulant therapy who underwent coronary angiography via the radial route. The patient developed a pseudoaneurysm requiring surgical intervention.

Demographic & angiographic profile of young patients aged 40 year & less undergoing coronary angiography in a tier II city of Eastern India.

BACKGROUND: Cardiovascular diseases (CVD) and its complications are on an increasing trend in the younger age group. In this study, we aimed to identify the different risk factor profile and coronary angiographic characteristics of young adults presenting with coronary artery disease. METHODS: We conducted this retrospective observational study at Tata Main Hospital, Jamshedpur, Jharkhand, for 5 years between April 2015 and March 2020. Inclusion criteria being patients admitted for acute coronary syndrome or chronic stable angina, aged ≤40 years, who underwent coronary angiography. Those below 40 years of age who underwent angiography in non-CAD (coronary artery disease) setting were excluded. RESULTS: Among the 117 cases included in this study, 81.1% were males and 18.8% were females. Majority of cases, i.e., 52.2% were in the age group of 36-40 years. Risk factor evaluation showed hypertension as the major risk factor, present in 30.76% of patients, followed by diabetes mellitus in 21.36%, Dyslipidaemia was noted in 7.6%. History of smoking was present in 8.54%, history of smokeless tobacco use was in 7.69%, family history of CAD was noted in 9.4% of patients. Among 117 cases, SVD (single-vessel disease) was most prevalent, seen in 55.5% cases. 21.3% had normal or recanalized coronaries. Among SVD, LAD (Left anterior descending artery) was the most commonly involved vessel (80%). CONCLUSIONS: Young patients with CAD are mainly males, and SVD in the form of LAD is more commonly involved. In this vulnerable age group, more emphasis should be given on diagnosis and management of risk factors.

Spontaneous coronary artery dissection involving all major arteries LAD, LCX and RCA -A case report.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death. Amongst various etiologies thought to be responsible for this condition, atherosclerosis seems to be the most common. There are various case reports on (SCAD) of single coronary artery but the presence of SCAD of all three arteries is not known. We describe a case of a 45-year-old gentleman without any conventional coronary risk factors, who was referred to us at Tata Main hospital, Jamshedpur, for cardiac evaluation prior to his urethral surgery. Although asymptomatic cardiac-wise, his ECG incidentally revealed healed inferior wall myocardial infarction. Echocardiogram confirmed hypokinetic inferior wall with left ventricular ejection fraction of 50%. His coronary angiography showed spontaneous dissection of LAD, LCX and RCA which was managed conservatively.