The "J wave" (also referred to as "the Osborn wave,""the J deflection," or "the camel's hump") is a distinctive deflection occurring at the QRS-ST junction. In 1953, Dr. John Osborn described the "J wave" as an "injury current" resulting in ventricular fibrillation during experimental hypothermia. Although "J Wave" is supposed to be pathognomonic of hypothermia, it is seen in a host of other conditions such as hypercalcemia, brain injury, subarachnoid hemorrhage, cardiopulmonary arrest from over sedation, the Brugada syndrome, vasospastic angina, and idiopathic ventricular fibrillation. However, there is paucity of literature data as regards to ischemic etiology of "J Wave." In this article, we present a case where "J waves" were probably induced by ischemia. We also discuss the mechanism of ischemia-induced "J wave" accentuation and its prognostic implications.

A 50-year-old man was admitted with high-risk acute coronary syndrome with enzyme elevation. A coronary angiogram revealed a critical 90% stenosis of the proximal left anterior descending artery. The lesion was predilated and a 3 mm × 18 mm bare metal stent was deployed at 14 atm. After stent deployment, balloon passage inside the stent was difficult. For better visualization of the stent, StentBoost (Philips Medical Systems, Netherlands) was used. With the balloon markers located within the stented segment, roughly 40 frames of digital cine were acquired without injection of contrast at 15 frames/s. StentBoost-augmented images (Figure 1) revealed that the stent had fractured into two pieces, which was not apparent on ordinary cine angiography. Subsequently, a second stent was deployed across the fractured stent.Stent strut fracture is a rare but important complication that can lead to serious consequences, such as stent thrombosis, if it is not treated in time. Stent fracture is a rare but important cause of restenosis in the drug-eluting stent era (1). In the present case, StentBoost enabled the diagnosis of this complication, which could then be treated. Stent strut fracture has been diagnosed previously by means of intravascular ultrasound (1), multislice computed tomography (2) and optical coherence tomography (3).StentBoost is a novel fluoroscopic stent visualization technique that creates a high-quality image of deployed stents by superimposing motion-corrected acquisition frames, thus giving a clearer image of the stent. The balloon markers must be in the frame. StentBoost does not require any additional expensive hardware and it can give important information about stent position, placement and complications, as illustrated in the present case. imageS in cardiology

No abstract

Background: In India, patients usually are responsible for medical records, carrying them to ambulatory clinic visits. Little is known about the characteristics of cardiovascular (CV) patients visiting Indian hospital outpatient departments (OPDs), as this information is not collected or analyzed in a standardized fashion. Methods: We used paper scanners along with an electronic data collection tool to systematically collect CV patient records in hospital OPDs. Standardized data definitions were used for all elements, including demographics, vital signs, and lab values. We normalized and analyzed the data collected, producing totals, means, medians, and standard deviations for all element values. Results: We collected 18,804 CV patient encounters in the OPDs of two tertiary facilities in Maharastra state from 2/12 to10/12. Of 18,622 records with gender recorded, 12,386 were male (66.5%). Only 22% of records were for patients over age of 65. Mean age was 57, the same mean age for males. Mean age for females was 54. Systolic blood pressure (BP) was documented in 8,481 (45%) of patient visits. Diastolic BP was documented in 8,477 (45%) patient visits. Mean systolic BP was 130, with a standard deviation of ± 18. Mean diastolic BP was 81 ± 9. Most BPs were high, with 6,651 (78%) greater than 120. Hypertension diagnoses could be applied to 2,566 (30%) of the encounters with a systolic BP over 140 documented. Ejection fraction (EF) was present in 857 patient encounter records (4.5%). Most EFs (704) fell within the normal range of ≥ 50%. Mean ejection fraction was 56% ± 11. For EFs outside normal range, 74 were mildly reduced (an EF of 40-49%), 57 moderately reduced (26-29%) and 22 severely reduced (≤ 25%). Complete lipid panel, consisting of values for total cholesterol, HDL, LDL, and triglycerides, was present in 594 patient records (3.2%). LDL values were present in 601 encounter records, with mean LDL of 101 mg/dL ± 35. 288 LDL values were over 100 mg/dL, the upper bound of optimal range. Conclusion: Indian ambulatory CV patients appear to be younger and more heavily male than outpatient CV populations in the US. Opportunity remains for increased documentation, allowing for performance measure generation.