Takotsubo cardiomyopathy complicating a twin pregnancy at partum

Takotsubo cardiomyopathy is a rare syndrome characterized by acute left ventricular dysfunction with regional left ventricular ballooning, mimicking myocardial infarction. This condition is often described in post-menopausal women. Authors present a case in an elderly primi with twin gestation immediately after Cesarean surgery. We discussed her presentation, investigations, diagnosis, management and outcome. 35 year female, a primi with twin pregnancy developed chest pain and shortness of breath immediately after Cesarean surgery. Her Electrocardiograph was abnormal, and Echocardiogram demonstrated abnormal apical ballooning of the left ventricle and severe dysfunction. Cardiac enzymes were elevated and chest skiagram showed pulmonary edema. She was managed in the intensive care unit with oxygen supplementation, diuretics and inotropes. She made an excellent recovery with normalization of left ventricular ejection fraction within 8 days. During the six months follow up, she was asymptomatic and left ventricular function remained normal.

Relationship of nitric oxide and protein carbonyl in tuberculosis.

BACKGROUND: Tuberculosis (TB) is a highly contagious disease caused by Mycobacterium tuberculosis. The bacilli replicate within the macrophages and can remain dormant for years; activated macrophages show immunity against these bacilli. MATERIAL AND METHODS: A prospective study was carried out in newly diagnosed TB patients (n = 70) before their antituberculosis treatment and in normal control subjects (n = 35). Serum level of nitric oxide was estimated by Moshage method, 1995 and Bories and Bories method, 1995 and protein carbonyl by Levine method, 1990. Pearson's correlation (r) and Fisher's 'z' test was performed on the obtained results. RESULTS: In our study, serum nitric oxide and protein carbonyl levels were significantly increased (p < 0.001) in TB patients as compared to normal control group. Positive correlation was seen in pulmonary TB (r = 0.8892, p < 0.001) [Fisher's 'z' transformed = 0.7901 to 0.9430] and extra-pulmonary TB (r = 0.8330, p < 0.001) [Fisher's 'z' transformed = 0.6918 to 0.9128]; 'r' and Fisher's 'Z' was significantly different from zero (two sided p < 0.001). CONCLUSION: The mean serum nitric oxide and protein carbonyl levels were concomitantly increased and positively correlated with each other in patients with pulmonary TB and extra-pulmonary TB. The changes in the level of nitric oxide and protein carbonyl are a reflection of increased defence mechanism and free radical activity in tuberculosis.