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Despite recent advancements in diagnostic and treatment modalities, malaria is still one of the most prevalent human diseases with high mortality and morbidity. We described a case of 45 years old man with Plasmodium falciparum malaria primarily presenting with myocarditis. The possibility of malaria was Subsequently considered when he developed fever followed by signs of cerebral involvement. This happens to be a distinctly unusual presentation and we highlighted various features of this case. Thus in hyperendemic areas complicated Plasomdium falciparum malaria may present initially With atypical features and high index of suspicion may lead to prompt early aggressive antimalarial therapy and reduce the complications.

Objective: To determine the frequency of risk factors in male patients presenting with acute coronary syndrome., Study Design: Observational study., Place and Duration of Study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from October 2007 to September 2008., Methodology: Male patients with acute coronary syndrome were included in this study. Patients having angioplasty (PCI), coronary artery bypass surgery, chronic liver and kidney diseases were excluded. Presence of diabetes, smoking, hypertension, dyslipidemia, physical activity, stress, a family history of coronary artery disease (CAD) and medication was documented. Blood pressure, ECG, cardiac enzymes, fasting blood glucose, lipid profile and echocardiography were done within 24 hours of admission. Body mass index and waist circumference were measured. Data was analysed using SPSS-15., Results: A total of 135 male patients of ACS were studied having mean age of 54.26±11.60 years. Maximum number of patients aged between 51 to 60 years, (n = 41, 31.9%). STEMI (ST-elevation myocardial infarction) was diagnosed in 96 (71.1%) patients, non-STEMI in 12 (8.9%) while 27 (20%) patients were having unstable angina. Smoking was documented in 60 (44%) patients, hypertension in 50 (37%), diabetes in 34 (25.2%) and a family history of premature CAD was recorded in 24 (17.8%) patients. Fifty one (37.8%) patients were overweight (BMI = 25-29.9) while 22 (16.3%) were obese (BMI ³ 30). Waist circumference > 90 cm was found in 86 (63.6%) subjects. Sixty four (47.4%) patients were active physically. Psychosocial stress was documented in 33 (23.75). Hypertension, diabetes and dyslipidemia were the most frequent combinations, observed in 24 (17.9%) subjects., Conclusion: Dyslipidemia, smoking, hypertension and diabetes were most frequent risk factors. Public awareness to control risk factors can reduce the prevalence of CAD.

Objective: To determine the outcome of Radiofrequency Catheter Ablation (RFCA) as a non-pharmacological curative therapy for idiopathic Ventricular Tachycardia (VT) and to identify procedure-related complications., Study Design: Descriptive study., Place and Duration of Study: The Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from February 2001 to October 2008., Methodology: Ninety eight consecutive patients with idiopathic VT, resistant to drug therapy, who underwent Electrophysiology Studies (EPS) radiofrequency catheter ablation were enrolled. Clinical and electrophysiological variables were recorded and a descriptive analysis was done., Results: Out of the 98 patients, 79 were males (80.6%). The mean age was 33.29+11.93 years. Modes of presentation were sustained VT, Repetitive Monomorphic VT (RMVT), Non-sustained VT (NSVT) and Ventricular Premature Beats (VPBs). Right Ventricular Outflow Tract (RVOT) VT was found in 37 patients, 37 had Idiopathic Left Ventricular Tachycardia (ILVT), 20 had Left Ventricular Outflow Tract (LVOT) VT, and Inflow Right Ventricular Tachycardia (IRVT) was found in 7 patients. Other sites of origin of VT were infrequent. Eight patients had dual morphologies of VT. Atrioventricular Nodal Re-entry Tachycardia (AVNRT) was found in 8 patients. RFCA was successful in abolishing inducible VT in 88 patients. One patient developed complete AV block requiring a permanent pacemaker., Conclusion: Results of this study confirm a high degree of success and safety of radiofrequency catheter ablation as curative therapy for idiopathic ventricular tachycardia.

Background: Conduction defects complicating acute myocardial infarction (MI) are frequent and associated with increased mortality and complications. Common conduction defects after acute MI are atrioventricular nodal blocks (1st, 2nd and 3rd degree) and intraventricular conduction defects (right or left bundle branch blocks and hemiblocks). In myocardial infarction occlusion of coronary arteries at different levels affects the conduction system of heart leading to various types of blocks. Conduction defects usually reflect extensive damage to the myocardium., Methods: In this descriptive case series with non-probability purposive sampling, 345 cases of acute ST elevation myocardial Infarction were studied at Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi from May 2007 to May 2008. ECG was continuously observed in CCU and daily ECGs were done. Conduction defects whether transient or persistent were recorded in pre-designed proforma in addition to other clinical features and associated complications during hospital stay., Results: Out of 345 patients, 251 (72.8%) patients received thrombolytic therapy and 61 (17.6%) developed various types of conduction defects (Group A) and 284 had no significant conduction defects (Group B). Isolated complete atrioventricular block (AVB) at the node level occurred in 28 patients (8.1%) mainly in inferior MI. Bundle branches Blocks occurred in 32 (9.2%) patients mostly in Anterior MI. One patient (0.6%) had complete heart block at bundle branch level. All patients with complete atrioventricular block reverted to sinus rhythm except one who required permanent pacemaker. Mortality rate and clinical complications were higher in group A as compared to group B., Conclusion: Conduction defects are common even in this thrombolytic era. Patients with conduction defects are at high risk of inhospital complications and mortality. They need close monitoring and optimum clinical care to reduce mortality and morbidity.

Objective: To describe the clinical features and cytogenetic analysis of patients with Down syndrome (DS)., Design: An observational study., Place and Duration of Study: The Departments of Paediatrics and Internal Medicine of Military Hospital, Rawalpindi (MH, RWP) from January 1998 to December 2001., Patients and Methods: Two hundred and ninety-five children <18 years of age clinically diagnosed as DS were included. The clinical presentation features, associated anomalies and maternal characteristics were noted., Results: Out of 295, 170 boys and 125 girls had chromosomal findings consistent with the diagnosis of DS. The mean presentation age was 16.2 months while 49 (16.6%) children presented in the neonatal period and 124 (42%) in infancy. Mongoloid slant, epicanthal folds, hypertelorism, simian crease, flat nasal bridge, and microcephaly were observed in >60% of cases. Congenital heart disease was documented in 103 (34.9%) cases and ventricular septal defect was the commonest cardiac anomaly. The cytogenetic analysis revealed that 282 (95.6%) had trisomy 21, 11(3.7%) had translocation, and only 2(0.7%) were mosaic. The mean maternal age was 29.8 years. One hundred and sixty (56.7%) cases with trisomy 21 had maternal age> 35 years, whereas 9/11(81.8%) cases of translocation had maternal age < 35 years., Conclusion: The cytogenetic pattern of DS was similar to previously described series. Inadequate antenatal screening and scarce neonatal examination results in late presentation of DS. Majority of cases can be diagnosed on the clinical features of DS.