Pseudoaneurysm of the ascending aorta is a rare but dreadful complication following cardiac surgery and it has more chances of rupturing in elderly females. It occurs as a result of lengthy cardiopulmonary bypass time and associated degenerative changes in old patients. Due to the poor prognosis, early diagnosis and management of this complication is essential. Our case is of a 68-year old female who developed a 44 mm large ascending aortic pseudoaneurysm 7 days after undergoing (coronary artery bypass grafting) CABG for long-standing. (Triple vessel coronary artery disease) TVCAD. The location of the pseudoaneurysm was found to be just above the vein graft to the RCA on (computerized tomography) CT-Aortogram. 2D-Echocardiography showed an Ejection Fraction of 45% and a 22 mm neck of the aneurysmal sac. Trans-catheter device closure was planned and the neck was successfully closed with no residual leak seen on (computerized tomography) CT-Aortogram performed after 3 days. However, she developed cardiac arrest during the device closure and even after successful resuscitation she went into a state of septic shock in the following weeks that did not respond to maximum medical treatment which unfortunately led to her death. A review of 3 similar cases of post-cardiac surgery aortic pseudoaneurysms which were successfully managed via trans-catheter device closure is also discussed. Early diagnosis and interventional treatment of post-cardiac surgery aortic pseudoaneurysms in elderly patients is necessary alongside very careful surgical technique while performing cardiac surgery to minimize the risk of aneurysm formation.

Objective: To measure the door-to-ECG time of patients presenting with chest pain at a Cardiac Emergency Unit. Study Design: Descriptive Cross-Sectional. Place and Duration of Study: Armed Force Institute of Cardiology/National Institute of Heart Disease, Emergency Department (ER) from Feb2022 to Apr 2022. Methodology: A total of 170 patients presenting to the ER with chest pain were reported. Their demographics were entered alongside the nature (cardiac/non-cardiac) and duration of their chest pain after which the time the first ECG strip was drawn till the time it was interpreted by a doctor (Door-To-ECG time) was recorded on a questionnaire. The patients were categorized in 4 different groups based on their ECG findings and were followed till their clinical decisions (PCI/Admission/Discharge/Referral) within the ER were made. Results: Out of 170 patients, 101(59.4%) had a door-to-ECG time within 10 minutes. Amongst these 101 patients, 23(22.7%)patients were diagnosed with STEMI and shifted for PCI, 15(14.8%) had NSTEMI and were admitted for management,41(40.6%) had cardiac chest pain without ECG changes and were admitted for workup while 22(21.8%) had non-cardiac chest pain and were discharged with out-patient follow-up or referred elsewhere. Non-availability of a bed in the emergency department accounted for the majority (49.3%) of the patients whose door-to-ECG time was more than 10 minutes while a higher ratio of patients that needed to be attended by doctors was identified as the second most common cause of delay(31.9%). Conclusions: Our findings suggest that the door-to-ECG time recorded for patients at our setup was almost 10 minutes....