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Extrinsic compression of the Left Main Coronary Artery (LMCA) by a dilated pulmonary artery is a rare but a treatable cause of angina in patients with Pulmonary Artery Hypertension (PAH). In majority of these patients, angina is attributed to right ventricular or left ventricular demand ischemia and in the absence of cardiovascular risk factors for atherosclerosis, they rarely undergo a coronary angiogram. So this rare diagnosis may be missed in such patients and optimal management delayed. In this case report we describe a patient of PAH secondary to Patent Ductus Arteriosus (PDA), presenting with heart failure and complaining of persistent angina, due to extrinsic compression of the ostial LMCA by the dilated pulmonary artery, treated successfully by Percutaneous Coronary Intervention (PCI). This case reminds us that in all patients of pulmonary hypertension presenting with angina and left ventricular dysfunction, this rare but treatable cause should be identified by coronary angiography and treated with PCI. [ABSTRACT FROM AUTHOR]

Congenital ventricular diverticula and aneurysms are very rare. Prenatal diagnosis of such cases is reported only by few authors. Differentiating these two entities by echocardiography alone is very difficult. We present a case of prenatally diagnosed right ventricular diverticulum at 33 weeks of gestation. She was 37-year-old and primigravida with no past medical history. She underwent a routine prenatal scanning and was suspected to have a foetal cardiac abnormality and referred to us. It was diagnosed as foetal right ventricular diverticulum with the help of Motion-mode (M-mode) echocardiogram and was advised follow up after delivery. One of the differential diagnosis is ventricular aneurysm. Unfortunately, she had a miscarriage at 36 weeks due to unknown cause. [ABSTRACT FROM AUTHOR]

Introduction: Obesity and metabolic syndrome frequently coexist and are one of the major health problems around the globe and its prevalence is 25-30%. In India prevalence of metabolic obesity is ≥30%, among females who have higher levels as compared to males. There is a significant proportion of the population who are obese (BMI >25 kg/m²) but metabolically healthy, likewise some people with normal BMI status, but metabolically obese. In this study, we have evaluated the association between metabolic obesity and severity of Coronary Artery Disease (CAD) in stable angina patients. Aim: To assess the association of severity of angiographic CAD based on the Metabolically Obese (MO) status and Body Mass Index (BMI). Materials and Methods: Total 408 subjects with stable angina and with positive stress test were included in the study and severity of CAD was measured by SYNTAX score. Obesity was defined as BMI ≥25 kg/m2, and normal weight was defined as BMI <25 kg/m2. The metabolic obesity was determined using the National Cholesterol Education Program-Adult Treatment Panel III (NCEPATP-III) classification in which Asian-specific cutoffs for abdominal obesity is used. Therefore, study subjects were categorised as follows: 1) Metabolically Healthy and Normal Weight (MHNW); 2) Metabolically Obese but Normal Weight (MONW); 3) Metabolically Healthy but Obese (MHO); and 4) Metabolically Abnormally Obese (MAO). Statistical analysis was carried out using statistical package for social sciences (SPSS) version 20. Baseline clinical, demographic, anthropometric and laboratory data are presented as mean±Standard Deviation (SD), median (range), or number (%) unless specified. Comparison among groups was calculated with an analysis of variance (ANOVA) test and Kruskal-Walis test for continuous variables and the Pearson chi-square test for categorical variables. Association between groups and severity of CAD was done by Kruskal-Wallis test. The p-value <0.05 was considered statistically significant. Results: Out of 408, 70.3% (n=287) subjects were male, 52.7% (n=215) subjects were hypertensive, and 42.9% (n=175) subjects had high BMI. Metabolic obesity showed higher prevalence of CAD (MO, OR=0.25, 95% (1): 0.31-1.03) than patients with higher BMI status (BMI, OR=1.39, 95% (1): 0.79-2.4). Syntax score which measures the severity of CAD is marginally high in MONW group (p-value-0.003) when compared to MHNW group. Conclusion: MO group was associated with a high prevalence and severity for CAD than metabolically healthy group irrespective of their weight status. [ABSTRACT FROM AUTHOR]

Polycythemia Vera (PV) is a chronic myeloproliferative disorder which is characterised by a high risk of developing arterial as well as venous thromboembolic complications like deep vein thrombosis, stroke, cortical vein thrombosis and rarely acute Myocardial Infarction (MI). PV has a risk rate of major thrombosis as high as 50%. Bleeding, thrombotic, and vascular complications are the major causes of morbidity and mortality, occurring in 40 to 60% of these patients. MI with heart failure is the most common cause of death in these patients. Congenital Protein S deficiency is an autosomal dominant disease. Venous thrombosis develops in 60-80% of patients who are heterozygous for Protein S deficiency. Hereditary Protein S deficiency is a well known risk factor not only for venous thrombosis but also for arterial thrombosis including MI and stroke. However, association of Protein S deficiency with arterial thrombosis is less appreciated. Very rarely, we find all the varied thrombotic complications in one patient. We hereby present a case who had varied thrombotic presentations due to underlying polycythemia with Protein S deficiency. [ABSTRACT FROM AUTHOR]

Introduction: Glycosylated HaemoglobinA1c (HbA1c) is a time-integrated marker for glycaemic control. It also helps in predicting the risk of Coronary Artery Disease (CAD) among diabetic patients. Aim: To determine the association between HbA1c and severity of CAD in patients with stable angina. Materials and Methods: A total of 144 patients with the positive cardiac stress test and stable angina who are undergoing a Coronary Angiogram (CAG) were enrolled. The patients were classified into three groups according to baseline HbA1c level (Normal group <5.6%, n=53; pre diabetic group 5.7-6.4%, n=62; diabetic group >6.4%, n=29). One-way ANOVA test analysed baseline characteristics of the study population. The association between HbA1c level and the risk of CADs was calculated by Pearson correlation. A p-value less than 0.05 considered to be significant. Results: The subjects who were pre diabetic have 1.77 times more odds of having CAD than the patients who are normal OR (95% CI)=1.77 (0.84,3.73). Patients who have diabetes have 3.13 times more odds of having CAD than the patients who are normal OR (95% CI)=3.13 (1.20,8.16), p=0.02. Higher HbA1c levels were associated with higher incidence of CAD. Conclusion: The study concluded that there was a significant association between raised baseline HbA1c levels and occurrence of CAD in patients with positive cardiac stress test/stable angina. [ABSTRACT FROM AUTHOR]