Three patients are described who had situs ambiguus and left isomerism (polysplenia syndrome) and advanced atrioventricular block. One presented with a complex bradyarrhythmia with Wenckebach block. The other two had congenital atrioventricular block with a narrow QRS at a ventricular rate of 80 per minute, an atrial rate of 150' per minute, and both had a P wave axis directed superiorly and to the right in one, and superiorly to the left in the other. This ECG pattern was not observed in more than 400 adult patients with complete A-V block treated in our service. It is our opinion that in infants and children with heart disease the presence of complete A-V block with narrow QRS and an unusual P waves axis directed superiorly is strongly suggestive of left isomerism. The incidence rate of complete A-V block in left isomerism is nearly twenty percent of the cases described.

Cardiac Sarcoidosis (CS) is a rare and deceptive disease affecting young adults with catastrophic results including life threatening arrhythmia, congestive heart failure and even sudden death as the initial presentation. CS has been linked to a significant high morbidity & mortality. We present two patients: The first patient with an initial cardiac event that led us to a diagnosis of Pulmonary and Cardiac Sarcoidosis. A second patient, who was diagnosed initially with pulmonary Sarcoidosis, presented with a severe heart conduction abnormality. Both patients were successfully treated with permanent pacemakers. The dual purpose of our study is first to emphasize the importance of follow up on patients with Non-Cardiac Sarcoidosis for cardiac involvement and secondly to increase awareness of CS as part of a differential diagnosis among young adults with unexplained arrhythmia.

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Thrombolytic therapy (TT) is now established as the main treatment of acute myocardial infarction (MI). Spontaneous breast hematoma, usually a rare complication of anticoagulant therapy, has been described in the last five decades, but not after thrombolytic therapy. We present three patients who developed the rare complication of breast hematoma after TT, out of 495 women treated with TT in ICCU in our hospital, because of acute MI in the last 12 years. One patient needed blood transfusion and in another patient, atypical ductal nuclei were observed in fine needle aspiration (FNA) of breast hematoma, needing further evaluation. As thrombolytic therapy becomes more widespread and essential in treating patients suffering acute occlusion of coronary, retinal, pulmonary or peripheral arteries, it is expected that more women will present with breast hematoma following such treatment.