Hypothyroidism is a recognized cause of pericardial effusion but as a cause of cardiac tamponade it is rare, especially in the sub-Saharan Africa where tuberculosis is the commonest cause. When clinically suspected, confirmation of cardiac tamponade with echocardiography is mandatory; technic that will assist in the execution of an ultrasound-guided, lifesaving, pericardiocentesis. We report a case of a patient who presented with cardiac tamponade secondary to myxedema and WolfParkinson-White pattern as incidental finding.
Cardiovascular disease is the number one cause of death and disability in the world. Low magnesium intake and low serum levels of magnesium have been inversely related to cardiovascular diseases and cardiovascular mortality in several epidemiological and meta-analytic studies. However, magnesium status is rarely evaluated in patients with cardiovascular diseases. Dietary evaluation is uncommon and supplementation is rarely advised or prescribed. This brief review scrutinizes the
Majority of persistent left superior vena cava (PLSVC) are asymptomatic and discovered incidentally. In this case report, we present a patient with bacteremia, osteomyelitis involving the lumbar spine, and infective endocarditis of the anterior/posterior leaflets of the mitral valve with moderate regurgitation who eventually underwent emergent mitral valve replacement. Prior to the surgery, Peripherally Inserted Central Catheter (PICC) and Triple-Lumen Central Venous Catheter were placed via left brachial vein and right internal jugular vein approach, respectively. Incidental PLSVC was identified on routine post-procedural radiograph as the catheters were seen in the left paramediastinal location. Interestingly, further analysis revealed that the PLSVC was not accompanied by a normal right-sided superior vena cava (SVC), which is a very rare variation of the venous system in the chest.
Cor triatriatum is a congenital anomaly in which the left atrium (cor triatriatum sinistrum) or right atrium (cor triatriatum dextrum) is divided into 2 parts by a fold of tissue, a membrane or a fibromuscular band.1 It is a rare cardiac malformation comprising about 0.1 to 0.4% of congenital heart disease.3 Its presentation is either classical or atypical.4 We present a case of an atypical cor triatriatum sinistrum with partial atrioventricular septal defect.
Infective endocarditis involving right side of the heart is uncommon and isolated involvement of pulmonary valve is even rare. It is highly unusual in patients with no apparent precipitating factors like intravenous drug use, congenital heart disease or valvular abnormalities. We describe a case of 37-year-old male who presented with very large vegetation on pulmonary valve leading to right ventricular outflow tract obstruction.
The ideal duration of cardiac resuscitation is unknown. Typically prolonged cardiopulmonary resuscitation is associated with poor neurologic outcomes and reduced long term survival. No consensus statement has been made and traditionally efforts are usually terminated after 15 – 30 minutes. We present a case of severe cardiomyopathy who developed multi-organ failure followed by cardiac arrest. He was resuscitated for nearly 2 hours and survived with good long-term outcome. Duration of Resuscitation that results in futility of care is unknown. Our patient is an exceptional case, as his multiple comorbidities would imply an extremely poor prognosis for which early cessation of resuscitation would be justified. However, given his young age and suspicion of a correctable lesion, we opted to prolong resuscitation with good results. This case report exemplifies the fact that CPR duration should be established on a case-by-case basis and take into account many determinants of survival. No single factor is predictive of outcome, so the clinician must integrate all the circumstances of the arrest and the patient's premorbid condition when making the decision to terminate resuscitative efforts. Prolonged cardiac arrest is generally not associated with a good outcome. The mortality in these cases is very high and the patients who survive are usually left with neurological sequelae. Case reports of complete neurological recovery after prolonged cardiac arrest are few and far in between. Our case is unique in that his Premorbid Conditions of Severe Ischemic Cardiomyopathy, Grade 4 Acute Pancreatitis, STEMI with In-Stent Thrombosis, AKI and DKA would all imply a Very Poor prognosis. Traditionally common practice would recommend stopping resuscitation after 15-30 minutes, but our decision to continue until the patient was in the cath lab, resulted in a good outcome with complete neurologic recovery.
