Heavily thickened pericardium with constrictive pericarditis.

A middle-aged male presented with symptoms of exertional shortness of breath and leg swelling for the past six months. Examination revealed raised jugular venous pressure (JVP), pitting pedal oedema, muffled heart sounds, bilateral pleural effusion and hepatomegaly. Echocardiogram showed features of constrictive pericarditis with heavily thickened pericardium, which was confirmed by cardiac computed tomography (CT). The patient underwent pericardiectomy following which echocardiographic features of constriction were reversed and the patient became asymptomatic

Hyperdominant left anterior descending artery presenting as anterior wall ST segment elevation myocardial infarction: A rare coronary anomaly

We report on a 75 year-old man who presented with severe chest pain for four hours. Physical examination was unremarkable and he was haemodynamically stable. ECG done in the ED showed ST segment elevations along with Q waves in the anterior and inferior leads with T wave inversions. He was rushed to the catheterization lab where the left anterior descending (LAD) artery was 99%occluded in the proximal segment while distal left circumflex showed 50-60% lesion. He underwent primary percutaneous coronary intervention to LAD with drug eluting stent and made an uneventful recovery. The LADwas found to be wrapping around the apex and continuing as the posterior descending artery (PDA). To the best of our knowledge, there are few case reports on the continuation of LAD across the left ventricular apex as PDA in the presence of a normally arising but small right coronary artery

Non-compaction of the left ventricle and associated ventricular septal defect.

A case report of a 28-year-old patient, who presented with symptoms and signs of congestive heart failure and had clinical signs of ventricular septal defect as well. On further work-up echocardiogram showed non-compaction of the left ventricle with severe left ventricular systolic dysfunction and a ventricular septal defect. He was treated with standard treatment of heart failure and is doing well

Peripartum cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan.

Background: There is very little literature regarding peripartum cardiomyopathy from the Asian countries. We conducted this study to determine demographic details, clinical presentations, complications and recovery of left ventricular (LV) systolic function in peripartum cardiomyopathy (PPCMP) patients of Pakistani origin. Method: A ten year retrospective case series of PPCMP was conducted at the Aga Khan University Hospital. Patients were also followed up for six months after presentation, with special regard to improvement in the LV function. Results: Total 45 patients were included, 25 (55.5%) primigravida and 8 (17.7%) gravida 2 and the remaining 12 (26.6%) were multigravida. Fourteen patients (31.1%) presented during pregnancy and 31 (68.8%) after delivery. All patients presented with CHF and three (6.6%) were complicated with ventricular tachycardia (VT) at presentation. LV systolic dysfunction was present in 39 (86.66%) patients and RV dysfunction in 15 (33.3%) patients. Two patients had LV clot and thromboembolic stroke occurred in another 4 patients. All patients received standard treatment except three patients who had asthma and could not be given beta blockers. Echocardiogram was repeated after 6 month and in 32 (71.1%) patients LV functions recovered to normal. RV function improved in all except 2 (4.4%) patients. All patients were discharged in stable condition. Conclusion: Significant numbers of PPCMP patients, who had severe LV dysfunction at presentation recovered their LV functions at six month follow u

Takotsubo cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan.

Objective: There is very little literature regarding Takotsubo Cardiomyopathy (TTC) from the Asian Countries other than Japan and Korea. We conducted this study to determine the demographics, clinical presentations, complications and recovery of left ventricular (LV) systolic function in TTC patients of Pakistani origin. Methods: A ten years retrospective case series study of TTC was conducted at the Aga Khan University Hospital. Patients were followed for up to six months after presentation, with special emphasis on the recovery of LV function. Conclusion: TTC is classically triggered by an acute illness or by extreme stress and a triggering incident may not always be identified. It usually presents in the guise of an acute coronary syndrome (ACS). Our data was congruent with the existing literature, except for more heart failure and cardiogenic shock. Average Troponin-I (Tn-I) levels were also higher as compared to western population. The reason for more severity in our patients may be late presentation or different level of response to stress

Spontaneous coronary artery dissection: a rare cause of acute coronary syndrome.

We present a case of a 71-year-old man, with a history of hypertension and dyslipidaemia, who presented with typical cardiac chest pain and palpitations of 2 h duration. The examination revealed irregular pulse of 138 bpm, blood pressure 115/75 mm Hg, variable first and normal second heart sounds. The lungs were clear to auscultation. The ECG showed atrial fibrillation with a rapid ventricular rate. His heart rate was controlled with β blockers and the acute coronary syndrome treatment protocol was initiated. His baseline blood reports were within normal limits and two serial troponin I tests were negative. Coronary angiogram showed dissection in the left coronary system extending into the branch vessels and 30-40% stenosis in the right coronary artery. The patient underwent coronary artery bypass graft as an emergent case. He suffered a mild stroke postsurgery with complete functional recovery. He is being followed up in the clinic and has performed well

Quadricuspid aortic valve with aortic regurgitation: a rare echocardiographic finding.

