Unveiling the complexity: coexistence of rheumatic heart disease and pulmonary arteriovenous malformation-a unique case report.

Background: The coexistence of rheumatic heart disease (RHD) and pulmonary arteriovenous malformation (PAVM) is a rare clinical scenario that poses diagnostic and therapeutic challenges. This case report explores the clinical presentation, diagnostic journey, and multidisciplinary management of a patient presenting with both conditions. Case summary: A 47-year-old female with a history of RHD presented with symptoms of dyspnoea on exertion and cyanosis, suggestive of both cardiac involvement and pulmonary involvement. Subsequent investigations involving imaging, echocardiography, and invasive pulmonary angiography revealed the coexistence of RHD and multiple PAVM in the patient's left lower lobe of the lung. The patient underwent a tailored treatment plan, initially involving percutaneous mitral balloon valvuloplasty for RHD, followed by a staged procedure of transcatheter PAVM closure with Amplatzer™ Vascular Plug II performed 1 month later. Her saturation normalized following the intervention. The patient's progress was monitored closely, with adjustments made to the treatment plan based on evolving clinical scenarios. The patient remained well in short-term follow-up. Discussion: This case highlights the complexity of managing patients having two diverse conditions RHD and PAVM coexisting together, thus emphasizing the importance of a multidisciplinary approach. The unique intersection of cardiac and pulmonary pathologies necessitates careful consideration of diagnostic nuances and tailored treatment strategies. Lessons learned from this case offer valuable insights for clinicians encountering similar scenarios and underscore the significance of individualized, patient-centred care in optimizing outcomes for those with dual pathologies.

Retrieval of a severely double-kinked catheter in the right brachial artery by internal fixation with a peripheral angioplasty balloon.

A 55-year-old female patient with unstable angina and accelerated hypertension was planned for invasive coronary and renal angiogram.

A Study on QT Dispersion before and after Thrombolysis in Acute Myocardial Infarction and its Prognostic Implications: A before and after Comparison Study.

Introduction: Acute myocardial infarction (AMI) stands as one of the most catastrophic occurrences in the progression of coronary artery disease. Measuring QT dispersion (QTd) is a fairly straightforward and noninvasive technique for predicting mortality in patients at high risk following a myocardial infarction (MI). Objective: To measure the QT, corrected QT interval (QTc), QTd, and corrected QT dispersion (QTcd) intervals before and after thrombolysis in patients with AMI and to determine prognostic implications of QTd in AMI. Materials and methods: This was a before and after comparison study conducted in the intensive care unit (ICU) of a tertiary care center in Central India. It was carried out in patients with AMI [ST-elevation myocardial infarction (STEMI)] who underwent thrombolysis in ICU. A total of 160 participants were enrolled over the time period of 24 months using the convenience sampling technique. Results: The most prevalent (68 patients) risk factor among MI patients was hypertension (HTN). QT parameters such as QT, QTd, and QTcd showed significant statistical variation of p-value < 0.0001 when compared at admission and after thrombolysis. No significant difference (p > 0.05) in QT parameters at admission (QTd, QTc, and QTcd) between anterior and inferior wall MI, except for QT interval (p = 0.0010). Among the 33 patients who experienced arrhythmia, ventricular tachycardia was the most prevalent arrhythmia in 22 patients (13.75%). There was a significant statistical correlation between the arrhythmic event and the outcome of the patient (p < 0.0001). Patients who died had higher QT parameter values at admission, and these remained on the higher side even after thrombolysis, whereas those who got discharged had lower QT parameter values at admission, and their values decreased after thrombolysis. Conclusion: Successful thrombolysis significantly decreases the QTd and thereby the arrhythmogenic potential, and thus can also be used as a reliable predictor of arrhythmia in patients of MI. How to cite this article: M A, Khandait H, Guralwar C, et al. A Study on QT Dispersion before and after Thrombolysis in Acute Myocardial Infarction and its Prognostic Implications: A before and after Comparison Study. J Assoc Physicians India 2023;71(10):14-18.

A Study on Qt Dispersion before and after Thrombolysis in Acute Myocardial Infarction, and its Prognostic Implications.

