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An 18-year-old girl presented with prolonged febrile illness with dyspnea. She was asymptomatic till an episode of infective endocarditis (IE). Patent ductus arteriosus (PDA) detection at this age is not unusual. IE is a common presentation of undiagnosed PDA in the second decade.

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In the Western world, cases of purulent pericarditis have become almost nonexistent with progress and advent of new immunizations against many causative organisms. We report Klebsiella pneumoniae pericarditis, a rare cause of this uncommon disease, hitherto unreported in Nigeria. K. pneumoniae, which is a rod-shaped, Gram-negative, facultative anaerobe, produces extended-spectrum beta-lactamases; hence, it is usually resistant to a lot of antibiotics and is associated with a significant case fatality rate. Our 13-year-old male patient had septic arthritis of the right hip joint came with a 3 weeks complaint of difficulty with breathing. He had respiratory distress, tachypnea, and tachycardia. Although blood pressure was normal, he had pulsus paradoxus, elevated jugular venous pressure, diffuse apex beat, and heart sounds were distant. Chest radiograph revealed an increased cardiothoracic ratio (0.86) with “water bottle” appearance. Transthoracic echocardiography confirmed pericardial effusion with cardiac tamponade. Echo-guided pericardiocentesis was done, and 340 ml of foul-smelling and creamy pus with greenish tinge was aspirated and this grew K. pneumoniae sensitive to ciprofloxacin and gentamycin but resistant to other conventional antibiotics. Recovery was complete after a week of pericardial tube drainage and 3 weeks of treatment. To the best of our knowledge, this is the first case of Klebsiella - induced pyopericardium and with successful management in a Nigerian child. Pyopericardium may follow rare causes such as K. pneumoniae infection with its unique antibiogram.

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Objective: Cardiovascular disease is the leading cause of death among Indian adults, and approximately 50% of deaths usually occur during the 1^st hour after symptom onset before arriving at the hospital. A study was planned to evaluate the prehospital and hospital delay in patients with acute myocardial infarction (AMI). Methods: This was a prospective observational study of 390 patients with AMI admitted to the Department of Cardiology between March 2014 and August 2015. Detailed patient demographics, socioeconomic status, and prehospital and hospital delay were reviewed. Results: The mean age of presentation for male and female was 57 ± 12.91 and 61.5 ± 12.83 years, respectively. The mean prehospital delay, time to act after chest pain, and travel time were 9.08 ± 6.3, 7.16 ± 6.1, and 1.84 ± 0.8 h, respectively, and only three (9.7%) patients reached the hospital within 2 h after symptom onset. Out of 300 patients who received reperfusion therapy, thrombolysis was done in 276 (92%) patients while primary percutaneous coronary intervention was performed in only 24 (8%) patients. Mean door-to-needle (D-N) time and door-to-device time for those who received reperfusion therapy were 27.8 ± 4.3 and 78.95 ± 9.5 min, respectively. A multivariate logistic regression analysis revealed that the prehospital delay was significantly associated with older age, female sex, rural background, diabetes, having atypical pain, and lack of knowledge regarding the seriousness of chest pain. Conclusion: Approximately 79% of total prehospital delay was due to patient-related factors; old age, female sex, rural background, diabetes, atypical angina, and lack of knowledge being the significant attributes. D-N time and door-to-device time were within the limits of those recommended by current guidelines.

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Objective: Reconstruction of right ventricular outflow tract (RVOT) during repair of Tetralogy of Fallot (TOF) often requires placement of a transannular patch (TAP). The purpose of the present study was to compare the outcomes following reconstruction of RVOT using polytetrafluoroethylene (PTFE) patch versus autologous glutaraldehyde-fixed pericardial patch. Materials and Methods: Fifty-three consecutive patients undergoing TAP repair for TOF in a single institute were randomized into two groups: Group I (pericardial patch), Group II (PTFE patch) and their postoperative outcomes in terms of postoperative rhythm, duration of mechanical ventilation, mediastinal and pleural drainage, stay in the Intensive Care Unit (ICU) and hospital, were assessed. The preoperative and postoperative gradients across the RVOT, pulmonary insufficiency, systolic right ventricular function were assessed echocardiographically by an independent cardiology team. Results: There was one death; there were no differences between the two groups regarding the postoperative duration of mechanical ventilation, ICU, and hospital stay. The requirement of inotropes was less in the PTFE patch group compared to the pericardial patch group (12.80 ± 8.04 vs. 17.30 ± 7.21, median 10 vs. 20, P = 0.025). The re-exploration rate in the PTFE group was higher than the other group (6 vs. 1). There was no difference in the RV systolic function between the two groups as assessed by echocardiogram before discharge. Conclusion: RVOT reconstruction during TOF repair can safely be performed using a PTFE patch with results similar to an autologous patch of glutaraldehyde-treated pericardium. Its results in the mid and long term need further evaluation.

