ABSTRACT Apical hypertrophic cardiomyopathy (ApHCM), also referred to as Yamaguchi syndrome, is a distinct variant of hypertrophic cardiomyopathy characterized by localized hypertrophy of the left ventricular apex. It is classically associated with giant T-wave inversion in the precordial leads, with additional T-wave inversion in the inferior and lateral leads on electrocardiography. Because of its uncommon occurrence, the condition may remain unfamiliar to many emergency department (ED) physicians, and it can be easily overlooked during the evaluation of patients presenting with chest pain. We report the case of a 61-year-old male who presented to the ED with an acute-onset retrosternal chest pain and palpitations of 2 h duration. The ECG findings suggested acute coronary syndrome (ACS), but echocardiography and cardiac biomarkers indicated otherwise.
ABSTRACT Right ventricular pacing leads to nonphysiological ventricular activation and causes electrical dyssynchrony and adverse cardiac remodelling. Left bundle branch area pacing (LBBAP) responsible for physiological pacing strategy that preserves synchrony of ventricles by engaging the His–Purkinje system. The objective of the study was to evaluate the procedural feasibility and outcomes of LBBAP in patients undergoing dual chamber pacemaker implantation. In this single center, retrospective observational case series, seven patients undergoing dual chamber pacemaker implantation with LBBAP between January 2025 and January 2026 were included. Procedural success was defined as achievement of stable LBBAP with acceptable pacing parameters and significant QRS narrowing. Electrical parameters include pacing threshold, sensing amplitudes, and lead impedance, were assessed at implantation and prior to discharge. A total of seven patients underwent LBBAP. Successful LBBAP implantation was achieved in 6 of 7 patients (85.7%). The mean procedure time was 75 ± 15 min, with fluoroscopy time of 8 ± 3 min. LBBAP caused important QRS narrowing with stable lead parameters. Mean pacing thresholds of RA and RV were low, measuring 0.66 V in right atrium (RA) and 0.49 V in right ventricle (RV), showing stable lead activity with sufficient sensing and impedance values. No acute procedural complications, including lead dislodgement, cardiac perforation, or pneumothorax, were observed. LBBAP is a feasible and safe physiological pacing strategy in those patients undergoing dual chamber pacemaker implantation, demonstrating high procedural success and favourable short term electrical outcomes. Larger prospective studies are warranted to evaluate long term clinical benefits.
ABSTRACT Femoral arterial access remains indispensable for diagnostic and interventional cardiovascular procedures despite the growing adoption of transradial techniques. However, femoral access site complications such as hematoma, pseudoaneurysm, retroperitoneal hemorrhage, and arteriovenous (AV) fistula continue to contribute to procedural morbidity. Accurate arterial puncture and maintenance of stable vascular access are critical determinants of procedural safety. We describe a novel technique utilizing a radial artery puncture set, consisting of a 20G needle with an integrated microsheath, for femoral arterial access. In this prospective pilot case series, 10 consecutive patients undergoing coronary angiography, percutaneous coronary intervention, or balloon mitral valvotomy via femoral access were included. After successful femoral artery puncture, the micro-sheath was advanced into the arterial lumen to stabilize access before guidewire insertion and subsequent sheath upsizing. Femoral access was successfully achieved in all patients without crossover to conventional techniques. No access-site complications, including hematoma, pseudoaneurysm, AV fistula, retroperitoneal hemorrhage, or significant hemoglobin decline, were observed during hospitalization or at 30-day follow-up. The technique appeared feasible across a heterogeneous population, including elderly, obese, and anticoagulated patients. This approach may offer advantages over conventional and micropuncture techniques by improving needle stability and reducing repeated puncture attempts. Use of a radial artery puncture set for femoral access appears to be a simple, safe, and cost-effective alternative to standard femoral access techniques. Larger comparative studies are warranted to validate these preliminary findings.
ABSTRACT Background: Coronary artery disease (CAD) in young women is being increasingly identified, often with atypical presentations and a higher prevalence of nonobstructive disease. This study aimed to evaluate the clinical profile, angiographic characteristics, and factors associated with obstructive CAD and multivessel disease. Materials and Methods: A retrospective observational study of 82 young women undergoing coronary angiography. Clinical features, risk factors, left ventricular function, and angiographic findings were analyzed. Results: Most patients were aged 41–45 years (53.7%). Dyslipidemia (52.4%) and hypertension (50%) were the most common risk factors. Chest pain (85.4%) predominated, with over half presenting as acute coronary syndromes (ACSs). Obstructive CAD was present in 50%, most commonly as single-vessel disease (30.5%) with predominant involvement of the left anterior descending. Nonobstructive CAD (26.8%) and normal coronaries (23.2%) were also common. Hypertension ( P = 0.001) and dyslipidemia ( P < 0.0001) were significantly associated with obstructive CAD, while diabetes ( P = 0.002) was significantly associated with multivessel disease. Conclusion: CAD in young women often presents as ACS and is significantly associated with dyslipidemia and hypertension, while diabetes is significantly associated with multivessel disease, reflecting greater disease severity. A substantial proportion had nonobstructive disease suggestive of the myocardial infarction with nonobstructive coronary arteries/angina with nonobstructive coronary arteries spectrum, emphasizing the role of microvascular mechanisms and the need for early diagnosis and risk factor control.
ABSTRACT Introduction: Despite advancements in chelation therapy, cardiovascular disease remains the leading cause of mortality among children with beta-thalassemia major (B-TM). Objective: To estimate the prevalence of subclinical cardiac dysfunction in children with B-TM and to identify associated clinical and biochemical risk factors. Methods: This cross-sectional study was conducted over an 18-month period at a tertiary care institute in Central India. Using consecutive sampling, 77 children with B-TM (aged 2–18 years) were enrolled. Comprehensive data were collected, including demographic profiles, transfusion history, and clinical parameters. All participants underwent hematological and biochemical investigations, electrocardiography, conventional echocardiography, and tissue Doppler imaging (TDI), in accordance with the American Society of Echocardiography guidelines. The Tei Index calculated by TDI was used to assess cardiac function, with elevated values indicating dysfunction. Statistical analysis included Chi-square test, independent t-test, and multivariate logistic regression, with P < 0.05 considered statistically significant. Results: The prevalence of subclinical cardiac dysfunction was 79.2%. All affected children had left ventricular dysfunction, while 64.9% also had right ventricular involvement. A prolonged corrected QT interval was observed in 29.9% of participants and cardiomegaly in 55.8%. Children with cardiac dysfunction were significantly older and had higher transfusion burden ( P < 0.0001). They also exhibited higher systolic blood pressure, lower hemoglobin levels, and elevated serum ferritin levels. Multivariate analysis identified age (odds ratio [OR]: 3.35), total number of transfusions (OR: 1.18), annual blood requirement (OR: 1.06), and serum ferritin (OR: 1.00) as independent predictors of cardiac dysfunction. Conclusion: Subclinical cardiac dysfunction is highly prevalent (79.2%) in children with B-TM. The findings emphasize that advancing age, transfusion burden, and iron overload (serum ferritin) are critical independent risk factors. Early screening using the Tei Index may facilitate timely identification and management of these high-risk pediatric patients.
