Gopal Chandra Ghosh

Heart Views, Official publication of Gulf Heart Association

A 58-year-old man presented to the chest pain unit with crescendo angina over 24 hours and worsening dyspnoea of 10 hours duration. He was a known diabetic and hypertensive on regular treatment for 10 years and a habitual smoker with over 15 pack-years smoking duration. Examination revealed a profusely diaphoretic and dyspnoeic (respiratory rate of 45/min) individual with a blood pressure of 100/60 mm Hg and heart rate of 124 beats/min. He was hypoxic and his oxygen saturation in the ambient air was 64%. His jugular venous pressure was elevated with a prominent V wave. Cardiovascular examination revealed a harsh grade IV/VI systolic murmur over the lower left parasternal border. There were bilateral extensive crepitations heard over the lung fields. ECG on admission revealed presence of Q wave and ST elevation in leads II and III, aVF with ST depression in I and aVL. X-ray chest showed normal cardiac shadow and features of grade III pulmonary venous hypertension. Transthoracic echocardiography is shown in figure 1. Figure 1 Transthoracic echocardiogram short axis view at mid cavity level, 2D (A) and colour Doppler (B) image. Question: What is the most likely diagnosis? A. Left ventricular (LV) true aneurysm B. LV pseudoaneurysm C. LV pseudo-pseudoaneurysm D. Ventricular septal rupture (VSR) E. LV free wall rupture

Heart Views, Official publication of Gulf Heart Association

Clinical introduction A 14-year-old boy presented with history of decreased appetite and bilateral swelling of feet for 6 months. He did not give any associated history of orthopnoea or paroxysmal nocturnal dyspnoea. He was born by a normal delivery after a non-consanguineous marriage. He had an unremarkable birth and childhood health history. There was no family history of significant cardiovascular illness or sudden death. Clinical examination showed an average built boy with elevated jugular venous pressure with prominent v wave and bilateral pitting pedal oedema. Cardiovascular examination showed normal first (S1) and second (S2) heart sounds and a short early systolic murmur over tricuspid region. Other systems examination was remarkable for soft tender hepatomegaly. ECG showed sinus rhythm with tall, peaked p waves. Chest X-ray revealed enlargement along the right cardiac border. Transthoracic echocardiographic images are shown in figure 1A (apical four-chamber view) and figure 1B (tricuspid inflow Doppler). There was no colour Doppler evidence of interatrial shunt. Question What is the most likely diagnosis of his condition? Endomyocardial fibrosis (EMF) Ebstein’s anomaly Arrhythmogenic right ventricular dysplasia (ARVD) Idiopathic dilatation of right atrium Restrictive cardiomyopathy

A 14 months old girl with history of right sided hemiparesis presented to us with mild cyanosis. The child was born by a non-consanguineous marriage and her infancy was uneventful. Cardiovascular examination was unremarkable. Oxygen saturation was 78–80% in room air.