Clopidogrel is an analogue of ticlopidine, used for reduction of atherosclerotic events in patients with acute coronary syndrome (ACS), stroke, peripheral arterial disease and for elective percutaneous coronary intervention (PCI). It selectively and irreversibly blocks ADP binding to platelets. Its primary side effect is bleeding. However potentially fatal types of haematological dyscrasia such as aplastic anaemia, neutropenia, thrombocytopenia, pancytopenia may be associated with clopidogrel therapy. A 50 years old diabetic, hypertensive lady with angina was started to treat with clopidogrel along with other anti-ischaemic and anti-hypertensive drugs. Subsequently the patient developed leucopenia and thrombocytopenia after starting of clopidogrel. Five days later her complete blood count returned to normal after withdrawal of both anti platelets. Aspirin was re-introduced with great precaution. Later repeat leucocyte and platelet count were found to be normal. At follow-up 1 month after discharge patient found asymptomatic with normal blood count. To the best of our knowledge, clopidogrel induced haematological dyscrasia was not reported earlier in our country.

DOI: http://dx.doi.org/10.3329/cardio.v1i1.8212Cardiovasc. j. 2008; 1(1) : 97-104

A middle aged man was admitted into National Institute of Cardiovascular Diseases with the complaints of intermittent syncopal attack, dyspnoea, low grade fever and headache. After admission, he was diagnosed as a of case right atrial (RA) myxoma by echocardiography. With all preoperative preparation, he was undergone surgery under general anesthesia with cardiopulmonary bypass (CPB). About 9cm x 7cm myxoma was removed and severe tricuspid regurgitation (TR) was found by regurge test. De Vega annuloplasty of the tricuspid annulus was done. Recovery of the patient was satisfactory with disappearance of all symptoms. DOI: 10.3329/jbcps.v27i1.4245 J Bangladesh Coll Phys Surg 2009; 27: 52-55

Introduction:Congenital complete atrioventricular block (CCAVB) is a relatively rare and potentially serious problem in pregnancy. 1 There have been relatively few reports of complete heart block in pregnancy. Obstetric experience in women who had pacemakers implanted before conception has been reported, 2 but there is a paucity of information on the management of complete heart block detected for the first time during pregnancy or labour. The patients of CCAVB with pregnancy create a special category because of the inherent risk associated with stress of normal vaginal delivery or cesarean section. Labour in these patients may be complicated by syncope and convulsions caused by slowing of the heart rate during the Valsalva maneuver exercised at the time of forceful contractions of the second stage of labour. 3 Moreover a pregnant woman cannot readily undergo permanent pacemaker implantation because of the radiation hazard involved with fluoroscopic procedure. We are reporting a case of CCAVB with full term pregnancy that has been managed by the coordinated action of cardiologist and obstetrician of two separate hospitals. Case Report:A 19-year-old lady (Fig.1), hailing from Madaripur, presented with complaints of occasional palpitation and full term pregnancy. She had a history of sudden fall on the ground 4 years back at school. She also experienced a syncopal attack 3 years ago while taking bath in a pond. Her antenatal period was uneventful. An ECG was done as part of her pre-operative assessment (for cesarean section) and it showed complete heart block with ventricular rate 43 beats/ min. (Fig.2). The patient did not have history of taking any beta-blocker, calcium-channel blocker or digitalis. She was referred to National Institute of Cardiovascular Diseases (NICVD). On examination her pulse rate was 38 beats/ minute, regular and blood pressure was 110/60mm Hg. Mild pallor was present. Otherwise her general, physical and cardiovascular examinations were unremarkable. On abdominal examination, there was a single foetus in cephalic presentation and uterine height corresponded to 36 weeks of gestation. There were mild uterine contractions

Increasing burden of cardiovascular disease risk factors has led to increase in the incidence in the coronary artery disease (CAD). Advancements in medical and surgical care of patients with heart disease have led to a large number of people surviving acute coronary events. Patients with acute coronary syndrome (ACS) are at high risk for recurrent coronary events, sudden death, and all cause mortality. Conventional revascularization therapies reduce the risk of further ischaemia but do not affect the underlying atherosclerotic disease. Statins have a proven record in the secondary prevention of coronary heart disease. Furthermore, statins have been shown to exert various pleotropic effects, which may stabilize vulnerable atherosclerotic plaques. Therefore, initiating, statin therapy in patients with established CAD is both beneficial and more cost effective. Trials conducted in recent times have addressed the issue of whether higher dose statin therapy provides further reductions in the risks of cardiovascular events following an acute coronary syndrome diagnosis, over and above that provided by a conventional dose statin regimen. However, recent trials of high dose statin therapy in patients with acute coronary syndromes have yielded conflicting results. The aim of this article is to provide a critical and up-to-date summary of the findings of clinical trials of intensive statin therapy, including a brief overview of safety and efficacy of such treatments. Keywords: Statin; Acute coronary syndrome. DOI: 10.3329/cardio.v2i2.6648Cardiovasc. j. 2010; 2(2) : 245-251