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An asymptomatic woman aged 24 years was informed about the presence of a heart murmur by her attending obstetrician while she was hospitalised for a spontaneous abortion 6 months ago and was subsequently referred to us to rule out underlying heart disease. After clinical examination and relevant laboratory evaluation, a diagnosis of severe valvular pulmonary stenosis (PS) was established. Interestingly, our patient had undergone an open thoracotomy for surgical closure of a patent ductus arteriosus (PDA) under general anaesthesia 12 years ago in the absence of any appreciable shunt across the ligated ductus at present. Considering the severe gradient across her pulmonary valve, she underwent a successful percutaneous balloon pulmonary valvuloplasty (PBPV) procedure with excellent haemodynamic outcome. The pertinent literature concerning the rare combination of PDA in association with PS as well as the technicalities of PBPV procedure in an adult are discussed.

Background: Admissions for acute myocardial infarction (MI) have declined significantly during the COVID-19 pandemic. The changes in the presentation, management, and outcomes of MI during the pandemic period are not well recognized, and data from low- and middle-income countries are limited. Methods: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with MI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We sought to determine the changes in the number of admissions, management practices, and outcomes. Findings: We included 41,832 consecutive adults with MI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India with the North zone reporting greater decline (-44·8%) than the South zone (-27·7%). The weekly average decrease in MI admissions in 2020 which peaked around the mid- study period, correlated negatively with the number of COVID cases (r = -0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume, and teaching programs. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. However, the in-hospital mortality rates did not differ. Interpretation: The magnitude of reduction in MI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing MI admissions during the pandemic. Funding Statement: The study is funded by cardiological society of India. Declaration of Interests: Nothing to declare for all the authors. Ethics Approval Statement: Individual participating centres either obtained an ethical approval from respective Institutional ethics committees or a no objection certificate from the administration.

AIMS: To study the genetic association of cardiac conduction defects (CCD) by evaluating Single nucleotide polymorphism(SNP) in genes of SCN1B and KCNJ2 and to evaluate baseline characteristics between cases and controls. METHODS AND RESULTS: Case group consisted of 81 individuals with diagnosis of conduction disturbances who underwent permanent pacemaker implantation. . The control group consisted of 79 unrelated individuals above 18 years of age of the local population not having a present or past personal or family history (first degree relatives) of any cardiac ailment especially cardiac conduction defects. Isolation of genomic Deoxyribonucleic acid(DNA) from all samples was done, Genomic DNA was checked to ensure the presence of intact DNA . SCN1B : SNP rs55742440 have no bearing on the protein except in producing a splice variant . SNP rs67701503 does not lie in the splice site region, not having any significance in the regulation of the gene as well. NetGene2 analysis of SNP rs67486287 negates its presence in the splice site. KCNJ2 :SNP rs199473653 is leading to a missense amino acid change resulting in homozygous GG variant found in almost equal frequency in both groups. SNP rs199473653 gene has not been reported as a disease-causing mutation. CONCLUSION:The alteration of nucleotide in SCN1B intron (SNP rs55742440, rs67701503, rs 67486287) between cases and controls was found to have no odds of affecting the outcome of CCD. There was no variation or alteration in nucleotide bases of KCNJ2 (SNP rs786205813, rs199473653) between the groups.

Background: Coronary artery disease (CAD) is the biggest killerof women globally.CAD among young women as a group is less easily recognized worldwide. Young women are underrepresented in most of theCAD studies. This study assessed Clinical and angiographic profile of CAD in young women of North-East India to have a better understanding of the nature and courseof the disease. Material and Methods:This was a prospective, observational, single centre analytical study. Totalparticipants were divided into 2 groups – young women less than 55 years and old women more than or equal to 55 years.Modes ofpresentation,riskfactors,clinicalandangiographicprofileofCADwere compared. Risk factors studied were smoking, hypertension, diabetes mellitus,dyslipidaemia, obesity and family history of prematureCAD.CADseveritywas assessedby SyntaxscoreandGensiniscore. Results: A total of 143women were studied. Out of these 57 women were Conclusion:In younger women, most of the patients presented withchronic stable angina and STEMI with a preceding history of angina. Hypertension and diabetes were most common risk factors both being modifiable needsutmost attention for prevention. Coronary angiography revealedless severe CAD in younger women than older women as assessed by coronary severity score. &nbsp

Background COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. Methods In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. Conclusions This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

A 32-year-old primigravida at a 38-week gestation was initially admitted in cardiology isolation ward on referral by her local obstetrician for inferolateral ST-segment elevation on ECG ([figure 1A][1]) which was obtained for complaints of New York Heart Association functional class II symptoms with

A 50-year-old woman with no cardiovascular risk factors was evaluated for easy fatigability and progressive dyspnoea on exertion for the last 1 year. Cardiac auscultation revealed a normal first heart sound, an ejection systolic murmur at the upper left sternal border and wide and fixed splitting of the second heart sound. The ECG demonstrated sinus rhythm, incomplete right bundle branch block (RBBB) and ‘crochetage’ sign (notch near the apex of the R wave) in inferior limb leads (figure 1). There was evidence of cardiomegaly, dilated main pulmonary artery …

Insulation break in a permanent pacemaker lead is a rare long-term complication. We describe an elderly male with a VVIR pacemaker, who presented with an episode of presyncope more than 3 years after the initial implantation procedure, attributed to insulation break possibly caused by lead entrapment in components of the medial subclavicular musculotendinous complex (MSMC) and repeated compressive damage over time during ipsilateral arm movement requiring lead replacement. The differential diagnosis of a clinical presentation when pacing stimuli are present with failure to capture and the role of the MSMC in causing lead damage late after implantation are discussed.

A male patient in his early 20s with recent onset of crescendo angina was referred for coronary angiography (CAG) in view of his young age and significant symptoms. His risk factors included tobacco use and dyslipidaemia (total cholesterol 240 mg/dL, low-density lipoprotein (LDL) 170 mg/dL, high-density lipoprotein (HDL) 32 mg/dL and triglyceride 190 mg/dL). He was non-diabetic with normal fasting blood sugar and glycosylated haemoglobin levels, and family history of premature coronary artery disease (CAD) was negative. General, physical and cardiovascular examinations, resting ECG and two-dimensional echocardiogram were normal. CAG revealed 80–90% left main (LM) stem stenosis (figure 1). Left anterior descending, circumflex and right coronary artery were normal with right dominant system (figure 2). During contrast injection, the patient experienced an episode of chest pain which responded …

A 32-year-old male patient presented with sudden onset of altered sensorium and vomiting preceded by respiratory distress of 5 h duration. On general physical examination his pulse rate was 40/min, blood pressure 140/60 mm Hg and prominent cannon ‘a’ wave in jugular venous pressure (JVP). Cardiovascular examination revealed an apex beat located in the left fifth intercostal space (ICS) inside the mid-clavicular line, palpable second sound (A2) in the second left ICS, variable S1, single and accentuated S2 (A2) and a grade 3/6 pan systolic murmur in the apical area. His ECG showed a complete heart block (CHB) with a ventricular rate of 40/min (figure 1). An emergency temporary pacemaker was implanted via the right transfemoral route in view of symptomatic CHB (figure 2). Figure 1 ECG showing a complete heart block; note the prominent Q waves present in the right precordial leads and absent in the left. Figure 2 ECG after temporary pacemaker implantation showing a ventricular paced rhythm. Clinical, ECG and two-dimensional transthoracic echocardiographic findings (figure 3) were consistent with a diagnosis of isolated congenitally corrected transposition of the great arteries (cc-TGA). A transvenous dual-chamber permanent pacemaker (Medtronic Relia …