The occurrence of silent myocardial ischemia (SMI) and serious arrhythmias during hemodialysis (HD) has been well documented. However, it is unclear whether these changes are due to epicardial coronary artery disease (CAD). We conducted a prospective study to assess whether SMI and arrhythmias during HD correlated with angiographically demonstrable CAD. Twenty-three patients with end-stage renal disease on maintenance HD underwent 48-hour Holter monitoring, beginning 24 hours prior to a HD session. All patients underwent biochemical evaluation, coronary angiography, and echocardiography. Holter monitoring showed SMI during HD in 22% cases. A significant increase in the frequency of ventricular ectopics (VEs) was noted during and after HD. Patients who showed SMI during HD and VEs prior to initiation of dialysis were more likely to develop significant ventricular arrhythmias during and after HD. Epicardial CAD was documented in four patients, and it did not correlate with SMI. To conclude, HD is an arrhythmogenic process. SMI during dialysis is probably not due to epicardial CAD but predisposes to clinically significant ventricular arrhythmias during and after HD. The cause of SMI during HD in patients without demonstrable CAD needs further investigation.

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The occurrence of silent myocardial ischemia (SMI) and serious arrhythmias during hemodialysis (HD) has been well documented. However, it is unclear whether these changes are due to epicardial coronary artery disease (CAD). We conducted a prospective study to assess whether SMI and arrhythmias during HD correlated with angiographically demonstrable CAD. Twenty-three patients with end-stage renal disease on maintenance HD underwent 48-hour Holter monitoring, beginning 24 hours prior to a HD session. All patients underwent biochemical evaluation, coronary angiography, and echocardiography. Holter monitoring showed SMI during HD in 22% cases. A significant increase in the frequency of ventricular ectopics (VEs) was noted during and after HD. Patients who showed SMI during HD and VEs prior to initiation of dialysis were more likely to develop significant ventricular arrhythmias during and after HD. Epicardial CAD was documented in four patients, and it did not correlate with SMI. To conclude, HD is an arrhythmogenic process. SMI during dialysis is probably not due to epicardial CAD but predisposes to clinically significant ventricular arrhythmias during and after HD. The cause of SMI during HD in patients without demonstrable CAD needs further investigation.

The aim of this study was to establish if there are any symptoms which can predict increased patient satisfaction following Endoscopic Sinus Surgery (ESS) and whether these symptoms correlate with Lund-Mackay score on Computerised Tomography (CT). A prospective observational study was performed. Ninety-three consecutive patients who were offered ESS were recruited from an otolaryngology department in a UK Teaching Hospital. All patients had failed medical therapies for chronic rhinosinusitis (CRS), recurrent acute sinusitis and/or nasal polyposis. Patients were asked to complete a questionnaire pre-operatively and 12 months after surgery. Symptoms were assessed using a visual analogue scale. Endoscopic examination of the nose was performed pre and post-operatively. Lund-Mackay score was recorded for the pre-operative CT scan. Results were analysed using linear regression analysis and Pearson correlation coefficient. All symptoms improved after ESS (P < 0.001). However, a high pre-operative score for nasal discharge and olfactory disturbance were predictive of lesser improvement in symptom scoring (P < 0.001). Patients undergoing polypectomy with ESS demonstrated greater improvement in symptom score than those undergoing ESS with septoplasty or turbinate reduction surgery. There was no correlation between symptom score improvement and pre-operative Lund-Mackay score (r = 0.09). Patients who have high pre-operative symptom scores for nasal discharge and olfactory disturbance may gain less benefit from ESS, whilst those with nasal polyposis appear to perceive the greatest benefit. Increasing pre-operative Lund-Mackay score is not a predictor of a favourable operative outcome.

Hypoparathyroidism patients present with features of hypocalcemia like carpopedal spasm, numbness and paresthesias but hypocalcemic cardiomyopathy leading to congestive heart failure (CHF) is a rare presentation. We present here a case of 55-year-old Asian man who was a known case of dilated cardiomyopathy for 6 months, presented with the chief complaints of shortness of breath on exertion and decreased urine output. On general physical examination, features suggestive of CHF were seen. Chvostek and Trousseau’s sign was positive. The patient had a history of cataract surgery of both eyes 15 years ago. Further investigations revealed hypocalcemia. Echo showed severe global hypokinesia of left ventricle with left ventricle ejection fraction 15%. This CHF was refractory to conventional treatment, though, with calcium supplementation, the patient improved symptomatically. On follow-up after 3 months, an improvement was seen in the echocardiographic parameters with ejection fraction improving to 25%.