Left Ventricular Intramyocardial Dissecting Hematomas.

Intramyocardial dissection is a rare complication of myocardial infarction, trauma, and percutaneous intervention. It is usually caused by hemorrhagic dissection among the spiral myocardial fibers. We hereby report the case of a patient with left ventricular intramyocardial dissection who presented with acute decompensated heart failure. (Level of Difficulty: Advanced.).

Clinical, angiographic profile and percutaneous endovascular management of Takayasu's arteritis - A single centre experience.

OBJECTIVE: Aim of the study was to evaluate clinical, angiographic profile and percutaneous endovascular management of Takayasu's arteritis. BACKGROUND: Takayasu's arteritis is a chronic inflammatory vasculitis affecting the aorta and its major branches. Although it is more prevalent in Asia, the distribution of the disease is worldwide with different vascular involvement patterns and clinical manifestations. METHODS: In this prospective study a total of 50 consecutive patients who were reported as having Takayasu's arteritis between January 2010 and April 2016 were evaluated. Detailed clinical presentation and angiograms of all patients were analysed. RESULTS: 50 patients were analysed during study period. Among 50 patients, 43(86%) were female and 7 (14%) were male. Average age of presentation was 26.92years. Most common clinical presentation was claudication (74%) followed by, musculoskeletal symptoms (48%), fatigue (46%), weight loss (22%), headache (22%), visual disturbances (16%), syncope (10%), dyspnoea (20%). Most common features were absent/diminished pulses (80%), difference in blood pressure (80%), followed by bruit (70%)hypertension (64%), cerebrovascular accident (8%),heart failure (8%) and aortic regurgitation (4%). According to the new angiographic classification, angiographic type I (40%) was encountered most frequently, followed by type III (30%), type V (16%), type IIb (8%), type IIa (2%), and type IV is (4%). Angioplasty was the main stay of treatment in 66% of the patients, remaining 34% of them were treated medically either with corticosteroids or methotrexate. CONCLUSION: Takayasu's arteritis is a rare disease, affects mainly women, manifestations range from asymptomatic disease, found as a result of impalpable pulses or bruits, to catastrophic neurological impairment. Takayasu's arteritis is the common cause of renovascular hypertension. Angiography remains the gold standard for diagnosis. Angiographic evaluation and percutaneous transluminal angioplasty with stenting is useful in selected cases.

Silent destruction of aortic and mitral valve by Klebsiella pneumoniae endocarditis.

Klebsiella endocarditis rarely affects the native valve especially in the immunocompromised and the elderly. We report a case of Klebsiella endocarditis in a 60-year-old man who had a nidus of infection on the aortic valve which led to severe aortic regurgitation. This possibly spread to the anterior mitral leaflet (AML) leading to AML perforation therefore causing moderate mitral regurgitation. The reason for this suspicion was that there was perforation of the AML in the absence of vegetation. Noteworthy is that he was asymptomatic apart from generalised fatigue. This case draws our attention to the nature of Klebsiella valvular affection due to the fact that it had bitten the aortic and mitral valve silently and compelled the patient to undergo double valve replacement without having a prolonged duration of symptomatic illness thereby calling for high suspicion especially in individuals in the extremes of ages where the symptoms are less-guiding than the signs.

Electrocardiographic localization of the occlusion site in left anterior descending coronary artery in acute anterior myocardial infarction.

BACKGROUND: The site of occlusion of left anterior descending coronary artery is important in acute anterior myocardial infarction because, proximal occlusion is associated with less favorable outcome and prognosis. The present study attempted to evaluate the electrocardiographic correlate of the location of the site of the left anterior descending coronary artery occlusion with respect to first septal perforator and/or the first diagonal branch. METHODS AND RESULTS: The study included 50 patients with a first acute anterior myocardial infarction. The electrocardiogram with the most pronounced ST segment deviation before the start of reperfusion therapy was evaluated and correlated with the left anterior descending occlusion site as determined by coronary angiography. ST segment elevation in lead aVR, ST segment depression in lead V5 and ST segment elevation in V1>2.5 mm strongly predicted left anterior descending occlusion proximal to first septal, whereas abnormal Q wave in V4-6 was associated with occlusion distal to first septal. Abnormal Q wave in lead aVL was associated with occlusion proximal to first diagonal, whereas ST depression in lead aVL was suggestive of occlusion distal to first diagonal branch. For both first septal and first diagonal, ST segment depression > or =1 mm in inferior leads strongly predicted proximal left anterior descending artery occlusion, whereas absence of ST segment depression in inferior leads predicted occlusion distal to first septal and first diagonal. All the patients were followed during their in-hospital stay (median of 7 days), during which four patients in the proximal to first septal and first diagonal group and one patient in the distal to first septal and first diagonal group died (p < or = 0.001). CONCLUSIONS: In acute myocardial infarction electrocardiogram is useful to predict the left anterior descending occlusion site in relation to its major side branches and such localization has prognostic significance.

Clinical profile and management of PDA in neonates.

Patent ductus arteriosus (PDA) is recognised more often with increasing survival of preterm babies. The pharmacological closure of ductus by indomethacin has changed the management of PDA. Twenty neonates admitted over a period of 21 months to Neonatal Intensive Care Unit (NICU) of M.S. Ramaiah Medical College hospital, Bangalore, who were diagnosed to have PDA, were analyzed. The objectives of this retrospective analysis were to study the clinical profile, the efficacy of oral indomethacin and the outcome of PDA. 2-D and Doppler echocardiaography were used to confirm the clinically suspected PDA. These neonates were treated with 3 doses of oral indomethacin (0.2-0.25 mg/kg/dose 12 hourly) along with fluid restriction and oxygen. Echocardiography was repeated to demonstrate the closure of PDA. The incidence of PDA was 2.3% of total NICU admissions. Seventy percent of this cohort were < 32 weeks of gestation, 55% had birth weight of < 1500 gms. Seventy percent (14) neonates had onset of PDA after 48 hrs of life. 81.25% of neonates responded to indomethacin and overall survival rate in treated group was 67%. Drug related complications were noted in 2 newborns. This study illustrates the utility of echocardiography in diagnosing and monitoring PDA in preterm and low birth weight babies with high index of suspicion of this common congenital heart disease. Pharmacological intervention with indomethacin is rewarding with acceptable results.