Context: An association between cardiac autonomic neuropathy and QT interval prolongation was demonstrated in many studies and it may predispose to sudden death in diabetes mellitus. Aims: To find out the prevalence of cardiac autonomic neuropathy and its relation to QTc interval and QTc dispersion in type 2 diabetes. Settings and Design: Observational study. Materials and Methods: Fifty patients with type 2 diabetes mellitus of more than 5-years duration and 30 age- and sex-matched controls without any history of diabetes were selected. A battery of five autonomic function tests was done in all cases. Heart rate, QTc values, and QTc dispersion were measured and compared among patients with and without autonomic neuropathy and controls. Statistical analysis used: Students t test/Chi-square test. Results: Among the 50 patients in the study population, 21 (42%) had severe autonomic neuropathy and 12 (24%) had early autonomic neuropathy. Mean heart rate was significantly more in patients with autonomic neuropathy than those without neuropathy. Diabetics with autonomic neuropathy had significantly higher QTc mean and QTc max values compared to diabetics without autonomic neuropathy and controls. QTc dispersion was significantly more among patients with autonomic neuropathy compared to those without autonomic neuropathy and controls. Conclusions: Diabetic autonomic neuropathy is associated with increase in resting heart rate and prolongation of QTc intervals. QTc max was correlating with severity of autonomic neuropathy. QTc dispersion is significantly high in diabetes mellitus with autonomic neuropathy.

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Acute myocardial infarction (AMI) is a rare complication of snake bite with few reported cases in literature. The author reports a case of a 32-year-old male who developed an anterior wall AMI several hours after a Russell's viper bite. The diagnosis of myocardial infarction was confirmed by a characteristic retrosternal chest pain, typical electrocardiographic changes, and elevated Troponin I levels. The patient had no risk factors for coronary artery disease and the coronary arteries were normal on cardiac catheterization. The importance of the case report is to highlight upon the fact that physicians, especially from developing countries like India should be aware of this potentially life-threatening complication of viper bite and take immediate steps for its recognition and management.

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Background: Electrocardiography (ECG) is a simple, noninvasive, and relatively cheap investigative tool used for cardiac evaluation. However, there are limited electrocardiographic studies of Nigerian children. Adult studies of ECG have shown significant differences between Black and Caucasian populations. These differences may also be seen in children, hence, the need to develop local reference values. Materials and Methods: This was a cross-sectional study and multistage random sampling method was applied to select 650 subjects. The ECG machine was a portable heated stylus direct writing AT-2 Swiss made electrocardiograph (Schiller AG Cardiovit CH6341). Results: There were 350 males (53.3%) and 300 females (46.7 %), with a male:female ratio of 1.2:1. The mean heart rate decreased with increasing age. R-wave amplitudes were higher in the left precordial leads, in keeping with left ventricular dominance. Mean values were higher in boys than girls in the three age-groups in most of the precordial and limb leads. In V ₄ R, V ₂ , and V ₃ highest mean R wave voltages of 0.5 ± 0.1, 1.4 ± 0.3, and 1.4 ± 0.2 mV, respectively, were recorded in the 5-7-year-old. While in V ₅ and V ₆ , the mean R waves were higher in the 12-15-year-old age group (3.7± 0.5 and 2.5±0.4 mV, respectively). The S-waves showed progressive decrease in its amplitude on the left precordial leads with increasing age. Conclusion: The mean values in heart rate, QRS duration, PR interval, and P-wave amplitude showed higher amplitudes in boys. Similarly higher amplitudes of R-waves in boys were recorded in precordial leads V ₂ , V ₃ , V ₅ , and V ₆ in the three age groups.

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Acute pulmonary embolism with floating right intra-ventricular thrombus is a rare phenomena associated with poor prognosis. Here, we are presenting a case of 35-year-young male with no co-morbid illness diagnosed to have right ventricular thrombus with bilateral pulmonary embolism, which was managed successfully with thrombolytic therapy.

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Ventricular septal defect (VSD) is a rare, but serious complication of acute myocardial infarction requiring early surgical intervention. We report a case of a 75-year-old man, who had a silent myocardial infarction followed by an asymptomatic ventricular septal rupture, both of which remained undiagnosed until the patient experienced biventricular failure. Asymptomatic myocardial infarction in elderly may be a risk factor for acquired VSD. Two-dimensional echocardiography is a sensitive, rapid, reliable and safe technique for diagnosing VSD postmyocardial infarction.

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Intracardiac tumors are rare and may be primary or of secondary metastasis; among primary tumors are atrial myxomas; these are most common in the left atrium, affect females more and it is seen more among teenagers in pediatric population. It has varied clinical presentation, and asymptomatic cases have been reported. However, the case of a 2-year-old female with the right atrial involvement who presented with overt signs severe malnutrition is reported.

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The advent of transcatheter aortic valve implantation (TAVI) has allowed many patients with severe aortic valve stenosis who were previously deemed too high risk or inoperable to be effectively treated.

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