Electrocardiographical case. J wave and presyncope in a middle-aged woman

A 46-year-old woman presented with three episodes of presyncope in the previous two days. Electrocardiogram (ECG) showed sinus rhythm, relatively short QT interval (QTc of 340 msec) and prominent J-waves in the inferior leads. Biochemical evaluation revealed serum calcium of 17.4 mg/dL, phosphorus of 2.3 mg/dL and alkaline phosphatase of 533 IU/ml. She was managed with saline diuresis followed by elective parathyroidectomy. ECG became normal with the disappearance of J-waves after correction of hypercalcaemia. She was asymptomatic at six months of follow-up. The presence of J-waves (Osborne waves) in hypercalcaemia has rarely been reported.     

Left atrial myxoma-influence of tumour size on electrocardiographic findings

ObjectiveThe data of 51 patients (33 females) who underwent excision of left atrial (LA) myxoma were retrospectively reviewed for correlation of tumour size and electrocardiographic (ECG) findings.Methods and resultsMean age was 39.1 ± 15 years (range 9–53 years). The LA enlargement (LAE) on ECG was defined by standard criteria. The LAE in ECG in these patients did not correlate with echocardiographic LA dimensions or with the degree of left ventricular (LV) inflow obstruction. But it was found that the presence of LAE in ECG predicted maximum tumour dimension of >5 cm and correlated with the degree of mitral regurgitation (MR). The LAE in ECG disappeared following surgery in 87.5% of patients.ConclusionThe LA enlargement on ECG in a patient with LA myxoma signifies larger tumour size or the presence of significant MR but is not necessarily associated with an increased LA size or LV inflow obstruction.     

Clinical Profile of Pediatric Patients with Long QT Syndrome Masquerading as Seizures

Objective

To study the clinical profile of patients with long QT syndrome presenting as seizures.

Methods

Retrospective analysis of six pediatric patients admitted at authors’ institute between October 2008 and January 2013 with seizures and a presumptive diagnosis of long QT syndrome (LQTS) was done. The diagnosis was made on the basis of updated Schwartz diagnostic criteria. Clinical data, investigation profile and follow up of patients was recorded in a standard format and analysed.

Results

All the 6 patients in the study were boys with a mean age of 10.3?±?2.8 y at the time of diagnosis. The lag period between symptom onset and diagnosis was 5.6?±?3.14 y. All patients had history of seizures with a history of precipitating event in 4 patients. Average baseline QTc interval was 556?±?41.31 ms. Mean Schwartz score was 6.66?±?1.16. Polymorphic VT was documented in 4 patients. After initiating standard treatment with betablockers, nicorandil, spironolactone or pacemaker, all the six patients were asymptomatic at a mean follow up period of 17.5 mo, with no recurrence of seizures.

Conclusions

LQTS can cause seizures due to prolonged ventricular arrhythmias in high risk subgroup. Children, who present with LQTS and seizures, generally have a precipitating event causing seizures, and they respond well to drug therapy.     

Patient profile and results of percutaneous transvenous mitral commissurotomy in mitral restenosis following prior percutaneous transvenous mitral commissurotomy vs surgical commissurotomy

Background

Patients with mitral restenosis who have undergone prior PTMC or surgical commissurotomy have increased. Predictors of outcome of repeat PTMC in either subgroup of patients may be different.

Aims and objectives

Aim was to assess and compare the immediate results of PTMC in patients who had undergone a prior PTMC or surgical commissurotomy.

Methods and results

This is a single center, prospective, open label study. Of 70 patients in study, 44 (62.85%) patients had prior history of PTMC and 26 (37.15%) had prior surgical commissurotomy (closed/open). Average time from the initial procedure was 8.88 ± 5.36 years overall, 6.75 ± 3.38 for patients with prior PTMC and 16.73 ± 3.67 for patients with prior surgical commissurotomy. Prior PTMC group had 75% female, patients with prior surgical commissurotomy were older (44 ± 7 vs 33.57 ± 9.1 years, p = 0.001), had higher NYHA class (III/IV in100% vs 86.36%, p = 0.006.), higher atrial fibrillation (73.1% vs 25% p < 0.0001) and higher Wilkins'' score (>8 in 88.46% vs 68.18%, p = 0.05). Successful PTMC was lower (65.4% vs 84.1%) in patients with prior surgical commissurotomy, though statistically not significant (p = 0.07). After PTMC, mitral valve area, PA systolic pressure, LA mean pressure and trans-mitral gradient were similar. Post procedure complications were not different in both the groups.

Conclusion

PTMC for mitral restenosis in patients with prior surgical valvotomy is as effective as in patients with prior PTMC despite older age, higher NYHA class, higher Wilkins score and atrial fibrillation and can be considered in all patients with restenosis irrespective of the type of past procedures done.     

Alcohol and HIV Risk Among Russian Women of Childbearing Age

Russia has one of the fastest rising rates of HIV among women in the world. This study sought to identify key factors in HIV transmission among women in Russia. Data were collected as part of a larger clinical trial to prevent alcohol-exposed pregnancies (AEP). Women at risk for an AEP were recruited at women’s clinics; 708 women, aged 18–44 (M = 29.04 years), completed HIV risk surveys. Structural Equation Modeling was used to test the relationships between alcohol use and sex behavior constructs with HIV/STI risk. While the model indicated that multiple factors are involved in women’s HIV/STI risk, the independent alcohol use variable explains 20 % of the variance in women’s HIV/STI risk. The findings suggest that alcohol use directly and indirectly predicts HIV/STI risk among women, and its effect is mediated by alcohol use before sex.     

Bundle branch reentry ventricular tachycardia in arrhythmogenic right ventricular dysplasia

A 42-year-old male had history of recurrent palpitation and was documented to have wide QRS tachycardia. Magnetic resonance imaging angiogram showed evidence of arrhythmogenic right ventricular dysplasia and severe right ventricular dysfunction. Electrophysiology study showed evidence of bundle branch reentry ventricular tachycardia. It was successfully treated by radiofrequency ablation of right bundle branch. This is probably the first case of bundle branch reentry as a mechanism for ventricular tachycardia in a case of arrhythmogenic right ventricular dysplasia.