A Study on Cardiac Manifestations of Dengue Fever.

AIMS: Incidence of cardiac involvement in dengue fever varies between 15 -50%. Cardiac manifestations of dengue fever include asymptomatic sinus bradycardia, transient AV blocks, transient ventricular arrhythmias, myocarditis and pericardial effusion. This study was done with the objective of finding actual incidence of different cardiac manifestations of dengue fever in our tertiary care hospital. METHODS: One hundred and twenty dengue patients were studied between January 2016 to December 2017. Routine biochemical parameters like complete haemogram, liver function tests, renal function tests, electrolytes were checked in all cases. ECG, echocardiography, Troponin T were evaluated in every patients and they were corroborated with clinical features like chest pain, dyspnoea, palpitation. Patients with electrolyte abnormalities, preexisting heart disease, drugs interfering with heart rhythm were excluded from study. RESULTS: Fifteen patients had cardiac involvement (12.5%). Eight patient had bradyarrhythmias (6.6%). Asymptomatic sinus bradycardia was commonest (3.3%). All had normal recovery within two weeks. Four patients had left ventricular systolic dysfunction (ejection fraction 35% - 45%) and there was spontaneous recovery within three months. Two patients had pericardial effusion which resolved within two weeks. Transient 2.1 AV block and atrial fibrillation were observed in two cases. CONCLUSION: Cardiac manifestations of Dengue were present in 11.4 % of our patents. Brady arrhythmias (6.6%) were commonest manifestation which resolves spontaneously within seven to fourteen days. Left ventricular systolic dysfunction was present in 3.3% of patients which recovered within three months. Pericardial effusion was seen in 2.5% of patients. There were no significant tachyarrhythmias in our patients except one case of atrial fibrillation.

Strain echocardiography in predicting LV dysfunction in RV apical pacing.

Right ventricular (RV) pacing is associated with a reduction in left ventricular (LV) systolic function, thought to be mediated by pacing-induced ventricular dyssynchrony. The prevalence of heart failure after RV pacing is reported to range from 31±3%. We studied 60 subjects with high-grade atrioventricular block and Complete Heart Block (CHB) scheduled to undergo right ventricular apical pacing. 2D echocardiography was done at baseline, 1 month and 12 months. Pacing-induced cardiomyopathy was defined as a reduction in LVEF to <45%. Strain was evaluated off-line from digitally stored images using all advanced software package (cardiac wall motion quantification (CMQ); Toshiba Medical Systems). Longitudinal strain for individual myocardial segments was measured from the apical four-chamber, two-chamber and long axis views (16 segment AHA/ASE model). None had LV dysfunction at baseline based on 2D and strain echo imaging. Subsequently 18 patients were detected to develop low GLS score (less than -14.5) at 1 month. On subsequent follow up at 1 year, all 18 patients developed LV dysfunction on 2D Echocardiography. Thus Strain imaging with GLS score helped in early detection of LV dysfunction in RV apical pacing subjects. Pacing-induced cardiomyopathy had significant association with high grade AV block with pacemaker dependency. It had no significant associations with other comorbidities like diabetes, hypertension, ischemic heart disease or with the type of medication intake. However there was a statistically significant association with heart failure.

Our experience of coronary angiography with and without heparin.

AIM: Coronary angiography is usually done with heparin. Our aim is to see whether it can be done without heparin through femoral route and its effect on local complications. METHOD: We have studied 3780 patients from 2006 to 2010 using standard dose Heparin (5000 units), low dose heparin (2000 units) and no heparin. We have compared safety and complications in these three groups. RESULTS: Local complications were lowest in no heparin group. Blood transfusion requirements and surgical interventions were lowest in no heparin group. Thrombosis rate did not increase in no heparin group. CONCLUSION: Coronary angiography can be done safely without heparin through femoral route.

A case of difficult temporary pacing.

A 55-year-old lady came with recurrent syncope due to complete heart block. A temporary pacing lead could not be advanced via the inferior vena cava (IVC) to the right atrium. A venogram demonstrated that the IVC had no connection to the right atrium. The temporary lead could then be advanced through the azygos and superior caval vein to the right atrium and ventricle. The patient had no congenital heart disease or visceral heterotaxy.

