Ventricular septal rupture (VSR) after acute myocardial infarction with the consequence of hemodynamic unstability is a rare complication and it's an medical emergency. Mortality of these group patients is higher than 90% to 95% without a rapid diagnosis and correction by surgical intervention.Spontaneous closure of VSR is extremely rare. We report the case of a patient with acute myocardial infarction with ventricular septal rupture (VSR) with cardiogenic shock that was diagnosed in our modern coronary care unit by the bed side portable echocardiographic machine (vivid).The incidence of ventricular septal rupture (VSR) after acute myocardial infarction is extremely rare in this reperfusion era.This condition is associated with a high mortality rate, even after the cardiac surgery . Our case emphasizes the risk factors and evolution of this condition.A 36 years old young hypertensive young man was admitted on 8 th August,2014 through the emergency department of university cardiac centre for central chest pain ,dyspnea, nausea and bilateral shoulder pain for the last last 7-8 days. He consulted with his family physician for the same complaints and later he was referred to get admission in our hospital. The patient's condition was detoriating gradually. Physical examination revealed a regular pulse of 110 beats/min. The blood pressure was 100/70 mmHg and there was a systolic murmur best heard at the apex, radiating to the axilla. . Pulmonary rales were present and there was no peripheral edema, hepatomegaly and raised JVP.The 12-lead electrocardiogram Figure 1) showed sinus rhythm at 125 beats/ min, low voltage QRS complex voltage in the limb leads, q waves in II,III, AvF and a 4 mm ST elevation in the anterior leads (V 2-4 ).Serum troponin T level at admission was 1.75 ng/ml, CK-MB 28 , Serun creatinine 1.25, Serum electrolytes are within normal limit.He was managed as a case of acute antero-septal MI with old inferior MI and on the following day after his admission he developed cardiogenic shock , examination reveals pulse was 115 beats/min and blood pressure was 80/40 mm of Hg.Then we put the patient under ionotrophic support ,transthoracic echocardiography was done and (figure 2,3 & 4) revealed a small rupture of the apical ventricular septum (figure 2) causing a VSR with left-to-right shunt (figure 3) and Doppler study showed the pressure gradient
The purpose of the study was to investigate the trends of permanent pacemaker implantations in the University Cardiac Center (UCC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. This retrospective study conducted in the department of Cardiology, UCC, BSMMU, Dhaka to evaluate demographic distribution, indications, complications of the permanent pacemaker (PPM) implantation and its hospital outcome. Data of this retrospective study was collected from hospital registry and patient's record files. Total 98 patients were studied. Among them male were 64.28% (n=63) and female were 35.71% (n=35). Most of them were elderly patients (58%). Complete heart block was the most common cause for PPM implantation, which was 67.35% (n=66). Single chamber multiprogrammable PPM (VVI) was implanted in 86.73% (n=85) and Dual chamber PPM (DDI) was implanted in 13.26% (n=13) cases. No Major complications occurred during the procedure and short term in-hospital outcome was good for all the cases. This study showed that PPM implantation is rapidly increasing modality of treatment for patients with cardiac bradyarrhythmias as effective technique with good in-hospital outcome.
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