Thrombolysis in Angiographically Proved Intermediate to High Risk Pulmonary Embolism.

PURPOSE OF STUDY: :Pulmonary embolism is a common emergency in the hospital setting. Main line of treatment is anticoagulant therapy. However, patients with right ventricular dysfunction are the subgroup with increased mortality and may have better outcome with initial treatment with thrombolytic therapy. The study was done to see the outcome of thrombolytic therapy in angiographically proved patients of pulmonary embolism. METHODS: We performed systemic workup of patients suspected of pulmonary embolism(PE). Diagnosis of PE was ruled out in patients with low probability of PE, as defined by Wells score and negative d dimer asssay. All patients were subjected to echocardiography. Those showing findings suggestive of PE, with right ventricular dysfunction, with or without hypotension, were subjected to pulmonary arteriography. Patients having evidence of PE were subjected to thrombolysis. Repeat angiography was done after the thrombolysis to see the effect of thrombolysis and fall in pulmonary artery pressures. RESULTS: :27 consecutive patients with angiographically proved PE were thrombolized. Mean age was 45.8±15.2 years. 18 were male and 9 were female. Average systolic and mean pulmonary artery pressure before thrombolysis was 71.2±14.4 and 47.5±10.5 mm Hg. Angiographic success was seen in 22 patients (81.5%). Average systolic and mean pulmonary pressure after thrombolysis was 47.1 ±21.7 and 29.4±16.5 mm Hg. Three patients with unsuccessful thrombolysis were successfully subjected to trans catheter thrombus extraction. One patient died during thrombolysis. None of the patients had major bleeding complications. CONCLUSION: Thrombolysis is effective in majority of patients with pulmonary embolism with right ventricular dysfunction. The bleeding risk is low.

Mandibular AV Malformation: A Rare Cause of Massive Bleeding from Mouth Managed with Multiple Vessel Embolization.

An arteriovenous malformation (AVM) is a site of abnormal connectivity between arteries and veins. Arteriovenous malformations of jaw are extremely rare conditions that can result in disastrous complications, if handled carelessly. Although various treatment modalities have been advocated in the literature, there seems to be no complete consensus on a suitable treatment in these cases. We describe a case of mandibular AVM, who presented with massive bleeding from mouth and each time, embolization of one vessel was done, it recruited new vessel.

Etiology and Left Ventricular Functions in Left Bundle Branch Block- A Prospective Observational Study.

PURPOSE OF STUDY: Left bundle branch (LBBB) is common ECG finding. Common causes of LBBB are coronary artery disease (CAD), hypertension and dilated cardiomyopathy (DCM). Purpose of the study was to find out the etiology and left ventricular function in patients coming to a territory care hospital. MATERIAL AND METHODS: All consecutive patients coming to our hospital as indoor or outdoor patients with ECG suggestive of LBBB were studied. The detail history and examination was done. Echocardiography was done in all patients. RESULTS: 132 patients with LBBB were studied. Mean age was 61.65±13.02 yrs. 70 were male (53.03%) and 62 were female (44.97%). 40 patients presented with dyspnea ((30.3%) and 34 with chest pain ((24.24%). 23 patients were asymptomatic (17.4%). 63 were hypertensive (47.7%) and 6 were diabetic (4.5%). Left ventricular hypertrophy (LVH) was present in 42 patients (31.8%), with 33 having diastolic and 9 systolic dysfunction. 33 patients had DCM (25%) and 31 patients had evidence of myocardial infarction (23.48%). 20 patients had normal echocardiography (15.15%). 75 patients had systolic dysfunction (56.8%). CONCLUSIONS: Commonest presentation in patients wih LBBB was dyspnea followed by chest pain. Majority had hypertension. LVH was the commonest echocardiographic finding followed by global hypokinesia and regional wall motion abnormality. More than 50% patients had left ventricular systolic dysfunction.

Clinical Profile of Acute Rheumatic Fever Patients in a Tertiary Care Institute in Present Era.