Ventricular pseudo-aneurysm with coronary ectasias.

A 51 years male presented with acute left ventricular failure and was diagnosed to have pseudo-aneurysm of left ventricle, coronary artery disease with diffuse ectasia of coronary arteries.

A case of primary ciliary dyskinesia with pulmonary arterial hypertension responding to oral sildenafil.

Primary ciliary dyskinesia (PCD) is an autosomal recessive heterogeneous group of conditions with variable clinical findings like recurrent respiratory tract infections, bronchiectasis, situs inversus, singly or in various combinations. Development of Pulmonary arterial hypertension can be a late complication of this disease. Here we present a case of PCD with recurrent respiratory tract infections, bronchiectasis and severe PAH, who responded to treatment with Oxygen, IV broad spectrum antibiotics and oral sildenafil.

Pacemaker pocket infection rate and suture technique.

OBJECTIVE: The incidence of cardiac implantable electronic device (CIED) infection is usually <2%. The interrupted suture technique is thought to be better than a continuous suture in order to prevent pacemaker pocket infection. The aim of this study was to determine if there was a correlation between the suture techniques and the pacemaker wound infection rate. METHODS: The data of 2200 patients from the 5-year period of 2011 to 2016 were studied. There were 1096 patients in the study group and 1104 patients in the control group. Continuous sutures were used in the study group and interrupted sutures were used in the control group. RESULTS: Pacemaker pocket infection occurred in 33 patients (1.5%). Seventeen patients in the study group and 16 patients in the control group developed a pacemaker pocket infection. A pacemaker pocket hematoma was seen in 54 patients in the study group (4.9%) and 50 patients in the control group (4.5%). CONCLUSION: Use of the continuous or interrupted suture technique for wound closure had no significant role in the prevention of pacemaker pocket infection.

Abnormal origin of right coronary artery and use of Tiger catheter through femoral route.

BACKGROUND: Abnormal origin of right coronary artery (RCA) is not uncommon. The incidence is .25-.92%. Right Judkin catheter is used universally for engaging right coronary ostium from femoral route. We have tried Tiger catheter from femoral route in abnormal origin of RCA patients. We were successful in cannulating RCA ostium in most of the cases. MATERIALS AND METHODS: We have studied about 5120 patients over 4 years. We have selected patients from November 2010 to November 2014. Our patients are from two institutions-I.P.G.M.E.R., Kolkata and Burdwan Medical College, West Bengal. Right Judkin 3.5 and 4 were used universally. We have used AL-1,2,3, AR1,2, multipurpose, different guide catheters for cannulating RCA ostium in those cases where we failed to engage by right Judkin catheter. We have used Tiger catheter as a last resort when all endeavor failed. RESULTS AND ANALYSIS: Among 40 cases of left sinus origin Type A-9, Type B-14, Type C-6, Type D-3, and Type E-8 patients were observed. But 668 cases abnormal origin of RCA were from right coronary sinus only. High take-off origin were 422 cases (8%), low take-off were 132 cases (2.5%), and posterior origin were 114 cases (2%). We could engage right coronary ostium by Tiger catheter in 690 cases (97%). We failed in 23 cases (3%). CONCLUSION: Tiger catheter can be used successfully in abnormal RCA origin cases. It is more effective but less risky in comparison to other catheters.

Broken guidewire - A tale of three cases.

Guidewire fracture is a rare complication of percutaneous coronary intervention. Retained guide wire fragments in the coronary tree can cause thrombosis, embolic phenomena, dissection, perforation, and vessel occlusion. The management of this complication is still debated and it involves conservative management of leaving wire alone, percutaneous retrieval of fractured fragment, use of second stent to crush the wire, or open heart surgery. Here, I am reporting three cases of broken guidewire and they have been managed in three different ways.

Syncope in a child.

