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Introduction: Coronary Artery Disease (CAD) remains a major problem worldwide. New and useful biomarkers for early diagnosis are necessary. MicroRNAs (miR) are short, non-coding RNAs that post transcriptionally regulate gene expression through degradation and translational repression of mRNAs. Aim: The current case-control study was designed to assess strength and relevance of diagnostic miR-126, 122 and Vascular Endothelial Growth Factor (VEGF) level in the diagnoses of angiographically proven CAD cases. Materials and Methods: Circulating levels of miR-126 and miR122 and VEGF levels were measured in serum from 100 middle aged 46-58 years patients with CAD and 100 patients without CAD through quantitative real-time polymerase chain reaction (qRT-PCR) analysis. Results: Circulating miR-122 level was significantly higher in CAD cases compared to control (1.60±1.06 and 0.93±0.43, p=0.001), however miR-126 was significantly lowered in CAD cases compared to control (0.82±0.51 and 1.01±0.47, p=0.02). Circulating VEGF level was significantly higher in CAD cases compared to control (182.97±156.49 and 105.49±103.88, p=0.02). Circulating miR-122, 126 and VEGF level did not show any association with demographic and clinical parameters. Area Under the Curve (AUC) for circulating miR-122, 126 and VEGF were 0.700, 0.644 and 0.649 with sensitivity and specificity of 66.67%, 56.41%, 61.18% and 70%, 60% and 64%, respectively. The combined diagnostic efficacy of miR-122 and 126 showed higher sensitivity and specificity. Conclusion: Circulating miR-122 and 126 might be novel, noninvasive biomarkers for early diagnosis of CAD. Further exposition of the role of miR-122, 126 and VEGF in the progression of CAD will add to the understanding of the disease process leading to a new diagnostic approach. However, further studies on larger patient cohorts are required to validate the findings.

Implantable Cardioverter and Defibrillators (ICD) prolong lifespan in patients at high risk of tachyarrhythmia, by their ability to appropriately detect and terminate it on the basis of Tachycardia Detection Rate (TDR). However, ICD patients often have Slow ventricular tachycardia (VT) defined as those below the detection limit of ICD. Such Slow VT’s are not entirely benign, leading to frequent emergency visits, in-hospital admissions, rate-induced cardiomyopathy and rarely death. Lowering the TDR to detect such arrhythmias has the potential of increasing inappropriate shocks which can be catastrophic. Although such slow VT’s are usually terminated by anti-tachycardia pacing, it is not always so. Here, the authors describe two such cases of resistant Slow VT’s in post ICD patients which ultimately necessitated ICD shocks.

Percutaneous Transvenous Mitral Commissurotomy (PTMC) is the preferred treatment for isolated rheumatic valvular mitral stenosis if the valve has suitable anatomy. Following transseptal puncture, entry into left ventricle is the crucial step. This may be difficult in patients with large left atrium and very severe mitral stenosis. We are reporting a case of 23-year-old female suffering from mitral stenosis in which the mitral valve could not be crossed with standard technique, so a novel “over the wire technique” was used to cross the mitral valve and successful valvotomy was performed without any complication.

A 26-year-old female, a known case of diffuse systemic sclerosis present with multiple episodes of syncope and progressive dyspnoea over six months. Her electrocardiogram revealed complete heart block and left ventricular systolic dysfunction with Ejection fraction of 42%. She underwent single chamber permanent pacemaker implantation and systolic dysfunction was managed medically. This case exemplifies a unique case of diffuse systemic sclerosis presenting with two rare primary cardiac manifestations namely complete heart block and systolic dysfunction, which occurred simultaneously.

Temporary transvenous pacing is often required as life saving measure in conditions such as Stokes Adams attack and symptomatic bradyarrhythmias. Bradyarrhythmias are also known complications of acute Myocardial Infarction (MI), which can be transient or persistent and often demand temporary pacing too. It is difficult to diagnose underlying MI in the setting of paced rhythm due to secondary ST-T changes. Elevated cardiac enzymes are essential in the scenario of paced rhythm to diagnose underlying acute MI. Remarkable T wave inversion and ST depression {similar to Left Bundle Branch Block (LBBB)} do occur in right ventricular paced ECG and some changes may persist following withdrawal of pacing (cardiac memory T waves) simulating ischaemia. Very rarely arrhythmias can also lead to troponin rise causing diagnostic dilemma in such a setting. Here, we report a case of an elderly female who presented with symptomatic Complete Heart Block (CHB) and developed T wave inversion with Q wave formation in anterior leads in sinus rhythm following temporary pacing. She also demonstrated a dynamic rise in serial cardiac troponin values mimicking an acute coronary syndrome. Ultimately, an invasive coronary angiogram was performed to rule of significant coronary artery disease.

