No abstract

The occurrence of acute myocardial infarction following a honeybee sting has been very rarely reported in the previous literature. Possible pathogenetic mechanisms include severe hypotension, rarely hypertension and coronary vasospasm with subsequent thrombosis of coronary vessels developed after the release of vasoactive, inflammatory and thrombogenic substances contained in the bee venom. This syndrome is also known as Kounis syndrome. We report a case of a 32-year-old man who presented with acute inferior wall myocardial infarction within 3 h of honeybee sting. He was treated with thrombolytic therapy. Coronary angiogram revealed normal coronary arteries.

Percutaneous transluminal septal myocardial ablation is an established therapeutic option for symptomatic hypertrophic obstructive cardiomyopathy refractory to medical therapy. It is a safe procedure in experienced hands, but complications can occur. We report two cases of right ventricular myocardial infarction with inferior wall infarction that occurred after alcohol ablation of the septum. There are no standard guidelines regarding the most appropriate treatment strategy in this clinical scenario. The probable mechanism and management issues are discussed.

A 40-year-old woman, known to suffer from rheumatic heart disease, presented with New York Heart Association class III breathlessness of 6 months duration. Transthoracic echocardiogram revealed severe mitral stenosis with deformed double orifice-like mitral valve and severe interatrial septal bulge. Considering the unfavourable anatomy, a high-risk percutaneous transluminal mitral commissurotomy (PTMC) was planned. Initial septal puncture resulted in pericardial effusion with tamponade, which was effectively managed by pericardiocentesis. After haemodynamic stabilisation and a fresh septal puncture, repeated efforts were made to negotiate the balloon across the deformed valve using the conventional Inoue technique. As the attempts were unsuccessful, the authors planned for over-the-wire (OTW) technique, with which the procedure was accomplished successfully. A technically challenging case of PTMC in the presence of adverse factors is presented herein. OTW technique is a useful alternative in the presence of deformed mitral valve.

Familial hypercholesterolemia is a rare, monogenic, co-dominant, life-threatening disorder resulting from loss of function mutations in the genes responsible for synthesis of low-density lipoprotein receptors or apo-B genes or gain of function mutations in PCSK9 genes in the liver which affects 0.2% of the population. It is characterized by severe lifelong elevation of LDL cholesterol and by development of xanthelasma, xanthomas, premature coronary artery disease and peripheral artery occlusive disease. Most patients develop PCAD and aortic stenosis before the age of 20 years and die before 30 years of age. The diagnosis of FH is usually based on clinical presentation and commonly used criteria are the Dutch lipid clinic network criteria, Simon Broome criteria or the WHO criteria. We encountered four cases of familial hypercholesterolemia over last 10 years. All the four patients presented with effort angina and all were found to have obstructive coronary artery disease oncoronary angiogram and two of them had severe supravalvular aortic stenosis. All four patients were on dietary modifications, high intensity statin and cholesterol absorption inhibitor. Two patients underwent coronary artery bypass grafting with aortoplasty, one patient underwent coronary artery bypass grafting and one patient underwent percutaneous transluminal coronary angioplasty.  Familial hypercholesterolemia leads to development of life-threatening manifestations early in the second and third decades of life. Early diagnosis, aggressive treatment and control of risk factors and cascade screening are important in management and will help to reduce the morbidity and mortality associated with this disease.