01 - Vol. 17, No. 1, JANUARY 2021 BSMMU H.J. 76 , 3 fering from , pain in the TIM SAHA TIM , pulsus deficit, pulsus 15 November 2020 PRA infraction is THA , taking deep breath, Class I but Class for the last 4 . . Shortness was Department of 2 PAR Accepted: , 2 of breath, difficulty of breath, in ment of the , National Institute of Ophthalmology Class IV t Mrs khursida was suf khursidat was Mrs ase inase this subcontinent. It can , National Institute of Cardiovascular associated with fever Although of breath shortness persisted for last oung Lady with Mitral with Lady oung Y , initially it in NYHA was University Heart 2021; 17(1): 76-78 Journal e were thinking tha was not was hour it in NYHA was associated with orthopnoea, paroxysmal nocturnal dyspnoea, palpitation but not associated with swelling any part of the body and not aggravated by exposure to dust and fume. There no history was of joint pain, rash, headache, in weakness any part of the body calf muscle and no recent history of air travel. past Her medical history unremarkable. was of breath shortness For labelled was she bronchial as asthma and took medicine for this problem general on and off. On examination, pulse is 108 beat per minute, irregularly irregular present, and low volume, blood 90/60mmHg pressure in raised butboth JVP hands, absence of a wave. precordialOn examination, apex beat tapping in nature, located in fifth intercostal space, just medial to mid clavicular line and feature of pulmonary present. auscultation On there variable was intensity of first heart , loud sound pulmonary component of 2nd heart and lowsound, pitched, localized, rumbling rough, murmur in apical area, best heard with bell of stethoscope ,breath hold in expiration. W movement of the chest. There no history of chest was trauma and no family history of coronary . alsoShe complained of breath of shortness for same duration. 3 year with chronic rheumatic heart disease with atrial . MD. MUKHLESUR RAHMAN MUKHLESUR MD. , Department of Cardiology 2 3 AMI ction in a HASAN , Dhaka, (NICVD), Dhaka. (NICVD), Diseases . few data few were 2 A TM IQBAL A , . 1 When spontaneous K M Mohiuddin M Bhuiyan, K Junior Consultant Cardiology AN A , housewife, mother of two . and Hospital &H), Dhaka. Email: (NIO [email protected] , The incidence of acute STEMI . , National Institute of Ophthalmology and &H), Dhaka, Hospital (NIO AF Coronary artery (CE) in which a 1 30 September 2020 Abstract: rheumaticChronic heart disease is the major contributor of valvular heart dise affect all valves. the four Among them mitral valve is affected most the of time. Involv could be presented nonspecific in various way like chest pain, palpitation, shortness swallowing, change in voice There behind the few are on. causes chest so pain. Myocardial and one of the important cause. Bangabandhu Sheikh Mujib Medical University K M MOHIUDDIN BHUIY K M MOHIUDDIN Acute MyocardialAcute Infar – Uncommon Presentation Problem – Uncommon a Common of Stenosis A Department of Cardiology 1 ol. 1, January 2021 17, No. Address of Correspondence:Address Dr Introduction: Acute is a major (AMI) cause of and disability worldwide. occurs, there is a >90% chance that the underlying aetiology is primarily due to coronary events as such plaque rupture, erosion, or dissection referred to as myocardial infarction type can (MI) 1. MI also occur secondary to an ischemic insult in the absence of overt coronary artery by an disease imbalance (CAD), between myocardial oxygen supply and demand termed type 2 MI. arising from other sources than the coronary vasculature propagates into the coronaryarteries causing fallsAMI in this second category Mitral is the Stenosis (MS) most frequent cause of systemic emboli, where the presence of may (AF) increase the risk of embolic events. examined on the incidence of coronary embolism in MS patients with or without children got admitted to National Institute of , Dhaka, through with complaints of severe retrosternal chest pain Chest pain