The steadily increasing use of contrast media in radiological and interventional cardiac procedures has led to more research and well designed studies of prophylactic strategies for its leading life threatening side effect of contrast induced nephropathy (CIN). CIN adversely affects the prognosis after interventional procedure and poses substantial extra burden on health care costs. The importance of understanding of CIN lies in the fact that no available treatment can reverse or ameliorate it once it develops, but prevention is possible. Herein, we discuss the detailed pathophysiological aspects, risk factors, proposed risk prediction algorithms and various prophylactic strategies for contrast induced nephropathy.

Introduction: Wide variations exist in the size, position, and shape of various body organs, finger prints, and proteins in different individuals. Some variations are of considerable clinical importance, such as the coronary arteries. Variations of coronary arteries can cause important clinical manifestation, including sudden death of the individual. Materials and Methods: Coronary arteries were dissected in 10% formalin-fixed cadaveric hearts. The normal and variant anatomy of coronary arteries was studied. Result: In 100% of cases, the right coronary artery (RCA) and main left coronary artery (LCA) were found to arise from anterior aortic sinus and left posterior aortic sinus, respectively. In 8% of cases, the conus was found to have independent origin from the anterior aortic sinus. The RCA was found to be dominant in 90% of cases. In 66.7% of cases, the length of RCA ranged from 4.5 cm to 7 cm. The average length of LCA was found to be 7 mm. In 10% of cases, the circumflex coronary artery was found to be dominant, where the length of the artery ranged 9-11 cm. In 10% of cases, LCA trifurcated, where the obtuse marginal branch was replaced by the ramus intermedius branch. Also, 43.3% of LAD showed myocardial bridging predominantly in the middle 1/3 ^rd segment, and 6.7% of cases of RCA showed myocardial looping. Discussion: Coronary arteries show immense variation in their origin, termination, branching pattern, myocardial bridging, looping, and dominance pattern. This knowledge is clinically and surgically important to manage coronary artery diseases.

Background: Smokeless tobacco has been advocated as a substitute for cigarette smoking. On the contrary, the use of smokeless tobacco is fraught with health risk and needs to be discouraged. Although previous reports have described long-term harmful effects of smokeless tobacco on various body parameters, little is known about short-term effects of smokeless tobacco on cardio-respiratory parameters. Very few studies have been undertaken on the effect of short-term use of smokeless tobacco in India on cardio-respiratory parameters of youngsters. This aspect of use of smokeless tobacco needs to be attended to. Material and Methods: The present study has been undertaken to study the effect of smokeless tobacco on cardio-respiratory fitness tests in young healthy tobacco chewers compared to age- and sex-matched nontobacco chewing healthy controls. Various cardio-respiratory parameters like resting HR, delta HR, MVV, VE max, VO ₂ max were studied by using treadmill exercise testing and computerized spirometry. Results: In the present study no statistically significant difference was found in any parameter studied that can be attributed to the residual effect of short-term use of smokeless tobacco. Conclusion: This is the reason enough to discourage smokeless tobacco from this unhealthy habit at this early stage itself before permanent residual effects on health is seen.

Right ventricular (RV) endocardial pacing in permanent pacemaker implantation usually yields a left bundle branch block (LBBB) pattern in surface electrocardiogram (ECG). The presence of right bundle branch block (RBBB) pattern raises the suspicion of lead perforation. We report a case of RV endocardial permanent pacemaker implantation showing a RBBB pattern in ECG, suggesting a complication. However, further work-up revealed that the lead was appropriately located at the RV apex.

Angioplasty of anomalous coronary arteries can be technically challenging because of the difficulty in selectively cannulating the aberrant vessel. I present my experience with angioplasty of an anomalous right coronary artery. A 6- Fr amplatz left 1 guiding catheter was used to obtain stable position in the right coronary artery and angioplasty was performed.

We are presenting a rare complication post Bioprosthetic aortic valve replacement. A middle age man presented with the clinical features of Pyrexia of unknown etiology and found out that he had endovascular infection, with septic emboli to the spleen. We are presenting two interesting images as a quiz and discuss in brief the clinical data of the infected pseudo aneurysm of the aortic root and ascending aorta.