Clinical and echocardiographic diagnosis, follow up and management of right-sided cardiac thrombi.

Background: Right-sided cardiac masses are infrequent and have varied clinical presentation. The present study describes the clinical features, echocardiographic findings and management of 19 patients presenting with right-sided cardiac thrombi in a tertiary care center in north India.

Methods: This is a retrospective, single center observational study of consecutive patients over the period January 2003-2008 admitted in our emergency intensive care unit (EICU).

Mechanical breakdown and thrombolysis in subacute massive pulmonary embolism: A prospective trial.

Aim: To assess role of combined modality of mechanical fragmentation and intralesional thrombolysis in patients with massive pulmonary embolism presenting subacutely.

Methods: Eight of 70 patients presenting in tertiary care centre of North India with massive pulmonary embolism within 4 years had subacute presentation (symptom onset more than 2 wk). These patients were subjected to pulmonary angiography with intention to treat basis via mechanical breakdown and intra lesional thrombolysis.

Pacemaker lead endocarditis.

A case of permanent pacemaker lead endocarditis staphylococcal aureus related is described and management is discussed.

TEE-guided left ventricular epicardial pacing lead placement for cardiac resynchronization therapy.

Biventricular pacing has demonstrated improvement in cardiac functions in treating congestive cardiac failure patients. Recent trials have proven the clinical and functional benefits of cardiac resynchronization therapy in severe heart failure and intraventricular cardiac delays, mainly left bundle branch block. Biventricular pacing improves the exercise tolerance, quality of life, systolic heart function, reduces hospitalization and slows progression of the disease.

Diagnosis of acute myocardial infarction.

Diagnosis of acute myocardial infarction (AMI) has to be made early in the emergency triage since maximal mortality occurs within first hour and the benefits of all interventions are greater once these are instituted early. Diagnosis is easy and based on simple principals of good history, physical examination, early and complete 12 lead electrocardiogram and use of echocardiography which should be available in the emergency triage area. Subsequently biomarkers are also available for documentation and risk stratification.

Subanaesthetic dose of ketamine in intractable asthma.

A 75-year-old male diagnosed to be a case of intractable asthma resistant to all conventional therapies requiring ventilatory support, was successfully weaned off the ventilator after treatment with subanaesthetic dose of intravenous ketamine.

Blood component therapy: Which, when and how much.

Blood transfusion refers to the perioperative administration of blood and blood components. Adherence to proper indications for blood component therapy is essential because of its potential adverse effects and costs of transfusion. Over the years, the significance of blood components in treating certain diseases or conditions has been recognized.

Cardiac amyloidosis--two case reports with variable presentation.

Many cases of progressive heart failure due to cardiac amyloidosis remain undiagnosed due to the rarity and lack of suspicion on part of physician. Treatment options are limited and patients are also poor responders in later stages. Hence, early diagnosis by recognition of syndromic presentation and diagnostic modalities is helpful in retarding the disease process.

Pulmonary embolism in cases of pulmonary tuberculosis: a unique entity.

Pulmonary tuberculosis is very prevalent in developing countries but its thrombogenic potential is a new entity. There are reports stating the relation of Deep Vein Thrombosis (DVT) with severe forms of tuberculosis but no literature is available for correlation of pulmonary tuberculosis and pulmonary embolism. We are presenting series of five patients with different forms of tuberculosis presenting with pulmonary embolism having no risk factor for hypercoagulability.

Successful removal of intrathyroidal parathyroid adenoma diagnosed and accurately located preoperatively by parathyroid scintigraphy (SPECT-CT).

We describe the case of a large intrathyroidal parathyroid adenoma in a 46-year-old woman who had a history of recently diagnosed hypercalcaemia and a 2-year history of an asymptomatic enlargement of the right lobe of the thyroid. This rare case highlights the potential difficulties that can arise in the evaluation of hyperparathyroidism, especially in cases of multinodular goiter. In some cases, including this one, even a thorough preoperative evaluation that includes radiological studies (ultrasonography and computed tomography [CT]) may not allow for a definitive preoperative diagnosis due to limited sensitivity, especially in multinodular goiter.

Combined modality of mechanical breakdown and intraembolus thrombolysis in failed systemic thrombolysis of subacute pulmonary embolism patients.

Objectives: Acute massive pulmonary embolism with failed systemic thrombolysis has a high morbidity and mortality with few treatment options available. This study assesses the role of combined modality of mechanical fragmentation and intralesional thrombolysis in failed systemic thrombolysis.

Methods: Seven (13.

A rare case of double orifice mitral valve with perimembranous ventricular septal defect: Application of three-dimensional echocardiography for clinical decision making.

Double orifice mitral valve (DOMV) is an uncommon anomaly of surgical importance characterized by a mitral valve with a single fibrous annulus with two orifices opening into the left ventricle (LV). Subvalvular structures, especially the tensor apparatus, invariably show various degrees of abnormality. Associated congenital heart defects are common, though DOMV can occur as an isolated anomaly.

Embolotherapy in massive post sphincterotomy bleed.

A 38-year-old female with obstructive jaundice underwent therapeutic ERCP. Minor self limiting bleed was observed from the ampulla during the procedure. Later she had massive bleed for which endoscopic therapy was not possible due to obscured vision of the ampulla.

Clinical and angiographic profile of patients presenting with first acute myocardial infarction in a tertiary care center in northern India.

Objective: Acute myocardial infarction (AMI) is one of the presentation of coronary artery disease (CAD) and is thought to occur in younger age group in this region. The objective of this study was to evaluate clinical, biochemical and angiographic profile of patients with first acute myocardial infarction.

Methods: Eight hundred and forty-six consecutive patients who underwent coronary angiography within 4 weeks of MI were included.

Milrinone infusion: a therapeutic option in coronary vasospasm after primary percutaneous transluminal coronary angioplasty.

A 42-year-old male presented to the emergency department with acute chest pain. The electrocardiogram revealed inferior wall myocardial infarction. Emergency coronary angiography revealed total occlusion of the distal right coronary artery with thrombus.