Epidemiological and clinical profile, management and outcomes of young patients (≤40 years) with acute coronary syndrome: A single tertiary care center study.

OBJECTIVE: To study the epidemiological and clinical profile, angiographic patterns, reasons for the delay in presentation, management, and outcomes of the acute coronary syndrome (ACS) in young patients (≤40yrs) presenting to a tertiary care hospital in North India. METHODS: We included a total of 182 patients aged ≤40 years and presenting with ACS to the cardiology critical care unit of our department from January 2018 to July 2019. RESULTS: The mean age of the study population was 35.5 ± 4.7years. 96.2% were males. Risk factors prevalent were smoking (56%), hypertension (29.7%), family history of premature coronary artery disease (18.2%), and diabetes (15.9%). The median time to first medical contact and revascularization was 300 (10-43200) minutes and 2880 (75-68400) minutes, respectively. ST-elevation ACS (STE-ACS) accounted for 82% and Non-ST-elevation ACS (NSTE-ACS) accounted for 18% of cases. Thrombolysis was done in 51.7% of the cases. Coronary angiography was done in 91.7% and percutaneous coronary intervention (PCI) in 52.2% (95/182) of the total cases. Coronary artery bypass surgery (CABG) was done in 2 patients (1.1%). Among those who underwent coronary angiography, single-vessel disease (SVD) was seen in 53% of the cases. There were no deaths in hospital, and only one patient died during the 30 days follow up. CONCLUSIONS: STE-ACS was the most common presentation of ACS in the young population. Smoking was the most common risk factor. The majority of the patients had single-vessel disease, and there was a significant delay in first medical contact and revascularization.

Congenital superior vena cava (SVC) stenosis and obstructed supracardiac total anomalous pulmonary venous connection (TAPVC)-A surgical perspective.

Congenital superior vena cava (SVC) stenosis is a very rare anomaly, especially in pediatric population. Coexistence with obstructed supracardiac total anomalous pulmonary venous connection (TAPVC) has never been reported. Clinical examination should prompt detailed and focused evaluation for this treatable etiology. Pericardial patch augmentation can cure SVC stenosis, and may allow for growth potential as well. We describe a case of congenital SVC stenosis in a case of obstructed supracardiac TAPVC in a 3-month-old infant, managed successfully.

Management of Arrhythmias in Pediatric Emergency.

Pediatricians often find it difficult to make specific diagnosis of arrhythmia based on ECG. This article is an effort to make the pediatricians understand common arrhythmias. Diagnosing arrhythmias is important as some arrhythmias, if not diagnosed or suspected, can lead to heart failure. With proper diagnosis, some of them can be cured with therapeutic ablation. Adenosine is not only a therapeutic drug but in many circumstances, it gives definite diagnosis also.

Sudden death of a young child due to cardiac rhabdomyoma.

This report describes a 1(1/2)-year-old boy who succumbed to acute obstruction of the left ventricular outflow tract by a cardiac rhabdomyoma. He was admitted to have a transient loss of consciousness episode evaluated. A mobile intracardiac mass obstructing the left ventricular outflow tract and protruding into the aortic root during systole was detected by transthoracic echocardiography. At autopsy, it was confirmed to be a rhabdomyoma.