Search

Long QT syndrome with Torsades de Pointes (TdP) is a life-threatening polymorphic ventricular arrhythmia. The corrected QT (QTc) prolongation >500 milliseconds (ms) has been associated with TdP. Hypocalcaemia due to severe vitamin D deficiency is an uncommon cause of acquired long QT. We hereby present a case of a 40-year-old woman with sensorineural deafness and having symptoms of palpitations and presyncope. She had a QTc interval of 556 ms (reference range, QTc 451–470 ms in adult healthy woman) on 24-hour Holter analysis. Genetic analysis for congenital long QT syndrome was negative. She was diagnosed with severe hypocalcaemia secondary to severe vitamin D deficiency. After treatment with intravenous calcium gluconate, followed by oral vitamin D and calcium supplementation, the QTc became normalised and no further episode of palpitations or presyncope occurred. The causes of vitamin D deficiency was due to inadequate exposure to sunlight and a strict vegan diet.

In-stent restenosis and stent thrombosis are the major concerns while choosing a coronary stent. This single-centre, retrospective study evaluated the one and three-year clinical outcomes following implantation of Yukon Choice Flex (YCF) sirolimus-eluting stent. A total of 168 consecutive patients with 217 lesions underwent stenting with YCF stent. The presentation was with acute coronary syndrome in 158 (94%) patients. At 3 years, 9 (5.3%) patients died due to cardiac cause. Myocardial infarction, and definite stent thrombosis occurred in 10 (6%) and 4 (2.4%) patients respectively. Redo stenting and coronary artery bypass surgery was performed in 3 (1.8%) and 1 (0.6%) patient respectively. The use of YCF sirolimus eluting stent was associated with a favourable safety and efficacy profile at one and three-years of follow-up in a high-risk population.

Background Among many drugs that hold potential in COVID-19 pandemic, chloroquine (CQ), and its derivative hydroxychloroquine (HCQ) have generated unusual interest. With increasing usage, there has been growing concern about the prolongation of QTc interval and Torsades de Pointes (TdP) with HCQ, especially in combination with azithromycin. Aims This meta-analysis is planned to study the risk of QTc prolongation and Torsades de pointes (TdP) by a well-defined criterion for HCQ, CQ alone, and in combination with Azithromycin in patients with COVID-19. Methods A comprehensive literature search was made in two databases (PubMed, Embase). Three outcomes explored in the included studies were frequency of QTc > 500 ms (ms) or ΔQTc > 60 ms (Outcome 1), frequency of QTc > 500 ms (Outcome 2) and frequency of TdP (Outcome 3). Random effects method with inverse variance approach was used for computation of pooled summary and risk ratio. Results A total of 13 studies comprising of 2138 patients were included in the final analysis. The pooled prevalence of outcome 1, outcome 2 and outcome 3 for HCQ, CQ with or without Azithromycin were 10.18% (5.59–17.82%, I2 – 92%), 10.22% (6.01–16.85%, I2 – 79%), and 0.72% (0.34–1.51, I2 – 0%) respectively. The prevalence of outcome 2 in subgroup analysis for HCQ and HCQ + Azithromycin was 7.25% (3.22–15.52, I2 – 59%) and 8.61% (4.52–15.79, I2 – 76%), respectively. The risk ratio (RR) for outcome 1 and outcome 2 between HCQ + Azithromycin and HCQ was 1.22 (0.77–1.93, I2 – 0%) & 1.51 (0.79–2.87, I2 – 13%), respectively and was not significant. Heterogeneity was noted statistically as well clinically (regimen types, patient numbers, study design, and outcome definition). Conclusion The use of HCQ/CQ is associated with a high prevalence of QTc prolongation. However, it is not associated with a high risk of TdP.

Background Amoebiasis is a prevalent infection in the tropics. Amoebic liver abscess is the most common extraintestinal manifestation. Cardiac tamponade is an uncommon complication of amoebic liver abscess that may need urgent pericardiocentesis. Case summary A 25-year-old man presented with abdominal pain and fever for 1 month. Abdominal ultrasound revealed a 4.7 × 4.7 cm abscess in the left lobe of the liver. Percutaneous pigtail drainage was performed to evacuate the abscess. After 2 days, the patient developed signs of cardiac tamponade and bilateral pleural effusion, requiring urgent pericardiocentesis and chest drain insertion. Persistent posterior collection of thick abscess in pericardium needed pericardial window for complete drainage. The patient recovered completely after pericardial window. There was no evidence of chronic constrictive pericarditis after 1 year of follow-up. Discussion A rare complication of the amoebic liver abscess was observed in this young adult who developed cardiac tamponade, requiring an urgent pericardiocentesis, and later requiring pericardial window. Management includes amoebicidal and luminicidal drugs for complete eradication of Entamoeba histolytica.

The reuse of sterilized Inoue catheters is practiced widely in developing countries to bring down the procedure cost. However, blood can enter the space between the latex layers and become embedded in the mesh layer, which is difficult to clean when sterilizing the catheters. This is a common cause of rupture. Proper meticulous inspection of reused Inoue balloons for deformity or leakage through the small holes is necessary to prevent such complications.

