Biswajit Majumder

Becker's nevus syndrome: a report of a rare disease with unusual associations

Becker’s nevus is a cutaneous hamartoma characterized by circumscribed hyperpigmentation with hypertrichosis. Becker’s nevus syndrome (BNS) is a phenotype characterized by the basic presence of Becker’s nevus with ipsilateral hypoplasia of the breast or other skin, and skeletal and/or muscular disorders. This syndrome generally originates at birth, intensifies significantly in adolescence, and is one of the syndromes that comprise epidermal nevus syndrome. We describe a case of BNS with a few unique and rare associations.

A rare case of dense spontaneous echo contrast within inferior vena cava

A 33-year-old gentleman was examined because of fatigue and progressive right heart failure. A striking finding in his echocardiogram was intense and slow-moving dense echo contrast in the inferior vena cava (IVC). Cardiac catheterization revealed constrictive pericarditis, and pericardiectomy was performed. Postoperatively spontaneous echo contrast in IVC have resolved. This case helps explain the origin of spontaneous IVC contrast.

Accidental injury of the right coronary artery during angioplasty of the left coronary system

Injury to coronary arteries can occur during diagnostic and therapeutic interventions. It is more common with angioplasty with certain guide catheters such as Amplatz catheter. The dissection is more common in ascending aorta with extension to the coronary arteries. We hereby report a case of right coronary artery (RCA) dissection without concurrent aortic dissection caused by injury with extra-backup left guide catheter during angioplasty of left anterior descending artery successfully managed by stenting of RCA from ostium with drug-eluting stent.

Unusual cause of angina in postpercutaneous transluminal coronary angioplasty patient

Among the many causes of Post Percutaneous transluminal coronary angioplasty angina (Post PTCA angina), stent restenosis is the most important cause. Other causes include incomplete revascularization, microvascular angina, and appearance of new lesions. Coronary arterio-venous (A-V) fistula is a rare cause of angina following PTCA. We hereby report a case of post-PTCA angina caused by coronary A-V fistula.

Cardiac cephalgia presenting as acute coronary syndrome: A case report and review of literature

Although chest pain is the most common presentation of ischemic heart disease, there are other rare presenting symptoms such as indigestion, diaphoresis, and rarely only with headache. High degree of clinical suspicion is needed in any patient presenting with headache to have ischemic heart disease as an etiology. Hereby, we report an unusual case of acute coronary syndrome in a young patient under the age of 50 presenting with only headache.

A Simple Non-invasive ECG Technique to Localize Culprit Vessel Occlusion Site in ST-Elevation Myocardial Infarction (STEMI) Patients

Background: Electrocardiograms (ECGs) are essential in identifying the type and location of acute myocardial infarction. In the setting of inferior wall myocardial infarction (IWMI), identification of the right coronary artery (RCA) as the culprit artery is important because of the potential complications associated with its involvement. Objectives: The study was conducted to identify the culprit artery responsible for STEMI from ECG tracings. To validate Fiol’s algorithm in Eastern Indian population and to compare the ECG findings with coronary angiogram. Methods: The cross-sectional study was conducted in 100 patients with acute STEMI. Patients presenting with acute ST-elevation myocardial infarction within 12 h of symptom onset were included in the study. In this study, we focused on Fiol’s algorithm and some other pre-specified criteria for prediction of occluded vessels. Cohen’s kappa statistical method was used to correlate ECG localisation of culprit artery with that of coronary angiogram. Results: Out of 100 STEMI patients, 73 patients had left anterior descending as the culprit artery, 24 patients had right coronary artery as the culprit artery and 3 patients had left circumflex artery as the culprit artery (73%, 24% and 3% respectively). Following Fiol’s algorithm, we have found that ECG has: high specificity (86%) but low sensitivity of 29% for an occlusion proximal to D1. Moderate sensitivity and moderate specificity (62% and 69% respectively) was noted for an occlusion distal to D1. Similarly, high sensitivity (90%) but low specificity (33%) was noted for lesion proximal to S1. Cohen’s kappa κ=1 suggests excellent agreement between ECG and coronary angiogram for inferior wall MI (both RCA and LCx occlusion). Conclusion: It can be concluded that ECG can reliably predict the culprit artery in STEMI patients. The Fiol’s algorithm is validated and considered as a simple tool to localize the infarct related artery in anterior wall myocardial infarction (AWMI) and inferior wall myocardial infarction (IWMI).

