Electrocardiogram (ECG) is usually the first and most important test in patients with acute coronary syndrome which helps to diagnose as well as classify patients into ST elevation or non-ST elevation myocardial infarction (STEMI). This classification is important as both the groups differ in their pathophysiology as well as management. Patients with STEMI require urgent reperfusion therapy either with percutaneous coronary intervention or fibrinolysis, if the earlier is not available. They may, however, sometimes present without obvious ST elevation in ECG resulting in delayed diagnosis and reperfusion therapy. Identification of such STEMI equivalents, therefore, becomes very important for physicians as well as interventional cardiologists. We report a 62-year-old male who presented without an obvious ST elevation in ECG and subsequently found to be having acute obstruction of mid-left anterior descending artery.

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Objective: The goal of this study is to evaluate and compare the midterm outcomes of bioprosthetic heart valve replacement in terms of survival, valve-related events, quality of life, and economic aspects of treatment in population age 45 years and above in females and 48 years in males and their comparison with mechanical valve recipients. Materials and Methods: The patient population under age group of 45–60 years is randomly divided into two groups: One receiving bioprosthetic valves and other receiving mechanical valves. Patients were followed up and data are analyzed. Results: The overall 10-year survival was similar in patients receiving bioprosthetic heart valve and mechanical heart valves. The incidence of major bleeding episodes was very high with mechanical valves (mitral valve replacement [MVR] = 14.3% and aortic valve replacement [AVR] =7.2%) as compared to 0.6% and 0.8% with bioprosthetic MVR and AVR, respectively. About 1.02% of patients with tissue valves have episodes of thromboembolism versus 8.3% patients with mechanical valves. Acute valve thrombosis rates were high in mechanical valve (3.1% vs. 0.0%). Incidences of endocarditis were also more with mechanical valve replacement group (2.3% vs. 0.3%). The quality of life was also better in patients with bioprosthetic valves. Conclusions: Bioprosthetic heart valves seem to be more beneficial in the Indian scenario as compared to mechanical valves because of low incidence of mortality and valve-related events and better quality of life.

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Background: Hypertension (HTN) continues to be a public health menace with substantial morbidity and mortality. The antihypertensive effect of Vitamin D is attributed to its negative regulation of renin–angiotensin–aldosterone system, antioxidant, and antiangiogenic effects. Data regarding Vitamin D deficiency in hypertensive Asian Indian population are scarce. Materials and Methods: One hundred and two Vitamin D naive essential hypertensive participants were enrolled from the outpatient department. Ninety-nine healthy age- and sex-matched nonhypertensive controls were taken for comparison. Serum Vitamin D level estimation was done in both groups through immunosorbent assay and deficiency defined as values <20 ng/ml. Results: Vitamin D deficiency was more prevalent among cases vis-à -vis controls (80.4% vs. 67.7%, P = 0.01). The mean 25-hydroxyvitamin D levels among cases were 15.15 ± 12.51 ng/ml versus a value of 33.59 ± 16.69 ng/ml among controls (P = 0.0001). We also observed trends towards an inverse association between Vitamin D levels and systolic blood pressure (BP) (P = 0.02). Conclusion: Vitamin D deficiency is more prevalent with HTN, and low levels tend to correlate with elevated systolic BP. However, larger studies are needed to confirm this association.

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The incidence of mechanical complications related to myocardial infarction has decreased due to various factors over the last few decades. Patients admitted for acute ST segment elevation myocardial infarction (STEMI) may respond well to thrombolytic therapy before being taken up for coronary angiography and percutaneous coronary intervention depending on the facilities available at the specific center. Unfortunately, some patients develop complications of myocardial infarction during hospital stay or postdischarge. We present a patient admitted with acute STEMI responding well to thrombolytic therapy. During transthoracic echocardiography of the patient in Intensive Care Unit, the patient developed ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, and cardiogenic shock and expired.

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Introduction: Coronary artery disease (CAD) is known to be severe and progress more rapidly in overt hypothyroidism. However, the role of subclinical hypothyroidism (SH) as a risk factor for CAD is controversial. Our aim is to explore association, if any, existing between SH and the angiographic pattern and severity of CAD in women. Subjects and Methods: We retrospectively studied 100 consecutive female patients with acute coronary syndrome who underwent coronary angiography. Baseline risk factor data and biochemical data were obtained from the hospital records. Patients with SH were compared with those without to assess differences in clinical characteristics and angiographic disease pattern. Results: Of the 100 women, 50 had SH (58.64 ± 10.92 years), and 50 were euthyroid (58.44 ± 9.34 years). Unstable angina was the most common initial diagnosis (38 vs. 36, P = 0.6484). Hypertension was the most common risk factor among both groups (36 vs. 32, P = 0.3912). Angiographic profile revealed, only euthyroid women had left main stem disease (0 vs. 5, P = 0.0218). Both groups had equal incidence of single vessel disease (7 vs. 7, P = 1), insignificant CAD (6 vs. 6, P = 1) and angiographically normal coronaries (17 vs. 17, P = 1), SH group had greater incidence of multivessel disease (18 vs. 12, P = 0.1904). Left anterior descending was the most commonly involved coronary artery in both groups, (43 vs. 34, P = 0.3991). Segmental distribution pattern showed near similar disease pattern, with proximal segment being the most common in both groups (30 vs. 27, P = 0.9369). Conclusions: As our study population was small and study had limitations, we cannot convincingly conclude that SH is not associated with the severity and angiographic disease pattern of the CAD.

