Dilemma of localization of culprit vessel by electrocardiography in acute myocardial infarction.

Acute coronary syndrome (ACS) and electrocardiography showing ST elevation in Lead aVR>V1 are considered specific for left main coronary artery lesion and also suggest extensive anterior wall myocardial infarction. In this backdrop, we are presenting an incidental observation of an association of ST elevation in lead aVR>V1 in isolated proximal left circumflex lesion in the setting of ACS, who later underwent successful primary percutaneous coronary intervention.

Echocardiographic parameters for assessing successful balloon mitral valvuloplasty in juvenile age groups.

Background: Different echocardiographic parameters have been studied and validated for assessing the severity of mitral stenosis; however, scant data are available for these markers in the context of balloon mitral valvuloplasty in juvenile age groups (ages ⩽20 years).

Objectives: The aim of the present study was to find out the utility of echocardiographic parameters such as mitral valve separation index, left atrial volume, right ventricular systolic pressure, tricuspid annular plane systolic excursion, tricuspid annular systolic velocity, and right ventricular Tei index in predicting success of balloon mitral valvuloplasty and their relation to mitral valve area in juvenile mitral stenosis.

Methods: We carried out a prospective single-centre study involving 52 juvenile mitral stenosis patients undergoing elective valvuloplasty.

Simple nonsurgical method of reduction of coronary catheter knot.

Knotting and kinking of the coronary catheter is one of the complications during diagnostic or interventional procedures. These complications can be tackled percutaneously without subjecting the patient to surgery. We are reporting one such case of catheter knotting and how it was reduced percutaneously.

Anomalous left anterior descending artery from pulmonary artery: an extremely rare coronary anomaly.

We report a rare coronary artery anomaly-anomalous origin of the left anterior descending artery from the pulmonary artery in a 40-year-old woman. The uniqueness of this case is the absence of any significant morbidity from this condition in adulthood which is in contrast to other reported cases where patients present with myocardial infarction, congestive heart failure, and sometimes death during the early infantile period.(1).

Ventricular tachycardia in repaired double chambered right ventricle - identification of the substrate and successful ablation.

A 35 year old female presented with recurrent ventricular tachycardia 5 years after she had undergone surgical repair of double chambered right ventricle. Electroanatomical mapping showed a localised scar in the apex with double potentials and good pace map. Ablation here resulted in non-inducibility of ventricular tachycardia.

Multiple inappropriate rate drop responses triggered by ventricular premature beats.

We report the case of a 70-year-old patient presenting with palpitations who was found to have recurrent inappropriate rate drop responses on interrogation of his pacemaker. These were found to be triggered by interpolated premature ventricular complexes (PVCs). We discuss the drop detect algorithm and how interpolated PVCs triggered the rate drop response.

Uncommon presentation of a common tachycardia.

We describe a patient with an implanted pacemaker for impaired AV conduction who presented with an incessant tachycardia. EP study showed that the tachycardia was atrioventricular nodal reentrant tachycardia (AVNRT) with repeated spontaneous initiation because of poor or absent antegrade fast pathway conduction. Slow pathway ablation was successful in terminating the tachycardia and making it non-inducible.