Volume I No. III April 2016 BENGAL HEART JOURNAL A PUBLICATION OF THE CSI - WEST BENGAL BRANCH Secretariat : INDIAN HEART HOUSE P-60, C.I.T. Road, Scheme VII-M Editor : Dr. P. K. Deb Kankurgachi, Kolkata-700054 Published by : Dr. D. Roy Ph : (033) 2355-1500/6308= Tele Fax : (033) 2355-6308 E-Mail : [email protected]= Website : www.csiwb.org.in BENGAL HEART JOURNAL Volume I No. III APRIL 2016 Contents 1.P. K. Deb, Editorial .................................................................................................................. 3-4 2. Case Report : Pranay Chatterjee, Pritam Kumar Chatterjee, Sukumar Ghosh Malignant melanoma of unknown primary origin presenting as cardiac metastasis ................................................................................................................... 5-7 3. Diabetes and Heart : Dr Subhayan Bhattacharya, Dr Soumyabrata Roy Chaudhuri, Dr Debmalya Sanyal Arrythmia in diabetics ........................................................................................................... 8-12 4. Case Report : Dr Suchit Majumdar A case of a difcult posteroseptal accessory pathway - how to suspect and approach to ablate ................................................................................. 13-14 5. Original Article : Biswajit Bandyopadhyay, Amitava Chattopadhyay, Mahua Roy, Indira Banerjee Left subclavian artery stenosis treated with trans - catheter stent placement in children ..................................................................................... 15-20 6. Review Article : Munna Das Novel mapping systems in cardiac electrophysiology - a perspective ............................... 21-25 7. Case Report : Dr. Md. Azizul Haque Spontaneous thrombosis within coronary sinus ................................................................. 26 8. Case Report : Amitabha Chakrabarty, Manujesh Bandyopadhyay A non cardiac etiology of atrial fibrillation : don't forget the mediastinum ................................................................................ 27-29 9. Review Article : Subhayu Das, Amitava Gupta Modeling of human heart using a systems approach - a survey of recent trends ...................................................................................... 30-33 10. Image corner : Dr.Soumitra Kumar Many a times ECG holds the clue .......................................................................... 34-35 1 BENGAL HEART JOURNAL EDITORIAL Dr. P. K. Deb ELECTRICITY AND HEART The knowledge that electric current can have effect on heart was first demonstrated way back in 1775, by Peter Christian Abildgaard, who applied electric shock on the chest of a hen, rendered lifeless with a prior shock to the head, to bring back its pulse. It was remarkable to note that though the hen was subjected to repeated shocks it recovered well and later even laid an egg.1 Thus began the quest for the relationship between electric current and heart. In 1838,Carlo Matteucci, Professor of Physics at the University of Pisa, showed that an electric current accompanies each heart beat.2 In 1887 British physiologist Augustus D. Waller of St Mary's Medical School, London published the first human electrocardiogram. It was recorded with a capilliary electrometer from Thomas Goswell, a technician in the laboratory.3 In 1893 Dutch physiologist, Willem Einthoven introduced the term ‘electrocardiogram’ at a meeting of the Dutch Medical Association.4 Later in1906 Einthoven published the first organised presentation of normal and abnormal electrocardiograms recorded with a string galvanometer. Left and right ventricular hypertrophy, left and right atrial hypertrophy, the U wave (for the first time), notching of the QRS, ventricular premature beats, ventricular bigeminy, atrial flutter and complete heart block were all described.5 In 1951 Paul Zoll, a Boston cardiologist developed first external tabletop pacemaker that was successfully applied to the treatment of heart block , ushering in the modern era of clinical cardiac pacing.6 Late 1950’s to early 1960’s witnessed several important achievements in the field of cardiac pacing by multiple persons and their teams working in different parts of the world: they were the “golden years” of pacing. Three landmark “firsts” were : the first battery-operated wearable pacemaker (1957), the first totally implantable pacemaker (1958) and the first long-term correction of heart block with a self-contained, implantable pacemaker (1960).6 These events had far-reaching consequences and opened up the field to the future. In this issue of the journal we gave special emphasis on the application of electrical principles for the understanding as well as treatment of the heart. In the review article by Shubhayu Das et al7 the basic engineering principles on which the heart can be modeled for better understanding of its physiology and pathology, has been stressed. In the other review article, Munna Das 8, dealt with the novel electrophysiologic methods for arrhythmia treatment.Both these,we believe,will enlighten our readers. 