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Most common electrocardiogram (ECG) findings of myocardial ischemia are ST segment deviations & T wave (ST-T) alterations. However, multiple other conditions can cause ST-T changes mimicking ischemia including ventricular hypertrophy, bundle branch block, electrolyte imbalance, drugs, channelopathies, etc. Uncommonly, incorrect placement of limb leads can also produce ST-T changes leading to diagnostic dilemma. We report a case of erroneous limb-lead placement in a 45 years male mimicking ischemic ECG changes.

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Background: Meditation is a mind and body practice for increasing calmness and physical relaxation, improving psychological balance, coping with illness, and enhancing overall health and well-being. Many studies have already been carried out to see the effect of Yoga, Pranayam, meditation, Sudarhan Kriya on physiological parameters, but till date, there is not a single study which shows the cumulative effect of yoga, pranayam, meditation along with sudarshankriya on physiological parameters. Methods: This observational study was conducted in the Department of Physiology, Rajasthan University of Health Sciences, Jaipur and in association with Art of living organization. The study participants were enrolled into three groups. In the first group, 10 participants of Advance Meditation Program (AMP), who were doing this program for the first time, in second group, 10 participants who were doing AMP along with regularly practicing Padam Sadhna for at least 2 years and finally, in the third group, 10 participants who were not practicing any kind of meditation or yoga. After consent, subjects filled the Cohen's stress questionnaire. Electrocardiography (ECG) was recorded before AMP and after AMP. Results: There was significant difference in heart rate (P = 0.002), systolic blood pressure (P = 0.028), diastolic blood pressure (P = 0.005), RR interval (P = 0.020), PR interval (P = 0.040), and stress score (P = 0.027) in first time participants. Similarly, in the second group (repeaters) also significant difference was noticed. Conclusion: AMP has its positive effects on ECG, blood pressure, and stress level. Thus, it can be considered as one of the important nonpharmacological methods for prevention of stress, anxiety, and cardiovascular diseases.

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When it comes to management of acute coronary syndrome (ACS), no other investigation can replace the role electrocardiogram (ECG) that still holds the pivotal role in emergency rooms. Rightfully thence, the classification of ACS patients into ST elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) is based on these zig-zag lines on a squared paper strip. This classification is important as both the groups differ in their pathophysiology as well as management. While, thrombolysis or percutaneous coronary intervention is done in STEMI sufferers; thrombolysis is contraindicated in the ones with NTEMI. There are, however, some patterns which do not show obvious ST elevation in ECG but are in fact associated with critical narrowing of major heart vessels. de Winter is one such “NSTEMI-STEMI equivalent.” Although now widely agreed on as a STEMI equivalent, its management with streptokinase (STK) is controversial. We are reporting a case of 38-year-old male with chest pain, whose ECG revealed the classical de Winter pattern and was successfully thrombolysed with STK. Complete set of classical ECG tracings and its management with STK (perhaps first such report across the globe) are the two major highlights of this report.

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Objectives: It is important to diagnose subclinical carditis in acute rheumatic fever (ARF) since it has a bearing on prognosis and duration of prophylaxis. Plasma N-terminal pro-brain natriuretic peptide (NT pro-BNP) has been used as both diagnostic and prognostic tools, and it was hypothesized that it may prove useful in ARF without overt carditis. The study was undertaken to measure the plasma levels of NT pro-BNP in patients of ARF who did not have overt clinical carditis and to correlate the same with echocardiographic (ECHO) parameters of subclinical myocardial involvement. Materials and Methods: A total of 27 ARF patients without overt clinical carditis were enrolled in this prospective follow-up study. Plasma NT pro-BNP levels of these patients were assessed on day 1 of presentation and then after 6 weeks. ECHO was performed and patients were divided into two groups: group I, patients with subclinical carditis (n = 18) and group II, patients without subclinical carditis (n = 9). Results: The mean plasma NT pro-BNP levels were significantly higher in patients with subclinical carditis (509.16 ± 282.9 pg/ml) compared to those without subclinical carditis (109.33 ± 82.95 pg/ml) (P < 0.001). A cutoff value of 134 pg/ml of NT pro-BNP had a sensitivity of 94.4% and specificity of 88.9% for detecting subclinical rheumatic carditis in ARF. Conclusions: The present study suggests that elevated levels of NT pro-BNP may be used to diagnose subclinical myocardial involvement in patients of ARF without overt clinical carditis.

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