Aims: To highlight the rare occurrence of double outlet right ventricle (DORV) with Dextrocardia and Situs Inversus in a three-year-old boy viz-a-viz what has been reported in the literatures.
Presentation of Case: N.A is a three year old boy who presented with easy fatiguebility, bluish discolouration of lips and tongue and occasional dyspnoea on exertion noticed since about 12 months of life. There was no associated history of cough, leg swelling or frequent hospitalization. Physical examination revealed a small for age, centrally cyanosed boy with conjuctival ejection, and grade 4 digital clubbing. Pulse rate was 100 beats /min regular and synchronous with other peripheral pulses. There was a praecordial bulge to the right with apex beat at the 4th right intercostal space mid-clavicular line. Heart sounds were 1st and 2nd with a grade 2 systolic murmur at the right upper sternal border. The liver was 4 cm palpable below the left costal margin firm non-tender.
Pulse oximetry showed SPO2 value of 75-79% in ambient air. He had chest radiograph, electrocardiogram, abdominal ultrasound and two-dimensional echocardiography which confirmed a diagnosis of DORV with Situs totalis.
Discussion and Conclusion: Situs Inversus totalis (Dextrocardia co-existing with Situs inversus) is associated with lower incidence of congenital heart defects as compared with Dextrocardia and Situs solitus. The defects commonly associated with it, are a transposition of great arteries (TGA) and ventricular septal defects (VSD) unlike in the index patient where DORV is being reported.
Acute limb ischemia secondary to systemic arterial embolism from left ventricular thrombus is a rare life threatening emergency. Peripheral arterial thrombosis superimposed on an atherosclerotic disease or thromboembolism from cardiac or aortic source are the two most common causes of acute limb ischemia. We present a case of a young healthy female who had recurrent admissions with acute lower extremity ischemia secondary to embolism from intra cardiac thrombus diagnosed by bedside doppler and computed angiogram, managed by surgical thromboembolectomy and discharge on anticoagulation.
Aortopulmonary window is a rare congenital anomaly with a communication between ascending aorta and main pulmonary artery. It may be associated with other cardiac malformations like aortic arch anomalies, ventricular septal defect, tetralogy of fallot etc. Survival beyond infancy is rare and early surgical intervention is important to prevent development of irreversible pulmonary hypertension. We report a rare case of larger Aortopulmonary window along with a large ventricular septal defect presenting at the age of 16 years.
Background of Study: Previous studies observed insulin resistance in the hypertensive population. However, evidence-based studies of insulin resistance in prehypertension are scant.
Aim: Our study aimed at determining the presence of insulin resistance and its correlation with blood pressure in prehypertensive adults.
Materials and Methods: This was a case-control study involving randomly selected 70 healthy adults in Makurdi, Nigeria. Anthropometric parameters and metabolic markers of insulin resistance (fasting plasma glucose (FPG), homeostasis model assessment of insulin resistance [HOMA-IR], fasting serum insulin [FSI], triglycerides [TGs], triglyceride/high density lipoprotein cholesterol [HDL-C] ratio [TG/HDL-C]) in apparently healthy adults were measured. The metabolic markers of IR in 35 prehypertensives were compared with anthropometrically matched 35 normotensive controls using the student’s t-test. Associations of blood pressure (systolic-SBP and diastolic-DBP) with metabolic markers of insulin resistance in prehypertensives and normotensives were determined using Pearson correlation analysis.
Results: A significantly elevated (P<0.05) SBP, DBP, FSI, and HOMA-IR was observed in prehypertensives compared to matched normotensive controls. A significant positive correlation (P<0.01) was observed between SBP and insulin (r=0.762), HOMA-IR (r=0.756), TGs (r=0.586), TG/HDL-C (r=0.499); DBP and insulin (r=0.659), HOMA-IR (r=0.634), TGs (r=0.469), TG/HDL-C (r=0.469) in prehypertensives. In normotensives, a significant positive correlation (P<0.05) was observed between DBP and TGs (r=0.371), TG/HDL-C (r=0.376); age (r=0.372), BMI (r=0.523), WC (r=0.338).
Conclusion: Our study shows that insulin resistance is associated with elevated blood pressure and could mediate the progression of normotension through prehypertension to hypertension.
Prisons are environments that have been characterised by high rates of communicable diseases until recently when the prevalence of cardiovascular diseases have been assessed, and high prevalence found. This study, involving 160 inmates assessed the prevalence of cardiovascular risk factors among prisoners in the Ashanti Region of Ghana. BMI, waist circumference and blood pressure of all participants were checked. Additionally, lifestyle and dietary factors such as exercise and fruit intake as well as medical history of inmates were assessed. Fasting blood samples were taken and analysed for lipid profile and FBG. The mean systolic blood pressure of study participants was 141.1±23.2 mmHg, diastolic 88.9±15 mmHg, BMI 22.8±4.1 kg/m2, waist circumference 81±10.3 cm, FBG 4.3±0.9 mmol/L, HDL 1.4±0.4 mmol/L and triglycerides 1.1±0.6 mmol/L. Prevalence of hypertension and dyslipidaemia was 57.5% each. Prevalence of metabolic syndrome was 8.1%, and 21.9% had two cardiovascular risk factors. In conclusion prevalence of dyslipidaemia and elevated blood pressure were high among inmates and cardiovascular risk factors were higher among female inmates compared to males. Most inmates were sedentary and occasionally consumed fruits. Interventions of appropriate dietary provision and exercise schedule should begin within Ghanaian prisons to curb this menace.
