Gaurav Chaudhary

Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India

Santanu Guha*, Rishi Sethi, Saumitra Ray, Vinay K. Bahl, S. Shanmugasundaram, Prafula Kerkar, Sivasubramanian Ramakrishnan, Rakesh Yadav, Gaurav Chaudhary, Aditya Kapoor, Ajay Mahajan, Ajay Kumar Sinha, Ajit Mullasari, Akshyaya Pradhan, Amal Kumar Banerjee, B.P. Singh, J. Balachander, Brian Pinto, C.N. Manjunath, Chandrashekhar Makhale, Debabrata Roy, Dhiman Kahali, Geevar Zachariah, G.S. Wander, H.C. Kalita, H.K. Chopra, A. Jabir, JagMohan Tharakan, Justin Paul, K. Venogopal, K.B. Baksi, Kajal Ganguly, Kewal C. Goswami, M. Somasundaram, M.K. Chhetri, M.S. Hiremath, M.S. Ravi, Mrinal Kanti Das, N.N. Khanna, P.B. Jayagopal, P.K. Asokan, P.K. Deb, P.P. Mohanan, Praveen Chandra, (Col.) R. Girish, O. Rabindra Nath, Rakesh Gupta, C. Raghu, Sameer Dani, Sandeep Bansal, Sanjay Tyagi, Satyanarayan Routray, Satyendra Tewari, Sarat Chandra, Shishu Shankar Mishra, Sibananda Datta, S.S. Chaterjee, Soumitra Kumar, Soura Mookerjee, Suma M. Victor, Sundeep Mishra, Thomas Alexander, Umesh Chandra Samal, Vijay Trehan

Calcified Aorto–Right Ventricular Tunnel in a Patient With Multiple Lentigines Syndrome

From the *Department of Cardiology, C.S.M. Medical University (King George’s Medical College), Lucknow, Uttar Pradesh, India; and the †Department of Radiodiagnosis, C.S.M. Medical University (King George’s Medical College), Lucknow, Uttar Pradesh, India. Manuscript received June 5, 2012; revised manuscript received June 14, 2012, accepted June 26, 2012. A12-year old boy with multiple pigmented nevi and lentigines (A) presented to us with symptoms of effort dyspnea and recent onset cyanosis. He had mild thoracolumbar scoliosis, unilateral sensorineural hearing loss, and growth retardation. The 2-dimensional transthoracic echocardiogram revealed a circular echolucency lateral to the tricuspid annulus (B, Online Video 1) (LA left atrium; LV left ventricle; RA right atrium; RV right ventricle), and color Doppler echocardiogram showed a tunnel-like structure with turbulent jet filling the right ventricle (C, Online Video 2). Two-dimensional echocardiogram with continuous-wave Doppler showed severe valvular pulmonic stenosis (D), and contrast echocardiogram revealed right to left shunt across the foramen ovale (Online Video 3). Cardiac catheterization showed spiral calcification and catheter passage from the aorta to the RV (E, Online Video 4), and the aortogram revealed flow across the tunnel (Online Video 5). Sixty-four slice computed tomography angiography showed a dilated aortic root (DA) with a tortuous aorto–right ventricular tunnel (F). Computed tomography volume-rendered imaging showed a giant tunnel and single left coronary artery giving branches (Bs) to the RV (G), with massive dilation of the aortic root and presence of calcified bands at the origin of the tunnel (H). LAD left anterior descending artery; MPA main pulmonary artery; PA pulmonary artery; RAA right atrial appendage. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.06.066

A rare case of huge cardiomegaly.

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 40-year-old male with history of rheumatic heart disease presented to us with symptoms of dysphagia, hoarseness of voice, and exertional dyspnea. He had past history of closed mitral valvotomy for severe mitral stenosis and

Symptomatic complete heart block leading to a diagnosis of Kearns–Sayre syndrome

Kearns-Sayre syndrome (KSS) is a rare syndrome characterized by the triad of progressive external ophthalmoplegia, pigmentary retinopathy and cardiac conduction system disturbances; it is a mitochondrial encephalomyopathy with which usually presents before the patient reaches the age of 20. Here we present a case report of a patient with KSS who presented with symptomatic complete heart block.

Incidence and predictors of 30-day mortality in patients with ventricular septal rupture complicating acute myocardial infarction

Objective We sought to investigate the incidence and predictors of 30-day mortality associated with ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) in a cohort of patients admitted to a single centre in India. Methods From October 2013 to February 2016, a total of 6560 patients with a diagnosis of AMI were admitted to our institution. Among these patients, those with a diagnosis of VSR were retrospectively included in this registry. Clinical and echocardiographic features were collected in all cases. The primary outcome was 30-day mortality. A Cox proportional hazard regression analysis explored the predictors of 30-day mortality. Results During the observation period, a total of 51 consecutive patients (mean age 63.8 years (9.1); 51.0% male, 41.2% were patients with diabetes) with a diagnosis of VSR complicating AMI were included. On echocardiography, left ventricular ejection fraction was 42.5% (6.5), and the most frequent location of VSR was apical (78.4%). Overall, 27.4% of the patients received reperfusive therapy (pharmacological, 23.5%; mechanical, 3.9%) and 19.6% of the patients underwent surgical repair. The mean time to surgery was 7.7 days (2.4). At 30-day follow-up, death occurred in 80.4% of patients. Advanced age (HR 1.07, 95% CI (1.02 to 1.13), p=0.004), previous cerebrovascular accident (HR 52.2, 95% CI (3.98 to 685.06), p=0.003) and surgical repair (HR 0.05, 95% CI (0.01 to 0.26), p<0.001) were effect modifiers of the 30-day risk of death. Conclusions In this retrospective cohort of patients with AMI, the occurrence of VSR was not rare and carried a considerable risk of 30-day mortality. Advanced age, previous cerebrovascular accident and surgical repair influenced the risk for 30-day mortality.

Life-threatening Hyperkalemia: Can Aggressive Medical Therapy Defer Temporary Pacing

Hyperkalemia is a life-threatening metabolic condition that can induce deadly cardiac arrhythmias. Here, we present a case of severe life-threatening hyperkalemia in a 35-year-old man with preexisting renal impairment who was managed only medically with close electrocardiogram and vital monitoring.