Study on correlation of obesity with short-term prognosis in acute myocardial infarction.

BACKGROUND: Obese patients with established coronary artery disease have reduced mortality compared to normal or low body mass index (BMI) patients. The reason for the relation is not yet clearly understood. We sought to evaluate the association of BMI and waist circumference (WC) at the time of presentation in patients with myocardial infarction (MI) with one-year adverse cardiac events. METHODS: In this prospective cohort study, we included consecutive patients with acute MI admitted to a tertiary care hospital during a period of one year. Upon admission, BMI and WC were measured. Patients were followed-up for a period of one year and the primary composite outcome of death or non-fatal MI was correlated with BMI and WC categories. RESULTS: There were 703 patients (males 559 (79.5%)). Combined non-fatal MI and death at one year was 128 (18.2%). Incidence of primary outcome was 25.0% in low BMI group, 19.9% in normal BMI group, 13.1% in overweight group, 13.4% in class I obese, and 11.1% in class II obese groups. In univariate analysis, the inverse correlation was significant (p value=0.007). In one-year follow-up period, 12.8% in high and 20.8% in normal WC groups had primary outcome (p value=0.01). Both BMI and WC lost their predictive value in multivariate analysis. CONCLUSIONS: Low BMI and normal WC were associated with a worse short-term outcome in patients with acute MI. Neither BMI nor WC independently predicted cardiac events or death after acute MI.

A floating right heart thrombus in transit across tricuspid valve causing an endocardial friction rub.

We report a 42-year-old lady on combined oral contraceptive pills with deep venous thrombosis and mild pulmonary embolism, who developed shock, while being treated with heparin. On auscultation, there was an unexpected loud, superficial, squeaky, triphasic friction rub over the left lower parasternal area. Simultaneous echocardiogram revealed a large serpiginous, freely floating mass in right atrium, prolapsing freely to right ventricular inlet across the tricuspid valve. The endocardial friction rub persisted for about 24 h as long as the thrombus was intracardiac and disappeared when the thrombus disappeared from right heart, occluding the proximal left pulmonary artery. She died due to shock awaiting surgery. We highlight that such a rub in a patient with deep venous thrombosis, though rare, may be an important clue to impending pulmonary embolism.

Isolated pulmonary valve endocarditis: A case report and review of literature.

Isolated pulmonic valve endocarditis is an uncommon clinical entity and is usually associated with intravenous drug abuse. We describe a case of isolated pulmonary valve endocarditis in a young woman with no apparent precipitating factors other than a history of recent normal delivery. During the clinical course she suffered a pulmonary embolism which could be managed conservatively and she was discharged after a 4-week course of antibiotic therapy. The literature on the isolated pulmonary valve endocarditis is reviewed. .