a b s t r a c tBacterial endocarditis gives rise to a variety of complications due to local tissue damage, immunological phenomena, and embolic phenomena. Only a small number of cases of coronary embolization have been reported in infective endocarditis patients. This is a case of subacute bacterial endocarditis in a postpartum mother complicated by fatal left and right coronary artery embolization. A 32-year-old postpartum mother with a history of rheumatic heart disease presented with a history of fever, shortness of breath, and bilateral ankle edema for 1-week duration. On admission, the patient was alert, febrile with a pulse rate of 90 beats/min, blood pressure 105/70 mmHg, and her lungs were clear. Transthoracic echocardiography revealed vegetations attached to both mitral and aortic valves. She was started on intravenous antibiotics. Her fever was settled and during the following 2 weeks she was clinically improving with settling inflammatory markers. On the 20th day of the illness, the patient developed sudden onset of chest pain, dyspnea with sinus bradycardia, and later developed pulseless electric activity. She expired despite intense cardiopulmonary resuscitation. Postmortem revealed multiple vegetations in both mitral and aortic valves and complete occlusion of both left and right coronary ostia by embolized vegetative materials.
Background: In the face of rising incidence of cardiovascular disease in the globe, the associated risk factors could be country or area specific. This study aimed to identify the important risk factors of myocardial infarction (MI) prevailing in the Kandydistrict of Sri Lanka. Methods: In a case control design, the cases were recruited from the Coronary Care Unit, General Hospital Kandy, with the diagnosis of myocardial infarction. Matched controls were selected from the Out Patient Department with other ailments, unrelated to cardiovascular diseases. Results: There were 205 cases and 197 controls with the mean age of 56 years (SD ± 8.4 years) and 54 years (SD ± 9.8 years) respectively with male: female ratio of 1:0.2. In analysis, hypertension (OR = 5.09, CI = 2.64 - 9.83), type 11 diabetes (OR = 3.45, CI = 1.90 - 6.10), smoking (OR = 1.95, CI= 1.44 - 2.65) and high LDL cholesterol levels (OR = 1.06, CI = 1.04 - 1.06) were identified as the independent risk factors of myocardial infarction. However, the anthropometric measurements, waist hip ratio (OR = 0.64, CI = 0.33 - 1.34) and body mass index ≥ 25 (OR = 0.75, CI = 0.46 - 1.22) did not show an association with myocardial infarctions. Conclusions: Anthropometric measurements did not qualify as risk factors of myocardial infarction in the local setting even though hypertension, diabetes, smoking and high LDL levels showed a significant association in par with the established data.
BackgroundThe major challenges in survivors following myocardial infarction (MI) are to prevent the subsequent coronary events for the achievement of a better quality of physical and psycho-sexual wellbeing. Issues pertaining to resumption of sexual activity, quitting smoking and psycho-social wellbeing are addressed as an integral part of the cardiac rehabilitation programme.
Ethylene Diamine Tetra Acetic Acid (EDTA) chelation therapy has been considered a definitive alternative therapy for by-pass surgery in atherosclerotic cardiovascular disease for more than four decades. It is a relatively inexpensive method believed to restore blood flow in atherosclerotic vessels. However, the benefits of chelation therapy yet remain controversial in the treatment of ischemic heart disease. We observed the effect of EDTA chelation therapy on exercise tolerance in 13 volunteering patients receiving conventional treatment for established symptomatic coronary heart disease. Each patient received 30 weekly infusions of EDTA followed by monthly 12 boosters according to the ACAM protocol (American College for Advancement in Medicine). This was in addition to the conventional therapies they received from their respective physician in hospital. Stress ECG, echocardiography and coronary angiogram findings were obtained at the beginning of treatment. The distance that a patient could walk on level ground at moderate speed and the number of steps he/she can climb up on a staircase until he/she begins to feel either chest pain or breathlessness were the two clinical parameters of exercise tolerance recorded to grade angina. Liver and renal functions were tested at 1st, 5th, 10th, 15th and 30th infusions. Of the 13 patients, 11 showed improvement in angina grading whilst 2 experienced no effect. One patient improved from angina grade IV to I, 6 from grade III to I, 1 from grade III to II and 3 from grade II to I. A statistically significant reduction in the mean score (p = 0.002) was noticed at 6th month of treatment when compared to that of the first month. A significant 1.7 fold increase (p = 0.009) in the mean SGPT level was observed at the 30th infusion when compared to the pre-treatment values. The SGOT level showed no significant change (p = 0.664). None of the patients showed clinical features of hepato-cellular damage. The mean serum creatinine level showed a trend for reduction (p = 0.083) with treatment. The recognized side effects of intravenous EDTA chelation therapy such as liver damage, renal damage, hypersensitivity, symptomatic hypocalcaemia, and thrombophlebitis were not encountered. Thus, EDTA chelation therapy as prescribed by the ACAM protocol seems safe and effective in improving exercise tolerance in ischemic heart disease when administered concurrently with conventional therapy
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