Bronchogenic Carcinoma with Cardiac Invasion Simulating Acute Myocardial Infarction.

Cardiac metastases in bronchogenic carcinoma may occur due to retrograde lymphatic spread or by hematogenous dissemination of tumour cells, but direct invasion of heart by adjacent malignant lung mass is very uncommon. Pericardium is frequently involved in direct cardiac invasion by adjacent lung cancer. Pericardial effusion, pericarditis, and tamponade are common and life threatening presentation in such cases. But direct invasion of myocardium and endocardium is very uncommon. Left atrial endocardium is most commonly involved in such cases due to anatomical contiguity with pulmonary hilum through pulmonary veins, and in most cases left atrial involvement is asymptomatic. But myocardial compression and invasion by adjacent lung mass may result in myocardial ischemia and may present with retrosternal, oppressive chest pain which clinically may simulate with the acute myocardial infarction (AMI). As a result, it leads to misdiagnosis and delayed diagnosis of lung cancer. Here we report a case of non-small-cell carcinoma of right lung which was presented with asymptomatic invasion in left atrium and retrosternal chest pain simulating AMI due to myocardial compression by adjacent lung mass, in a seventy-four-year-old male smoker.

Albuminuria and neuropathy in newly detected diabetics: profile and correlation.

Neuropathy and nephropathy are two most common chronic complications of diabetes mellitus. Albuminuria and neuropathy has been found to be associated in patients with long standing diabetes. In the present study, the profiles of proteinuria and neuropathy have been studied in newly diagnosed cases of type 2 diabetes mellitus and attempt has been made to determine any relationship between the two. We studied 100 newly diagnosed ceases of type 2 diabetes mellitus and presence and type of neuropathy was assessed clinically and electrophysiologically. Albuminuria was detected by morning spot sample for albumin to creatinine ratio estimation. Results were analysed using appropriate statistical methods. It was found that 21 patients (21%) had proteinuria and 31 (31%) had neuropathy. Both were present in 16% patients and absent in 64% cases. The overall prevalence of neuropathy and proteinuria among study subjects was 36%. Isolated peripheral neuropathy was found in 9% patients, isolated autonomic neuropathy was found in 7% patients, and both were present in 15% cases. Proteinuria was mostly micro-albuminuria (90.5%). Occurrence of albuminuria and neuropathy has been found to be significantly associated with increasing age. Concurrence of diabetic neuropathy and albuminuria has been found to be significantly associated. The present study reveals that presence of neuropathy as well as nephropathy is common in newly diagnosed cases of type 2 diabetes mellitus. Both these complications have been significantly associated with increasing age indicating the possibility of a longer duration of undetected diabetes among them. Concurrence of neuropathy and nephropathy found in this study suggests that microvascular complications go hand in hand.

Left atrial extension of lung malignancy with ECG changes resembling STEMI.

Lung malignancy extending into left atrium is seen very infrequently. We had a patient with a fast growing symptomatic lung mass and electrocardiogram showing persistent coving ST elevation without any biomarker change. Transthoracic echocardiography showed a large left atrial mass which was fixed to the free walls and extended into the appendage. There was also a large lung mass that was compressing the heart from its lateral aspect. CT-scan of chest corroborated the lung mass & CT-guided FNAC showed small cell carcinoma.

Echocardiographic profile of ART naïve human immunodeficiency virus (HIV) infected patients in a tertiary care hospital in Kolkata.

AIMS AND OBJECTIVE: Cardiac affection in human iummunodeficiency virus (HIV) infection is a recognized entity. Some form of heart disease is demonstrable at autopsy in approximately 40 percent of cases and by echocardiography in approximately 25 percent of patients with HIV. the studies indicate that cardiac involvements associated with HIV are mainly characterized by cardiomyopathy and pericardial disease. HIV infection is a global pandemic which is also rapidly spreading in india. We conducted the study to have some insight into the profile oflndian patients. MATERIAL & METHODS: In this cross sectional hospital based study, we evaluated immunological (CD4 count) and echocardiographic status of 45 asymptomatic HIV seropositive patients who did not receive anti-retroviral therapy. The results were compared with age and sex matched controls. Statistical analysis was done using appropriate statistical methods. RESULTS: Most common cardiovascular abnormalities were diastolic dysfunction (18%) followed by pericardial effusion (13%) and systolic dysfunction (7%). When compared with controls the study population had statistically higher number of diastolic dysfunction (p value = 0.035) but not systolic dysfunction (p value = 0.61); none of the control population was having pericardial effusion. Low CD4 count was significantly associated with pericardial effusion (p value 0.048) but the association with diastolic dysfunction (p value = 0.46) or systolic dysfunction (p value = 0.84) was not statistically significant. CONCLUSION: Cardiovascular complications are common among HIV infected patients in india, most common being diastolic dysfunction and pericardial effusion. Low CD4 counts are associated significantly with pericardial effusion. These abnormalities are likely to be found with greater frequency in clinical practice as management of opportunistic infections continues to improve.