Multicentric cardiac myxoma is a rare syndrome; usually it is familial. We report a rare case of sporadic right atrium (RA) and right ventricle (RV) myxoma in a 26-year-old female presenting to our hospital for the evaluation of sudden onset of dyspnea and left precordial pain attributed to the embolization of degenerating tumor fragments to the pulmonary artery (PA). The exact incidence of sporadic multicentric RA and RV myxoma presenting as acute pulmonary embolism is unknown as multicentric RA and RV myxoma are very rare. Myxomas presenting as pulmonary embolism is <10%. Majority of cardiac myxomas present as exertional dyspnea, chest pain, positional syncope, fever, weight loss and other constitutional symptoms. Any young patient presenting with acute onset dyspnea with multiple cardiac masses may have tumor embolization to the PA diagnosis with transthoracic echocardiography and high-resolution computed tomography of thorax, fast-tracks patient transfer for urgent cardiac surgery to prevent further embolization.

Objective: Hypertension has been reported in 12.1% of young adults in a recent population-based study in India and is a growing concern. There is a paucity in guidelines on the definite therapeutic approach in young hypertensives. This study aimed to understand the clinician's perspective on approach to management of hypertension in young adults in India. Design and method: Cross-sectional observational survey conducted between February 6, 2020 and 22 February 22, 2020 using a structured 14-item questionnaire. Total of 2287 clinicians (cardiologists, diabetologists, consultant physicians, and family physicians) across India participated in this survey. Descriptive statistics were first computed. Inferential statistics, namely chi-square test was then run to test the associations among knowledge, awareness and practice among the respondents across India. Results: Prevalence of hypertension in young adults was observed in 10–30% by 64.8% participant clinicians. Smoking, mental stress and obesity were considered as the most common risk factors for hypertension in young adults. Parameters of sympathetic overactivity in young hypertensive patients were considered as only increased systolic blood pressure, only increased heart rate and both increased heart rate and increased systolic blood pressure by 15.1%, 24.2% and 57.4% of respondents respectively. Angiotensin II receptor blockers (ARBs) were considered the most appropriate class of drugs to treat hypertension in young by 61.6% respondents. Beta-blockers were preferred by 15.8%, followed by calcium channel blockers, diuretics and ACEI by 10.4%, 7.6% and 4.6% respondents respectively. Beta-blockers were selected as antihypertensive class in young hypertensive adults based on their perception of sympathetic overactivity by 74.5% respondents. Metoprolol was the preferred beta-blocker by 63.1% respondents. Combination therapy of telmisartan & metoprolol was preferred by 15.5%, 40.9%, 43.6% clinicians in young hypertension, uncontrolled hypertension, both young and uncontrolled hypertension patients respectively. Conclusions: This study adds to the real-world data in management strategies of young Indian hypertensives. Amongst the current class of anti-hypertensive drugs, ARBs and beta -blockers were preferred by the clinicians who participated in the study. Monotherapy and combination therapy with telmisaratan and metoprolol as a prototype of the respective anti-hypertensive class were preferred in the study.

An isolated single coronary artery (SCA) is a rare anomaly. A SCA originating from the left sinus of Valsalva is even rarer than one arising from the right. Most patients with a congenital coronary artery anomaly are asymptomatic. Herein, we report an extremely uncommon variant, where the right coronary artery arose from the distal segment of the left circumflex artery with slow coronary flow leading to myocardial ischemia.

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