Journal of Cardiovascular Medicine and Surgery

 We present a case of 62 year old male presenting with effort dyspnea NYHA class II with evidence of inferior ischaemia in EKG. Being a nonharbor of conventional coronary risk factors and as the patient was unable to perform TMT in view of disabling osteoarthritis, we subjected the patient to conventional invasive coronary angiogram which revealed an empty right coronary sinus with anomalous origin from right coronary artery (RCA) from left coronary sinus with interarterial course (between aorta and pulmonary artery) delineated in 256 slice CT coronary angiogram. Being notorious to develop syncope, artherothrombosis, torsades de pointes and sudden cardiac death in its natural course, this anomaly presented with a more benign way in present case. A vigilant look should be there to left sinus when someone encounters an empty right sinus during routine coronary angiography and CT coronary angiogram must be taken to delineate its anatomic route that dictates its natural history.

Keywords: Coronary; Syncope; Interarterial.

 We report a rare case of Type IV dual left anterior descending artery (LAD) in 65 year old male nondiabetic, nonhypertensive and nonsmoker, with effort dyspnea NYHA class II presenting to OPD of Dept of Cardiology, AIIMS, Bhubaneswar for presurgical evaluation. Dual left anterior descending artery constitutes 1% of all abnormal coronary artery morphogenesis described by Morettin [1] and Spindola-Franco et.al [2]. Ours case which is one of the six variants of Dual LAD i.e. Type IV was first described in 1939 by Waterson et.al [3]in Sir James Mackenzie who had this type of distribution. Concept of this rare anomaly should be there in the mind of interventional cardiologists and cardiac surgeons when this anomaly develops artherothrombosis and limiting angina and needs a balloon or graft landing. Single LAD usually supplies 54% of the ventricular myocardium in normal persons but in this rare anomaly the same job is carried out by two LADs.

Keywords: Dual; Coronary; Angiogram.

 Thrombus formation post Blalock-Taussig shunt and Fontan surgery is well known. Thrombus formation following Glenn surgery has only limited case reports. Early detection and treatment of thrombosis is important as it may lead to neurological complications, may render patient unfit for completion Fontan surgery and can even lead to mortality. We report a rare case of post Glenn procedure in a patient with double outlet right ventricle with ventricular septal defect, who developed recurrent thrombi in both right and left pulmonary arteries.

Keywords: Bidirectional Glenn; Thrombosis.

 We present a 15 year old boy presenting to the Department of Cardiology with complain of tuberous eruptions over knees and elbows not responding to the antilipidemic drugs. He has lost his elder brother at 10 years of age secondary to sudden cardiac death. Father was quite apprehensive to save his single child surviving. Child was nonobese, nondiabetic, nonhypertensive and belonged to low socioeconomic status. Lipid panel showed total cholesterol being 467mg/dl with LDL as 298 mg/dl with normal HDL and TG level. Patient was on highest dose of statin with life style modification but lipid panel were not in the way to regress, we thought to put the patient on PCSK 9 inhibitor which was ultimately available with much difficulty, to get some improvement. FH was a foe before the era of new antilipidemic drugs but it is a friend now with new therapeutic strategies.

Keywords: Familial Hypercholesterolemia; PCSK 9 inhibitor; LDL; HDL.

 Aquatic Physiotherapy is physiotherapy practised in warm water and can help relieve aches and pains, mobilise stiff joints and strengthen weak muscles. The water in the pool is approximately 340 C, allowing your muscles to relax and easing the pain in your joints. The buoyancy of the water unloads the weight of the body, reducing stress on joints and allowing freedom of movement. Aquatic Physiotherapy can accelerate healing and provides a general sense of well-being. The underwater treadmill mightbe useful for rehabilitation of horses because such exercise increased the overall range of motion of joints of the distal aspects of the limbs. Water depth also affects the amount of flexion and extension of various joints differently. 

Keywords: Equine Hydrotherapy; Underwater Treadmill