Fingers on the Wrist and Taming the Funny Current, Rejuvenate the Wounded Heart: Ivabradine-Responsive Atrial Tachycardia.

A 19-year-old male presented with dyspnea on exertion (New York Heart Association [NYHA] class II) and occasional palpitations for six months. He had initially been evaluated at another facility and diagnosed with dilated cardiomyopathy. Despite treatment, there was no improvement in his symptoms. On evaluation at our centre, his previous electrocardiograms appeared normal. However, palpation of his radial pulse for one minute revealed runs of regular tachycardia, interspersed with a normal pulse rate. A 30-second rhythm strip electrocardiogram (ECG) showed multiple runs of ectopic tachycardia originating from the right atrial appendage, interspersed with ectopic atrial rhythms. Echocardiography showed severe left ventricle (LV) dysfunction with an ejection fraction of 20-25%. Radio-frequency ablation was recommended, but the patient declined. Instead, he was started on Ivabradine. After a month, his symptoms fully resolved. The ECG displayed a normal sinus rhythm with no tachycardia, and his left ventricular ejection function improved.

Left Ventricular Angiogram in Constrictive Pericarditis.

A 14-year-old boy presented with dyspnea on exertion and easy fatiguability for 1 year. He also had an episode of pedal edema 6 months prior, which resolved with diuretics. He had a history of tuberculosis treated with a 6-month course of antitubercular therapy. After a series of tests and analyses, it was evident that longitudinal contraction of the left ventricle was preserved, whereas the circumferential contraction was severely impaired. Pericardial calcification also could be seen encircling the left and right ventricles. Pericardial calcification is evident in around 25% of cases of constrictive pericarditis and predominantly seen in those with tubercular and pyogenic etiology. The subepicardial myocardial fibers are responsible for radial shortening and subendocardial fibers are responsible for longitudinal shortening. In constrictive pericarditis, the involvement of the subepicardial fibers leads to reduction in the circumferential shortening. The patient was referred for pericardiectomy.

Acute Dyspnea After Inferior-Wall Myocardial Infarction.

A 57-year-old woman presented with acute-onset dyspea with a duration of more than 2 days. Four days earlier, she had been thrombolyzed with streptokinase for inferior wall myocardial infarction in a nearby hospital. On examination, we found that the patient had elevated jugular venous pressure and systolic murmur in left lower parasternal region. In addition, there was a ventricular septal rupture in the posterobasal interventricular septum, with at least 2 exit points into the right ventricle. Timely identification of ventricular septal rupture before PCI is of paramount importance, as it has major implications in management of the patient.

A Study of Correlation between High Normal Glycosylated Hemoglobin as Risk Factor for Coronary Heart Disease with Framingham 10 Year Risk Factor in Non-Diabetic Patients.

BACKGROUND AND PURPOSE: Framingham 10 year risk score traditionally used to diagnose future risk. There is need to find simple and powerful marker for future risks of coronary artery disease. Framingham 10 year risk score take many variables together. Recently, abnormal glucose metabolism is a major determinant of CHD. Although the relationship between cardiovascular disease (CHD) and glycaemia is believed to represent a continuum without a threshold effect, as it is a more stable, accurate parameter of glucose homeostasis. Therefore, the aim of the current study was to establish association between high normal HbA1c and Framingham 10 year risk score for coronary artery diseases in non-diabetics. METHODS: A total 100 patients of coronary artery disease, aged 18-80 years were enrolled. Complete physical and systemic examination including vitals was performed. Framingham's 10 year risk score, Height, Weight, Hip Circumference, Waist Circumference, and Waist-Hip Ratio and BMI are calculated. Investigated for HbA1c, HsCRP and other routine investigations needed to diagnose coronary artery disease. Chi square test was applied to detect association between HsCRP and High HbA1c and Correlation Coefficient(r) was calculated to study linear relationship. RESULTS: The Chi square Test significant meaning that higher value of HsCRP associated with high level of HbA1c (p=0.04). The Correlation Coefficient(r) is -0.02 so there were no linear relationship between HbA1c and Framingham risk score. In our study average Framingham risk score was 9.72 while average age of patient was 53.7 years. There were linear relationship between patient's age and Framingham 10 year risk score (r= 0.60). CONCLUSIONS: Coronary artery disease patients had high prevalence of High HsCRP. there was significant association between glycosylated haemoglobin and High HsCRP (P=0.04). We find association between high normal HbA1c and Framingham risk score in non-diabetic patient. But, There is no any linear correlation between high normal HbA1c and Framingham 10 risk score (r=0.02). We find out that Framingham 10 year risk score has linear relationship with patient's age and sex. It implies that coronary artery disease calculated by using Framingham 10 year risk score increases with increase in age. But Glycosylated Haemoglobin predicts coronary artery disease risk independence of patient's age. It predicts low risk in young female patients compare to young male patient in our study. Glycosylated haemoglobin is independent of age and sex of patient. So Glycosylated haemoglobin is good marker for coronary artery disease.