No abstract

Introduction : Myocarditis remains an under-diagnosed entity among children. We evaluated the spectrum of electrocardiogram (ECG) changes and arrhythmias in children with myocarditis. Methods : A single-center prospective observational study was conducted over a period of 18 months at a public university hospital, which included all cases with myocarditis from the ages of 1 month to 12 years. Myocarditis was diagnosed according to standard criteria. Arrhythmias were detected by 12-lead ECG or by multiparameter monitors. Results : There were 63 children with myocarditis. Sinus tachycardia remained the most important ECG finding (61, 96.8%) followed by ST-T changes (30, 47.6%), low voltage QRS complexes (23, 36.5%), and premature complexes (11, 17.4%). Sustained arrhythmias were seen in 14/63 (22.2%) of the children (Group A), while the remaining 49 patients were designated as Group B. There were 11 (17.5%) cases with sustained tachyarrhythmias, comprising 5 with supraventricular tachycardia, 4 with ventricular tachycardia, and 2 with atrial flutter/fibrillation. Bradyarrhythmias were seen in 3 patients, including 2 children with atrioventricular block and 1 with severe sinus bradycardia. A longer hospital stay of 18.5 (4.75) days vs. 13 (4) days, P = 0.001), and more ST-T changes [12 (85.7%) vs. 18 (36.73%), P = 0.003] were seen in Group A. Multivariate regression analysis found only the presence of ST-T changes as predictors for arrhythmia. Conclusions : A variety of arrhythmias and other ECG changes were commonly seen in children with myocarditis. Sustained arrhythmias were seen in one-fifth of the patients, being associated with ST-T changes and a longer hospital stay.

Background Familial hypercholesterolaemia (FH) is a primary genetic dyslipidaemia characterized by elevation in serum low-density lipoprotein cholesterol and its deposition in systemic arteries, which causes premature atherosclerosis. Case summary A 10-year-old girl presented with severe symptomatic coronary artery disease. She demonstrated characteristic morphological features of FH. Despite aggressive medical management and lipid-lowering therapy, her symptoms were not relieved and she had dynamic electrocardiogram changes. Coronary angiography showed a distal left main coronary artery lesion along with significant lesions in ostio-proximal and mid-left circumflex artery which were managed by provisional left main coronary artery to left circumflex artery stenting technique, with good immediate- and short-term results and angina relief. Discussion To the best of our knowledge, this is the first reported case of a paediatric patient with FH and acute coronary syndrome treated with percutaneous coronary intervention to left main coronary artery and left circumflex artery using provisional stenting technique. Revascularization strategies for symptomatic coronary artery disease in paediatric patients with FH have multiple unique challenges and remain an unexplored and under-reported subject.

Background: Tuberculous constrictive pericarditis (CP) is a chronic inflammatory disease by Mycobacterium tuberculosis affecting the pericardium, occurring mainly in developing nations. The aim of this study was to evaluate left atrial (LA) and left ventricular (LV) myocardial mechanics in tuberculous CP using standard two-dimensional (2D) echocardiography and speckle tracking echocardiography (STE). Methods: A prospective observational echocardiographic study of 30 subjects was performed: 15 patients with tuberculous CP and 15 controls. 2D echocardiography, color Doppler imaging, and tissue Doppler imaging (TDI) were performed along with STE to evaluate the LV and LA mechanics. Results: We found that the global circumferential strain (GCS, P = 0.002) and the global longitudinal strain (P = 0.02) were significantly reduced in patients with CP compared with controls. The longitudinal lateral wall strain was significantly reduced (P = 0.001) in CP patients, whereas longitudinal septal strain was not reduced significantly (P = 0.18) in CP patients compared with controls. The longitudinal lateral strain was significantly reduced as compared to the longitudinal septal strain (P = 0.001) within the CP group (strain reversus). Annulus reversus (medial early diastolic mitral annular velocity [e'] > lateral e') by TDI was observed in 11 cases out of 15 in tuberculous CP group, whereas strain reversus (septal strain > lateral strain) was seen in all cases of CP group. The LA reservoir strain showed a statistically significant reduction in CP patients (P = 0.001) compared to controls. Conclusions: “Strain reversus” and reduced GCS are characteristic imaging findings on STE in patients with tuberculous CP and may provide an additional parameter to conventional echocardiography in the diagnosis of tuberculous CP.

Congenital left atrial appendage aneurysm are a rare entities and are caused by congenital dysplasia of the atrial muscle. Less than 100 cases have been reported in literature so far. Patients usually present with dyspnoea ,palpitations ,thromboembolic phenomenon in their 3rd decade with slight higher preponderance in females.In asymptomatic individuals the condition is often diagnosed incidentally during cardiac imaging . We hereby report a case of 30 year old male with a giant LAAA containing thrombus presenting with palpitations diagnosed with echocardiography and cardiac MRI. The patient successfully underwent aneurysmal resection sugery, post which atrial arrhthias stopped and symptoms relieved. Therefore,even though rare,if a young patient presents with atrial tachyarrthymia with no other associated cardiac pathologies, a LAAA should be ruled out. Since this condition has been shown to be associated with increased morbidity and mortality. A transthoracic echocardiogram or even better,a TEE colour Doppler echocardiogram may suggest the diagnosis by demonstrating the exchange of blood between LA and LAAA. Surgical resection is the standard modalitiy of treatment even in asymptomatic individuals to reduce risk of associated complications. Learning objectives : It is a rare case of giant left atrial appendage aneurysm, few cases have been reported, LA appendage aneurysm usually present as atrial arrhythmias ,stroke or as incidental diagnosis on imaging.Though patients may be asymptomatic it still requires operative intervention since it has very high risk of atrial arrhythmias and thrombus formation which result into stroke.Therefore, if a young patient presents with atrial tachyarrthymia with no other cardiac pathologies, LAAA should be ruled out.