A game of Whack-A-Mole: closing multiple ventricular septal defects

Multiple ventricular septal defects (m-VSD), are a challenging clinical problem. m-VSD can be onerous to manage. Besides the inability to close all the defects in one operative setting due to inadequate visualization, previously undetected defects may become clinically apparent after the closure of the dominant defects, leading to inadequate ventricular septation. This increases the morbidity from the progression of pulmonary hypertension, persistence of congestive cardiac failure, higher incidence of postoperative heart block, and the need for reoperations.

Congestive Cardiac Failure: A Case Report

Introduction: Congestive Cardiac Failure (CCF) is an anomalous clinical condition involving insufficient heart pumping and filling. Cardiac failure causes the heart to be unable to provide enough blood to meet the tissue's oxygen needs. Heart disease is the most common explanation why older people are admitted to hospitals or are in need of palliation. This puts a huge economic strain on the health care system. The dynamic, progressive nature of heart failure also leads to poor results, with hospital readmissions being the costliest. About half of those patient die within 5 years after diagnosis. Case presentation [1]: A male patient of 62years from Aarvi Naka was admitted to Medicine Intensive Care Unit (MICU), AVBRH on 11th January 2020 with a known case of Ischemic Cardiomyopathy which was diagnosed itself at AVBRH on 22nd October 2018 and a known case of diabetes and hypertension for 10 years. My patient was brought to AVBRH Emergency Unit on 11th January 2020 with a chief complaint of breathlessness for 2 days, sweating over both feet for 5 days and generalized weakness for 2 weeks. He was having difficulty in breathing for about 2 days which eventually become severe on 11th January 2020 evening and was brought immediately to AVBRH and got admitted on the same day. The patient was delirious and vomit two times on admission.

Acute kidney injury with cardiorenal syndrome; experience from a tertiary care renal unit in Pakistan

Introduction: Acute kidney injury (AKI) is a commonly recognized clinical problem after many morbid conditions related to heart like congenital heart disease surgery, acute or chronic congestive heart failure, acute myocardial infarction, infective endocarditis or cardiomyopathies. Cardio-renal syndrome (CRS) includes a spectrum of disorders involving both the heart and kidneys simultaneously; here acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other. Objectives: To report here, case series of patients with AKI developing in association with CRS. We aim to report different causes of CRS and outcome of patients in this group of patients. Patients and Methods: Subjects for the study reported here comprised a cohort of 34 patients coming to this institution with AKI in association of CRS. AKI was defined according to KDIGO guidelines and CRS based on consensus conference of ADQI in 2012. Type 1or type2 CRS are included in the study. All patients had normal size kidneys on ultrasonography. Results: Thirty-four patients with AKI and CRS were brought to this institute from January 1990 to December 2014; this was contributing 1% to medical causes of total AKI. Among these 25 were males and 9 females; mean age of these patients was 54.06±14.106 years. Causes of CRS were acute myocardial infarction (ST elevated), congestive cardiac failure, infective endocarditis and dilated cardiomyopathy. More than two third of patients were either oliguric or anuric on presentation. Fluid replacement and/or inotropic support required in 79%. Renal replacement therapy in form of hemodialysis was conducted in 64.7% and intermittent peritoneal dialysis in one patient. Complete renal recovery was observed in 19 (56%) patients, while 12 (35%) died during acute phase of illness. CKD-V developed in one patient, 2 patients lost long term follow up, but became dialysis free and renal functions were in improving trends, they were labeled as partial recovery. Secondary insults like hypotension, aggressive diuresis, and volume loss from gastro-intestinal tract or infection were evaluated for any co-relation with outcome but statistically no significant difference was found. Conclusion: CRS can be severe life-threatening condition especially when patients present with circulatory collapse. Diuretics must be used cautiously in patients with congestive cardiac failure. Infective endocarditis with acute right heart failure can lead to CRS.

Children with Myocarditis: Clinical Profile and Electrocardiographic Changes and Their Prognostic Significance: A Prospective Observational Study

Aims and Objective: To study the clinical profile and electrocardiographic changes in children with myocarditis and their prognostic significance. Methods: 223 children presented with signs and symptoms of myocarditis from June 2016 to May 2017. Amongst them, 21 children with congenital heart disease or rheumatic heart disease and 166 children with negative cardiac markers were excluded. The remaining 36 patients with myocarditis and elevated levels of both SGOT and CKMB were studied. The patient outcome was recorded as expired or discharged. Data were analyzed using the chi-square test. Results: Majority (13; 36%) were infants. Post infancy, there was a uniform age distribution of cases. Myocarditis was commonly seen in association with culture-negative (probably viral) pneumonia, and diphtheria. Bradycardia and A-V block, although seen less frequently, were having a significant association with mortality. Congestive cardiac failure (28.6%) and cardiomegaly (25.0%) were not significantly associated with mortality. ECG changes like Sinus tachycardia and T wave inversion (most common) and ST elevation, Q waves and low amplitude (less common) were insignificantly associated with mortality. Conclusion: In children, myocarditis should be suspected especially in infants with unexplained breathlessness or fatigue, arrhythmia, or signs of acute cardiac decompensation. It was seen more with bacterial-culture-negative (viral) pneumonia and diphtheria. Continuous ECG monitoring and chest X-ray should be done. Congestive cardiac failure and cardiomegaly, though observed in a quarter of patients were not significantly associated with mortality. Bradycardia and A-V block have a poor prognosis and cardiac pacing should be considered. Echocardiography should be available in-house.