Emerging evidence has shown an association between cardiovascular (CV) disease and cancer due to shared risk factors and biological mechanisms especially chronic inflammation. The objective of this case report is to highlight the association between these two lethal diseases and the challenges in the management of coronary artery disease in patients with coexisting malignancy.A 65-year-old nonsmoker, nondiabetic, and normotensive male presented with a history of abdominal pain and significant weight loss. Colonoscopy and biopsy showed adenocarcinoma of the ascending colon, and he was planned for right hemicolectomy. Electrocardiogram exercise stress test performed as a part of preoperative evaluation was strongly positive. Coronary angiography was suggestive of Chronic total occlusion of the left main coronary artery. Though the syntax score was intermediate, coronary artery bypass grafting was decided as the revascularization strategy as he needed early surgery for the colonic malignancy. A month later, he underwent right hemicolectomy.Clinicians should be aware of the association between CV disease and cancer as they are likely to face similar situations where both coexist. Understanding the connections between heart disease and cancer will help to formulate combined preventive guidelines.

Objective: The aim was to compare the cost of treating deep-vein thrombosis (DVT) using unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) among patients in rural tertiary care hospitals. Materials and Methods: A retrospective study was conducted at a Rural Tertiary Care Hospital from April 2017 to April 2019. Fifty-four patients who had symptoms of swelling of the unilateral or bilateral lower limb with or without pain were subjected to Padua prediction score and Doppler study of both lower limbs. Confirmed cases of DVT were treated with UFH or LMWH. The cost of these two treatments was compared. Results: The mean cost of heparin was 2493.33 ± 1406.27 Indian rupee (INR) in the study population. The mean cost of LMWH was 13,520 ± 9806.35 (INR) in the study population. There was a statistically significant difference between UFH and LMWH with regard to the cost of drugs (INR) for treatment (P < 0.001), which indicated that UFH was a cost-effective treatment compared to LMWH. Conclusions: The study's findings prove that UFH is a cost-effective treatment compared to LMWH in Rural Tertiary Care Hospitals for DVT. Based on the patient's affordability, the treatment decision can be made.

CASE REPORT: A 54 year old female patient was seen in pulmonary medicine outpatient department with complaints of postnasal drip for 6 to 7 years and difficulty in breathing for past 2 years, progressive in nature and with moderate exertion and relieved by rest. No history of PND/ Orthopnoea. History of headache was present for 2 months and relieved with rest and painkillers. No history of palpitations and chest pain.Patient had history of asthma and was on tablet salbutamol and steroid nebulisation during periods of acute attack. Patient is not a known hypertensive, diabetic mellitus, seizures, bleeding diathesis, pulmonary tuberculosis, TIA or stroke. No similar complaints in family members. Patient is married and has 3 children alive and healthy. She had undergone hysterectomy 4 years back for dysfunctional uterine bleeding.Clinically patient was conscious, comfortable, oriented, a febrile. No pallor, cyanosis, Icterus or pedal edema. Saturation was 100% without O2.Heart rate was 84/min and BP was 110/70 mmHg. Cardiovascular examination was normal. Respiratory system revealed rhonchi and occasional basal crepts. Abdomen was normal and CNS system was normal without any neurological deficit.Investigations were done and blood investigations were within normal levels and eosinophil count was normal. Blood sugar, urea, creatinine and serum electrolytes were within normal levels. Xray chest was normal. ECG was normal with sinus rhythm and no ST-T segment changes. ECHOCARDIOGRAPHY:Left Atrial mass of size 3.5cm * 3.27 cm was present attached to floor of left atrium. No LA/LV dilatation. Normal cardiac valves. No pulmonary hypertension. LVEF was 64%.Angiogram done showed normal Epicardial coronaries. PROCEDURE:Under GA, midline sternotomy was done, pericardial patch harvested after opening pericardium. Systemic heparinisation given and standard aorta bicavalcanulation was done. Core cooled to 32 degrees centigrade and aorta was cross clamped. Plegic arrest of heart was done and RA opened and interatrial septum was opened. A mass of size 3*3 cm was seen attached to the floor of the LA and the same was excised without any spillage and sent for HPE.A thorough wash of LV cavity was done. Interatrial septum was closed using harvested pericardial patch using 4-0 prolene sutures. LA deairing was done. Core rewarmed to 33 degree centigrade and cross clamp removed. Heart picked up in normal sinus rhythm without defibrillation. RA was closed using 5-0 prolene. Heparin was neutralized with protamine. Adequate hemostasis was obtained. Decannulation done.Mediastinal drains were kept and wound closed in layers. Patient had stable hemodynamics and was shifted to CT-ICU ward. Patient was extubated after 4 hours of elective mechanical ventilation.

Background: Pulmonary Hypertension in mitral valvular heart disease leads to various adverse outcome following surgical treatment of this condition. In majority of the patients this Pulmonary Hypertension is reversible following surgery. The objective of this study is to assess the outcome of changes in Severe Pulmonary Hypertension after Mitral Valve Replacement during the follow up with postop Echocardiogram. Patients and methods: In all our 265 patients who underwent Mitral Valve Replacement Surgery (MVR) for Mitral valvular heart disease with pulmonary hypertension, females 111/195(56.9%) outnumbered the males in this study. 195 among 265 cases had severe PHT. MVR was done with cardiopulmonary bypass using St Jude's medical valve. Results: Despite the high operative mortality in most series of MVR in patients with severe PHT, a striking improvement in survival was noted in the study with 5.3% mortality rate.A sudden drop of PHT is not observed in our study. The fall was found to be gradual and significant over follow up and the maximum reduction was at 1-3 months post operatively. Conclusion: It is concluded that MVR reduces PHT in a gradual way and the mortality rate is also minimum in severe PHT patients. MVR thereby is an effective invasive procedure for the management of patients with severe mitral valve disease and PHT.