Background: Atrial fibrillation with accessory pathway can present with confounding ECG findings leading to inaccurate diagnosis sometimes leading to fatal outcomes. Treatment with AV nodal blockers is contra-indicated in pre-excited atrial fibrillation as it can lead to fatal ventricular arrythmia. Case Presentation: A 72-year-old female presenting with acute onset palpitations, chest discomfort, shortness of breath and light-headedness with similar past episodes was initially diagnosed to have atrial fibrillation. An ECG after metoprolol administration revealed the features of pre-excitation and Wolff-Parkinson-White syndrome. A repeat episode of tachyarrhythmia was terminated with electrical cardioversion and patient was followed-up in cardiology for radiofrequency ablation. Conclusion: A bizarre ECG with irregular wide complex tachycardia with QRS of varied shape and amplitude and sustained rates surpassing 200 beats per minute, suspicion of WPW syndrome with pre-excited AF should be considered. It is difficult to distinguish from polymorphic ventricular tachycardia, although electrical cardioversion is the primary therapy when hemodynamically unstable.
Background: There has been an increase in the incidence of acute pancreatitis reported globally and despite of improvements in access to care and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. The present study was aimed to assess the clinical profile of acute pancreatitis and to assess the efficacy of various severity indices in view of outcome of patients. Methods: A hospital based prospective cross-sectional study was conducted from October 2022-March 2023 in Gastro and Liver care center in Ongole, Prakasam District, Andhra Pradesh India. All consecutive 72 patients with a diagnosis of acute pancreatitis were included in this study. Results: Out of total acute Pancreatitis cases 61 (84.7%) were males and 11 (15.3%) were females and acute abdominal pain (97.2%) and decreased appetite (95.8%) were the most common presenting complaints, 54.2% cases were due to Alcoholism, followed by hyperlipidemia with 20.8% and Gall stones 13.9%. All 72 (100%) received pancreatic supplements, 68 (94.4%) were given pain killers, and 65 (90.3%) were taken anti-ulcer agents. Twenty-three (31.9%) patients with 0 to 3 points as per CTSI Score and 4-6 range points were observed in 47 (65.3%) pancreatitis patients. Maximum (40.3%) were improved on 2nd day, 22 (30.6%) were on 3rd day. Positive correlation noticed between Amylase and in diagnosing acute Pancreatitis, it is significant at 0.05 level. Conclusions: Early assessment of the clinical severity and identification of patients at risk is important for early intensive management and timely intervention and to improve quality of life. So, it is mandatory to assess the clinical severity using different scoring systems. and appropriate treatment based on guidelines.
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