Myxomas are the most common type of primary cardiac tumor. They cause a variety of clinical manifestations depending on size and anatomical location. Sometimes, manifestations are atypical challenging differential diagnosis and the therapeutic approach. Left atrial myxomas are commonly missed clinically and often lead to grave consequences. We present here a series of 6 cases of left atrial myxomas with demographic and clinical characterization of the patients that were managed successfully.
Background: Poisoning with Thevetia peruviana (yellow oleander) is commonly observed in Northern and Eastern provinces of Sri Lanka causing significant morbidity and mortality. It contains cardiac glycosides which are toxic to cardiac muscle that results in cardiovascular dysrhythmias.
Objective: To determine the pattern of cardiac dysrhythmias and outcome of yellow oleander poisoning at a tertiary care center of Northern Sri Lanka.
Methods: A descriptive, cross sectional, prospective study was carried among patients with yellow oleander poisoning admitted to Teaching hospital, Jaffna, Sri Lanka over a period of two years. Twelve lead standard electrocardiography and 2‑lead ECG monitoring were performed in all patients during the hospital stay at the cardiology unit. Data were entered in Microsoft Excel sheet and was analyzed using SPSS [version 21] analytical package. Results were presented as counts, percentages and mean ± SD for continuous variables.
Results: 23 out of 44 patients were females. Mean age of the patients was 24.84 [SD ± 0.43] years. Most of the patients were symptomatic and presented with gastro intestinal symptoms like vomiting, abdominal pain and diarrhea. Bradycardia was the most commonly observed cardiac rhythm abnormality within the first 24 hrs of ingestion of yellow oleander seeds. Sinus bradycardia [75%] was the commonest cause for bradycardia. All patients were treated with multiple doses of activated charcoal irrespective of the time of presentation. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and 12 of them needed temporary pacing.
Conclusion: Most of the victims of Yellow oleander poisoning were young adults. The cardiac toxicity developed within 24 hours of ingestion of the seeds. The risk of toxicity has not related to the number of seeds consumed. Most patients have nonspecific symptoms. AV conduction abnormalities are common. Activated charcoal is useful in most cases.
Background: Congenital heart disease (CHD) is commonly seen in patients with Down syndrome (DS) and is closely associated with morbidity and mortality. Maternal age is an established risk factor for DS.
Objectives: The aim of the present study is to analyze the incidence of CHD in Down syndrome and the effect of maternal age on this incidence and the type of CHD.
Materials and Methods: Six hundred and thirty-one patients with DS who were admitted to pediatric cardiology department, between December 2014 and December 2018, were retrospectively analyzed. The detected CHDs were evaluated in association with maternal age.
Results: Four hundred forty-five (70.5%) cases had one or more congenital heart defect. Two hundred and seven patients (32.8%) had isolated simple defect while the remaining had complex or associated multiple CHDs (n:238, 37.7%). Considering all patients, secundum ASD (42.1%) was the most frequent CHD followed by PDA (33.9%), VSD (28.6%) and AVSD (9.6%). Regarding the maternal age, the incidence of CHD was lowest in babies whose maternal age were between 25-35 years. AVSD, was most frequent in patients born to mothers aging ≤20 years. Incidence of ASD did not markedly differ between maternal age groups while nearly half of the patients born to mothers aging between 21-25 years had PDA and incidence of VSD was markedly increased with the maternal age of >45 years.
Conclusion: Distribution of CHD also varies in accordance with maternal age. Babies born to mothers aged <25 or >35 years are more likely to have CHD. Incidence of AVSD, which had been reported to be the most common CHD in patients with DS, has been decreased in time and tends to be mostly associated with maternal age of ≤20 years.
Objective: We aimed to find the prevalence and the reasons for receiving non-guideline-concordant treatment in patients with multivessel coronary artery disease (mv-CAD), at a single centre.
Methods: All consecutive patients who underwent coronary angiography, due to stable angina pectoris or non-ST-elevation acute coronary syndrome (NSTE-ACS), and were diagnosed with mv-CAD at our hospital between August 2017 and February 2018 were included in this study. Stand-alone medical treatment, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or hybrid revascularization is recommended treatment methods by The European Society of Cardiology (ESC) and The European Association for Cardio-Thoracic Surgery Guidelines (EACTS) on Myocardial Revascularisation. Stabilised NSTE-ACS patients were assessed as stable angina pectoris patient
Results: A total of 140 patients (96 male, 68.6% and 111 NSTE-ACS, 79.3%) were included in this study, of which 65 (46.4%) received non-guideline-concordant treatment and 75 patients (53.6%) received guideline-concordant treatment. Sociodemographic and clinical characteristics did not differ statistically between patients who received guideline-concordant treatment and non-guideline-concordant treatment. Patients that received non-guideline-concordant treatment did so for the following reasons: patient’s preference and/or cardiologist’s decision of PCI over CABG (42, 64.6%), patient’s refusal of the revascularization method (14, 21.5 %), refusal by the surgery team to perform surgery due to advanced patient age or low left ventricular ejection fraction (5, 7.7%),unavailability of the surgery team (1, 1.5%) and developing ischaemia/myocardial infarction during the waiting period (3, 4.6 %). There was no inappropriate CABG decision.
Conclusions: In our study, the prevalence of non-guideline-concordant treatment was high and associated primarily with the preferences of the interventional cardiologists and patients.
Myosin is defined as a mechano-enzyme molecule which converts the chemical energy stored as adenosine triphosphate (ATP) into mechanical energy (muscle contraction). Moreover, the cardiac muscle has different types of myosin heavy chain when it separated with the one dimensional electrophoresis; in addition to their structural difference cardiac myosin isozymes have different contractile functions.
