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Search Results: 1 - 10 of 259 matches for " Prashanth Panduranga "
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Aortic Root Abscess Presenting as Pyrexia of Unknown Origin and the Importance of Echocardiography
Prashanth Panduranga
Case Reports in Critical Care , 2013, DOI: 10.1155/2013/636519
Abstract: Aortic root abscess in patients with aortic endocarditis is not uncommon. Aortic root abscess may cause persistent sepsis, worsening heart failure, conduction abnormalities, fistula formation, and an increased need for surgery. We present a young patient with aortic root abscess presenting as pyrexia of unknown origin. She had acute severe aortic and mitral regurgitation which produced very soft murmurs that were easily missed. This report reiterates that a high index of suspicion is needed in suspecting valvular endocarditis as well as a comprehensive transthoracic and transesophageal echocardiographic examination to diagnose complications like aortic root abscess. 1. Introduction Aortic root abscess in patients with aortic endocarditis is not uncommon. Aortic root abscess may cause persistent sepsis, heart failure, conduction abnormalities, fistula formation, and an increased need for surgery. We present a young patient with aortic root abscess presenting as pyrexia of unknown origin that was diagnosed by echocardiography. 2. Case A 26-year-old female with no past medical problems was admitted to critical care unit of our hospital with history of intermittent high-grade fever (39-40°C) for 3-week duration. She was extensively investigated in other hospitals with results yielding negative blood culture, autoimmune profile, and immunodeficiency profile. She was diagnosed to have pyrexia and sepsis of unknown origin. She had received multiple antibiotics during this period from other hospitals. Apparently previous cardiac examination was normal. Clinically she was febrile, tachycardic, tachypneic, and hypotensive. Chest X-ray showed pulmonary edema. Careful clinical examination revealed elevated jugular venous pressure, soft aortic early diastolic murmur, and a soft pan systolic murmur at apex. ECG showed sinus rhythm with normal PR interval. An urgent bedside transthoracic echocardiogram (TTE) revealed dilated left ventricle, large vegetation attached to base of anterior mitral leaflet with severe mitral and aortic regurgitation with EF 45%. The aortic valve looked edematous, but no clear-cut aortic root abscess was seen. The valves were thickened suggesting rheumatic etiology. Laboratory investigations revealed anemia, leucocytosis with markedly elevated inflammatory markers. She was immediately shifted to OR, and a transesophageal echocardiogram (TEE) confirmed TTE findings. In addition there was an aortic root abscess behind the noncoronary cusp (Figure 1) along with perforation of anterior mitral leaflet with severe aortic and mitral regurgitation
Catastrophic Cardiac Amyloidosis
Prashanth Panduranga,Mohammed Mukhaini
Cardiology Research and Practice , 2011, DOI: 10.4061/2011/479314
Abstract: We report a case of a 61-year-old patient presenting with cardiogenic shock. His echocardiogram suggested typical features of cardiac amyloidosis. This case demonstrates that cardiac amyloidosis can present acutely and may be catastrophic.
An elderly man with pulmonary hypertension
Panduranga Prashanth,Mukhaini Mohammed
Annals of Thoracic Medicine , 2011,
Abstract:
Intramyocardial dissecting haematoma causing cardiac tamponade: An unusual complication after mitral valve replacement surgery
Prashanth Panduranga,Mukhaini Mohammed,Maddali Madan
Annals of Cardiac Anaesthesia , 2009,
Abstract:
Dynamic left ventricular outflow tract obstruction complicating aortic valve replacement: A hidden malefactor revisited
Panduranga Prashanth,Maddali Madan,Mukhaini Mohammed,Valliattu John
Saudi Journal of Anaesthesia , 2010,
Abstract: It is known that a dynamic left ventricular outflow tract (LVOT) obstruction exists in patients, following aortic valve replacement (AVR) and is usually considered to be benign. We present a patient with dynamic LVOT obstruction following AVR, who developed refractory cardiogenic shock and expired inspite of various treatment strategies. This phenomenon must be diagnosed early and should be considered as a serious and potentially fatal complication following AVR. The possible mechanisms and treatment options are reviewed.
