We report a rare case of anomalous origin of right coronary artery (RCA) from the left coronary sinus with a peculiar medusa head pattern of left coronary system in an octogenarian presenting with inferior wall myocardial infarction. Although anomalous origin of RCA from the left coronary sinus is the most common anomaly to be reported, this rare association of extensive arborization of left coronary system appearing like a medusa head is not reported in literature so far. The anomalous RCA harbored critical mid-RCA lesion, but the crux of coronary intervention was that we engaged the anomalous RCA with extra back up guide catheter in place of conventionally used Judkins right guide catheter to engage the anomalous origin and accomplished the coronary intervention with buddy wire technique. Our case is unique and the first to describe the association of medusa head appearance of left coronary circulation in a case of anomalous origin of RCA from the left coronary sinus.

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Background: Coronavirus disease of 2019 (COVID-19) is a respiratory disease which can lead to cardiovascular complications including myocarditis, myocardial infarction, and heart failure. Electrocardiogram (ECG) may change in patients with COVID-19 with or without heart involvement. In this study, the ECG changes were evaluated in myocardial injuries due to COVID-19. Methods: This study was done on 22 COVID-19 patients with ST segment elevation in ECG and high troponin level. COVID-19 was confirmed using reverse-transcription polymerase chain reaction test. The ECG variables were evaluated by an expert cardiologist. Statistical analyses were carried out on ECG variables where the significance level of 0.05 was assigned. Results: Of 22 patients, 17 cases (77.3%) were male and 6 cases (27.3%) had a history of coronary artery disease. The most common myocardial involvement was extensive anterior type (31.8%), followed by anterior type (22.7%). Sinus rhythm was observed in 95.5% of patients and 54.5% had low voltage ECG in limb leads. No significant correlation was found between low voltage ECG and demonstrable etiologies of low voltage. Conclusion: The prevalence of low voltage ECG was significantly high in limb leads of patients with myocardial injury due to COVID-19 which was considerably greater than that of myocarditis or myocardial infarction patients.

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Pericardial effusion is usually caused by infection, fluid overload states, connective tissue disorders, heart surgery, aortic dissection, and malignancy. When a patient presents with recurrent isolated pericardial effusion accompanied by a nonspecific history and negative laboratory tests, it can pose a diagnostic dilemma to the clinician. Primary malignant tumors of the pericardium are sporadic, and most primary malignant pericardial tumors are mesotheliomas. We report the case of a young adult male with recurrent pericardial effusion and no specific clinical clues enabling an early diagnosis, which later turned out to be caused by a primary angiosarcoma of the pericardium.

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We present a simple novel technique of crossing the calcium spur at right-angle bend in coronary artery by deploying a noninflated balloon over the calcium spur where the tip of the passing stent frequently hits and create difficulty in negotiation of the stent forward. When we deploy a balloon over the calcium spur, the tip of the stent does not hit the edge of the calcium spur and the stent gently slides over the hydrophilic slippery balloon forward with ease. We describe a rare case of intervention in anomalous anterior origin of right coronary artery where we were not able to pass the stent across two 90° bends which were harboring calcium spur. In spite of we adopted buddy wire and triple wire technique to make the bend straight, we were not able to move the stent forward, each time it was hitting at the edge of the calcium spur. We put a 2 mm × 10 mm noninflated semicompliant balloon each time while crossing the right-angle bend with calcium spur which covered the calcium spur and over the balloon we were easily able to slide the stent forward, deployed the stent across the lesion, and achieved distal TIMI III flow. We describe this simple novel technique of “sliding the stent over the balloon technique” to cross the calcium spur remaining at 90°-angle bend causing difficulty in forward negotiation of the stent.

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Background: Atherogenic index of plasma (AIP), a logarithm of ratio of triglycerides and high-density lipoprotein-cholesterol is associated with the risk of cardiovascular diseases. The cardiovascular complication in Type 2 diabetes is often assessed by the left ventricular ejection fraction (LVEF). Aim: This study aimed to observe and to find any correlation between LVEF and AIP in newly diagnosed Type 2 diabetes mellitus patients. Materials and Methods: In this cross-sectional observational study, we recruited 140 (male 81, female 59) newly diagnosed Type 2 diabetes mellitus patients from a tertiary care hospital. Plasma lipids were measured from venous blood after 12-h fasting. The LVEF was measured by echocardiography. Data were presented as mean, standard deviation, and statistically tested by Chi-square and Pearson correlation coefficient in IBM SPSS Statistics 20. Results: The mean age of the participants was 53.95 ± 11.63 years (male 53.85 ± 11.12 years, female 54.08 ± 12.39 years, unpaired t-test P = 0.91). The mean LVEF was 0.59 ± 0.06 and 0.6 ± 0.05 (unpaired t-test P = 0.17) in males and females, respectively. The AIP was 0.57 ± 0.07 and 0.57 ± 0.07 (unpaired t-test P = 0.97) in males and females, respectively. There was a negative correlation (r = −0.56, P < 0.001) between LVEF and AIP. Conclusion: Newly diagnosed type 2 diabetes mellitus patients showed a high AIP. Hence, serum lipid profile may be tested early in these patients. Patients with a higher AIP may have lower LVEF. Hence, diabetic patients with a high AIP may be screened for LVEF periodically for early detection and management of heart failure.

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Background: Patients' hesitation to seek medical care has seriously compromised the management of acute coronary syndrome during coronavirus disease 2019 (COVID-19) outbreak. In the present study, we have reported the rate of discharged against medical advice (DAMA) among patients referred to chest pain unit (CPU) of a tertiary cardiovascular center and compared their clinical outcomes with whom admitted or managed conservatively. Methods: Patients with modified HEART risk score ≥4 referred to the CPU were included in the present study. Population requiring CPU admission due to positive serial troponin were divided into admitted and DAMA groups. Patients with negative serial troponin were managed as outpatient (conservative treatment group). 30-day major adverse cardiac events (MACE) and all-cause mortality were compared between the study groups. Results: A modified HEART risk score (≥4) was calculated for 440 of 5490 patients visited our CPU. One hundred and one (22.9%), 80 (18.1%), and 249 (56.5%) patients were categorized as DAMA, admitted, and conservative treatment groups, respectively. Myocardial infarction was significantly higher in the DAMA versus admitted group (2 vs. 0; P ≤ 0.001). MACE and all-cause mortality were significantly higher in the DAMA group than that in the conservative treatment group (5 vs. 2; P = 0.02 and 4 vs. 2; P = 0.055, respectively). Conclusion: In the present study, we have demonstrated a considerable rate of DAMA in patients with high modified HEART risk score referring to CPU during the COVID-19 outbreak. Importantly, the DAMA group experienced a higher incidence rate of 30-day MACE and all-cause mortality compared to patients who were admitted or managed conservatively.

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