INTRODUCTION: Rheumatic heart disease (RHD) is still a common cause of morbidity and mortality in India. Rheumatic fever commonly occurs between 5-15 yrs of age. Rheumatic activity is a common cause of deterioration of symptoms in a stable or undiagnosed case of RHD. MATERIAL AND METHODS: 41 consecutive patients of acute rheumatic activity were studied. Presenting symptoms were noted. Physical examination was done for major and minor Jone's criteria. Detailed cardiac examination was done. All underwent echocardiography. RESULTS: Mean age was 14.80 ± 7.01 yrs, 26 were female and 15 were male. Joint pain was the commonest present complaint (29 patients), followed by fever in 17 patients, 32 had carditis, 26 had arthritis, 13 had subcutaneous nodules, 7 had chorea and one had erythema marginatum. In patients with carditis, 30 had mitral regurgitation (MR) only, 15 had MR with aortic regurgitation (AR). Out of 32 patients with carditis, 10 patients did not have any clinical evidence of carditis and were detected by echocardiography only. Six patients were known cases of rheumatic fever but had stopped penicillin prophylaxis. CONCLUSION: Commonest complaint in patients with rheumatic fever was joint pain followed by fever. In patients with carditis, all had MR, with 1/3rd of these patients having associated AR. 1/3rd of patients with carditis were detected by echo only and therefore, echo should be included in diagnostic criteria for acute rheumatic fever. None of the patients who developed rheumatic fever was on penicillin prophylaxis.

Isolated tricuspid valve stenosis--probably of rheumatic etiology.

Rheumatic heart disease is still a common cardiac disease in developing countries. Triscupid valve is not usually involved in RHD and whenever it is involved, it is always associated with mitral valve disease. We report a case of isolated tricuspid stenosis, most likely of rheumatic etiology.

Giant aneurysm of left main coronary artery, presenting as acute myocardial infarction in a young man.

We present a case of a young male, who presented with acute extensive myocardial infarction and later was found to have giant aneurysm of left main coronary artery.

Atrial myxoma: a rare cause of ischemic stroke.

Arial myxoma can present as stroke and should be considered as a differential diagnosis of stroke in young individuals. We present here a 42 years female who presented with sudden loss of conciousness. After extensive work up for young stroke, left atrial myxoma was detected and tumor was removed surgically and histopathological report was consistent with the atrial myxoma.

No reflow phenomenon in CAD patients after percutaneous coronary intervention: A prospective hospital based observational study.

The present study assessed incidence, risk factors, in-hospital and short-term outcomes associated with no-reflow in patients undergoing percutaneous coronary intervention (PCI) in STEMI, NSTEMI, unstable angina and stable angina. Out of 449 patients, 42 (9.3%) developed no-reflow. Hypertension, dyslipidemia, obesity and smoking were significant risk factors. There was significant association of no-reflow with left main disease, multiple stents, target lesion length≥ 20 mm and higher thrombus grade. Interestingly, 93 patients (23.4%) of normal flow had myocardial perfusion grade (MPG) of 0/1 with mortality in 9 (10%) patients. No-reflow is associated with poor in-hospital and short-term outcomes with higher incidence of death, cardiogenic shock, heart failure and MACE. Knowledge of risk factors of no-reflow portends a more meticulous approach to improve final outcomes. MPG could be better predictor of outcomes in these patients.

Atrial fibrillation in a tertiary care institute - a prospective study.

OBJECTIVE: Atrial fibrillation is the commonest sustained arrhythmia. In western countries the common causes of atrial fibrillation are hypertensive heart disease, dilated cardiomyopathy, and coronary heart disease. Rheumatic heart disease being still common in India, we studied its contribution to atrial fibrillation. MATERIAL AND METHODS: 137 consecutive patients of atrial fibrillation coming to our hospital were subjected to echocardiography to determine the cause. RESULTS: Out of 137 patients with atrial fibrillation, 76 were female (55.47%) and 61 were male (44.43%). Mean age was 51.24±15.36 years. Commonest cause of AF was rheumatic heart disease found in 84 (61.31%) patients. Next common causes were hypertensive heart disease in 14 (10.2%) patients and chronic obstructive pulmonary disease (COPD) in 14 (10.2%) patients. Mean left atrial size was 47.8±12.25mm. CONCLUSION: In our study of patients coming from a rural back ground of North India, more than 60% patients of AF are due to RHD. Hypertensive heart disease and COPD are the next common causes.