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Background Temporary pacemaker lead implantation is a common low-risk procedure, but can occasionally get complicated by infections, arrhythmias, thromboembolic events, and perforation of the vessel or the heart. However, intracardiac knotting of the temporary pacemaker lead has been rarely reported. This could lead to vascular or valvular injury, pneumothorax, symptomatic loss of pacing or haemodynamic compromise, and difficult lead removal. Case summary We are reporting a case of twice twice-knotted temporary pacemaker lead, which to our knowledge has not been reported before. The two knots in the transjugularly inserted temporary pacemaker lead, via a 6F venous sheath made it difficult to retrieve it. Discussion We decided to snare the knotted TPI into the inferior vena cava, and then retrieve it via a large-size femoral sheath, thus avoiding the need for a venotomy or any surgical intervention. [ABSTRACT FROM AUTHOR]

BACKGROUND: An important sequelae post myocardial infarction is left ventricular remodelling, which determines the long term outcome and occurrence of heart failure. Biomarkers are used as a tool to identify high risk individuals, to diagnose disease conditions promptly/accurately and to effectively prognosticate and treat patients with disease. ST2 is one such promising relatively new biomarker. Myocytes that are subjected to mechanical stress secrete ST2 and the ST2 level has been found to be an independent predictor of heart failure and adverse outcome in patients with acute myocardial infarction. METHODS: We checked the Serum ST2 level on admission of 102 patients admitted with acute myocardial infarction in our hospital. In 34 patients out of these a discharge time ST2 level was also measured. The ST2 levels obtained on presentation, were correlated with the clinical severity of the disease on presentation and subsequent acute complications during hospital stay. ST2 level at discharge was correlated with readmission and occurrence of heart failure or cardiovascular event after discharge for a follow up period of 6 months. RESULTS: In our study high ST2 levels on admission significantly correlated (P values < 0.05) with disease severity in the form of high TIMI score and low LV systolic function. High ST2 level had a statistically non-significant negative association with blood pressure (lower blood pressures having higher ST2 values) and a positive association with duration of symptoms (longer duration had higher values), ‘in hospital’ adverse events. In our study none of the patients from low ST2 group had ‘in hospital’ adverse events or mortality. Majority of patients readmitted were from high ST2 group (statistically non-significant). CONCLUSION: ST2 is a promising biomarker for prognostication and can be included in routine biomarkers for risk stratification of acute myocardial infarction and heart failure. Patients admitted with acute MI or heart failure who have high ST2 levels should be followed up closely to prevent the occurrence of adverse cardiovascular events. [ABSTRACT FROM AUTHOR]

Pulmonary embolism is the occlusion of the pulmonary arteries by blood or foreign material. Commonly pulmonary embolism is seen when thrombus from the deep veins of the legs or pelvis embolise into the pulmonary artery. Rarely tumours, vegetations can embolise to pulmonary artery. We report a rare case of a haematological malignancy presenting as right atrial mass and pulmonary embolism, in a young male., (© Journal of the Association of Physicians of India 2011.)