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Context: Infective endocarditis (IE) still carries significant mortality and morbidity ever since 1835. Despite improvement in medical technologies, mortality outcome remains unchanged. We sought to analyze the pattern of presentation, treatment, and outcomes predictors for patient presenting to our hospital. This study will explore some of the factors that could be associated with the outcome of a patient diagnosed with IE for a better guidance in management. Subjects and Methods: This is a retrospective dual center cohort study from North Kuala Lumpur from January 2012 to December 2013. Fifty patients with definite IE based on modified Duke's criteria were recruited into the study. Clinical presentation, risk factors, biochemical markers, echocardiography, and outcome were obtained through chart review, clinic data, and telephone call. Simple logistic regression was utilized for inferential statistic. Results: A total of 50 patients, 37 (74%) males and 13 (26%) females were included in the study. The mean age was 42 ± 16.4. Most patients (80.39%) were diagnosed within the 1^st week of admission. Staphylococcus aureus was the most common pathogen (38%) and the mitral valve was predominantly affected (68%). Complication was common and in-hospital mortality remains high (28%). Nearly 20% of the patients who had surgical intervention survived and discharged alive. Presence of complications predicts poor outcome (odds ratio [OR]: 5.5 P = 0.02), whereas surgical intervention predicts good outcome (OR: 1.56 P = 0.027). Conclusions: Mortality remains relatively high in patient with IE. Those who presented with complications are at 5.5-fold risk of mortality. Surgical intervention showed an association with good outcome within this cohort.

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As the number of catheterization laboratory procedures increase, there is more incidence of retention of foreign body in the form of torn catheters or devices or stents. Improvised snares are necessary in the absence of readymade snares. Retrieval of peripherally inserted central catheter from the pulmonary artery can be very challenging sometimes. Very few case reports are available regarding retrieval of dislodged stent from right profunda femoris artery.

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Arrhythmogenic right ventricular dysplasia (ARVD) is a common cause of sudden cardiac death in young adults. It is a disease that has a wide spectrum of presentation. Early identification of the disorder is of paramount importance considering the fatal complications. Here, with this case, a rare sporadic presentation of ARVD, we try to discuss the various presentations, methods of diagnosis and options for treatment for this frequently masquerading and occasionally fatal disorder of cardiac myocytes.

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We describe a case of fatal intracerebral hemorrhage (ICH) complicating carotid stenting. The manifestation is distinct from the well-known hyperperfusion syndrome. In our patient, neurologic deterioration appeared within 15 min of stenting, without any prodromal symptom. This early postprocedural complication is radiologically similar to hypertensive ICH and might have the same pathogenesis. Appropriate antihypertensive therapy might be beneficial in preventing this devastating complication.

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Background and Objective: To evaluate the association between severe generalized periodontitis and carotid intima-media thickness (CIMT) in young, otherwise systemically healthy individuals. Materials and Methods: A total of 60 systemically healthy individuals of age between 20 and 40 years were included in the study. Group I consisted of 30 individuals with healthy periodontal tissue and Group II with 30 individuals with severe generalized periodontitis. Ultrasonographic evaluation of bilateral CIMT at the level of common carotid artery was done. Results: The overall mean intima-media thickness (IMT) in Group I was 0.52 ± 0.07 mm and in Group II was 0.61 ± 0.07 mm. Bivariate analysis considering the binomial IMT (≥0.6) as outcome variable showed odd's ratio = 16 for probing depth and clinical attachment loss. The final model of stepwise logistic regression using binomial IMT (>0.6) as outcome variable showed statistical significance with clinical attachment loss suggesting that as the clinical attachment loss increases the IMT also increases. Conclusion: Severe generalized periodontitis is associated with subclinical atherosclerosis in young systemically healthy patients.

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Background and Objective: Cardiotoxicity is one of the dose-limiting toxicities of anthracycline antibiotics, and electrophysiological abnormalities have been established. However, the existence of the established electrocardiographic abnormalities in pediatric cancer patients on chemotherapy is yet to be reported in Nigeria. This research seeks to characterize anthracycline cardiotoxicity in Nigerian children using electrocardiogram (ECG). Materials and Methods: Seventeen children on anthracycline-based regimen for various malignancies in the Paediatric oncology ward of Aminu Kano Teaching Hospital Kano, Nigeria, were recruited for this cross-sectional study. Those with normal serum electrolytes had a bedside ECG after obtaining informed consent. Their QTc, QTc-dispersion, and ST segment morphology were studied and compared with reference ranges of apparently normal Nigerian children where applicable. Results: There were 12 males (70.6%) and 5 females (29.4%) studied. The age range of the subjects was 2–7 years. Of the 17 subjects, only 3 were on daunorubicin-based regimen, while the rest were on doxorubicin-based regimen. The corrected QT was prolonged in 23.5% of the subjects; the QTc dispersion ranged from 20 to 126 for chest leads and 20–200 for limb leads. Whereas elevation of ST segment occurred in only one patient accounting for 5.9%, ST segment elevation, ST segment depression was present in 6 patients. Conclusion: There are remarkable differences in the ECG characteristics of patients in this report who had anthracyclines when compared to apparently healthy children.

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