Introduction: Coronary Heart Disease is still a leading cause of death in developing as well as in developed countries. Incidence and prevalence of myocardial infarction increases progressively with the age; Women lag behind men by 10 years, however, this difference in male, female genders narrows progressively with advancing age. The mortality ratio is higher in women. Objective: To determine the age and gender distribution in patients with acute ST Elevation Myocardial Infarction and its comparison with other studies. Study Design: Descriptive analytical study consisting of 100 patients from both genders with acute STEMI, who were selected for thrombolytic and had underwent routine investigations. The data was collected by interviewing the patients and filling out the questionnaires, accordingly. Old IHD, late arrivals or STEMI during admission were excluded. Results: Study of 100 patients; Mean age 53.99 years. 81% were males and 19% were females. Mean age of females 56.0 years and males 53.4 years. 49 % patients belong to age group 51-70 years, 44 % to 31-50 years, 7% to 71-90 age groups. The Majority (51.85 %) of male patients were from 51-70 years age group and the majority of female patients (52.63%) from 31-50 years age group. Conclusion: In our community, like other communities, males are more at risk than females. However, quite unexpectedly, majority of the female patients were found to be in premenopausal period i.e. before 50years. On comparison, the percentage of our female patients is far less than in the international study. Less frequency of smoking or ignorance regarding consultation to hospital could be the cause of it in the female gender of our community, further studies required for the verification.
Introduction; Heart failure (HF) is the major cause of mortality, morbidity, and hospitalization. Cardiac resynchronization therapy (CRT) significantly improves functional status, quality of life, reduces hospitalizations and decreased mortality in patients with congestive heart failure (CHF). Presence of intraventricular, left ventricular (LV) dyssynchrony, is an important factor determining response to CRT. Objective: To determine the Echocardiographic intra ventricular (Left Ventricle) dyssynchrony and its correlation with QRS width of surface ECG in patient with heart failure. Study Design: Cross-sectional study. Setting: The study was conducted at the National Institute of Cardiovascular Disease (NICVD). Duration Of Study: Six months, from March, 2007 to September, 2007. Patients And Methods: The patients presented to the Echo department through OPD or Ward at NICVD Karachi with severe HF. Informed consent was taken, ECG obtained and after performing the conventional transthoracic echocardiography, parasternal long axis 2D directed M-mode was obtain in left lateral position. Dyssynchrony between septum and posterior wall was measured in millisecond by identifying the peak posterior excursion (contraction) of intraventricular septum and anterior excursion (contraction) of Posterior wall. Result; The study included 100 patients, 85% were males. Among 45 patients of LV dyssynchrony, 80% were diagnosed to have Ischemic Cardiomyopathy (Group-1) and 20% were diagnosed as Non-Ischaemic Cardiomyopathy (Group-2). 68.08 % patients had LV dyssynchrony in Group-W QRS (120-160)ms and 24.52 % patients were in Group-N QRS (80-119) ms. Overall, 55% of our patients had no LV dyssynchrony. Out of these 55 patients, 75.47% were in group N while 31.91% were in group W. Conclusion; We did not find linear correlation between QRS width and dyssynchrony by septal-posterior wall delay (SPWMD) on M mode echocardiography. Patients with narrow QRS complex also have LV dyssynchrony and need echocardiographic criteria to confirm diagnosis.
Takotsubo cardiomyopathy is a transient syndrome that has been rarely reported as a cause of chest pain, elevated cardiac enzymes and ST elevations mimicking acute coronary syndrome with no coronary artery stenosis. It commonly occurs in postmenopausal women due to elevated catecholamines, mainly from intense emotions or stress. Only one case of insecticide induced takotsubo cardiomyopathy from a suicide attempt has been documented. However, we present this very rare case of taktsubo cardiomyopathy from use of aninsecticidesprayin a post-menopausal woman with no identifiable acute emotional or physical stress.
