Ravindran Rajendran

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.

Significant biventricular obstruction in non-syndromic hypertrophic cardiomyopathy.

Although hypertrophic cardiomyopathy (HCM) is classically considered a disease of the left ventricle (LV), we present a rare case of biventricular HCM presenting in middle age. A 57-year-old man without a family history of HCM and sudden death presented with presyncope and New York Heart Association (NYHA) class II breathlessness. Clinical examination was normal except for ejection systolic murmur. ECG showed biventricular hypertrophy with deep T-wave inversions. Echocardiography demonstrated pronounced asymmetric LV hypertrophy and thickened right ventricle (RV) muscular components (figure 1A–C; videos 1–3). Doppler revealed a peak LV mid-cavity gradient of 109 mm Hg and subvalvar obstruction of the RV outflow tract with a peak gradient of 138 mm Hg (figure 2 …

Quadri-chamber cardiac thrombi in alcoholic cardiomyopathy: a rare though ominous finding.

Alcoholic cardiomyopathy is a cause of reversible cardiomyopathy, in which long-term abuse of alcohol leads to ventricular dysfunction. Multiple mechanisms have been attributed to the development of alcoholic cardiomyopathy such as mitochondrial damage and oxidative stress, though coexistent nutritional deficiencies like thiamine deficiency, tobacco abuse and other comorbidities such as hypertension can contribute to ventricular dysfunction. Ventricular thrombus formation can occur secondary to akinesia or hypokinesia of the ventricular wall. We report a case of alcoholic cardiomyopathy with an alarming finding of thrombi in all cardiac chambers. Echocardiographic evidence of quadri-chamber intracardiac thrombi has rarely been described in the literature. A 48-year-old man with history of chronic alcoholism presented with progressive breathlessness of 1 years duration. Cardiovascular examination showed sinus tachycardia and evidence of congestive …

Giant Cardiac Hydatid Cyst: An Uncommon Cause of Cardiomegaly

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 25-year-old male presented with dyspnea of 6 months duration. Physical examination revealed muffled heart sounds. Electrocardiogram was normal. Chest x-ray in posteroanterior view showed cardiomegaly

Incidence, predictors, and long term clinical outcome of angiographic definite stent thrombosis in real world scenario - A prospective cohort study

BACKGROUND The occurrence of stent thrombosis (ST) in real world scenario is far different from that mentioned in the literature. Our study identifies the various parameters of ST. METHODS This is a prospective observational-cohort study where-in consecutive patients who received successful percutaneous transluminal angioplasty (PTCA) over the study period of 1-year was included and were followed for 1-year from the primary procedure. RESULTS The overall incidence of definite ST was 1.4% and 1.7% at 30 days and 1 year respectively. The most common mode of presentation of ST was ST-elevation myocardial infarction (82.6%). The history of prior PTCA, multi-vessel disease, emergent PTCA, acute coronary syndrome and type B2/C lesions were found to be the independent predictors for definite ST. The incidence of late ST was significantly higher with bare metal stent (BMS) than drug-eluting stent (DES) (OR-2.4, 95% CI:1.3-4.5). At mean follow-up of 13.9 months after ST, the overall mortality was 36.9%. The independent predictors of mortality after ST were post-PTCA thrombolysis in myocardial infarction (TIMI) flow grade < 3, and cardiogenic shock at the time of presentation. CONCLUSION The overall incidence of definite ST is high in the real world scenario and the DES fared better than BMS. ST carries a bad prognosis especially so if the patients present in cardiogenic shock, or unable to achieve TIMI-3 flow after PTCA.

Percutaneous Coronary Intervention for Coronary Thrombo-embolism during Balloon Mitral Valvuloplasty in a Pregnant Woman

Coronary embolism as a cause of acute myocardial infarction is considered rarer than it actually is because of the difficulties associated with its documentation. Equally rare is the event of a clot embolising to the coronary artery during balloon mitral valvuloplasty (BMV). We had a unique and a rare opportunity to encounter, recognise, document and successfully manage this rare complication during BMV in a pregnant woman.

Subtle chest x-ray signs of pulmonary thromboembolism: the Palla's and Westermark's signs

Pallas sign,1 dilated right descending pulmonary artery >16 mm , and the Westermarks sign,2 focal oligaemia, are useful chest x-ray signs of pulmonary thromboembolism (PTE) even though their sensitivity and specificity are less. Here, we present a case in which PTE was suspected based on these chest x-ray signs. A 35-year-old male with fever, right thigh pain, breathlessness and cough was considered to have community-acquired pneumonia, and received intravenous antibiotics for 2 days …

A Rare Cause of Unilateral Rib Notching

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 19-year-old male with cyanosis and clubbing was diagnosed with tetralogy of Fallot (TOF). Chest x-ray (A) showed prominent rib notching involving the left hemithorax (arrow) . Major aortopulmonary

Mobile subpulmonary membrane in a patient with hypertrophic cardiomyopathy and right ventricular mid-cavitary obstruction.

A 51-year-old male was referred for evaluation of systolic murmur, at the left sternal border. An echocardiogram showed bi-ventricular hypertrophy ( Panel A and Supplementary data online, Video S1 ) without an obvious cause. In the para-sternal long axis view, there was no systolic anterior motion of anterior mitral leaflet, left ventricular outflow obstruction, or mitral regurgitation (Supplementary data online, Video S2 …