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Alterations of cardiac metabolism occur with ischemia and heart failure (HF). This results in increased utilization of noncarbohydrate substrates for energy production and depletion of myocardial adenosine triphosphate, phosphocreatine, and creatine kinase with decreased efficiency of mechanical work. A direct approach to manipulate cardiac energy metabolism consists in modifying substrate utilization by the failing heart. The results of research suggest that shifting the energy substrate preference away from fatty acid metabolism and toward glucose metabolism could be an effective adjunctive treatment in patients with HF, in terms of left ventricular function and glucose metabolism improvement. In this paper, some of these concepts will be discussed, and the role of drugs such as trimetazidine will be discussed.

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Background: Elevated mean platelet volume (MPV) has been proposed as a risk factor for coronary artery disease (CAD) and is associated with poor clinical outcome in acute coronary syndrome (ACS). However, some studies have contradictory findings. Hence, we aimed to evaluate the association of MPV with the presence of coronary collateral vessel (CCV) in patients with ACS. Objective: To find MPV value in ACS patients and to find the predictive value of MPV in the spectrum of CAD and to examine whether levels of MPV predict the presence of CCVs. Methods: A total of 180 patients with first ACS were included in the study. MPV was measured. All patients underwent coronary angiography to know disease severity and CCVs. The CCVs are graded according to the Rentrop scoring system and according to coronary angiography results; patients were divided into two groups as Group 1 (poor CCV) and Group 2 (good CCV). Results: The MPV was 10.74 ± 2 fl in poor collateral group patients and 11.01 ± 1.7 fl in good collateral group (P = 0.421). The presence of CCV was not significantly associated with high levels of MPV. MPV value did not show any prediction of the spectrum of CAD. Conclusion: MPV on admission was not associated with the development of CCV positively in patients with ACS. Furthermore, it is not associated with a number of vessel involvements.

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Nucleic acid-based tests (NABTs) were developed to decrease the time required to identify microorganism in the pathological specimens. The commercially available NABTs are of two types – one those can be applied to positive cultures grown in blood culture bottles and other those can be applied directly to blood samples. The latter tests are polymerase chain reaction (PCR)-based assays which can amplify the existing load of microorganism nucleic acids many a times like a culture in a blood culture bottle. Both tests then identify the pathogenic organisms with the use of specific nucleic acid probes. These tests have proven useful in management of heart transplant sepsis management.

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Mendelian randomization (MR) is a statistical technique used by genetic epidemiologists to determine causal effects, i.e. whether a biomarker actually influences disease risk, is it just a statistical association. It uses common genetic polymorphisms with known biological effects (propensity to drink alcohol) or effects that mimic modifiable exposures (raised blood cholesterol). For MR, it is necessary that the genotype only affects the disease status indirectly through its effect on the exposure of interest.

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In the latter half of 2016, the Danish study evaluated the need of automatic implantable cardioverter-defibrillator in nonischemic cardiomyopathies group of heart failure population. HOPE-3 in 2016 expanded the dimension of statin use. Novel age, biomarker, and clinical history stroke risk score for atrial fibrillation was validated. Success of Phase 2b clinical trial for CSL112 was one more step to reduce the ischemic events in the postmyocardial infarction period. On the one hand, NORSTENT study compared the bare-metal stents with drug-eluting stent, and on the other hand, 3-year follow-up data of ABSORB II trail discussed the performance of bioresorbable scaffolds. NOBLE and EXCEL trials evaluated the coronary intervention with coronary artery bypass graft in the left main coronary artery disease. Reduction of major adverse cardiac event with low-density lipoprotein cholesterol <50 mg/dl was analyzed with alirocumab. Fractional flow reserve was tested as a tool to decide treatment modality in patients with stable coronary artery disease. Natural history of rheumatic heart disease in the current era was described in REMEDY study. A few technological advancements in cardiac resynchronization therapy defibrillator technology were also approved by the Food and Drug Administration. Birth prevalence and pattern of congenital heart disease in North India were presented.

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