3 BENGAL HEART JOURNAL It is our proud privilege to inform you that the journal received encouragement and acclodes from quite a number of doyens of Indian cardiology. According to their suggestion, we introduce from this issue two new topics- Diabetes and Heart and Image Corner. We hope these will make interesting reading. Finally our apologies for being late to bring out this issue. But as you all know a toddler is bound to tumble and we express our sincere gratitude for bearing with us. References : 1. Abildgaard, Peter Christian. Tentamina electrica in animalibus. Inst Soc Med Havn. 1775; 2:157-61. 2. Matteucci C. Sur un phenomene physiologique produit par les muscles en contraction.Ann Chim Phys 1842;6:339- 341 3. Waller AD. A demonstration on man of electromotive changes accompanying the heart's beat. J Physiol (London) 1887;8:229-234 4. Einthoven W: Nieuwe methoden voor clinisch onderzoek [New methods for clinical investigation]. Ned T Geneesk 29 II: 263-286, 1893 5. Einthoven W. Le telecardiogramme. Arch Int de Physiol 1906;4:132-164 (translated into English. Am Heart J 1957;53:602-615) 6. Aquilina O .Abrief history of cardiac pacing.Images Paediatr Cardiol. 2006Apr-Jun; 8(2): 17–81. 7. Das Shubhayu, Gupta Amitava.Modeling of Human Heart using a Systems Approach - A Survey of Recent Trends.Bengal Heart J 2016;1: 29-32 8. Das Munna .Novel Mapping Systems in Cardiac Electrophysiology -Aperspective. Bengal Heart J 2016;1: 20-24 4 BENGAL HEART JOURNAL Case Report Malignant Melanoma of Unknown Primary Origin Presenting as Cardiac Metastasis Pranay Chatterjee 123, Pritam Kumar Chatterjee , Sukumar Ghosh . 1. Senior Resident; 2. RMO-cum-Clinical Tutor; 3.Head of the Department. Department of Cardiology. Calcutta National Medical College Corresponding Author : Pranay Chatterjee Abstract : Malignant melanoma has a very high propensity to metastasize to the heart. However, melanoma may sometimes present as a metastatic lesion in the absence of a primary lesion, which are called melanomas of unknown primary origin. We report a case in which a patient presented with a metastatic malignant melanoma in the right atrium with pericardial effusion and without a primary origin. Key words : Melanoma; Neoplasm, unknown primary; Unknown primary; Heart neoplasm. Fig. 1. Chest computed tomography. An inhomogeneous Introduction : Malignant melanomas are tumors enhancing mass in the right atrium (arrow) and a massive with the highest rates of cardiac metastasis. amount of pericardial effusion were identied However, cardiac metastasis is diagnosed in less than 1% of patients with malignant melanoma because less than 10% of these patients present with cardiac symptoms.1-3 Identication of cardiac metastasis from melanoma usually means that the patient is suffering systemic metastasis. Unlike typical cardiac metastasized patients, we report a rst case of a patient with a metastatic malignant melanoma in the heart without an identiable primary source or additional metastasis in Korea. Fig. 2. Two-dimensional cardiac echocardiogram. In a Case : A 59-year-old woman was admitted for subcostal view of the heart, a large mass measuring 42×31 cough and pleuritic chest pain with no history of mm was visualized in the right atrium. malignancy or heart disease. Her initial blood pressure was 110/70 mm Hg, pulse rate 70 beats/min, respiratory rate 20/min, and body temperature was 36.1°C. Jugular veins were not distended. No hepatomegaly or audible cardiac murmurs were present. Laboratory studies, including a complete blood count, liver, and chemical proles were in normal ranges. Electrocardiography revealed a normal sinus rhythm. Chest radiography showed cardiomegaly without abnormal lesions in bilateral Fig. 3. Cardiac MRI. A large mass surrounding ascending lung elds. Chest computed tomography showed a aorta spread into transverse sinus and around pulmonary large amount of pericardial effusion and a mass in trunk and right pulmonary artery the right atrium (RA) (Fig. 1). Trans-thoracic 42×31 mm in the RA, which did not obstruct echocardiography showed a large mass measuring tricuspid valve ow. Her ejection fraction was 5 BENGAL HEART JOURNAL normal (Fig. 2). Pericardiocentesis was performed. early stages of the disease.6 A complete resection of Effusion analysis showed a red blood cell count of an intracardiac melanoma prevents potential 1.9×1053 /mm and a white blood cell count of morbidities that are associated with progressive 3300/mm3 (lymphocytes, 55%; neutrophils,