Idiopathic brachial plexopathy after pacemaker implant.

A middle-aged woman presented with symptomatic complete heart block and underwent an uneventful dual chamber pacemaker implantation. Three weeks post procedure, she developed left arm pain and weakness, with neurological localization to the lower trunk of left brachial plexus. Possibilities of traumatic compression by the device/leads or postoperative idiopathic brachial plexopathy were considered. After ruling out traumatic causes, she was started on oral steroids, to which she responded remarkably. This case highlights the importance of recognizing this rare cause of brachial plexopathy following pacemaker implantation, because not only does an expedited diagnosis and medical treatment lead to prompt recovery with minimal neurological deficits, but it also circumvents an unnecessary surgical re-exploration.

Challenging Case of Balloon Mitral Valvuloplasty: Coronary Balloon to the Rescue.

Owing to the demonstrated safety and cost-effectiveness, balloon mitral valvuloplasty is frequently performed using reused hardware. However, chances of hardware malfunction are higher in such settings, making it pertinent for operators to be adept at recognition and management of such complications. This case illustrates that when the rent is small, a coronary balloon may be used to tackle the inflation failure.

Regional impact of updated guidelines on prevalence and distribution of blood pressure categories for hypertension in India: Results from the National Family Health Survey 4.

INTRODUCTION: In 2017, the American College of Cardiology/American Heart Association revised guidelines for diagnosis and management of hypertension in adults. The regional impact of the updated guidelines on the prevalence of hypertension in India is unknown. METHODS: Data from nationally representative Indian households were analyzed to estimate the regional prevalence of hypertension according to the old and the new guidelines in men (age 18-54 years) and women (age 18-49 years). The old guidelines defined hypertension as a systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg or treatment. The new guidelines define hypertension as a systolic blood pressure of ≥130 mmHg or diastolic blood pressure of ≥80 mmHg or treatment. We calculated the increase in the prevalence of hypertension among the states and union territories of India (hereafter "states"). RESULTS: Among 679,712 participants (85.6% women), the median age was 31 years (interquartile range 24, 40) and was comparable among men and women (33 vs. 31 years, respectively). The overall weighted prevalence according to old and new guidelines was 18.5% (95% CI 18.2, 18.7) and 43.0% (95% CI 42.8, 43.3), respectively. There was a significant increase in hypertension prevalence, both among men and women, and across all regions. The northeast region of the country had the highest prevalence. CONCLUSION: The overall prevalence of hypertension significantly increases with the new compared to the old guidelines, however, the regional heterogeneity of prevalence of hypertension is maintained.

Recurrent Drug-Eluting Stent In-Stent Restenosis: A State-of-the-Art Review of Pathophysiology, Diagnosis, and Management.

Recurrent in-stent restenosis (R-ISR) refers to the re-occlusion of a successfully treated in-stent restenosis. Much of the present understanding of this condition stems from studies on in-stent restenosis, as literature on R-ISR is sparse. Compounded by multiple previous struts, narrower luminal diameters and worse patient profiles, R-ISR is a clinical challenge that demands urgent attention. Recent studies have explored various diagnostic and therapeutic strategies to identify and suitably manage R-ISR. In this review, we discuss our understanding of the risk factors, invasive and non-invasive imaging techniques, therapeutic options and gaps in present knowledge for the management of R-ISR.

Treatment of Pulmonary Embolism with Chemotherapy in a Case of Newly Diagnosed Osteosarcoma.

A 21-year old female, recently diagnosed with osteosarcoma of right humerus, presented to the emergency with history of fever, productive cough, chest pain and progressive respiratory distress for six days. Initial investigations suggested pneumonia but she did not respond to parenteral antibiotics. CT pulmonary angiogram revealed bilateral pulmonary artery embolism. Thrombolysis was performed using alteplase, which failed to improve the clinical condition. In view of underlying malignancy, a possibility of tumour-embolism was considered and she was started on chemotherapy for osteosarcoma. There was dramatic improvement in her respiratory symptoms after the first chemotherapy cycle, along with radiological resolution of the embolism. This case highlights the importance of suspecting tumour embolism in a known case of malignancy with respiratory distress.