BackgroundMassive pulmonary embolism (PE) is associated with significant mortality, especially if compounded by haemodynamic instability, right ventricular (RV) dysfunction and right atrial (RA) thrombus. Thrombolysis can be lifesaving in patients with major embolism and cardiogenic shock, and accelerates the resolution of thrombus. Only three fibrinolytic agents—namely streptokinase, urokinase, and recombinant tissue plasminogen activator (alteplase) have been approved in the treatment of PE, with studies demonstrating similar safety profiles.Case presentationWe report the case of a 33-year-old Bangladeshi Bengali female with a history of recent ankle fracture and immobilization, who presented with massive PE, leading to cardiac arrest. Upon rapid resuscitation, urgent echocardiogram revealed RV dysfunction with floating RA thrombus, and she was successfully treated with 1.5 million IU of streptokinase over 2 h as per accelerated regimen recommended by the European Society of Cardiology guidelines, resulting in successful resolution of the right heart thrombus, and significant clinical improvement. Subsequent CT pulmonary angiogram confirmed the diagnosis of PE, and she was anticoagulated to a PT/INR of 2.0–3.0 for 3 months.ConclusionsEchocardiography is a suitable alternative for rapid diagnosis of acute massive PE associated with RA thrombus and cardiovascular collapse, especially when a delay to CT pulmonary angiogram may be anticipated, and in the setting of immediate cardio-pulmonary resuscitation. Thrombolysis is a rapid and life-saving therapeutic measure in such cases.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2177-1) contains supplementary material, which is available to authorized users.

BackgroundElectrophysiological studies have become an established practice in the evaluation and treatment of arrhythmias. Symptomatic pulmonary embolism as a result of deep vein thrombosis arising from multiple venous sheath femoral vein catheterization is an uncommon complication associated with it. We report the case of a 33-year-old woman who developed pulmonary embolism after an electrophysiological study, which was successfully treated at a cardiac hospital in Bangladesh.Case presentationA 33-year-old Bangladeshi woman with hypertension and diabetes had initially presented with recurrent episodes of paroxysmal atrial fibrillation that manifested as palpitations for 2 years. Her atrial fibrillation was drug-refractory and could not be attributed to a treatable etiology. She had undergone an electrophysiological study at a different hospital, where right femoral venous catheterization was performed followed by the insertion of three venous sheaths. However, tachyarrhythmia could not be induced and a procedure to isolate the pulmonary vein was postponed because all the veins could not be isolated. Forty-eight hours later, she presented to our hospital with shortness of breath, chest heaviness, palpitations, and recurrent episodes of syncope.She had normal coronary arteries and no other risk factors for venous thromboembolism. She was hemodynamically stable on examination. There was echocardiographic evidence of pulmonary hypertension and right ventricular dilatation and dysfunction. A computed tomography pulmonary angiogram confirmed pulmonary embolus in the descending branch of her left pulmonary artery, extending up to the segmental arteries.Subsequently, a duplex ultrasound confirmed acute deep vein thrombosis affecting her right ilio-femoral segment. She was successfully managed with subcutaneous enoxaparin and oral warfarin (target international normalized ratio 2.5–3).ConclusionsPulmonary embolism is a rare but serious complication that may occur in patients who undergo electrophysiological studies. Multiple venous sheaths inserted into the femoral vein and catheter-induced endothelial injury, further compounded by prolonged procedural time, may be responsible for the increased thrombogenicity leading to deep vein thrombosis and subsequent pulmonary embolism. An adequate observation time after the procedure and clinical alertness are necessary for rapid diagnosis and treatment.

Large left to right shunt across an atrial septal defect results in volume overload and dilatation of the right atrium and ventricle. 1 As a result of increased flow into the lungs, the pulmonary arteries, capillaries & the veins are dilated & there can be flow related pulmonary artery hypertension. Overtime this can lead to medial hypertrophy of pulmonary arteries & muscularization of arterioles resulting in pulmonary vascular obstructive disease. 2, 3 Once PAH develops, it is challenging to determine operability and predict outcomes after repair in borderline situations. 4 We report a woman with large atrial septal defect and severe pulmonary hypertension 9.84 wood units /m 2 of indexed total pulmonary vascular resistance. She underwent successful corrective repair of atrial septal defect after 4 months of medical management. This case supports that careful evaluation of reversibility of borderline pulmonary arterial hypertension associated with atrial septal defect and pre operative medical management with advanced pulmonary vasodilator therapy can modify a life to normal following closure of ASD. .

Objective : To identify etiology of neonatal hyperbilirubinaemia requiring Exchange Transfusion (ET) and to see the complications of ET and its outcomes.Methods : This prospective study was done in a tertiary hospital. Total 39 admitted newborn babies with hyperbilirubinaemia who required exchange transfusion were enrolled and all information regarding etiology of jaundice, laboratory investigations, complications and outcomes of cases were documented and analyzed.Results : During one year of study period ET was done in 39 neonates. Among them 16 (41%) cases were male and 23(59%) were female. Fifteen (38%) babies were preterm and 24(62%) babies were term. Fifteen (38%) babies were preterm low birth weight (PLBW) with or without septicaemia as comorbidity. Twelve (31%) cases had only hyperbilirubinaemia. Rh-incompitability was seen in 17 (44%), ABO incompitability in 15(38%) cases and unknown cause in 7(18%) neonates. Common complications seen were hypoglycaemia in 7(18%) and thrombocytopenia in 6(15%) neonates. Two (5%) neonates who died had comorbidity.Conclusion : E x change transfusion is required mostly in Rh incompitability and common complications of ET were hypoglycaemia and thrombocytopenia.

Massive Pulmonary Embolism (PE) is associated with significant mortality, especially if compounded by haemodynamic instability, right ventricular dysfunction and right atrial thrombus. Thrombolysis can be lifesaving in patients with major embolism and cardiogenic shock, and accelerates the resolution of thrombus. Only three fibrinolytic agents - namely streptokinase, urokinase, and recombinant tissue plasminogen activator (Alteplase) have been approved in the treatment of PE, with studies demonstrating similar safety profiles. We report the case of a 33 year old Bangladeshi female with a history of recent ankle fracture and immobilization, who presented with massive PE, leading to cardiac arrest. Upon rapid resuscitation, urgent echocardiogram revealed right ventricular dysfunction with floating right atrial thrombus, and she was successfully treated with 1.5 million IU of Streptokinase over 2 hours as per accelerated regimen recommended by the European Society of Cardiology (ESC) guidelines, resulting in successful resolution of the right heart thrombus, and significant clinical improvement. Subsequent CT Pulmonary Angiogram confirmed the diagnosis of PE, and she was anticoagulated to a PT/INR of 2.0 to 3.0.Anwer Khan Modern Medical College Journal Vol. 7, No. 1: Jan 2016, P 60-63