Giant aneurysm of right coronary artery: A case report and review of literature

Coronary artery aneurysms are seen in 1.5-5% of patients presenting for coronary angiography, but giant aneurysms, defined as being greater than 2 cm in diameter, are rare. Clinical presentation, prognosis and management of giant coronary artery aneurysm are not well defined due to limited experience, so each case is a learning tool in itself. We report the rare case of a 56-year-old female patient who presented to us with effort angina and was subsequently found to have a giant right coronary artery aneurysm with a fistulous communication to right atrium. This case describes one of the varied presentations of an ill defined and heterogeneous disease process.

Dyspnoea and Cyanosis in Pregnancy: An Extremely Rare Cause

Pulmonary arteriovenous malformation first presenting with platypnea and orthodeoxia in the 3rd trimester of pregnancy is an extremely rare entity and poses a great diagnostic challenge to the treating physician. We hereby report a patient with pulmonary arteriovenous malformation presenting for the first time in third trimester of pregnancy diagnosed by pulmonary angiogram with subsequent improvement in symptoms post-delivery. Key words: Pulmonary Arteriovenous Malformation, Pregnancy, Platypnea, Orthodeoxia, Pulmonary Angiogram.

Cake-like material within the pericardium: an unusual picture of pyopericardium.

An 80-year-old female patient presented with a 12-day history of fever with cough, breathlessness, and chest pain. She had no past history of hypertension, diabetes or any other significant illness. On examination her blood pressure was 110/70 mmHg, pulse 112/min, respiratory rate 24/min, and jugular venous pressure was raised 7 mm above the sternal angle with normal wave form. On auscultation, muffled heart sounds were found with pericardial friction rub and basal crepitations. A chest radiograph showed an enlarged cardiac silhouette and an ECG revealed lowvoltage QRS complex with nonspecific ST-T changes. A complete haemogram revealed a total leucocyte count of 20,000/mm with 87 % neutrophils. Other biochemical parameters were within normal limits. Echocardigraphy showed normal-sized cardiac chambers and normal biventricular systolic function along with a thick cake-like material occupying the entire pericardial cavity with a tiny amount of pericardial fluid, without any evidence of cardiac tamponade (Figs. 1, 2). A computed tomography scan of the thorax showed thickened pericardium with contrast enhancement with very thick pericardial effusion without any mass lesion suggestive of infective etiology. Echoguided diagnostic pericardiocentesis yielded approximately 300 ml of thick pus-like material which on biochemical examination showed 7gm/dl protein, 10 mg/dl sugar, and adenosine deaminase within normal limits. Cytology of the fluid revealed a cell count of 7,000/cu mm, with 90 % neutrophils without any malignant cells or acid fast bacilli. Fig. 1 Two-dimensional echocardiography parasternal long-axis view showing cake-like material within the pericardial cavity

Large hematoma over the puncture site of percutaneous transluminal coronary angioplasty as a presenting sign of severe dengue infection

Dengue fever is a common arboviral infection all over the world. It is endemic in the tropical and subtropical areas of the world with periodic epidemics in these areas. In its severe form dengue patients may develop life-threatening bleeding manifestations. We report here a case of large hematoma formation precisely located over the puncture site of percutaneous transluminal coronary angioplasty as a presenting sign of severe dengue infection for its unusual occurrence. <Learning objective: Severe dengue including dengue shock syndrome is a potentially life-threatening condition. Dengue virus-induced coagulopathy and thrombocytopenia may further complicate cardiological interventions like percutaneous transluminal coronary angioplasty or coronary artery bypass grafting as such patients are already on antiplatelet drugs. Performing any cardiovascular intervention in an endemic area of dengue needs proper vigilance to avoid such potentially life-threatening complications.>.