Acute rheumatic fever (ARF) is a well-characterized illness. However, syncope in ARF due to advanced heart block is very rare. A 10-year-old boy was admitted with recurrent syncope for 12 h. The patient was diagnosed as ARF because of arthritis, elevated acute phase reactants, advanced heart block, high antistreptolysin O titer, and echocardiographic evidence of mitral regurgitation. On the 9(th) day of hospitalization, the electrocardiogram revealed normal sinus rhythm.

Primary percutaneous coronary intervention in a case of idiopathic spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is a rare but important cause of acute coronary syndrome. SCAD can cause unstable angina, acute myocardial infarction, and sudden death. The diagnosis of coronary dissection is usually made by coronary angiography. Therapeutic options include medical therapy, percutaneous coronary intervention, and bypass surgery. A 23-year-old male patient presented with acute inferior wall myocardial infarction. He was taken for primary percutaneous coronary intervention and found to have long segment SCAD in the right coronary artery. He was stented with 2 drug-eluting stents; TIMI 3 flow was restored; and the patient had an uneventful, complete recovery.

An Uncommon Ventricular Tachycardia due to Inactive PPM Lead.

Our patient had recurrent syncope due to ventricular tachycardia (VT) after one year of VVI Pacemaker implantation. He had pacemaker pocket infection for which new pacemaker was implanted on opposite side but old lead was not explanted completely. Flouroscopy showed redundant loop of old lead in right ventricular inflow which was snared out subsequently. He never had syncope or VT after that.

Amelioration of immune cell number depletion and potentiation of depressed detoxification system of tumor-bearing mice by curcumin.

BACKGROUND: The true therapeutic benefit of the use of natural products, especially acceptable dietary components such as curcumin, which can spare the normal cells and boost host immunity, has opened new horizons in cancer prevention and treatment. METHODS: In our model system we used Ehrlich's ascites carcinoma cells grown in peritoneal carity of Swiss albino mice and curcumin was fed every alternative day. RESULTS: Here, we report that curcumin administration to tumor-bearing mice decreased tumor cell number significantly in a dose-dependent manner. Furthermore, tumor-induced depletion of immune cell number of the host, as was evidenced from the decrease in bone marrow progenitor as well as thymic and splenic mononuclear cell numbers, was reintrated by curcumin. In fact, curcumin inhibited tumor-induced apoptosis of both thymocytes and splenocytes thereby restoring immune cell numbers to normal level in treated Ehrlich's ascites carcinoma-bearing mice. Moreover, curcumin was not toxic to the host; rather in tumor-bearing mice it inhibited hematopoietic toxicity, acted as a hepatoprotective agent and activated depressed anti-oxidant and detoxification systems. CONCLUSION: The ability of curcumin to regress tumor as well as to protect the host from tumor-induced immunosuppression and toxicity strongly supports the candidacy of curcumin as a potential agent for the dietary therapy of cancer.

Apoptogenic effects of black tea on Ehrlich's ascites carcinoma cell.

Next to water, tea is the most ancient and widely consumed beverage in the world. Epidemiological studies have suggested a cancer protective effect, but the results obtained so far are not conclusive. In the current study, mechanisms of the apoptogenic effect of black tea extract were delineated. Black tea administration to Ehrlich's ascites carcinoma (EAC)-bearing Swiss albino mice caused a significant decrease in the tumor cell count in a dose-dependent manner. Flowcytometric analysis showed an increase in the number of cells in the sub-G(0)/G(1) population signifying tumor cell apoptosis by black tea. These results were further confirmed by nuclear staining that demonstrated distinct morphological features of apoptosis. Our data also revealed an increase in the expression of pro-apoptotic protein p53 in EAC. It is known that upon p53 induction, multiple downstream factors contribute to the decision making between growth arrest and apoptosis. Among those, pro-apoptotic gene Bax is up regulated during p53-mediated apoptosis. On the other hand, p53-mediated growth arrest involves p21 as a major effecter. In our system, increase in p53 expression was followed by moderate expression of p21/Waf-1 and high expression of Bax at protein levels. Interestingly, anti-apoptotic protein Bcl-2 was down regulated resulting in decrease in Bcl-2/Bax ratio. All these observations together signify that black tea-induced apoptogenic signals overrode the growth-arresting message of p21, thereby leading the tumor cells towards death.