Introduction:Pulmonary embolism (PE) ranges from incidental, clinically unimportant occurrences to causing sudden death. Virchow's triad of local trauma to the vessel wall, hypercoagulability, and stasis of blood leads to thrombus formation in the leg veins. 1 As thrombi form in the deep veins of the legs, pelvis, or arms, they may dislodge and embolize to the pulmonary arteries with potentially serious consequences. The most common sources of pulmonary emboli are the pelvic veins or deep veins of the thigh. 2 Pulmonary arterial obstruction by clot causes dilatation, dysfunction, and ischemia of the right ventricle. 1 Pulmonary embolism and deep venous thrombosis is responsible for more than 250,000 hospitalizations and approximately 50,000 deaths per year in the United States. Because it is difficult to diagnose, the true incidence of pulmonary embolism is unknown, but it is estimated that approximately 650,000 cases occur annually. 1 Despite this high incidence, the diagnosis of pulmonary embolism continues to be difficult primarily because of the notorious varities of symptoms and signs in its presentation. 2 We present the case of a patient with pulmonary embolism presented with dyspnoea and review the pathophysiology and diagnostic considerations. Case report:Mr. X 68 yrs old pleasant gentleman admitted in CCU of UHL for respiratory distress along with sweating for 2 hours. He had also history of exertional dyspnoea and dyspepsia for last 4 days. He is diabetic, hypertensive and nonalcoholic. On G/E his Pulse-104/min, BP-120/ 90mmHg, RR-20/min and cardiac examination showed that there was a pansystolic murmur over the tricuspid area which increased with accentuated pulmonary component of the second heart sound.Initial investigations showed Hb-14gm/dl,TC-12.3X10 3 /µl, Platelet-222 x10 3 /µl, S,creatinine-1.45mg/dl,H s troponinI423ngm/ml, PT-13.7sec, INR-1.22, APTT-31.2sec, D Dimer4860ng/ml(0-550ng/ml) . Electrocardiography showed sinus tachycardia with SIQ3T3. Chest X-Ray revealed cardiomegaly. 2-D transthoracic echocardiography showed a dilated right side of the heart with a 5.7 cm × 1.4 cm mass in the right pulmonary artery. Valvular morphology was normal with moderate tricuspid regurgitation and moderate pulmonary hypertension. CT pulmonary angiography found pulmonary embolism involving the right pulmonary artery and most of their segmental branches. He underwent a duplex scan of the deep venous system of both lower limbs, which was found to be deep venous thrombosis in left popliteal vein. The patient was treated with streptokinase which was given initially as a loading dose of 250,000 IU over 30 minutes, followed by a dose of 100,000 IU/hour over 72 hours. After initial evaluation, a blood sample was taken to examine the thrombophilia panel [protein C-61IU/dl(70-146IU/dl), protein S-75IU/dl (60-130IU/dl), antithrombin-III-76.7 µg/ml (75-125 µg/ml) ].There his protein C level was low.Further echocardiography was performed and it revealed normal right heart function.After the recovery of the patient from...
IntroductionSpontaneous coronary artery dissection (SCAD) is a rare entity; the overall incidence on coronary angiographies is around 0.2%. The mean age of presentation is 42 years, with three-quarters of cases reported in women, of which 30% are peripartum. 1 the left anterior descending coronary artery is the most involved vessel in women (75%) and the right coronaryartery in men (20%). 2 Risk factors for SCAD comprise pregnancy,hypertension, recent delivery of a baby, fibromuscular dysplasia and connective-tissue disorders (e.g.,Marfan syndrome and Ehlers-Danlos syndrome). 3 The clinical presentation of SCAD depends on the extent and the flow limiting severity of the coronary artery dissection, and ranges from asymptomatic to unstable angina, acute myocardial infarction, ventricular arrhythmias to sudden cardiac death. Coronary angiography is frequently used in the evaluation of patients with acute coronary syndromes. Spontaneous Coronary Artery AbstractSpontaneous coronary artery dissection is a rather rare cause of myocardial infarction, chest pain, and sudden death.There are currently no known direct causes of this condition.Most of the reported dissections have occurred in the left anterior descending coronary artery.Herein, we report the case of a 58-year-old woman who presented at our institution with an acute ST-elevation myocardial infarction secondary to a spontaneous dissection of the right coronary artery. Primary PCIresolved the occlusion of the artery, and the patient was discharged from the hospital on medical therapy. Key Words: Coronary artery dissection, myocardial infarctionWe illustrate below the rare case of a 58-year-old postmenopausalwoman with a history of Hodgkin's lymphoma treated with chemotherapy, presented with acute coronary syndrome caused by an extensive dissection of the right coronary artery. Case reportA 58 -year-old hypertensive and diabetic lady was attended in the emergency department in the morning suffering from chest pain that had started 20 minutes previously associated with diaphoresis,vomiting. She was known case of Hodgkins lymphoma and treated with combination of chemotherapy and radiotherapy for last 3 months. The patient was anemic, her pulse rate was 50 beats per minute, and blood pressure at admission was nonrecordable Physical examination of chest revealed no abnormality.ECG: ST elevation in lead II, III,AVF , h s TnI -3375.3 pg/ mL. CBC revealed Hb%-7.4g/dl, WBC-2.8x10 3 /µl, PC165x10 3 /µl.Anti CCP-5.3 U/l.
We are reporting a case of multiple myxoma in right atrium and right ventricle in a 55 years male. Dignosis of myxomas were incidental when he was under evaluation for heart failure.Diagnosis was done by both echocardiography and CT scan of chest. Myxomas originating from the right ventricle and right atrium are even less common and can present unusual diagnostic and therapeutic challenges.University Heart Journal Vol. 13, No. 1, January 2017; 33-35
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