Ravinder Batra

A Rare Case of Adult Type ALCAPA Syndrome: Presentation, Diagnosis and Management

We report a case of a 43 year-old previously fit and healthy woman presenting with cardiac arrest secondary to an anomalous origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) Syndrome, a very rare congenital anomaly that it is extremely unusual to survive to adulthood if left uncorrected. To our knowledge, this is the first case of its type to be diagnosed and reported in an Australian hospital. Suspicion of this anomaly on conventional coronary angiography is essential given the life threatening nature of this condition.

A Case of Aborted Sudden Cardiac Death and Consequent Extreme Electrical Storm Secondary to a Metastatic Cardiac Tumor

We report a 43‐year‐old man with an implantable cardioverter defibrillator for aborted sudden cardiac death. He represents in extreme electrical storm with 111 different ventricular fibrillation episodes. Successful treatment was achieved with multiple antiarrhythmic agents, mechanical ventilation, external shocks, and ultimately overdrive pacing. A cardiac magnetic resonance scan revealed two cardiac lesions that were later diagnosed as metastatic fibrosarcoma. This case highlights two very important and increasingly common cardiological dilemmas: the management of extreme electrical storm and the role of magnetic resonance imaging in aborted cardiac death patients with an apparent “normal” heart.

Accurate Reporting of Door-to-Balloon Times.

We recently audited our hospitals door-to-balloon times. In the years between 2011 and 2014 we achieved a door-to-balloon time of less than 90 mins in 81% of cases ( Figure 1). The overall median time was 65 mins. While the review showed we are meeting recommended targets we also wonder whether we are selling ourselves short [ 1 ].

A Clinical Review of Implantable Cardioverter Defibrillators and Bi-Ventricular Pacemakers at one Institute

Background: ICD/BVP indications are expanding. They areexpensive devices and historically, morbidities associated withtheir use were high. The starting experience at the Gold CoastHospital is being reviewed.Methods: A retrospective chart review of all the ICD/BVPsimplanted in the Gold Coast Hospital from 06/07/2007 -17/06/2008, with special emphasis on device indications andcomplications.Results: Devices implanted were (31). Primary preventiondevices (67%), secondary prevention devices (33%).Indications were; Non-ischemic Dilated Cardiomyopathy(35%), Out-of-hospital Cardiac Arrest (26%), Conscious VT(13%), Ischemic Dilated Cardiomyopathy (10%), In-hospitalCardiac Arrest (6%), Long-QT Syndrome (6%) andCatecholamine-related Polymorphic VT (3%). Majorcomplications reported; lung contusion (1), left haemothorax(1), failed coronary sinus lead positioning (2), lead repositioning(2), atrial lead removal (1), left subclavian veinthrombosis (1), lead malfunction leading to VT under sensingand syncope (1). Device-administered therapies were eight;Inappropriate discharges (5), Appropriate discharges (1),successful Anti-tachycardia Pacing (2).Conclusions: We believe that ICDs are very effective lifesavingdevices but unfortunately they still are very expensiveand their use can be associated with significant morbiditiesespecially during the learning curve.