Shepherd's Crook (UPSL0PING) right coronary artery (RCA) is a special situation where RCA origin is not only superiorly oriented but also courses superiorly to some extent before making a U-turn. Presence of Shepherd's Crook RCA along with tortuosity in coronary artery makes the angioplasty very much technically demanding. Here I am reporting a case of Non-ST segment elevation myocardial infarction presented with 99% thrombus containing lesion in tortuous and Shepherd's Crook RCA successfully managed with angioplasty.

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Introduction: Thalassemia is the most common genetic disorder worldwide. Regular transfusion therapy, while improving patient quality of life, creates a state of iron overload. Once reticuloendothelial stores saturate, iron deposition increases in parenchymal tissues such as endocrine glands, hepatocytes, and myocardium. Cardiac iron deposition produces arrhythmias, systolic and diastolic dysfunction, and congestive heart failure in the second or third life decade. Aims and Objective: The present study was planned to find the prevalence of thalassemia cardiomyopathy and to study the spectrum of cardiac disease in thalassemia patients. Methods: All consecutive patients of thalassemia more than 12-year-old were included in this study. Screening included medical history assessment, focusing on cardiovascular symptomatology, transfusion and chelation history, physical examination, and transthoracic resting echocardiography. Clinical parameters included age, sex, address, height weight, body mass index (BMI), systolic blood pressure (BP), diastolic BP, mean hemoglobin, and mean serum ferritin. Results: A total of 56 patients of thalassemia were included in the study. Fifty-one patients were of thalassemia major and 5 patients were of thalassemia intermedia. Mean age of patients included in our study was 15.9 ± 4.6 years. Mean duration of thalassemia in our patients was 12.9 ± 3.05 years. Mean hemoglobin of the patients included in our study was 8.7 ± 1.1 g%. The level of mean serum ferritin in our patients was 666.69 ± 325.46 ng/ml. In our study, we had 8 (14.2%) patients out of 56 having systolic dysfunction. Furthermore, our patients with left ventricular systolic dysfunction had younger mean age as compared to those patients who had a normal left ventricular function. We also found a higher ferritin value in patients with left ventricular dysfunction as compared to patients with normal left ventricular dysfunction studies. Conclusion: In our study, we found out that patients with left ventricular dysfunction had a younger age of onset of disease, higher ferritin levels, lower blood pressure, and paradoxically higher BMI as compared to patients with normal left ventricular dysfunction.

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Objectives: The purpose of this study was to evaluate the event-free survival from major adverse cardiac events for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) as a function of whether they underwent infarct-related artery (IRA)- only percutaneous coronary intervention (PCI) or complete revascularization at index admission. Background: The optimal management of patients with STEMI and MVD while undergoing primary PCI (P-PCI) is uncertain. Methods and Results: STEMI patients with MVD undergoing P-PCI between April 1, 2012, and March 31, 2014, were subdivided into those who underwent complete revascularization during index admission (n = 150) and IRA-only revascularization (n = 156). Complete revascularization was performed at index admission of P-PCI. The primary endpoint was a composite of all-cause death, recurrent MI, heart failure (HF), and ischemia-driven revascularization within 24 months. Patient groups were differed at baseline by gender and prevalence of HF. The average door-to-balloon time was significantly higher in the complete revascularization group. The primary endpoint occurred in 11.0% of the complete revascularization group versus in 23% of the IRA-only revascularization group (hazard ratio: 0.51; 95% confidence interval: 0.34–0.93; P = 0.039). There was a significant reduction in death; a nonsignificant reduction in all primary endpoint components was seen. Conclusions: In patients presenting for P-PCI with MVD, complete revascularization at index admission significantly lowered the rate of the primary composite endpoint at 24 months compared with treating IRA-only.

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Objective: The objective of the study was to examine the correlation between the carotid ultrasound findings (i.e., carotid intima-media thickness [IMT] and plaque score) and complexity of coronary artery disease (angiographic SYNTAX score) in Indian patients with stable ischemic heart disease. Materials and Methods: This was a hospital-based, prospective, consecutive comparative case series. The study population comprised 117 Indian patients with stable ischemic heart disease, who underwent carotid ultrasonography for the estimation of mean carotid IMT and plaque score and coronary angiography for the estimation of SYNTAX score. Groups comprising patients with low SYNTAX score (0–22; n = 88) and patients with intermediate (23–32) and high (≥33) SYNTAX score (n = 29) were compared for various demographic factors and carotid ultrasound findings. Results: Patients with intermediate or high SYNTAX score had significantly higher prevalence of diabetes (51.7% vs. 15.9%), hypertension (89.7% vs. 30.7%), and hypercholesterolemia (100% vs. 31.8%) as compared to patients with low SYNTAX score (P < 0.001). Further, the mean IMT and plaque scores increased with increasing SYNTAX score. Patients with intermediate and high SYNTAX score had significantly higher mean IMT (1.1 ± 0.1 vs. 0.9 ± 0.1 mm) and plaques score (6.6 ± 1.2 vs. 1.9 ± 1.9 mm) as compared to patients with low SYNTAX score. Significant correlation between SYNTAX score and mean IMT (r = 0.73; P < 0.01) and plaque score (r = 0.68; P < 0.01) was observed. Conclusions: Carotid ultrasound findings showed a significant correlation with the degree of complexity of coronary artery lesions.

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Congenital absence of the left circumflex artery is a rare anomaly of the coronary circulation with a prevalence ranging from 0.6% to 1.3%. We report a 33-year-old male who presented with recent anterior wall myocardial infarction, in whom coronary angiography revealed absent left circumflex artery and stenosed left anterior descending artery. The left circumflex territory was being perfused by the superdominant right coronary artery. Although the absence of an artery is mostly considered as a benign condition, atherosclerotic lesions may diminish the compensatory mechanisms and worsen the outcome.

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We report a case of coronary cameral fistula arising from the left circumflex artery (LCX) draining into the coronary sinus. This 55-year-old male, with no prior symptoms or risk factors, presented with sudden-onset palpitations and sweating. Contrast enhanced computed tomography coronary angiogram as well as conventional coronary angiography revealed a hugely dilated extremely tortuous fistula from the LCX draining into the coronary sinus. This case is unique because of such a giant fistula remained totally asymptomatic till the sixth decade of life and with no perfusion defect on myocardial perfusion imaging.

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Statins play a vital role in the prevention of atherosclerotic cardiovascular complications and statin therapy continues to be cornerstone in treating patients with dyslipidemia. However, statin-associated myopathy affects up to 10%–12% of patients which can range from myalgia to a severe muscle weakness and rhabdomyolysis. Histopathological features and neuroimaging changes of statin-induced weakness are not studied so often. We present a case of 65-year-old female patient who presented with quadriparesis and myalgia-induced by statins; and we tried to find histopathological and electromyographic changes associated with statin-induced myopathy.

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