Asif Hasan

Relationship of high altitude and congenital heart disease.

High altitude typically refers to elevations over 2000 m/6360 ft, but no single value is an adequate definition for all patients. During the ascent to high altitude, barometer pressure declines exponentially, and in keeping with Daltons law, the partial pressure of oxygen falls accordingly. Pressure chambers and air travel serve as a poor option to study the effect of hypoxemia on human physiology. Most natural is the systemic effects of high altitude on the natives and persons visiting hilly areas from low lands. The basis of the effects of high altitude comes from studies performed on aviators, mountaineers and natives of high lands. More than 140 million people worldwide live at more than 2500 m above the sea level and around 80 million live in Asia.

Spontaneous closure of a large left ventricular pseudoaneurysm.

Fig. 1 – Left ventriculogram in right anterior oblique 308 view showed large nonopacified pseudoaneurysm around the apex and antero-lateral wall of LV (outlined with white arrows). A 52-year-old nondiabetic, normotensive male presented with dyspnea on exertion NYHA class II of 6 months duration. He sufferedananteriorwallmyocardial infarction, 3 years back. His clinical examination was unremarkable. ECG showed normal sinus rhythm and qs pattern in V3–V6 chest leads, and I, aVL limb leads. Two-dimensional echocardiography revealed akinetic and thinned out anterior wall and septum, and left ventricle (LV) ejection fraction of 0.25. Coronary angiography revealed 70% discrete stenosis of mid left anterior descending artery; rest of the coronaries were normal. Left ventriculogram showed akinetic antero-lateral, apical and inferior wall, and an ejection fraction of 0.25. Around the antero-lateral wall and apex of LV, there was a non-opacified mass thatwasmovingalongwithheartmovements, suggestive of occluded LV pseudoaneurysm (Fig. 1, Video 1). Computed tomography image showed an 89mm 33 mm multilayered thrombosed, calcified hypoattenuating LV pseudoaneurysm around the anterior wall and apex of the heart (Fig. 2). There was no communication between the pseudoaneurysm and the LV cavity. He was managed with standard medical treatment, and remained asymptomatic at 5-year follow-up.

Elevated DNA Damage, Oxidative Stress, and Impaired Response Defense System Inflicted in Patients With Myocardial Infarction

Background: Ischemic tissue damage in myocardial infarction (MI) is allied with the exaggerated production of reactive oxygen species (ROS) beyond the countering capability of chain-breaking radical scavengers, fallouts in the form of oxidatively burdened myocardial tissue. Methods: One hundred and twenty five patients with MI were included in the study to evaluate the dynamics of redox status of patients by monitoring the antioxidant potential, biomarkers of oxidative stress, lipid indices, RBC membrane damage when compared to healthy individuals in patients with MI congregated on the basis of Global Registry of Acute Coronary Events (GRACE) score, risk factors, and age. Results: Higher levels of malondialdehyde, 8-hydroxy-2-deoxyguanosine, lipid indices, ROS content, and membrane deterioration in erythrocytes were seen in patients with MI. Furthermore, reduced activities of erythrocyte antioxidant enzymes and lower concentrations of antioxidant molecules, plus reduced total antioxidant capacity, were observed in plasma of all patients with MI with respect to control. However, elevation in oxidative stress was found to be significantly marked in patients having GRACE score >100, risk factors, and MI >45 years when compared to patients with GRACE score ≤100, without risk factors, and MI ≤45 years, respectively. Conclusion: These findings indicate the existence of increased oxidative damage and reduced antioxidant potential in patients with MI have a potent relationship with their GRACE risk score, risk factors, and age.

Hereditary angioedema: A case report and literature review

Hereditary angioedema (HAE), also known as Quincke′s disease, is an autosomal dominant condition characterized by painless and nonpitting swelling of soft tissues. It is not an allergic phenomenon, as it appears to be on initial examination, thus fails to respond to injectable steroids and adrenaline. The disease may become potentially life threatening due to involvement of airway, thus early suspicion, recognition, and treatment of disease are important. We present here a case of 22-year-old female who developed sudden facial swelling and breathlessness. In the presence of poor response to anti-allergic treatment, past and family history of similar complaints, and low C1 esterase levels, a diagnosis of HAE was made.