We report on a middle-aged woman treated for chronic hepatitis C virus infection with pegylated interferon. Auscultation revealed a diastolic murmur and the peripheral signs of aortic regurgitation. She had shortness of breath on moderate exertion for the past 4 months, which she attributed to her liver disease. Echocardiogram showed a quadricuspid aortic valve with severe aortic regurgitation. She was referred to a cardiothoracic surgeon for aortic valve replacement (AVR). However, she decided against AVR despite detailed counselling, and opted for medical treatment

Treatment options for Primary CNS Lymphoma

Primary CNS lymphoma (PCNSL) is a rare and aggressive brain tumour that is uniformly fatal. The rarity of the disease and the poor response to treatment makes it difficult to reach a consensus with regards to treatment options. In this review, the authors have discussed different treatment modalities used in the management of PCNSL including chemotherapy, surgery and radiation, as well as the results of recent clinical trials on treatment options for PCNSL

Prevalence of Xerostomia in Diabetes Mellitus at lower Sindh.

Introduction: Xerostomia is a common problem in apparently normal as well as in ill individuals. Diabetes mellitus is a common endocrine disorder in which Xerostomia is complained frequently. Xerostomia contributes to altered eating habits and increase risk of dental caries and oral infection if there is inadequate blood glucose control. Factors affecting Xerostomia includes socioeconomic and medical condition, includes uncontrolled diabetes mellitus, presence of peripheral neuropathy, use of medications, gender and age. Objective: To document the prevalence of Xerostomia among diabetic patients. Methodology: This prospective, cross sectional study was conducted on known cases of Diabetes mellitus attending medical OPD at Muhammad Medical College, Mirpurkhas Sindh from March 2017 to August 2017. During this period 100 patients were included according to inclusion criteria. Demographic details were recorded. Fox questionnaire was filled in, the data collected was analyzed by SPSS version 22, and presented as number and percentage. Result:  Among100 patients; 37% were xerostomic and 63% were non xerostomic, age range of xerostomic was 50 ±7years and non xerostomic was 35 ±11 years. 21 females had Xerostomia and 29 had no Xerostomia .16 males were xerostomic, and 34 males were non xerostomic. Among xerostomic patients 15 were insulin dependent and 21 were non-insulin dependent. Where as in non xerostomic 22 were insulin dependent and 42 were non-insulin dependent. The mean duration of diabetes mellitus was 10 ±5 years in Xerostomic and it was 8 ±3 years in non xerostomic diabetes mellitus. Conclusion: Xerostomia is common in elderly diabetics and in females and is dependent on glycemic control and duration of diabetes. Key words: Xerostomia, Diabetes mellitus, Elderly and Duration of Diabetes Mellitus.&nbsp

Fingolimod plays role in attenuation of myocardial injury related to experimental model of cardiac arrest and extracorporeal life support resuscitation

Background: Sudden cardiac arrest is a major global health concern, and survival of patients with ischemia-reperfusion injury is a leading cause of myocardial dysfunction. The mechanism of this phenomenon is not well understood because of the complex pathophysiological nature of the disease. Aim of the study was to investigate the cardioprotective role of fingolimod in an in vivo model of cardiac arrest and resuscitation.Methods: In this study, an in vivo rat model of cardiac arrest using extracorporeal membrane oxygenation resuscitation monitored by invasive hemodynamic measurement was developed. At the beginning of extracorporeal life support (ECLS), animals were randomly treated with fingolimod (Group A, n = 30) or saline (Group B, n = 30). Half of the animals in each group (Group A1 and B1, n = 15 each) were sacrificed after 1 h, and the remaining animals (Group A2 and B2) after 24 h of reperfusion. Blood and myocardial tissues were collected for analysis of cardiac features, inflammatory biomarkers, and cell signaling pathways.Results: Treatment with fingolimod resulted in activation of survival pathways resulting into reduced inflammation, myocardial oxidative stress and apoptosis of cardiomyocytes. This led to significant improvement in systolic and diastolic functions of the left ventricle and improved contractility index.Conclusions: Sphingosine1phosphate receptor activation with fingolimod improved cardiac function after cardiac arrest supported with ECLS. Present study findings strongly support a cardioprotective role of fingolimod through sphingosine-1-phosphate receptor activation during reperfusion after circulatory arrest