Introduction: Early stent thrombosis is a relatively rare but deleterious complication of Percutaneous Coronary Intervention (PCI). Data on early stent thrombosis from an Indian setting are rare and indistinct. Aim: To determine the incidence and clinical outcomes of early stent thrombosis in patients receiving drug-eluting stents. Materials and Methods: In this retrospective study, data of all consecutive patients who underwent PCI with stenting and reported an incidence of early stent thrombosis between March 2014 and November 2016 at our Tertiary Care Centre (King George’s Medical University, Lucknow, India) were considered. Incidence of early stent thrombosis was determined based on total number of patients who underwent PCI with drug-eluting stents during the study period. Subsequently, the patientrelated, lesion-related, procedure-related, and stent-related characteristics were examined for patients with early stent thrombosis. Clinical outcomes of stent thrombosis were also analysed for these patients. Additionally, a comparative analysis for various characteristics was performed between patients who died and patients who survived. Results: Early thrombosis was noted in 41 (1%) patients out of 3,869 PCI that were performed during the study period. Among this cohort, substantial presence of established risk factors of stent thrombosis was observed including for diabetes (n=12, 29.3%), smoking (n=19, 46.3%), STEMI (n=30, 73.2%), chronic total occlusion (n=8, 16.3%), thrombus-containing lesion (n=24, 49%), Type C lesions (n=36, 73.5%). Although, all patients were aimed to manage appropriately, mortality in patients with early stent thrombosis was reported in 18 (43.9%) patients and re-infarct was reported in 26.8% (n=11) patients. Conclusion: Although, the incidence of stent thrombosis in patients receiving drug-eluting stents was around 1%, it was found to be associated with a higher 30-day mortality rate. Further studies examining a larger cohort of patients, incidence of late and very late stent thrombosis, and a comparative analysis of characteristics between patients with and without stent thrombosis are warranted.

Combined hereditary thrombophilia is an uncommon entity associated with higher risk of early onset thrombosis. We report a case of 39-year-old male with combined deficiency of natural anticoagulants (protein C, S and anti thrombin) along with hyper homocystenemia and factor V Leiden mutation, presenting with life threatening bilateral pulmonary embolism. The clinical implications of combined thrombophilia are also discussed.

Introduction: Several Single Nucleotide Polymorphisms (SNPs) in lipid transport genes have been shown to be associated with Coronary Artery Disease (CAD). The Hepatic Lipase (HL) glycoprotein is a key component that catalyzes the hydrolysis of triglycerides and phospholipids in all major classes of lipoproteins. Aim: We studied whether the HL gene-250G/A polymorphism affect blood lipid level and the CAD in a North Indian population. Materials and Methods: A total number of 477 subjects were enrolled in the study after approval of the Institutional Ethics Committee. Out of 477 subjects, 233 were with coronary artery disease as study group and 244 subjects without coronary artery disease as control group. All subjects recruited with matched ethnicity in age group of 40-70 years. Blood samples were collected in EDTA vials and genomic DNA was extracted from blood using the phenol-chloroform method. Lipid profile was estimated by using a commercially available kit. Polymorphisms in the HL (-250 G/A) gene were analysed by using restriction fragment length polymorphism-polymerase chain reaction (PCR-RFLP) method. The effect of this polymorphism on plasma lipids, lipoproteins and coronary artery disease was determined. Results: In Human Hepatic Lipase (LIPC)-250G/A genotype, the frequencies of GG, GA and AA genotype in CAD group was 80.69%, 15.45% and 3.86%, respectively; in the control group, the corresponding frequencies were 90.16%, 9.02% and 0.82%, respectively. A significant difference was found in the genotype (LIPC-250G/A) distribution between the two groups. Further logistic regression analysis indicated that the GA and AA genotypes in SNP-250G/A were significantly associated with CAD in all genetic models (In codominant model- GA vs. GG, OR=1.91, 95% CI=1. 09-3.37, p=0. 03 and AA vs. GG, OR= 5.26, 95% CI= 1.10-24.60, p=0.04; in dominant modelGA+AA vs. GG, OR=2.19, p=0.004 and in recessive model- AA vs. GG+GA, OR=5.26, p=0.04 whereas, A allele at nucleotide -250G/A in the LIPC gene had an association with increased risk of CAD (OR=2.33, p=