Madhav Hegde

Supra-valvular aortic stenosis in a patient with homozygous familial hypercholesterolaemia

An 18-year-old female was referred for a cardiac murmur before surgical excision of large subcutaneous swellings over bi-lateral trochanteric areas ( Panel A ). On evaluation they were found to be tendon-xanthomas, that also involved the gluteal-folds, finger web-spaces ( Panel B ), and tendons of the foot. Corneal arcus was also noted ( Panel C ). Her total cholesterol of 696 mg% and low-density lipoprotein (LDL) cholesterol of 648 mg% were consistent with familial …

SYNTAX Score in Patients with High Computed Tomography Coronary Calcium Score

Objectives: To study the conventional coronary angiogram ( CA) findings in patients with high coronary calcium on multidetector computed tomogram. Materials and Methods: Fifty patients with coronary calcium high enough in its extent and location to interfere with the interpretation of a contrast-filled coronary artery for a significant lesion were studied with conventional CA. Framingham risk score (FRS), computed tomography (CT) coronary calcium score (CCS), and SYNTAX score (SS) from the CA were calculated by separate investigators who were blinded to other scores. Effectively, 250 coronary arteries (left main, left anterior descending, left circumflex, and right coronary artery and posterior descending artery in each subject) with calcium scores were studied for lesions on CA. Results: Thirty-five subjects had high FRS, 10 had intermediate FRS, and 5 had low FRS. Eight subjects of 25 (32%) with CCS between 350 and 1000 had no significant coronary artery disease (CAD). Overall, the CCS and the SS had a strong agreement with each other (r = 0.68, P < 0.01) that persisted in those with very high scores >1000 (r = 0.55, P < 0.01, n = 30), but only a nonsignificant weak correlation with scores between 350 and 1000 (r = 0.1, P = 0.62, n = 20). Individual vessel calcium scores correlated strongly for the presence of any lesion (r = 0.52, P < 0.01) in the same artery but only weakly for a significant lesion (r = 0.29, P = 0.05). Conclusion: High CT CCS in this cohort of intermediate to high (Framingham score) risk patients correlated strongly with the subject′s global burden of the CAD as derived by the SS, more so for subjects with very high scores. Similarly, CCS correlated strongly with the presence of any lesion but only weakly for a significant stenosis; also, about one-third of patients with CCS between 350 and 1000 may not have significant disease on conventional CA.

Idiopathic dilatation of the pulmonary artery-a case report.

Idiopathic dilatation of the pulmonary artery (IDPA) is a rare anomaly presenting with enlargement of the pulmonary artery in the absence of an identifiable cause. The natural history of this silent but potentially life‐threatening disease can be unpredictable. We report a case of IDPA in an 80‐year‐old female with a massively dilated pulmonary artery.

Thrombolysis With Single Bolus Tenecteplase Compared With Streptokinase Infusion in the Treatment of Acute Pulmonary Embolism A Pilot Study

Objective: This study was planned to compare the efficacy of bolus regimens of tenecteplase (TNK) and 24 hours infusion of streptokinase (STK) in acute pulmonary embolism (APE) in a resource-poor setting. Interventions: In all, 25 patients received injection of TNK, and 75 patients received infusion of STK over 24 hours. Results: Pulmonary artery systolic pressure and right ventricular function were improved separately and significantly (P = .01) in both the study groups of patients from baseline at 24 hours or at seventh day and was comparable among the TNK and STK groups of patients. Mean duration of stay in intensive care unit was significantly less (2.2 ± 0.8 vs 3.2 ± 1.3 days; P = .04), and bleeding risk was also found to be nonsignificantly less in the TNK group. Conclusion: These results suggest that a 24-hour infusion regimen of STK is as effective as bolus TNK in the treatment of patients with APE in countries with limited resources.

Right Aortic Arch With Left-Sided Arteria Lusoria: A Challenge for Radial Interventionalists

A 67-year-old male, hypertensive nonsmoker was admitted with unstable angina. He gave a history of acute anterior wall myocardial infarction 4 months earlier for which he underwent primary percutaneous coronary intervention (PCI) with stenting of the left anterior coronary artery (LAD). During

Giant left atrium due to rheumatic mitral regurgitation.

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 38-year-old woman with a known history of rheumatic heart disease for 10 years presented with complaints of breathlessness, dysphagia, and hoarseness of voice for 6 months. On physical examination, she had an apical

Acute pulmonary embolism being the first presentation of undetected HIV infection: report of two cases:

Summary Though HIV infection is considered as a hypercoagulable state, but occurrence of acute pulmonary embolism (PE) is rare and usually seen in the advanced stage of the disease. PE as a presentation in a case where there is no previous history of having HIV infection is very rare; a Medline search revealed only one case reported previously. We describe two cases who presented with acute PE and were treated; they were subsequently diagnosed as having HIV infection.

Misdiagnosis of subclavian artery stenosis: the importance of dynamic manoeuvre.

A 27-year-old man was referred for endovascular intervention to the left subclavian artery. There was no history of giddiness or claudication pain in the upper extremities. On examination, the left upper limb pulses were feeble. Blood pressure was 160/90 mm Hg in the right upper limb and 110/90 mm Hg in the left upper limb. There was a bruit in the left supraclavicular area. Routine blood …

An adult with right aortic arch and dysphagia

A 38-year-old male presented with history of atypical chest pain and dysphagia. Cardiovascular examination was unremarkable. Electrocardiography and transthoracic echocardiography were normal. Chest radiograph showed right-sided aortic arch ( Panel A ). Barium swallow was performed, which showed extrinsic compression from right side ( Panel B ) and from posterior aspect ( Panel C ) at the level …

Giant aneurysm of right sinus of valsalva in a HIV-infected patient with extrapulmonary tuberculosis.

A 46-year-old male patient admitted with fever, cough, chest pain and dyspnoea during the past 7 days. He had a history of unprotected sexual exposure and was previously undiagnosed for HIV infection. Chest X-ray revealed bilateral pleural effusion along with cardiomegaly. ECG showed sinus tachycardia with low-voltage complex. Blood investigation revealed haemoglobin-10.4 g/dL, total leucocyte count 8600/mm3, platelets 215 000/mm3 with normal liver and renal function test. 2D echocardiography demonstrated moderate pericardial …