Sharmistha Chatterjee

A rare case of dense spontaneous echo contrast within inferior vena cava

A 33-year-old gentleman was examined because of fatigue and progressive right heart failure. A striking finding in his echocardiogram was intense and slow-moving dense echo contrast in the inferior vena cava (IVC). Cardiac catheterization revealed constrictive pericarditis, and pericardiectomy was performed. Postoperatively spontaneous echo contrast in IVC have resolved. This case helps explain the origin of spontaneous IVC contrast.

A Simple Non-invasive ECG Technique to Localize Culprit Vessel Occlusion Site in ST-Elevation Myocardial Infarction (STEMI) Patients

Background: Electrocardiograms (ECGs) are essential in identifying the type and location of acute myocardial infarction. In the setting of inferior wall myocardial infarction (IWMI), identification of the right coronary artery (RCA) as the culprit artery is important because of the potential complications associated with its involvement. Objectives: The study was conducted to identify the culprit artery responsible for STEMI from ECG tracings. To validate Fiol’s algorithm in Eastern Indian population and to compare the ECG findings with coronary angiogram. Methods: The cross-sectional study was conducted in 100 patients with acute STEMI. Patients presenting with acute ST-elevation myocardial infarction within 12 h of symptom onset were included in the study. In this study, we focused on Fiol’s algorithm and some other pre-specified criteria for prediction of occluded vessels. Cohen’s kappa statistical method was used to correlate ECG localisation of culprit artery with that of coronary angiogram. Results: Out of 100 STEMI patients, 73 patients had left anterior descending as the culprit artery, 24 patients had right coronary artery as the culprit artery and 3 patients had left circumflex artery as the culprit artery (73%, 24% and 3% respectively). Following Fiol’s algorithm, we have found that ECG has: high specificity (86%) but low sensitivity of 29% for an occlusion proximal to D1. Moderate sensitivity and moderate specificity (62% and 69% respectively) was noted for an occlusion distal to D1. Similarly, high sensitivity (90%) but low specificity (33%) was noted for lesion proximal to S1. Cohen’s kappa κ=1 suggests excellent agreement between ECG and coronary angiogram for inferior wall MI (both RCA and LCx occlusion). Conclusion: It can be concluded that ECG can reliably predict the culprit artery in STEMI patients. The Fiol’s algorithm is validated and considered as a simple tool to localize the infarct related artery in anterior wall myocardial infarction (AWMI) and inferior wall myocardial infarction (IWMI).

Cake-like material within the pericardium: an unusual picture of pyopericardium.

An 80-year-old female patient presented with a 12-day history of fever with cough, breathlessness, and chest pain. She had no past history of hypertension, diabetes or any other significant illness. On examination her blood pressure was 110/70 mmHg, pulse 112/min, respiratory rate 24/min, and jugular venous pressure was raised 7 mm above the sternal angle with normal wave form. On auscultation, muffled heart sounds were found with pericardial friction rub and basal crepitations. A chest radiograph showed an enlarged cardiac silhouette and an ECG revealed lowvoltage QRS complex with nonspecific ST-T changes. A complete haemogram revealed a total leucocyte count of 20,000/mm with 87 % neutrophils. Other biochemical parameters were within normal limits. Echocardigraphy showed normal-sized cardiac chambers and normal biventricular systolic function along with a thick cake-like material occupying the entire pericardial cavity with a tiny amount of pericardial fluid, without any evidence of cardiac tamponade (Figs. 1, 2). A computed tomography scan of the thorax showed thickened pericardium with contrast enhancement with very thick pericardial effusion without any mass lesion suggestive of infective etiology. Echoguided diagnostic pericardiocentesis yielded approximately 300 ml of thick pus-like material which on biochemical examination showed 7gm/dl protein, 10 mg/dl sugar, and adenosine deaminase within normal limits. Cytology of the fluid revealed a cell count of 7,000/cu mm, with 90 % neutrophils without any malignant cells or acid fast bacilli. Fig. 1 Two-dimensional echocardiography parasternal long-axis view showing cake-like material within the pericardial cavity

Large hematoma over the puncture site of percutaneous transluminal coronary angioplasty as a presenting sign of severe dengue infection

Dengue fever is a common arboviral infection all over the world. It is endemic in the tropical and subtropical areas of the world with periodic epidemics in these areas. In its severe form dengue patients may develop life-threatening bleeding manifestations. We report here a case of large hematoma formation precisely located over the puncture site of percutaneous transluminal coronary angioplasty as a presenting sign of severe dengue infection for its unusual occurrence. <Learning objective: Severe dengue including dengue shock syndrome is a potentially life-threatening condition. Dengue virus-induced coagulopathy and thrombocytopenia may further complicate cardiological interventions like percutaneous transluminal coronary angioplasty or coronary artery bypass grafting as such patients are already on antiplatelet drugs. Performing any cardiovascular intervention in an endemic area of dengue needs proper vigilance to avoid such potentially life-threatening complications.>.

A profile of heart failure patients in a tertiary care centre in Eastern India

Background: Epidemiological data regarding profile of heart failure in India is lacking. So this study was done to assess the epidemiological profile of heart failure patients in eastern India. Aim of the study was to assess the epidemiological profile of heart failure patients in this part of country. Methods: Total 1000 outdoor and indoor patients presented with symptoms and signs of heart failure according to Framingham criteria were studied. Results: Age of onset of HF is lower than western country. IHD is the commonest cause of HF. Diabetes and hypertensions are important risk factors. Conclusions: Earlier detection and treatment of hypertension and diabetes mellitus might have greater impact in reducing the burden of HF in this part of country.

Symmetrical peripheral gangrene complicating ventricular pseudoaneurysm: a report of an unusual case and a brief review of the literature

Symmetrical peripheral gangrene is an ischemic necrosis simultaneously involving the distal portions of two or more extremities without any proximal arterial obstruction or vasculitis. It may occur as a result of a large number of infectious and non-infectious causes. A few cases of symmetrical peripheral gangrene associated with cardiac disease have been described in the literature. We describe a case of symmetrical peripheral gangrene complicating ventricular pseudoaneurysm, probably a hitherto unreported occurrence. In this report, we sought to emphasize the importance of cardiac evaluation while dealing with a case of symmetrical peripheral gangrene.