No abstract

Background: sST2, an interleukin (IL)-1 receptor family member, has been identified as a novel biomarker for cardiac strain. Concentrations of sST2 have prognostic value and found to be predictive of the rate of mortality in the follow-up of patients after an acute heart failure episode. The present study aims to study relationship between serum sST2 levels along with prognosis and risk of mortality in heart failure patients.Methods: The Study was conducted in A.J. Institute of Medical Sciences, Mangalore, Karnataka, India with 56 heart failure patients in the duration of 1 year. sST2 level of each patient was taken on the day of admission then after one month, six months and one year.Results: Concentration of sST2 was consistently higher in 55.3% patients. Patients with lower values of ST2 levels were having less number of hospital admissions for heart failure symptoms (44.6%). The patients who were having high ST2 levels died due to cardiac events by the end of one month, six months and one year were 7.1%, 11.5% and 13% respectively (p<0.001) which was highly significant. Overall mortality with the patients who were having higher ST2 levels was 28.5% (p<0.001 HS).Conclusions: Elevated sST2 levels are predictive of cardiac events in patients with heart failure and provide complementary information about prognostication and risk stratification of patient. Serial monitoring of sST2 will aid in clinical decision making.

With a history of right pneumonectomy, pulmonary embolism affecting bilateral pulmonary artery is rare and needs to be meticulously managed to prevent pulmonary infarction of the normal lung with a clinical decision regarding thrombolysis. A 64 years male diabetic and hypertensive with a history of right pneumonectomy 10 years back, presented to ER with dyspnea and 2 episodes of syncope with right leg pain and swelling for 3 days. BP was 140/90mmHg and pulse rate of 100/min. SPO2 in room air was 95%. ECG suggested S1Q3T3 with sinus tachycardia. Echocardiogram revealed features of pulmonary embolism. Venous doppler of right leg showed DVT and CT Pulmonary angiogram was suggestive of pulmonary embolism. High-sensitive troponin I and NT-pro BNP were negative. Diagnosis of submassive pulmonary embolism was made. Protecting the normal lung from infarction was of paramount importance. There was no indication for thrombolysis. Treatment with LMWH was initiated and overlapped with the novel oral anticoagulant (NOAC) dabigatran. Symptomatically patient improved along with a reduction in pulmonary arterial hypertension and improved RV function. Post pneumonectomy of one lung, protecting the normal lung from infarction is utmost important in a setting of pulmonary embolism. It is a rare case scenario. Clinical decision regarding thrombolysis should be taken carefully. In this case thrombolysis was not indicated as per guidelines. LMWH, oral anticoagulation and broad-spectrum antibiotic to prevent secondary lung infection are the mainstay in the treatment of submassive pulmonary embolism where thrombolysis is not indicated.