Rajneesh Calton

Cardiovascular response in Anemia

Objective: To study the functional consequences of nutritional anemia by evaluating the exercise performance in these children.Methods: The study was conducted on 30 each of anemic and normal children of both sexes aged between 7 and 14 years. Relevant history was taken, and detailed examination was done. These children were classified according to severity of anemia based on hemoglobin estimation as mild (10–11.9 g/dl), moderate (7–9.9 g/dl) and normal (>12g/dl). Children with severe anemia (Hb <7g/dl), heart disease, non-nutritional anemia, acute febrile or respiratory illness were excluded. The subjects were tested on Mortara X Scribe colour stress treadmill using the modified Bruce protocol. Continuous computerised electrocardiographic analysis was done. The parameters studied included heart rate, systolic blood pressure, double product (DP = HRxSBP), ECG changes, metabolic equivalents (METS) and exercise duration. The end point of the test was a HR of 170/min (non-fatigue group) or inability to perform further (fatigue group). Statistical analysis was done by appropriate tests.Results: Fifteen children each with mild and moderate anemia and 30 age-matched controls were enrolled in the study. There was no significant difference in the resting HR, exercise duration or DP between the cases and controls. Thirty-one children reached the target HR (non-fatigue group). The end-point HR was significantly lesser among the anemic children in the fatigue group (P 0.04). The percent gain of SBP, at peak exercise (P 0.0007) and recovery SBP as percent of resting SBP (p 0.006) were significantly more in the anemic children, more so in the mildly anemic ones. Lesser METS was achieved by anemics as compared to controls (P 0.04). ECG changes occurred significantly more often in anemic children, 53.8% of those with changes being moderately anemic, the main abnormality being ST depression. None developed arrhythmia during exercise testing.Conclusion: The cardiovascular response to physical exercise is compromised in children with nutritional anemia and hence these children may never attain their full potential in various school activities. Prevention of anemia should be a priority in school going children

Persistent left superior vena cava: A challenge for permanent pacemaker implantation

Persistent left superior vena cava is the most common variation in the anomalous venous return to the heart. It is usually asymptomatic and discovered incidentally during imaging and the aberrant position of a pacemaker lead, central venous catheters, or retrograde cardioplegia for cardiac surgery. We present two different approaches of pacemaker implantation in this congenital anomaly.

Syncope as a presenting feature of complete extrusion of a unipolar permanent pacemaker

Complete extrusion of a permanent pacemaker is an extremely rare complication. We report a unique case of a patient presenting with syncopal episodes after complete extrusion of his implanted pacemaker. An 82-year-old gentleman with a history of pacemaker implantation, 6 years back, presented with syncopal episodes and was found to have complete extrusion of his pacemaker out of its pocket. An electrocardiography revealed complete heart block which would revert to paced rhythm when the pulse generator would be pushed back into the pacemaker pocket. Neglecting the pre-extrusion stage, he presented with syncopal episodes after complete extrusion and loss of contact of the unipolar pacemaker with the pacemaker pocket resulting in complete loss of pacing.

Angioembolization for post-traumatic renal arteriovenous malformations

The risk of renal arteriovenous malformations (AVMs) must be kept in mind as a cause as sudden hematuria in patients with previous renal injury. Treatment of renal AVMs has evolved from nephrectomy to angioembolization, as it allows good control bleeding while preserving maximum renal function and appears to be the first treatment of choice. Hence, angioembolization facilities must be available in centers dealing with renal trauma.

Quantification of Coronary Risk Score

Objective : To quantify the coronary risk score in children and/or grandchildren of patients with coronary artery diseae (CAD).Methods : One hundred and fifty children with positive family history of CAD (cases) and age and sex matched children with no such history (controls) were enrolled in the study. Fasting blood sugar, serum cholesterol and triglycerides were estimated on all children and a risk score was calculated using Nora’s scheme.Result : The cases and controls were similar with respect to mean age, six distribution, mean weight and mean height. None of the child was hypertensive. Mean serum levels of triglycerides were 164.7 m/dl and 105.7 mg% respectively in cases and controls (p<0.005). Prevalence of hypertriglyceridemia was three times more in cases (p<0.001). Cases had a significantly higher risk scores (p<0.00001) and this was mainly attributable to higher biochemical risk (P<0.0006).Conclusion : Children and grand children with a positive family history of CAD had significantly higher risk scores for future CAD. The increased risk was mainly due to biochemical derangements.