Arif Wahab

Acute onset quadriparesis with sine wave: a rare presentation

Secondary hyperkalemic paralysis is a rare disease entity, and initial presentation with sine wave pattern is even rarer. We report a case of acute onset flaccid quadriparesis due to hyperkalemia and sine wave pattern in electrocardiogram. A 56-year-old diabetic woman presented to our emergency department with a history of acute onset flaccid quadriparesis and slight breathlessness for 1 hour. For the last 15 days, the patient was having repeated episodes of vomiting; and her urine output had progressively decreased, she had no history of fever, diarrhea, trauma, vaccination, or similar neurologic episode before. The patient had poorly controlled diabetes, renal failure, and hypertension for many years. On examination her vitals were: temperature, 98 °F; respiratory rate, 20/min; heart rate, 130/min; and blood pressure, 150/90 mm Hg. Examination of neurologic system revealed conscious and oriented patient with areflexic paralysis of both lower limbs. Power in lower limb was 2 of 5, and both planters were mute. Power in both upper limbs was 3 of 5, and reflexes were diminished. There was no sensory deficit, and all cranial nerves were normal. Cardiovascular and gastrointestinal systems were normal; examination of respiratory system revealed bilateral basal crypts. Bedside electrocardiogram (ECG) showed broad-complex tachycardia suggestive of sine wave pattern (Fig. 1). Blood was sent for biochemistry immediately. Keeping in view the clinical picture of the patient and the sinewave pattern inECG, the patient was provisionally diagnosed as a case of acute onset hyperkalemic flaccid Fig. 1 Pretreatment ECG showing broad-complex 0735-6757/

Angiographic severity and morphological presentation of coronary artery disease in NIDDM patients compared with matched nondiabetic subjects in a north Indian cohort

– see front matter

Acute myocardial infarction in a patient of dextrocardia and situs inversus totatis—when right is not right

Abstract Diabetes is considered as a coronary artery disease (CAD) riskequivalent and diabetics are prone to a more severe and diffuse atherosclerotic CAD. In this study, we evaluated a north Indian cohort of type II diabetics for their angiographic and morphological features and compared them with a similar nondiabetic subgroup. The study included 100 consecutive non-insulin-dependent diabetes mellitus (NIDDM) patients undergoing clinically indicated elective coronary angiography and 100 nondiabetic patients who were individually matched for sex, age, and clinical diagnosis. On analysis, we found that the frequency of single and multivessel CAD were statistically different between the two groups with single vessel disease (SVD) being more frequent in nondiabetic CAD patients (10 vs 26, p

Spontaneous self-ignition in a case of acute aluminium phosphide poisoning

Abstract Diagnosis of myocardial infarction in patients with dextrocardia and situs inversus is considerably difficult. The clinical diagnosis and electrocardiography (ECG) recognition in this setting poses significant challenges, as the clinical signs may be misleading and the ECG changes may simply be interpreted to be due to improper lead placement. In this case report we report one such case of acute myocardial infarction in a patient of situs inversus totalis. A deviated apex beat and heart sounds coupled with right axis deviation of P wave and QRS complexes in lead I, and positive R wave in aVR lead to the diagnosis of dextrocardia. Elevated ST segment in Vl and right-sided leads indicated acute myocardial infarction which was later confirmed by raised creatine phosphokinase-MB (CPK-MB) levels, and transthoracic echocardiography.