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Background and Aims: The use of coronary angiography in diagnosing coronary artery disease is limited by its invasive property. In the other hand correct interpretation of tread mill test data and its use as a key diagnostic modality also has been a problem. The study was thus aimed to see the diagnostic accuracy of treadmill test to rule out coronary artery disease.Methods: We included all the patients who had positive tread mill stress test and underwent coronary angiography and were subsequently analyzed for presence of coronary artery disease.Results: A total of 303 patients were included with 119 males and 184 females with mean age of 53.6±10.5 yrs and 51.7±8.6 yrs respectively. Normal coronaries was seen in 114(54.0%), borderline lesion in 29 (13.7%) and significant lesion in 68 (32.2%) with 48(22.7%) having single vessel disease, 29(13.7%) double vessel disease and 14(6.6%) triple vessel disease. Coronary artery diseases was highest among diabetics (57.7%, OR 1.72 (95 % CI: 0.92 to 3.20), p value-0.08).Similarly the risk of coronary artery disease was significantly highest among patient with ≥2 risk factor (OR: 8.10,95 % CI: 4.96 to 13.24, P < 0.0001). Gender distribution showed that coronary artery disease was significantly higher in males than females (53% vs 35% respectively, OR: 2.08, 95 % CI: 1.30 to 3.32, p value-0.002).Conclusion: The value of tread mill test to predict coronary artery disease is highest in patients with two or more risk factor especially in those with diabetes with significance increased among males.

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The overall incidence of embolic complications in infective endocarditis (IE) ranges from 20 to 50%. It is very uncommon for a treating physician to encounter a patient having multiple manifestations of systemic embolisation.Acute coronary syndrome complicating infective endocarditis is an uncommon finding and the incidence has been found to be upto 10%.Cerebral embolism should be suspected in patients with infective endocarditis and neurological sign and symptoms. Neurologic manifestations can sometimes be the first presentation of infective endocarditis. We present the scenario of a 51-year-old diabetic male with chronic kidney disease, rheumatic heart disease with infective endocarditis leading to multiple embolic complications. Our case is notable because the patient had evidence of coronary, cerebral, splenic, hepatic and musculoskeletal manifestations due to embolic complications of IE within a duration of one year. Our case was primarily managed by multidiscipliniary approach. It is an impossible task for a cardiologist to treat such cases with showering complications where a multidisciplinary team approach is the only treatment option.

Coronary embolism, though uncommon, can occur in young patients with mechanical prosthetic heart valves. Coronary embolism has been reported in patients with prosthetic heart valves with or without thrombosis in literatures. It can cause acute coronary syndrome and lead to death if threshold of diagnosis of coronary embolism is not low. Here we report a case of coronary embolism in a 26 year old female with history of double mechanical prosthetic valve replacement, presenting to our centre with acute coronary syndrome. She was managed with thrombosuction establishing almost complete revascularization.