Protein-C and Protein-S deficiency states are responsible for 3-5% (Protein-C) and 2-3% (Protein-S) of patients with venous thrombosis. Some cases of arterial thrombosis have been reported. It occurs twice as often in female as in males. A 50 years old lady presented with acute severe pain in the left upper limb for 2 days. On investigation she was diagnosed as a case of bracheal artery thrombosis with Protein-C & Protein-S deficiency. Bracheal thromboembolectomy was done and discharge her with life long warfarin therapy. In one year follow up the patient had no untoward event and INR done every month and warfarin is adjusted. Keywords: Arterial thromboembolism; Protein-C and Protein-S deficiency. DOI: 10.3329/cardio.v3i1.6433Cardiovasc. j. 2010; 3(1): 92-93
Introduction:Coronary heart disease (CHD) is the most common cardiovascular disease and the major cause of death in middle-aged and older people. Despite steady progress in the management of cardiovascular diseases, people are still dying of these diseases and substantial early mortality remains.AMI is a major component of acute coronary syndrome which usually due to anterior and or inferior wall involvement. The presentation of acute myocardial infarction is different depending on the coronary artery involved. Inferior wall MI results from either right coronary artery (RCA) or left circumflex coronary artery (LCX) occlusion. RCA predominantly supply the part of conducting system, right atrium, right ventricle part of left ventricle and the posteromedial papillary muscle. Occlusion of it may cause RV infarction with hypotension, cardiogenic shock, and different types of conduction disturbance, mitral regurgitation and sudden death. The LCX perfuses the posterior wall and variably the inferior and lateral segments. Lesion of it causes arrhythmias, heart failure and sudden death.The occurrence of an inferior left ventricular infarction involving the right ventricle ranges from 14% to 84%, but is typically thought to be about 50%. 1
Introduction:Ischaemic heart disease is a major health problem throughout the world. In the western countries 50% of all death are due to cardiovascular diseases, half of these are attributed to myocardial infarction. 1 In Bangladesh coronary artery disease is the third largest cause of death today. One survey by Malik et al 2 detected the prevalence rate of IHD as 3.3/ thousand and a multicentre study by Farid N et al 3 revealed prevalence of IHD as 14/thousand .The diagnosis of acute myocardial infarction requires a joint evaluation of the clinical aspects, the ECG and the serum enzyme activity. ST Segment of the electrocardiogram (elevation in the leads overlying the infarction and depression in the reciprocal leads) is altered very early in the course of AMI and is one of the indirect markers of myocardial damage. Latter on pathological Q wave and T wave inversion occur. But in many instances, it (about 50% of patients with AMI) does not show diagnostic ECG changes. 4 Moreover the standard 12 lead ECG is a relatively insensitive tool for detecting posterior myocardial infarction. 5 This a particularly true in the acute stage when prompt and accurate diagnosis of AMI is critical in determining the initiation of reperfusion therapy. 6 The major obstacle in the ECG diagnosis of posterior myocardial infarction lies in the absence of standard leads facing the posterior left ventricular wall, which results in failure to reveal ST segment elevation in a high proportion of patients with acute posterior infarction. Recently it was demonstrated that during acute inferior infarction, ST segment elevation in the posterior chest leads V7-V9 identifies those patients with concomitant posterior wall involvement. 7 It was shown that ST segment elevation is present solely in posterior chest leads in 3%-4% of all patients with AMI and in as many as 20% of Ami patients without ST segment elevation on the standard 12 lead. 8 Shlomi M et al 8 showed that in acute posterior myocardial infarction ST segment elevation was present in lead V7 and V9 in 91% and in lead V8 in 100% patients. Prominent R-wave appeared in lead V1 in 9% and in lead V2 in 44%. In 25% patients, on admission, no pathologic ST segment changes were noted in standard 12 lead ECG and the ST segment elevation in leads V7 through V9 was the only pathologic ST segment change.
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