Dobutamine stress echocardiography (DSE) is commonly used to assess the extent, location, and severity of coronary artery disease (CAD), and for myocardial viability. DSE is generally well tolerated, and its side effects and contraindications are mostly related to consequences of excess inotropic or chronotropic stimulation of the heart. Bradycardia and transient atrioventricular (AV) block are not infrequent during DSE. Hereby, we present a case report of a patient who developed symptomatic junctional bradycardia during dobutamine stress echocardiography.

Infective endocarditis (IE) is primarily a bacterial infection of the heart valves. The most common organisms implicated include Staphylococcus and Streptococcus species. However, with the advent of MALDI-TOF and molecular techniques, the reports of IE being caused by rare organisms are on a rise. Here we describe a case of IE due to Abiotrophia defectiva. This is the first report of simultaneous infection of both mitral and aortic valves by Abiotrophia defectiva from India. IE caused by Abiotrophia defectiva has been seen to be more severe, associated with higher failure rates and relapse. This emphasizes the accurate identification of nutritionally variant Streptococcus (NVS) species as the management of choice varies between Abiotrophia and Granulicatella.

The 12-lead electrocardiogram (ECG) of a 79-year-old male patient with recurrent pre-syncope showed irregular sinus rhythm with constant PR interval and left bundle branch block (LBBB) with intermittently blocked P waves. The beat following the blocked P wave had a narrower QRS with a shorter PR interval. The phenomenon of bilateral bundle branch block explains the sudden improvement in the atrioventricular conduction.

Radial artery pseudoaneurysm is a very rare complication. In the presented case, computed tomography 3 months post percutaneous coronary intervention demonstrated contrast extravasation, suggestive of radial artery pseudoaneurysm. This complication was managed with thrombin infusion at the distal radial artery.

Spontaneous coronary artery dissection (SCAD) is an unusual but important cause of acute coronary syndrome and is often underdiagnosed. The first clue to the diagnosis is the angiographic appearance of the lesion, and, in certain cases, intravascular imaging is needed to confirm it. Conservative management is the preferred treatment strategy for the majority of cases. However, revascularization is needed in the presence of high-risk features, including hemodynamic instability, ongoing ischemia, and left main dissection. We report a case of a 43-year-old man who presented with acute inferior wall myocardial infarction. Angiogram revealed SCAD of the right coronary artery (RCA). In view of ongoing chest pain, we proceeded with direct stenting. However, during the stent delivery, the stent got embolized and laid unexpanded in the proximal RCA. The stent was successfully retrieved and was deployed at the right radial artery. Subsequently, after the troubleshoot, we again secured wire access across the RCA, and this time after pre-dilatation, successful stenting across the SCAD segment was achieved. Percutaneous coronary intervention (PCI) in SCAD is technically challenging with lower success and higher complication rates compared to atherosclerotic disease. Stent embolization is a potential complication during PCI of SCAD and to the best of our knowledge has never been reported before. Though, in general, the SCAD lesion is soft and one may proceed with direct stenting with long stents, occasionally adequate pre-dilatation may be necessary in order to facilitate the smooth passage of stent across the lesion. Though stent embolization in SCAD is a rare event, the operator must be aware of such a possibility and the potential bailout strategies if faced with such a scenario.

The recent outbreak of coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, primarily involves the respiratory system with viral pneumonia as a predominant manifestation. In addition, SARS-CoV-2 has various cardiovascular manifestations which increase morbidity and mortality in COVID-19. Patients with underlying cardiovascular diseases and conventional cardiovascular risk factors are predisposed for COVID-19 with worse prognosis. The possible mechanisms of cardiovascular injury are endothelial dysfunction, diffuse microangiopathy with thrombosis and increased angiotensin II levels. Hyperinflammation in the myocardium can result in acute coronary syndrome, myocarditis, heart failure, cardiac arrhythmias and sudden death. The high level of cardiac troponins and natriuretic peptides in the early course of COVID-19 reflects an acute myocardial injury. The complex association between COVID-19 and cardiovascular manifestations requires an in-depth understanding for appropriate management of these patients. Till the time a specific antiviral drug is available for COVID-19, treatment remains symptomatic. This review provides information on the cardiovascular risk factors and cardiovascular manifestations of COVID-19.

Hardware loss and entrapment during percutaneous coronary intervention is one of the important complications, which an interventionist should anticipate in his practice. Basic knowledge about various extraction methods is essential to bail out in such situations. We describe a 74-year-old male, in whom a used thrombuster device got stuck in struts of an already deployed stent in the right coronary artery. The device could not be retrieved via various percutaneous maneuvers, necessitating an emergency surgical device retrieval and concomitant coronary bypass.

