Introduction: The clinical features, management, and the associations of dosage in poisoning with the cardiotoxic plant Cerbera odollam (suicide tree), responsible for more than half of plant poisoning deaths in the South Indian State of Kerala alone, have not been evaluated. There are only few studies on its clinical features and none on the usage of cardiac pacing in its management, given its rarity in the Western world. We depend on data for similar toxins to form our management protocols. Aims: Our aim was to describe the clinical features of C. odollam poisoning, dosage, and its relations to clinical features and pacemaker initiation therapy and to study the characteristics of temporary pacemaker therapy in its management. Subjects and Methods: This study was conducted in fifty consecutive cases who presented with a history of C. odollam poisoning from whom clinical data were obtained. Cases initiated on temporary cardiac pacemaker therapy due to the toxin effects were also studied. Effect of dosage on various clinical manifestations and pacing was analyzed. Results: All cases were due to suicidal ingestion. Vomiting (54%), thrombocytopenia (50%), and sinus bradycardia (32%) were the most common features. The need for cardiac pacing had a significant association with dosage in kernels ingested (P < 0.05) and with thrombocytopenia (P < 0.05). There was no association between hyperkalemia and death. Thirty-six percent of cases had to be paced, of which 16% died. In-hospital mortality of odollam poisoning was 12%. Conclusions: C. odollam poisoning cases merit monitoring and treatment in Intensive Care Unit with facilities for electrocardiographic monitoring and temporary cardiac pacing. The clinical features and the factors associated with mortality are different from other cardiac glycosides.

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Background: Hypertrophic cardiomyopathy (HCM), characterized by a thickened, fibrotic myocardium, remains the most common cause of sudden cardiac death in young adults. Based on animal and clinical data, we hypothesized that atorvastatin would induce left ventricular (LV) mass regression. Methods: Statin Induced Regression of Cardiomyopathy Trial (SIRCAT) was a randomized, placebo-controlled study. The primary endpoint was change in LV mass measured by cardiac magnetic resonance imaging 12 months after treatment with once-daily atorvastatin 80 mg or placebo. A key secondary endpoint was diastolic dysfunction measured echocardiographically by transmitral flow velocities. SIRCAT is registered with www.clinicaltrials.gov (NCT00317967). Results: Of 222 screened patients, 22 were randomized evenly to atorvastatin and placebo. The mean age was 47 ± 10 years, and 15 (68%) were male. All subjects completed the protocol. At baseline, LV masses were 197 ± 76 g and 205 ± 82 g in the placebo and atorvastatin groups, respectively. After 12 months treatment, the LV masses in the placebo and atorvastatin groups were 196 ± 80 versus 206 ± 92 g (P = 0.80), respectively. Echocardiographic indices were not different in the two groups at baseline. After 12 months, diastolic dysfunction as assessed using transmitral flow velocities E/E', A/A', and peak systolic mitral velocity showed no benefit from atorvastatin. Conclusions: In patients with HCM, atorvastatin did not cause LV mass regression or improvements in LV diastolic function.

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Coronary perforation is a potentially fatal complication during percutaneous coronary intervention . Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. Although the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management. Here we present a case of distal coronary perforation, and review the management of coronary perforation in the current practice.

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Uhl's anomaly is a rare congenital heart disease characterized by partial or complete absence of the right ventricular myocardium and high early mortality rates. We describe a case of Uhl's anomaly in a 27-year-old young male patient presenting with portal hypertension and esophageal varices. In this article, we review the literature associated with this condition and highlight a rare presentation of a rare disease. This report adds to our current knowledge of this exceedingly rare disorder.

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Embolization due to blast injury with projectiles entering the bloodstream from the heart is a rare event that is unlikely to be suspected during the initial assessment of trauma patients. We report a case in which a missile penetrating the heart chambers managed to embolize and occlude the right common femoral artery. This was successfully managed by means of a multidisciplinary approach that included exploration, cardiorrhaphy, and embolectomy.

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In India, stab injury is not uncommon, but identifying potential life threatening conditions in the emergency room (ER) and initiating prompt treatment are challenging. This is a case report of a young patient who presented to the ER with assault injury to the chest and shock; timely extended focused assessment with sonography for trauma helped to fast-track the patient to the operating room. A brief review of diagnosis and management of penetrating cardiac injury is presented herewith.

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Hemodynamic compromise immediately after chest closure can be potentially fatal event. Such condition warrants urgent reopening of sternum. In the present case, we discover An uncommon cause of unstable hemodynamics.

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A case of a patient presenting with an acute myocardial infarction is presented. A transthoracic echocardiographic examination revealed an abnormal color flow signal that traversed the myocardial wall from a large inferior aneurysm and initially considered to be a ventricular septal defect. However, further echocardiographic manipulation utilizing modified views along with sequential injections of both agitated saline and Definity^® proved very useful to identify a pseudoaneurysm. There was no further need for any other diagnostic test, and the patient was treated surgically, undergoing successful repair of the pseudoaneurysm as well as coronary artery bypass grafting of the left coronary artery.

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