Sameer Ambar

Twin heart with a fused atria and separate ventricles in conjoined twins

One of the most interesting congenital malformations is that of conjoined twins. We report echocardiographic features of twin heart in dicephalus, tribrachius, dispinous, thoracoomphalopagus twin. It showed two hearts fused at atrial level. Right-sided heart had single atrial chamber with a single ventricle. A single great vessel, aorta, originated from it. Left-sided heart was well developed with two atria and two ventricles. There was a small mid muscular ventricular septal defect and a small patent ductus arteriosus. Great arteries had normal origins.

CHA2DS2-VASc-HSF score – New predictor of severity of coronary artery disease in 2976 patients

BACKGROUND CHADS2 and CHA2DS2-VASc scores have been used for assessing prognostic risk of thromboembolism in non valvular atrial fibrillation patients. They include similar risk factors for the development of CAD To increase the likelihood of determining CAD severity, the CHA2DS2-VASc-HS and CHA2DS2-VASc-HSF score comprising of hyperlipidemia, smoking and family history respectively in addition to the components of the CHA2DS2-VASc score and male instead of female gender. The aim was to investigate whether these risk scores can be used to predict CAD severity. METHODS AND RESULTS A total of 2976 consecutive patients who underwent coronary angiography were enrolled in the study. Presence of >50% stenosis in a coronary artery was assessed as significant CAD. Of the patients,804 had normal coronary angiograms and served as group 1. The remaining 2172 patients with coronary stenosis were further classified into 2 groups according to CAD with stenosis of <50% or >50%: 834 patients with mild CAD as group 2 and 1338 patients with severe CAD as group 3. The scores were significantly different among the 3 groups. All the four scores correlated significantly with the number of diseased and the Gensini score. CONCLUSION CHADS2, CHA2DS2-VASc, and especially CHA2DS2-VASc-HS and CHA2DS2-VASc-HSF scores could be considered predictive of the risk of severe CAD with CHA2DS2-VASc-HSF the best scoring scheme to predict CAD severity. The risk scoring systems may play an important role as predictive models because they are simple and can be easily applied by physicians without any additional costs in routine practice.

Malignant Mediterranean spotted fever

Fever with rash is one of the most common causes of referral to a dermatologist. A plethora of conditions need to be considered in the differential diagnosis. They may be broadly classified into infectious causes, drug reactions, and autoimmune disorders. Here we present a rare case of rickettsial fever with cardiac involvement in an elderly male patient with no comorbidities.

PREVALENCE OF TRICUSPID VALVE DISEASE IN RHEUMATIC HEART DISEASE

To study the incidence of tricuspid valve disease (TVD) in patients with rheumatic heart disease (RHD). Tricuspid valve disease is also involved in chronic RHD with coexistence of mitral & aortic valve disease. The natural course of patient with Tricuspid valve disease is not well defined. We

Successful Treatment of Double-Orifice Mitral Stenosis with Percutaneous Balloon Mitral Commissurotomy

Double-orifice mitral valve (DOMV) is an uncommon congenital anomaly, being present in 0.05% of the general population. The isolated occurrence of this anomaly is very rare and, to our knowledge, no data are currently available on the incidence of an isolated DOMV. A DOMV is characterized by a mitral valve with a single fibrous annulus with 2 orifices opening into the left ventricle (LV). Subvalvular structures, especially the tensor apparatus, invariably show various degrees of abnormality. It can substantially obstruct mitral valve inflow or cause mitral valve incompetence. We present a rare case of nineteen-year-old male who underwent percutaneous mitral balloon commissurotomy in stenotic DOMV.

Percutaneous mitral balloon valvotomy in a case of situs inversus dextrocardia with severe rheumatic mitral stenosis

The efficacy, safety and applicability of Inoue balloon technique for BMV are clearly established worldwide in selected subset of patients with rheumatic mitral stenosis (MS). However, in altered cardiac anatomy it offers technical challenges. Distorted cardiac anatomy and cardiac malpositions considerably increase the complications involved in interatrial septal puncture and left ventricular entry during BMV. There are only a few reports worldwide on successful BMV in altered cardiac anatomy using the standard Inoue technique. Here we describe a case of a 27-year-old female with situs inversus and dextrocardia, where BMV was successfully performed with a few modifications of the standard Inoue technique previously described in similar patients.

JNC-7 definition of hypertension needs alteration

Abstract OBJECTIVES By altering JNC-7 definition of hypertension as per our modified definition, we tried to find out the difference in prevalence of hypertension. Our modified definition is 1 mmHg less than JNC-7 criteria. METHODS We did the analysis of data collected in Belgaum Hypertension Prevalence Study conducted by KLE University Belgaum; to know the difference between the JNC-7 classified group and modified classification what we thought can change the hypertension statistics. RESULTS According to JNC-7, only 16.3% population in our study were in normal group while 41.1% had come in pre-hypertension group and 42.6% were in hypertensive group. According to our proposed modified definition, nearly double the populations i.e. 37.4% were in normal group, 40.2% remained in pre-hypertension group and only 22.4% were in hypertension group. CONCLUSION This statistics significantly altered prevalence of hypertension from 42.6% to 22.4% indicating that by making 1 mmHg alteration in number, the prevalence could be brought down by 20.2%. This simple alteration of figure by 1 mmHg can put more than 20% of people in normal group as compared to pre-hypertensive group of JNC-7, thereby reducing the agony and psychological torture.