A 52-year-old woman presented to another hospital with progressive dyspnea of 10-day duration. The patient was diagnosed with a massive pericardial effusion and underwent pericardiocentesis. However, the patient's symptoms did not improve and she was referred to our hospital with a pericardial sheath in situ. On evaluation, the patient had a large pericardial effusion and evidence of cardiac tamponade, but no fluid could be aspirated from the sheath. This case underscores the importance of image-guided pericardiocentesis.

A 25-year-old man came to our clinic with the complaints of exertional palpitations and dyspnea. He had skeletal features suggestive of Marfan's syndrome. Contrast-enhanced computed tomography confirmed aneurysmal dilation of the aortic root and the proximal part of the ascending aorta. The patient was advised to undergo Bentall procedure for replacement of the aortic valve, aortic root, and ascending aorta. Marfan's syndrome is a connective tissue disorder with autosomal-dominant inheritance. Patients have a predisposition for progressive aortic root and ascending aortic dilation, and should undergo periodic echocardiographic monitoring.

During inflation of the Inoue balloon during a balloon mitral valvotomy, indentation and compression of the Inoue balloon was seen. This is indirect evidence of severe subvalvular disease.

Iatrogenic pneumopericardium after pericardiocentesis due to accidental leakage from the side port of the sheath has been reported in the literature. In the present case, it occurred during passage of the guidewire. Every step needs to be done meticulously. The patient should be advised not to take a deep breath during the puncture.

A 30-year-old lady presented with complaints of fever, haemoptysis, dyspnoea and chest pain for 1 week [...]

A 56-year-old male, chronic smoker, presented with persistent dry cough, hoarseness of voice and difficulty in swallowing. Indirect laryngoscopy revealed left vocal cord paralysis. Further evaluation revealed eccentric saccular aneurysms arising from the aortic arch and descending thoracic aorta, compressing the trachea, esophagus, left atrium and left recurrent laryngeal nerve. The patient was diagnosed with Ortner's syndrome which is an uncommon presentation of aortic aneurysm. He awaits an endovascular aorta aneurysm repair.

Background and Objectives In East Asia, tuberculous pericarditis still occurs in immunocompetent patients. We aimed to investigate clinical course of tuberculous pericarditis and the trends of echocardiographic parameters for constrictive pericarditis. Methods We retrospectively analyzed medical records of patients with tuberculous pericarditis between January 2010 and January 2017 in Samsung Medical Center. Treatment consists of the standard 4-drug anti-tuberculosis regimen for 6 months with or without corticosteroids. We performed echocardiography at initial diagnosis, 1, 3 and 6 months later. Results Total 50 cases with tuberculous pericarditis in immunocompetent patients were enrolled. Echocardiographic finding at initial diagnosis divided into 3 groups: 1) pericardial effusion only (n=28, 56.0%), 2) effusive constrictive pericarditis (n=10, 20.0%) and 3) constrictive pericarditis (n=12, 24.0%). The proportion of patients with constrictive pericarditis decreased gradually over time. After 6 months, only 5 patients still had constrictive pericarditis. Out of the 28 patients who initially presented with effusion alone, only one patient developed constrictive pericarditis. Echocardiographic parameters representing constrictive pericarditis gradually disappeared over the follow up period. Ventricular interdependency improved significantly from 1 month follow-up, whereas septal bounce and pericardial thickening were still observed after 6 months without significant constrictive physiology. Conclusions Tuberculous pericarditis with pericardial effusion without constrictive physiology is unlikely to develop into constrictive pericarditis in immunocompetent hosts, if treated with optimal anti-tuberculous medication and steroid therapy. Even though there were hemodynamic feature of constrictive pericarditis, more than 80% of the patients were improved from constrictive pericarditis.

A 37-year-old man was presented in outpatient clinic of cardiology department with symptoms of easy fatigability and progressive increasing generalised anasarca since 5 months. Echocardiogram showed large mass of 9.8×7.8 cm in size in right atrium, attached to interatrial septum. Urgent opinion of thoracic surgeon was taken and surgical excision of mass under cardiopulmonary bypass was done. The tumour was large, fragile and histology confirmed it as myxoma. The patient made a good recovery and his symptoms resolved completely on follow-up.

Holt-Oram syndrome or heart-hand syndrome consists of phenotypic and genotypic abnormalities. It is characterized by abnormalities of upper limbs and congenital cardiac defects. It is an autosomal dominant disorder due to a mutation in TBX5 gene located on chromosome 12, but sporadic cases have also been reported. We describe a 26-year-old female with a history of shortness of breath for 5 years. She had bilateral hand deformities, and on evaluation, found to have ostium secundum atrial septal defect which is common cardiac defect in Holt-Oram syndrome.

Right ventricular endocardial pacing is partially contraindicated in the presence of mechanical tricuspid valve. Occurrences of atrioventricular block are commonly associated in postoperative period in Ebstein anomaly repaired with mechanical tricuspid valve. Coronary sinus (CS) pacing is the preferred site in this scenario. However, the anatomical variations in Ebstein anomaly leads to difficulties in hooking the CS. With the help of real time left coronary injection enabled in understanding the anatomical orientation of CS ostium take off, leading to successful CS lead implantation.