Background: The objective of this study was to determine if clinical diagnosis of cardiac abnormalities tally with 2 D Echocardiography findings. Methods: A cross-sectional retrospective study in which a review of the records of all children attending children outpatient clinics including cardiology clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu over a five year period (January 2007-June 2012) was undertaken. All children presenting with cardiac anomalies were included in the study and the cases were investigated using 2 D Echocardiographic studies. Results: A total of 31,795 children attended the children outpatient clinics of the hospital over the study period. Of these, seventy one (71) had cardiac diseases. Among children with cardiac disease ,thirty five Percent ( 35%) of all the patients had their clinical diagnosis not tallying with 2 D Echocardiography while 21 (29.5%) had clinical diagnosis in tandem with 2 D Echocardiography. Thirty five and half percent had no 2 D Echocardiograph done for them for financial reasons. Conclusions: Despite the fact that clinical diagnosis may not always tally with 2 D Echocardiography in the diagnosis of congenital heart disease ,it should not be downplayed.
Eyes are the portals through which one can glimpse signs of certain health problems. Retinal microvascular signs are common fundus findings in the general population; even in individuals without hypertension or diabetes. This paper provides new insights into the clinical significance of retinal microvascular signs in adults with elevated blood pressure so as to aid in identifying susceptible individuals with certain retinopathy signs who need further referral and systemic assessment for appropriate risk reduction therapy. It provides evidence based information on the systemic associations of hypertensive retinopathy signs, classification of these signs, clinical guidelines for hypertension management and critiques some famous 'population-based' studies describing the relationship of retinal microvascular signs, as quantified from fundus photographs, to various systemic diseases in the general population and discusses their relevance in context of current hypertension management.
Situs inversus with dextrocardia is the complete reversal of the position of the abdominal and thoracic viscera. It may remain asymptomatic or could be detected early in infancy when associated with other congenital malformations especially of the cardiovascular system. Situs inversus with dextrocardia usually exists without co-existing congenital heart disease. We report the case of a seven month old Nigerian male infant who presented with complaints of recurrent cough and bluish discoloration of the lips. Examination revealed central cyanosis with grade 3 digital clubbing and a right-sided apical impulse. Chest radiograph showed a right sided heart and Echocardiogram confirmed multiple cardiac anomalies (Complete Atrio-ventricular septal defect (AVSD), Pulmonary atresia and Patent ductus arteriosus.
Pericardial lipoma is a rare cardiac condition involving extensive fat deposition in the pericardium. While typically an incidental finding on non-cardiac imaging, the condition has the potential to exert a mass effect and thus compromise ventricular filling, leading to symptomatic outcomes associated with cardiac insufficiency, conduction defects and arrhythmias. It is therefore of importance in clinical practice. In this cardiac vignette, we illustrate the diagnostic dilemma present with this condition, with first-line investigations such as echocardiography often misinterpreting this condition as a pericardial effusion. Less routine cardiac imaging modalities, including cardiac CT and CMR, are the preferred diagnostic tests for accurate diagnosis of this condition, however are scarcely utilised. CARDIAC VIGNETTE: A CASE OF PERICARDIAL LIPOMA A 79 year old female was referred for evaluation of a pericardial effusion detected on echocardiography in an outpatient cardiology service. She had a background of a recent pre-syncopal episode during ambulation, with associated nausea and diaphoresis, requiring supine posturing for symptomatic relief. This episode was associated with tachycardia (135 beats /min) and significant orthostatic hypotension, however no chest pain or discomfort was noted. The patient’s relevant past medical history included stage 1 (uncontrolled) hypertension, transient ischemic attack requiring anti-platelet prophylaxis and alcohol-induced hepatitis. There was no significant family history of cardiac disease. The patient was a lifelong non-smoker, but consumed 40-60g of alcohol per day for the past 20 years. Physical examination revealed unremarkable vital signs, with the exception of a significant postural blood pressure drop of 