Nayan Desai

Tuberculous myopericarditis: a rare presentation in an immunocompetent host

Tuberculosis is a common cause of pericardial disease in India. Myocardial involvement, although well described in the literature, is a rare manifestation of tuberculosis. We report a patient with disseminated tuberculosis and myopericarditis manifesting as cardiogenic shock. The patient gradually improved on antituberculosis drug therapy, steroids and an evidence-based guideline driven therapy for heart failure. Follow-up imaging showed calcification of the pericardium and improvement of his left ventricular systolic function.

Impella left ventricular assist device in cardiac arrest after spinal anaesthesia for caesarean section

Cardiac arrest after neuraxial anaesthesia is very well described. Inhibition of the sympathetic efferent system and vagal activation leading to decrease preload and severe bradycardia results in cardiac arrest. Pregnant patients undergoing spinal anaesthesia are at increased risk for vasovagal events due to aortocaval compression and higher level of spinal block. A 36-year-old pregnant woman at 39 weeks presented for an elective caesarean section. She underwent spinal anaesthesia. Immediately after, she had severe bradycardia followed by asystole cardiac arrest. She had spontaneous return of circulation. The patient was in cardiogenic shock causing pulmonary oedema and required four vasopressors to maintain her blood pressure. An Impella 2.5 percutaneous microaxial left ventricle (LV) support device was inserted to support her haemodynamics. She fully recovered and was discharged in stable condition. To the best of our knowledge, this is first case report of the use of an LV-assist device in a patient postcardiac arrest from spinal anaesthesia.

Idiopathic chylothorax in a young man.

Chylothorax refers to the presence of chyle in the pleural space owing to disruption or obstruction of the thoracic duct or one of its tributaries. We present a case of non-traumatic, idiopathic chylothorax in an 18-year-old man. Lymphoscintigraphy was used to identify the site of leak. We tried the full armamentarium of available non-surgical therapy on him, including a modified diet, chest tube insertion, total parenteral nutrition and octreotide. Yet, despite optimal medical therapy, his effusion continued to persist. He eventually required thoracic duct ligation, which resulted in resolution of the effusion.

Levamisole-induced vasculitis with ecchymosis and necrosis syndrome from contaminated cocaine

A 43-year-old-man presented with 1-month history of progressive erythematous painful lesions over multiple sites involving bilateral lower extremities, trunk and pinnae. He was a chronic cocaine user; last use was 3 days prior to presentation. On examination he had bilateral large retiform, geometric, dusky, erythematous, tender plaques with central necrosis and ecchymosis over aforementioned areas …

Interventional Echocardiography of the Mitral Valve: What the Interventionist Wants to Know

The past 2 decades have seen a proliferation of transcatheter mitral valve (MV) therapies, which are less invasive and distinct from surgical MV repair or replacement. The commonly used MV transcatheter therapies include (1) percutaneous mitral balloon commissurotomy (PMBC) for rheumatic mitral stenosis; (2) edge-to-edge repair with the MitraClip for mitral regurgitation; (3) valve-in-valve implantation in bioprosthetic MV, native MV, or mitral ring; and (4) closure of paravalvular leaks (PVLs). This article will focus on the use of echocardiography in the diagnosis, patient selection, procedural guidance, and postprocedural follow-up for PMBC, with notes on the role of transesophageal echocardiography in transcatheter interventions for prosthetic valve degeneration and PVL closure.

COMPLIANCE WITH PERFORMANCE MEASURES IN THE NCDR ICD REGISTRY

Beta-blocker (BB) and angiotensin converting enzyme inhibitors (ACEI)/receptor blockers (ARB) are well-established treatments for patients with left ventricular systolic dysfunction, with availability of NQF (National Quality Forum) endorsed performance measures related to guideline-directed medical

Disseminated histoplasmosis: missed opportunistic infection in a HIV-infected patient.

Oral ulcers are common in HIV-infected patients, with a broad differential, including viral, bacterial, fungal, mycobacterial and neoplastic aetiologies. We present a case of a patient with AIDS with oral ulcer, which was a cutaneous presentation of disseminated histoplasmosis. Our patient responded excellently to treatment.