Pericardial Effusion in a Patient with Non-ST-Elevation Myocardial Infarction: Beware of a Hidden Malefactor
Mamatha Punjee Raja Rao,Prashanth Panduranga,Mahmood Al-Jufaili
Case Reports in Emergency Medicine , 2013, DOI: 10.1155/2013/365623
Abstract:
Pericardial Effusion in a Patient with Non-ST-Elevation Myocardial Infarction: Beware of a Hidden Malefactor
Mamatha Punjee Raja Rao,Prashanth Panduranga,Mahmood Al-Jufaili
Case Reports in Emergency Medicine , 2013, DOI: 10.1155/2013/365623
Abstract: Pericarditis with pericardial effusion in acute coronary syndrome is seen in patients with ST-elevation myocardial infarction specifically when infarction is anterior, extensive, and Q wave. It is very uncommon to have pericardial effusion in a patient with non-ST-elevation myocardial infarction. We present an elderly hypertensive patient who was diagnosed as non-ST-elevation myocardial infarction with pericardial effusion that turned out to be acute aortic dissection with catastrophic end. We conclude that, in patients with suspected diagnosis of non-ST-elevation myocardial infarction or unstable angina, if pericardial effusion is detected on echocardiography, aortic dissection needs to be considered. 1. Background Pericarditis with pericardial effusion (PE) in acute coronary syndrome is seen in patients with ST-elevation myocardial infarction (MI) specifically when infarction is anterior, extensive, and Q wave [1–3]. It is very uncommon to have PE in a patient with non-ST-elevation MI. We present an elderly hypertensive patient who was diagnosed as non-ST-elevation myocardial infarction with pericardial effusion that turned out to be acute aortic dissection with catastrophic end. 2. Case Presentation A 50-year-old obese woman with history of hypertension was diagnosed to have non-ST-elevation MI. She visited a regional health center with very severe central chest pain and profuse sweating lasting for 30 minutes. Blood pressure was noted to be 90/60?mmHg, and pulse rate was 100 beats per minute. ECG was reported to show evidence of left ventricular (LV) hypertrophy with minimal inferolateral ST depression. Her troponin T was 0.023?μg/L (normal <0.010?μg/L), and on repeating, it jumped to 6.16?μg/L. A chest X-ray was done and was interpreted to be normal. D-dimer level was not done. Transthoracic echocardiogram done there reported concentric LV hypertrophy with hypokinesia of septum and lateral wall with good LV systolic function. There was mild PE. She was treated with small dose of dobutamine for few hours along with morphine, antiplatelets, and anticoagulants. She was transferred next day to our institute for percutaneous coronary intervention. On arrival in emergency department, she was hemodynamically stable, off inotropes with no pain, and all peripheral pulses intact. Blood pressure was 150/70?mmHg, and pulse rate was 70 beats per minute. Cardiac examination revealed normal jugular venous pressure, no ankle edema, and no gallop, but there was a harsh ejection systolic murmur in aortic area. Repeat ECG was nondiagnostic for acute coronary syndrome
Accessory mitral valve tissue causing severe left ventricular outflow tract obstruction in a post-Senning patient with transposition of the great arteries
Prashanth Panduranga,Thomas Eapen,Salim Al-Maskari,Abdullah Al-Farqani
Heart International , 2011, DOI: 10.4081/hi.2011.e6
Abstract: Accessory mitral valve tissue is a rare congenital anomaly associated with congenital cardiac defects and is usually detected in the first decade of life. We describe the case of an 18-year old post-Senning asymptomatic patient who was found to have accessory mitral valve tissue on transthoracic echocardiography producing severe left ventricular outflow tract obstruction.
Management dilemmas in patients with mechanical heart valves and warfarin-induced major bleeding
Prashanth Panduranga,Mohammed Al-Mukhaini,Muhanna Al-Muslahi,Mohammed A Haque
World Journal of Cardiology , 2012, DOI: 10.4330/wjc.v4.i3.54
Abstract: Management of warfarin-induced major bleeding in patients with mechanical heart valves is challenging. There is vast controversy and confusion in the type of treatment required to reverse anticoagulation and stop bleeding as well as the ideal time to restart warfarin therapy safely without recurrence of bleeding and/or thromboembolism. Presently, the treatments available to reverse warfarin-induced bleeding are vitamin K, fresh frozen plasma, prothrombin complex concentrates and recombinant activated factor VIIa. Currently, vitamin K and fresh frozen plasma are the recommended treatments in patients with mechanical heart valves and warfarin-induced major bleeding. The safe use of prothrombin complex concentrates and recombinant activated factor VIIa in patients with mechanical heart valves is controversial and needs well-designed clinical studies. With regard to restarting anticoagulation in patients with warfarin-induced major bleeding and mechanical heart valves, the safe period varies from 7-14 d after the onset of bleeding for patients with intracranial bleed and 48-72 h for patients with extra-cranial bleed. In this review article, we present relevant literature about these controversies and suggest recommendations for management of patients with warfarin-induced bleeding and a mechanical heart valve. Furthermore, there is an urgent need for separate specific guidelines from major associations/ professional societies with regard to mechanical heart valves and warfarin-induced bleeding.
Blue Toes
Mamatha Rao,Mahmood Al-Jufaili,Prashanth Panduranga,Abdullah Amour Riyami
Oman Medical Journal , 2012,
Abstract:
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