Asymptomatic, delayed migration of intracoronary stent in pericardial space: A rare phenomenon

Delayed perforation of the coronary artery and extraluminal migration of coronary stent is a rare phenomenon. We report a case in which the stent was documented to perforate the coronary artery at least 1 year after the intervention and migrated within the pericardium without any symptom. (Level of Difficulty: Intermediate.)

Preoperative, perioperative and CCU care in primary electrical disorders of the heart

Primary electrical disorders of the heart predominantly consist of Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia, early repolarization syndrome and idiopathic ventricular fibrillation. The diagnostic approach and peri-operative and anaesthesia challenges are discussed. Isoprenaline infusion is a life-saving therapy in Brugada syndrome–related electrical storm

Iron deficiency in chronic systolic heart failure(indic study)

Background: Chronic systolic heart failure (HF) is characterized by the left ventricular dysfunction, exercise intolerance and is associated with neurohormonal activation that affects several organs such as kidney and skeletal muscle. Anemia is common in HF and may worsen symptoms. Iron deficiency (ID) is also common in HF patients with or without anemia. Iron is the key cofactor in oxidative metabolism in skeletal muscle and the Krebs cycle. There is a paucity of data regarding iron metabolism in chronic systolic HF in India. Methods: IroN Deficiency In CHF study (INDIC) is an observational study that investigated forty chronic heart failure patients for the presence of ID. Serum ferritin (micrograms per liter), serum iron (micrograms per liter), total iron binding capacity (micrograms per liter), transferring (milligrams per deciliter), and transferrin saturation were measured to assess iron status. Results: There were 67.5% (27/40) patients who had ID with a mean serum ferritin level of 76.4 μg/L. Of the 27 iron deficient patients, 22 (55%) had an absolute ID, and 5 had a functional ID. Eight out of 27 of the iron deficient patients were anemic (20% of the total cohort, 30% of the iron deficient patients). Anemia was seen in 6 other patients, which was possibly anemia of chronic disease. There was a trend for more advanced New York Heart Association (NYHA) class (NYHA III and NYHA IV) patients with ID (37.4% vs. 30.77%, P = 0.697). Conclusion: In our study, ID was very common, affecting more than half of the patients with systolic HF. Absolute ID was the most common cause of ID and patients with ID had a tendency to have advanced NYHA class. Our study also demonstrated that ID can occur in the absence of anemia (iron depletion)

An unusual genetic observation in a case of short-coupled PVC-triggered ventricular fibrillation

Ventricular fibrillation induced by short-coupled premature ventricular complex is an uncommon cause of cardiac arrest in young individuals with no structural heart disease. The genetic substrate of this condition is heterogeneous and remains incompletely defined. We describe a case of short-coupled premature ventricular complex-triggered ventricular fibrillation with a likely pathogenic variant in the titin (TTN) gene. (Level of Difficulty: Advanced.)