20mmHg. There was no pulsus paradoxus. The peripheral pulses were normal in character and volume with a resting heart rate of 84 beats /min. The carotid upstroke was brisk and the jugular venous pressure was not elevated. The patient had a negative Kussmaul’s sign. Heart sounds were normal with no extra sounds, murmurs or pericardial frictions rubs noted. The chest was clear to auscultation and there was no peripheral oedema. Blood biochemistry and haematology results were unremarkable, with the exception of macrocytosis consistent with the patient’s alcohol history. A 12-lead electrocardiogram (ECG) during admission was unremarkable. Repeat transthoracic echocardiogram [Figure 1] revealed an echo-lucent pericardial space (maximum diameter 2cm with no evidence of cardiac tamponade). Left ventricular size and function was within normal limits. There were no other cardiac abnormalities. Cardiac Magnetic Resonance Imaging (CMR) [Figures 2 and 3] revealed marked pericardial fat with minor fatty replacement of the myocardium. No definitive features of constriction were present; however cardiac chamber volumes were reduced, possibly making the effects of dehydration prominent. A diagnosis of pericardial lipoma was made. Cardiac Vignette: A Case of Pericardial Lipoma 2 of 4 Figure 1 Transthoracic Echocardiography revealing an echo-lucent pericardial space with maximum ‘pocket’ diameter of 2cm. There is no evidence of cardiac tamponade. Figure 2 Cardiac MRI (Horizontal View) revealing marked pericardial fat with minor fatty replacement of the myocardium. There are no obvious features of cardiac constriction. Figure 3 Cardiac MRI (Saggital View) revealing marked pericardial fat with minor fatty replacement of the myocardium. There are no obvious features of cardiac constriction. The patient remained stable throughout admission with improvement in symptoms and orthostatic hypotension with oral rehydration. No further diagnostic interventions were performed and the patient was subsequently discharged. At three month follow-up, the patient remained asymptomatic and repeat echocardiogram revealed no change in the appearance of the pericardial space.
Introduction: Outcome of acute ST elevation myocardial infarction (STEMI), specifically size of infarct and mortality is directly related to the time between the onset of symptoms and the commencement of thrombolytic therapy. Objective: To determine the frequency of various causes of delay in initiating Thrombolytic therapy in patients with acute STsegment Elevation Myocardial Infarction (STEMI). Study Design: This descriptive analytical study consisted of 100 patients diagnosed with acute STEMI and selected for thrombolysis from emergency unit of National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. The patients underwent history & examination, diagnosis confirmed, questionnaire filled and data collected. Results: Frequency of the major causes of delay was found to be due to lack of patient awareness 55%( 31% were neglecting their chest pain, 24% thought that their pain was due to some non-cardiac reason), delay in referral from other healthcare centers 45%, transportation 25% (8% had problems in getting conveyance, 17% delayed because of traffic block), misdiagnosis by doctor 13%. Conclusions: Every effort should be made to decrease pain to needle time (PTN) of thrombolysis. We found that lack of patient awareness as the main cause of delay in initiating thrombolysis. The PNT can be reduced by encouraging other healthcare centers to give immediate thrombolytic therapy rather referring patients; increasing public awareness of the disease, immediate consultation in case of chest pain; developing a better system of transportation.
A very few case reports have indicated that hyperkalemia can induce a Brugada pattern in the electrocardiogram (EKG). On the other hand, very rare case reports have indicated that cocaine has precipitated life-threatening arrhythmias associated with development of Brugada syndrome. We present a 26-year old patient with hyperkalemia secondary to muscle damage and renal insufficiency after a reported large intake of cocaine. The electrocardiogram showed a Brugada pattern. These EKG changes disappeared directly after normalization of serum potassium. We concluded that cocaine and the hyperkalemia were probably the culprit causes of the Brugada-pattern EKG. Unfortunately, the provided data in this case appear to be incomplete; the patient was found unresponsive at home, and we do not exactly whether or not he developed a cardiac arrest secondary to a malignant arrhythmia before the arrival of the Emergency medical services. This case highlights the importance of recognizing cocaine and hyperkalemia as potentialtriggers of the acquired Brugada-like electrocardiographic pattern.
