a b s t r a c tBacterial endocarditis gives rise to a variety of complications due to local tissue damage, immunological phenomena, and embolic phenomena. Only a small number of cases of coronary embolization have been reported in infective endocarditis patients. This is a case of subacute bacterial endocarditis in a postpartum mother complicated by fatal left and right coronary artery embolization. A 32-year-old postpartum mother with a history of rheumatic heart disease presented with a history of fever, shortness of breath, and bilateral ankle edema for 1-week duration. On admission, the patient was alert, febrile with a pulse rate of 90 beats/min, blood pressure 105/70 mmHg, and her lungs were clear. Transthoracic echocardiography revealed vegetations attached to both mitral and aortic valves. She was started on intravenous antibiotics. Her fever was settled and during the following 2 weeks she was clinically improving with settling inflammatory markers. On the 20th day of the illness, the patient developed sudden onset of chest pain, dyspnea with sinus bradycardia, and later developed pulseless electric activity. She expired despite intense cardiopulmonary resuscitation. Postmortem revealed multiple vegetations in both mitral and aortic valves and complete occlusion of both left and right coronary ostia by embolized vegetative materials.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with ‘traditional’ chronic kidney disease (CKD). However, chronic kidney disease of uncertain aetiology (CKDu), a tubular interstitial nephropathy is typically minimally proteinuric without high rates of associated hypertension or vascular disease and it is unknown if the rates of CVD are similar. This study aimed to identify the prevalence and the risk of CVD in patients with CKDu. This cross-sectional study included patients with confirmed CKDu who were attending two renal clinics in CKDu endemic-area. A detailed medical history, blood pressure, electrocardiogram (resting and six minutes vigorous walking), echocardiograms, appropriate laboratory parameters and medical record reviews were used to collect data at baseline. The WHO/Pan American Health Organization, cardiovascular risk calculator was employed to determine the future risk of CVD. The clinics had recorded 132 number of patients with CKDu, of these 119 consented to participation in the study. The mean age was 52 (± 9.5) years and mean eGFR was 51.1 (± 27.61); a majority (81.5% (n = 97)) were males. Thirty-four patients (28.6%) had evidence of ischaemic heart disease (IHD). Troponin-I (p = 0.02), Age >50 years (p = 0.01) and hyperuricemia (p = 0.01) were significantly associated with IHD in CKDu. Left ventricular hypertrophy was reported in 20.2% (n = 24). According to the risk calculator, 97% of the enrolled patients were at low risk (<10%) for experiencing a cardiovascular event within the next 10 years. Patients with CKDu have low prevalence and risk for CVD, implying that a majority are likely to survive to reach end-stage kidney disease. Our findings highlight the need for developing strategies to minimize the progression of CKDu to end-stage renal disease.

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Acute Left Main Coronary Artery (LMCA) occlusion is a rare clinical presentation which often manifests as a cardiogenic shock with worse prognosis. However the clinical outcome depends on the age of the patient, co-morbidities and the patency and dominancy of Right coronary artery. Since it supplies a large myocardial territory of left ventricle, it shows a characteristic Electrocardiographic (ECG) pattern which helps to an early diagnosis. Presence of ST elevation in aVR with ST depression of more than six leads is highly characteristic for LMCA occlusion. Here we are reporting an extremely rare case of acute concomitant occlusion of LMCA and Right coronary artery manifesting as a cardiogenic shock with ST elevation in aVR, ii, iii leads with ST depression in all other leads. Patient showed excellent clinical outcome and reversal of characteristic ECG pattern following Percutaneous Coronary Intervention (PCI) to the culprit vessels.