for four hours. central was in position, compressing in nature, radiating to left arm, jaw and neck, associated with sweating, aggravated by exertion, and not fully relieved by sublingual nitrate spray Case report:Case khursida begum,Mrs. 38years old, normotensive, nondiabetic, betelnut chewer accompanied is fairly MS by rare cases. Received: UniversityHeart Journal V 01 - Vol. 17, No. 1, JANUARY 2021 BSMMU H.J. 77 V 77 74mmHg) ASP Anteroseptal wall of the L ge thrombus in left atrium A K M Mohiuddin Bhuiyan M K etA al. :0.8cm2); Lar A e did coronary angiogram of the patient, it revealed hypokinetic; Chronic rheumatic heart disease; Severe mitral stenosis( MV Her echocardiogramHer : showed (25.3cm2); Severe (P W normal and but LCX LAD huge LMCA, thrombus burden in RCA After Before thrombolysis elevation oung Ladyoung with Mitral Stenosis Y gency it ECG, revealed acute ST e did emer W Acute Myocardial Infarction in a myocardial infraction (anterio inferior) with atrial fibrillation. thrombolysis She was with streptokinase baseHer line investigation revealed :10.7gm/dl; st Hb ESR :35mm in 1 hour; WBC: 7000/ml3; platelet :150000/ml3; S. Creatinine :1.3 mg/dL; Na: 129 mEq/L; K: 3.7 mEq/L; I : 101ng/ml. 01 - Vol. 17, No. 1, JANUARY 2021 BSMMU H.J. 78 . , . 2015; , Braunwald E. Atrial Fibrillation: Ann Intern Med , causing infarcts Circulation Proc (Bayl Univ Med 4 . 2019: 1415–44. , Romero Embolic ME. alve Disease. In: Zipes DP omaselli GF textbook of cardiovascular V AV ol. 17, No. 1, Januaryol. 2021 No. 17, T A V A: Elsevier , O R. Mitral, O irmani R, Finn s hearts disease: ion, should keep we in mind to evaluate V fraction, clinically diagnosed in 15 (27%) , Bonow RO, Mann DL, Mann RO, , Bonow . 2015;28:20709. Eds. Braunwald’ 1978;88:155–61. Prizel Bulkley Hutchins Coronary KR, GM, artery BH. embolism and myocardial infarction. medicine. Philadelphia, P Myocardial Infarction a as Consequence of PrevailingA Disease of the Future. Kolodgie FD, Libby P 132:22326. Cardoz Jayaprakash George J, R. Mitral K, stenosis and acute ST elevation myocardial infarction. Cent) Thomas, Bonow J, D 4. (29%), coronary (16%), and chronic atrial fibrillation Mural (24%). thrombi were present in 18 (33%)4. Myocardial in patients, caused death in emboli 11 (20%). Most involved the left coronary artery and lodged distally that were usually transmural. Because of their distal location and recanalization, coronary emboli may be a cause of infarcts with angiographically normal coronaries. Thus, coronary emboli are not rare, may produce and signs symptoms indistinguishable from atherosclerotic coronary disease, and by lodging distally in coronary that are usually previouslynormal, they most often cause small but transmural myocardial infarction. Charles and colleagues reported that coronary embolism occurs in the left coronary artery in 75% of cases and threequarters of them present with ST elevationmyocardial infarction, whereas the rest present with nonST elevation myocardial infarction. suggestionOur is that acute myocardial infarction in this patient with no risk factors for coronary atherosclerosis of thromboembolicwas origin, from left atrial thrombi. : Conclusion Although rear cause of chest pain in mitral stenosis is myocardial infract the cause of chest pain in mitral stenosis patient. References: 1. 2. 3. 3 Thickening and fibrosis of both leaflet with restricted opening, both commissure both fused commissure are fused 78 Mitral stenosis presenting for the first time acute as STEMI is rare. In the study by Prizel et al, coronary artery embolic infarcts comprised 13% of the autopsystudied infarcts. Underlying diseases predisposing to coronary emboli included (40%), Discussion: There is three possibilities of chest pain in a patient with mitral stenosis. severepulmonary hypertension secondary to the pulmonary vascular disease concomitant coronary atherosclerosis coronary obstruction caused by coronary embolization. Large thrombus in left atrium UniversityHeart Journal