High mortality diphtheritic myocarditis with conduction disturbance, case series, and review of literature.

Diphtheria cases are still being reported in various parts of the globe. Although complete heart block resulting from diphtheric myocarditis is infrequent, it can lead to fatality. Awareness and recognition of this help strengthen the importance of vaccines and their proper management. Case presentation: The authors report two young patients who presented in the interval of a month, to the emergency department with signs and symptoms of diphtheria. Both developed diphtheric myocarditis with complete heart block and severe left ventricular systolic dysfunction, which did not respond to temporary pacing. Discussion: Diphtheria remains rare but few cases continue to emerge, especially in developing countries. Those who develop it have high mortality, particularly from cardiomyopathy, airway compromise, and organ failure. Conduction abnormalities are diagnostic of diphtheric myocarditis and have a grim prognosis and treatment options are limited. Conclusion: Diphtheric myocarditis has a poor prognosis and is an independent predictor of mortality. Since aggressive invasive treatment has not been shown to improve survival, early recognition along with antitoxin at the earliest suspicion and proper supportive care are the current best available options.

Changes in Electrocardiogram in Patients With Spontaneous Subarachnoid Hemorrhage: A Cross-Sectional Study.

Background Electrocardiographic (ECG) changes are frequently reported findings in patients with subarachnoid hemorrhage (SAH). We conducted a retrospective descriptive study to assess the prevalence of electrocardiographic changes in patients with non-traumatic SAH.  Methods In this single-center retrospective cross-sectional study, ECG recordings of 45 patients who presented to Tribhuvan University Teaching Hospital in the year 2019 with SAH were collected and analyzed to detect any abnormalities.  Results In our study, 88.8% of patients had some form of ECG abnormality. The most common ECG abnormalities associated with SAH were QTc prolongation, T-wave abnormalities, and bradycardia, which were found, respectively, in 35.5%, 24.4%, and 24.4% of the patients. Other ECG changes we observed include ST depression, large U-waves, atrial fibrillation, and premature ventricular contractions. Conclusion Morphological and rhythm abnormalities are frequently observed in patients with SAH, which may cause diagnostic dilemmas and unnecessary workups. Further studies are required to evaluate their significance and correlate ECG changes with clinical outcomes.