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Isolated Coronary Artery Stenoses (CAS) involving the ostium of the Left Anterior Descending (LAD) artery is very challenging, especially in a setting of primary Angioplasty in Myocardial Infarction (PAMI). Intimal atherosclerosis in the Left Main Coronary Artery (LMCA) bifurcation is primarily in area of low shear stress which is the lateral wall, close to the LAD and Left Circumflex (LCx). Thus, carina is usually free of disease, which can explain why single-stent strategy can be successful. However, precise stent placement is often difficult due to unwanted stent movement within vessel or its proximity to side branches. A decision must be made at the outset, to decide on the approach to be employed, to treat osteal LAD lesions. Limited data is available on patients undergoing primary PCI of osteal LAD lesions. Here, we present our experience and problems encountered during the management of osteal LAD lesions in the setting of PAMI.

Cardiac myxofibrosarcoma (MFS) is an uncommon entity. It is among the most challenging conditions to diagnose due to its rarity, high variability, and non-specific findings. These tumors often simulate left atrial myxoma or mitral stenosis at clinical presentation. Although, the definitive diagnosis of cardiac tumors depends on histopathological examination, various imaging techniques are also useful to study tumor characteristics to plan an appropriate treatment strategy. Here we highlight a case of primary cardiac MFS of left atrium (LA) showing areas of transition to undifferentiated pleomorphic sarcoma (UPS) with bone or osteoid formation, which is extremely rare and not well described.

OSA is considered as an independent risk factor for cardiovascular morbidity and mortality. Hypertension, atrial fibrillation, heart failure with reduced ejection fraction, stroke and metabolic syndrome are also known to be associated with OSA. Each of these conditions are associated with 2D-ECHO abnormalities and often present with increased hospitalization rates or morbidity. However, echocardiographic parameters in newly detected OSA, without any other associated illness, is poorly defined. The aim of this study is to evaluate systolic and diastolic dysfunction using 2D speckle tracking in patients with newly diagnosed OSA and normal left ventricle ejection fraction. The association between diastolic dysfunction, Global Longitudinal Strain (GLS), LV hypertrophy, LV mass, estimated pulmonary artery pressures and severity of OSA was also studied.The results indicated that most of the patients with OSA, without any other cardiovascular diseases, exhibited normal left ventricular (LV) ejection fraction (EF), but had clinical signs and symptoms of LV systolic dysfunction.

Background: Cardiac involvement is a major cause of mortality in Beta-Thalassaemia Major (ß-TM) patients. Despite many advances in therapeutic management of ß-TM, cardiac involvement remains the primary cause of mortality in ~70% of the cases. Chronic iron overloading results in thalassaemic cardiomyopathy, leading to diastolic dysfunction and overt heart failure (HF). Serial electrocardiography (ECG), 2D-echocardiography (2DECHO) and cardiovascular magnetic resonance (CMR) help in early detection and risk stratification of ß-TM patients, to prevent complications, such as arrhythmias and sudden cardiac death. An established network of care between thalassaemia centres and local health providers is essential for optimal management. Case presentation: We report 2 cases of HF in ß-TM of varied etiology, and different approaches undertaken for its early diagnosis and treatment. Conclusion: It is important to differentiate various phenotypes of cardiomyopathy in ß-TM. Since, the management of each varies accordingly. ß-TM patients require a multi-disciplinary approach that includes HF specialists, haematologist, hepatologist, endocrinologist, psychologist, transfusion experts and nursing personnel to maximise benefits from the application of the modern HF therapeutic strategies in evaluation, monitoring and treatment.

Stent infection after drug-eluting stent implantation is uncommon but is a critical event. In this study, we describe two such cases of coronary stent infection but with varied presentation. The first patient presented with recurrent stent thrombosis and acute coronary syndrome while the second patient was erroneously diagnosed as having tubercular pericarditis and was started on anti-tubercular therapy. Due to their possible fatal outcome, we herein report our experience with this uncommon clinical entity to help in rapid diagnosis and treatment. .

Cardiac rhythm abnormalities have been uncommonly observed in dengue fever and most of them have been reported in children. We discuss a 30-year-old female with dengue fever, who presented with repeated symptomatic episodes of high degree atrioventricular block with ventricular asystole, which responded to intravenous atropine and oral orciprenaline without recurrence on 6 months follow-up.