Case Report On: Complete Heart Block

When the electrical signal normally does not travel from the atria, the upper chambers of the heart, to the ventricles, or lower chambers, full heart block occurs. During surgery, the atrio ventricular (AV) node is weakened and complete heart block can result. Often, complete heart block occurs naturally without surgery [1]. Patient History: Heart block is an irregular heart rhythm where the heart (bradycardia) beats too slowly. In this condition, between the upper chamber (atria) and the lower chamber (ventricles), the electrical signals that tell the heart to contract are partially or completely blocked. Present history- The patient 71-year old male who was admitted to hospital on date 25/11/2019 with the chief complaint was severe chest pain, breathlessness, excessive palpitation, vertigo, and sweating since in 4 months. Conclusion: The patient was admitted in the hospital with the chief complaint of severe chest pain, breathlessness, excessive palpitation, vertigo and sweating since 4 months and his condition was very critical and the patient was admitted in AVBR Hospital and immediate treatment was started.

Rare Case of Dual Right Coronary Artery Intervention Presenting as Acute Coronary Syndrome

Dual right coronary artery (RCA) is a very rare coronary anomaly. This anomaly is often undetected and may be totally asymptomatic to presenting as acute coronary syndrome. Here , we present a young diabetic male who presented with acute onset severe chest pain of 30 minutes duration which was managed as acute coronary syndrome ( NSTE-ACS). His urgent coronary angiogram revealed single ostial origin of right coronary artery (RCA) with total occlusion from proximal segment followed by double right coronary arteries with their respective distal branches.

Radial Extracorporeal Shock Wave Therapy to Support Breathing in Case of Coronavirus Disease 2019 (COVID-19): A Case Report

Many patients with Coronavirus disease 2019 (COVID-19) suffer from shortness of breath and severe chest pain. Here we report successful therapy of a patient with diagnosis of COVID-19, severe chest pain and significant shortness of breath, using radial extracorporeal shock wave therapy (rESWT). The latter started seven days after beginning of symptoms and drug therapy without success, and involved daily application of 15.000 to 20.000 radial extracorporeal shock waves over the intercostal muscles as well as the paravertebral muscles of the thoracic and lumbar spine, diaphragm and flanks. Immediately after the first rESWT session the patient experienced significant pain relief and improvement of breathing. Four days later the pain had completely subsided and breathing was largely normalized. This type of noninvasive, non-pharmacologic treatment could help many COVID-19 patients or patients who still suffer from breathing problems weeks after having been infected with SARS-CoV-2, giving them back quality of life.

Surgery is an option in evolving myocardial infarction induced by spontaneous coronary artery dissection: a case report

Background Spontaneous coronary artery dissection (SCAD) has emerged as one of the important yet rare causes of acute coronary syndrome that primarily affect young peripartum women without cardiovascular risk factors. Despite the recent improvements in diagnosis and recognition of the importance of SCAD, it remains poorly studied and there has been no consensus of opinion regarding its optimal management. Case summary A 29-year-old breastfeeding woman presented with 1-day history of severe chest pain radiating to the jaw and both shoulders. Cardiovascular examination, 12 leads electrocardiogram, and echocardiography were normal. Troponin levels were elevated; hence, coronary angiogram was done and showed type 2 SCAD of the left anterior descending artery (LAD). The patient was managed conservatively. The next day, she started again to complain of severe chest pain and her troponin levels continued to rise. Repeated coronary angiogram revealed progression of the previous LAD dissection. Another dissection was also noticed in the left circumflex artery. Chest pain recurred over the night and her troponin levels continued to rise. An emergency coronary artery bypass grafting (CABG) was performed. The patient was doing well postoperatively and was discharged home on Day 8. Discussion Our patient presented with acute ischaemic changes secondary to SCAD. The report illustrates the risk factors, pathogenesis, diagnostic work up, and the possible therapeutic options of SCAD, which include conservative management and CABG. The management varies depending on the clinical presentation and the extent of the coronary artery dissection.

Boerhaave syndrome due to excessive alcohol consumption: two case reports

Background Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure owing to forceful vomiting. Patients with Boerhaave syndrome often present with chest pain, dyspnea, and shock. We report on two patients of Boerhaave syndrome with different severities that was triggered by excessive alcohol consumption and was diagnosed immediately in the emergency room. Case presentation The patient in case 1 complained of severe chest pain and nausea and vomited on arrival at the hospital. He was subsequently diagnosed with Boerhaave syndrome coupled with mediastinitis using computed tomography (CT) and esophagogram. An emergency operation was successfully performed, in which a 3-cm tear was found on the left posterior wall of the distal esophagus. The patient subsequently had anastomotic leakage but was discharged 41 days later. The patient in case 2 complained of severe chest pain, nausea, vomiting, and hematemesis on arrival. He was suggested of having Boerhaave syndrome without mediastinitis on CT. The symptoms gradually disappeared after conservative treatment. Upper gastrointestinal endoscopy performed on the ninth day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the patient in case 2 was initially considered to have Mallory–Weiss syndrome. Conclusion Owing to similar histories and symptoms, Boerhaave syndrome and Mallory–Weiss syndrome must be accurately distinguished by emergency clinicians. CT can be a useful modality to detect any severity of Boerhaave syndrome and also offers the possibility to distinguish Boerhaave syndrome from Mallory–Weiss syndrome.

Boerhaave Syndrome Due to Excessive Alcohol Consumption: Two Case Reports

Background: Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure owing to forceful vomiting. Patients with Boerhaave syndrome often present with chest pain, dyspnea, and shock. We report on two patients of Boerhaave syndrome with different severities that was triggered by excessive alcohol consumption and was diagnosed immediately in the emergency room.Case presentation: The patient in case 1 complained of severe chest pain and nausea and vomited on arrival at the hospital. He was subsequently diagnosed with Boerhaave syndrome coupled with mediastinitis using computed tomography (CT) and esophagogram. An emergency operation was successfully performed, in which a 3-cm tear was found on the left-posterior wall of the distal esophagus. The patient subsequently had anastomotic leakage but was discharged 41 days later. The patient in case 2 complained of severe chest pain, nausea, vomiting, and hematemesis on arrival. He was suggested of having Boerhaave syndrome without mediastinitis on CT. The symptoms gradually disappeared after conservative treatment. Upper gastrointestinal endoscopy performed on the ninth day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the patient in case 2 was initially considered to have Mallory–Weiss syndrome.Conclusion: Owing to similar histories and symptoms, Boerhaave syndrome and Mallory–Weiss syndrome must be accurately distinguished by emergency clinicians. CT can be a useful modality to detect any severity of Boerhaave syndrome and also offers the possibility to distinguish Boerhaave syndrome from Mallory–Weiss syndrome.