Coronary sinus anatomy: Ajmer Working Group Classification.

BACKGROUND: Coronary sinus (CS) anatomy is a major predictor of successful implantation of left ventricular (LV) lead and procedural outcome. We therefore made an attempt to look at the CS anatomy and possible feasibility to classify them into categories depending upon their size, branching pattern, location of posterolateral vein (PLV), and other parameters in order to guide the cardiologist for successful cannulation of the CS and LV lead implantation. METHODS: We analyzed the levophase angiograms of patients (n = 100) undergoing routine coronary angiography in the right anterior oblique view. We have made an attempt to classify these observations on the basis of predetermined parameters and a working classification was brought out for the ease of the operator and to predict the bottlenecks of the procedure. OBSERVATIONS: On the basis of predetermined parameters, venograms obtained from 100 patients were analyzed and findings were divided into three groups depending upon the ease of cannulation of posterolateral vein for LV lead placement. These 3 groups were further classified as type I, type II, and type III coronary sinuses. CONCLUSIONS: This observational study proposes a new anatomical working classification for CS for purposes of successful LV lead placement and optimal operative success.

A study of coronary artery patency in relation to the index event in patients with myocardial infarction thrombolysed with streptokinase.

BACKGROUND: Restoration of infarct vessel patency is the key treatment for acute ST-elevation myocardial infarction. OBJECTIVE: The purpose of the study was to confirm the effectiveness of streptokinase (STK) for successful thrombolysis of the infarct-related artery (IRA) in patients with acute myocardial infarction (AMI), in relation to the time of the index event and age compared with newer thrombolytic agents, in a tertiary care centre. METHODS: 100 patients (77% male) thrombolysed with STK underwent coronary angiography within 48 h of presentation. Patency of the IRA was used to assess successful thrombolysis. RESULTS: The mean pain-to-needle time was 3.24 h. 76 patients (76%) treated with thrombolysis had patent arteries with thrombolysis in myocardial infarction (TIMI) 2 or 3 flow. In subgroup analysis of time from the index event, patency rates were 83.3%, 77.5%, 68.7% and 40% in patients presenting within 0-2, 2-4, 4-6 and 6-12 h, respectively. In subgroup analysis, all patients less than 30 years of age had patent arteries with TIMI 2 or 3 flow. Coronary angiography showed the IRA was the left anterior descending artery (LAD) in 55%, the right coronary artery (RCA) in 33% and the left circumflex artery (LCX) in 12%. The patency rates of the LAD, RCA and LCX were 74.5%, 69.6% and 100%, respectively. CONCLUSIONS: We found STK to be as effective as newer thrombolytic agents reported in other studies. In patients with AMI thrombolysed within 4 h, STK results in higher patency in young compared to older patients.

Cardiac conduction system affection in a case of swine flu.

We present a case of swine flu presenting as bilateral pneumonia with involvement of cardiac conduction system in the form of increased PR interval and sinus bradycardia during the initial course of disease process. To the best of our knowledge, affection of conducting system in a case of swine flu has not been reported in the literature so far.

Transvenous pacing in the presence of acute right ventricular infarction.

Ventricular tachycardia and ventricular fibrillation are very frequent during transvenous pacing in the presence of acute right ventricular infarction. An acceptable pacing threshold is not usually achieved. A relatively high pacing threshold should, therefore, be accepted in these cases with minimum catheter manipulation. Invisible or very small pacing spikes, increased time intervals between the spike and paced QRS, atypical QRS configurations and sensing failure are frequent in these cases.

Masking of electrocardiographic features of right ventricular infarction by true posterior left ventricular infarction.

An echocardiographically documented case of right ventricular infarction is reported. Electrocardiographic diagnosis was masked by concomitant true posterior left ventricular infarction. This case highlights an important limitation of electrocardiography in diagnosing right ventricular infarction.

Acute right ventricular infarction without infero-posterior left ventricular infarction.

Two cases of acute right ventricular infarction associated with acute extensive anterior myocardial infarction in the absence of inferior and/or posterior left ventricular infarction are presented. Such a combination is likely to occur from acute occlusion of the left anterior descending artery in the face of severe narrowing of the infundibular (conus) artery rather than from acute occlusion of the right coronary artery.