Acute myocardial infarction (AMI) represents one of the catastrophic events in the natural history of CAD. Early mortality is attributed to arrhythmic events, mainly VT/VF. Ventricular repolarization time varies for different cells located in diverse regions of the left ventricle, resulting in a regional heterogeneity of repolarization time, which in turn causes QT interval dispersion in various leads of ECG. Increased dispersion of ventricular recovery time is believed to provide a substrate for serious ventricular arrhythmias. QT dispersion measurement is a simple non-invasive method for predicting mortality in high-risk patients after MI. It reflects variations of ventricular repolarization and arrhythmogenic potential. Our study was designed to analyze QT dispersion variation in patients of AMI, the effect of thrombolysis on QT dispersion and assess its prognostic implications. MATERIAL: A before and after comparison study was conducted, including 160 patients of AMI who received thrombolytic therapy. Relevant clinical data was collected. A 12-lead ECG was recorded at the time of admission and a repeat ECG was taken 1 hour after thrombolysis. QT interval was measured manually from the onset of QRS complex to the end of T wave. The patients admitted were followed up for a minimum five days of their hospital stay for assessing the outcome. Occurrence of sustained VT, VF, VPC or sudden death was considered to be an arrhythmic event. OBSERVATION: In patients who experienced arrhythmia, QTcd was 0.07±0.06 sec at admission and 0.04±0.03 sec after thrombolysis (p=0.0227). Among patients who did not experience any arrhythmia, QTcd was 0.04±0.03 sec at admission and 0.02±0.03 sec after thrombolysis (p= <0.0001). Thus, patients who experienced arrhythmia had higher QT dispersion at admission and it remained on the higher side even after thrombolysis, probably due to failed reperfusion, in contrary to those without arrhythmia. There was a significant statistical correlation between arrhythmic event and outcome of a patient (p<0.0001). QTcd showed significant statistical correlation after thrombolysis in predicting the outcome of MI patients (p=0.0120) with median (IQR) QTcd of 0.01(0-0.09) in discharged patients and 0(-0.09-0.03) in patients who expired. CONCLUSION: Successful thrombolysis was associated with lower QT dispersion on ECG in patients of AMI. Our data supported the hypothesis that QT dispersion after MI depends on reperfusion status. Reduction in QT dispersion maybe a mechanism of benefit of thrombolytic therapy. QTcd reflects the amount of dispersion of refractoriness associated with the scarred myocardium, which is a marker of future arrhythmogenicity.

Hearing outcome in infants following correction of maternal hypothyroidism during pregnancy.

PURPOSE: There is significant prevalence of overt and subclinical hypothyroidism in pregnant women in rural areas. Maternal hypothyroidism is known to cause congenital hypothyroidism resulting in sensorineural hearing loss. Anti-Thyroperoxidase antibodies are known to cross placental barrier. There is no literature on hearing assessment in infants born to women whose hypothyroidism was corrected during pregnancy. Do these infants suffer hearing loss? Our study addresses this question. METHODS: 140 infants born to women on treatment for hypothyroidism during pregnancy and 140 infants born to euthyroid women were evaluated for hearing by Brainstem Evoked Response Audiometrry at 1 and 4 months age. Anti-TPO antibodies were estimated at 4 months of age. RESULTS: There was no clinical hearing deficit or delay in neurological development in infants born to women undergoing treatment for hypothyroidism during pregnancy. However wave V latency on BERA was slightly prolonged in them compared to infants born to euthyroid women. There was absence of wave V when maternal subclinical hypothyroidism persisted till parturition. However within 6-8months of age the wave V latencies corrected to normal. Anti-TPO antibodies were within normal range at 4months age. CONCLUSION: Maternal hypothyroidism when corrected before parturition does not affect hearing in the infants clinically. The mild delay in wave V on BERA corrects within first year of life. However larger studies to assess hearing in infants born to women having overt hypothyroidism during first trimester of pregnancy may be desirable to assess whether hearing is adversely affected in them.

The Effect of Scaling and Root Planing on Glycaemic Control, Periodontal Status and Gingival Crevicular Fluid TNF-α Levels in an Indian Population- To Reveal the Ambivalent Link.

CONTEXT: Periodontal disease and diabetes mellitus(DM) share a two - way relationship. It can be hypothesized that successful management of periodontal infection in diabetes will lead not only to reduction of local signs and symptoms of the disease, but also to better control of glucose metabolism. AIMS: To monitor the effect of Scaling and Root planing (SRP) on glycaemic control in patients with type 2 diabetes mellitus by estimating the HbA1c and GCF TNF-α levels. SETTINGS AND DESIGN: This Interventional clinicobiochemical study was carried out over a period of 6 months from December 2010-May 2011 in Bengaluru, Karnataka, India. MATERIALS AND METHODS: Fifteen well-controlled, 15 moderately controlled and 15 poorly controlled diabetic subjects were enrolled in this study. All participants were subjected to non-surgical periodontal (SRP) therapy. GCF sampling and clinical periodontal parameters assessment were done at baseline and 3 months post-therapy. TNF-α levels in GCF were analyzed by enzyme-linked immunosorbent assay (ELISA) at baseline and 3 months post therapy. The improvement in glycaemic control was assessed using HbA1c levels at 3 months reevaluation. STATISTICAL ANALYSIS: The data obtained were statistically analysed using Kruskal-Wallis test, Mann-Whitney test and Wilcoxon Signed Rank test. RESULTS: Following periodontal treatment, all patients demon- strated a significant improvement in periodontal status. A reduction in TNF-α level and the HbA1c values were also observed. CONCLUSION: The result indicates that SRP is effective in improving metabolic control in Type 2 Diabetes Mellitus patients possibly through the reduction of TNF-α which in turn might improve the insulin resistance.