Aortic aneurysm is a rare, but mostly fatal condition; the incidence is 5.9 new aneurysm/100,000 person-years with median age of 65 years for men and 77 years for women. It becomes still rarer when the cause is idiopathic and is associated with aortic regurgitation. Most of these patients present with aortic regurgitation and on investigation aneurysm is detected. Owing to its rarity and disguised presentation it is important to be aware of this entity. This case is being presented not only because of its rarity, but also because of its atypical presentation.

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Left atrium thrombus is seen in patients with rheumatic heart disease, severe mitral stenosis and/or atrial fibrillation, but is usually immobile and located in left atrial appendage. Freely mobile thrombus is rarely seen, and the size may vary from few millimeters to centimeters. The clinical presentation varies from presyncope or syncope in a small well organized thrombus to transient ischemic attacks or stroke in large poorly organized thrombus. Management includes urgent surgical removal of thrombus with underlying valvular correction and anticoagulation.

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Background: The diagonal earlobe crease (DELC) has been proposed to be a marker of coronary artery disease (CAD), but this association still remains controversial. The aim of the present study was to evaluate the frequency of DELC in patients with CAD. Materials and Methods: Eighty patients with angiographically documented CAD from Borujerd were evaluated for the presence or absence of ELC. The ELC was said to be present if the patient had a deep diagonal crease extending obliquely from the outer ear canal toward the border of the earlobe without discontinuity covering at least two-thirds of the ear lobe length. Results: The prevalence of DELC was 58.7% (95% confidence interval: 61.1-55.3). The frequency of hypertension and dyslipidemia was significantly higher in patients with DELC (P = 0.002 and P = 0.034, respectively). But no such difference was seen between diabetic and nondiabetic patients (P = 0.241). Conclusion: The frequency of DELC in patients with CAD was high in our study. The data suggest that the ELC sign may be a useful marker for the presence of CAD in patients.

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Context: Autonomic function is said to be different between males and females. Uric acid (UA) levels also vary with gender. We tried to explore if these differences exist among the subjects grouped based on their blood pressure (BP) profiles. Aims: The aim of this study was to compare the level of UA and autonomic function differences between males and females classified according to their BP levels. Settings and Design: This was a cross-sectional study conducted on 105 subjects classified into three groups according to Joint National Committee (JNC) VII criteria. Materials and Methods: Heart rate variability (HRV) was analyzed in Lead II electrocardiogram recording and UA levels were measured among 105 subjects after classifying them based on their BP levels according to JNC VII criteria. Statistical Analysis: Statistical analysis was performed using SPSS 18.0 version software. Chi-square test and Mann - Whitney U-test was used. Results: Males had significantly higher UA levels. The time domain parasympathetic parameters of HRV were higher among females on comparison with males indicating vagal withdrawal among males. The sympathetic parameters in the frequency domain were higher among males. This difference in HRV was observed among all BP profile groups. Conclusions: Males have a higher degree of vagal withdrawal and sympathetic activity as shown by HRV markers and UA levels. It is thus suggested that males could undertake more preventive measures and therapy at an earlier date than females. Further, treatment of male patients with hypertension should be much more vigorous than females.

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Context: World Health Day is celebrated on 7 ^th April to mark the anniversary of the founding of World Health Organization in 1948. Each year a theme is selected for World Health Day that highlights a priority area of public health concern in the world. The theme for 2013 is on high blood pressure (BP). High BP, if left uncontrolled increases the risk of heart attacks, strokes, and kidney failure. Materials and Methods: A community-based cross-sectional survey was carried out among adults (>18 years) in Basavanapura Village, Nanjangud Taluk using simple random sampling method to study the pattern of BP using the Seventh Report of the Joint National Committee criteria. A total of 447 persons were screened. A total of 223 individuals (90 men and 133 women) were selected by simple random sampling, interviewed, and clinically examined for hypertension. BP of all the study participants was measured using a standardized technique. Statistical Analysis Used: Mean ± standard deviation (continuous data), proportions and percentages (categorical data), Chi-square test (association between age and hypertension) and odds were calculated to see in which age group the risk of hypertension was more. Kruskal-Wallis test was used to test the significant difference of systolic BP and diastolic BP for males and females among age groups. Results: Of the 447 persons surveyed in Basavanpura Village, BP was recorded among 223 individuals. The overall prevalence of hypertension was found to be 36 (16.1%), of which 22 (61.1%) were diagnosed, 20 (90.90%) treated, and only 14 (70.0%) controlled. Increasing age, sedentary lifestyles, and male sex were identified as the predisposing factors. Conclusions: The prevalence of hypertension in the village is slightly higher (16.14%) than the national prevalence (14%). There is an urgent need to educate the people to modify the lifestyle and to monitor their BP values regularly.

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Surgery is the standard procedure for closure of atrial septal defects (ASDs). Recently, percutaneous transcatheter procedures emerged as therapeutic alternatives for closure of both ASDs and patent foramen ovale. Here, we report a 21-year-old young female underwent ASD closure using an Amplatzer device, unfortunately, however the device misplaced to the right atrium during procedure. Percutaneous extraction of the device was failed; patient was taken for immediate surgical intervention in cardiogenic shock. Amplatzer device was removed surgically on cardiopulmonary bypass successfully, patient recovered well.

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Takayasu's arteritis is a large-vessel vasculitis which is characterized by both stenotic lesions as well as aneurymal lesions. 1 Aneurysmal lesions most commonly occur in the aortic root and arch leading to development of aortic regurgitation. AR is seen in about 24% of cases at the time of presentation. 2 The documentation of high blood pressure in Takayasu arteritis may be difficult because of subclavian and innominate artery stenoses. This case report highlights the importance of checking all the peripheral pulses and recording the blood pressure in both upper limbs and in the lower limbs in a case of "hypotension".

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