Pakistan has recently witnessed an epidemic of dengue infection and thereafter, certain various presentations of patients with dengue infection have been reported. The cardiac manifestation of dengue infection is primarily an inflammatory response to infection, however, dengue can rarely present as Takotsubo syndrome. Here, we report a the case of a 69‐year- old male, who presented with fever and ab‐ dominal pain and was diagnosed with dengue fever on serological workup. Just prior to being discharged, the patient developed acute chest pain, and dyspnoea with ST‐segment elevation in the anterolateral leads on electrocardiogram and raised cardiac biomarkers. An urgent coronary angiogram showed non‐obstructive coronary artery disease with apical ballooning on ventriculography. On the basis of this, the patient was diagnosed as have TTS associated with dengue fever. The patient was medically treated with success and was later discharged. He remains currently asymptomatic and his left ventricular ejection fraction recovered to normal (60%) on repeat echo after 6 months. JRCD 2018; 3 (8): 278–280

We present the case of a young patient with dilated cardiomyopathy (DCM) and concomitant pulmonary tuberculosis (TB), emphasising the need for an interdisciplinary approach when considering underlying aetiology. A 36‐year‐old male was admitted to the hospital due to signs of acute heart failure (HF). After diagnostic work‐up, which included laboratory examination, echocardiography, and coronary angiography, a diagnosis of DCM was established and therapy was initiated. Despite optimal medical therapy for HF, the patient’s condition did not improve. During further diagnostic workup, pulmonary tuberculosis was identified. A significant reduction in HF signs and symptoms and improvement in left ventricular ejection fraction occurred only after TB was treated with 6 months of therapy. The presented case study illustrates the necessity to perform a complete diagnostic workup to identify reversible causes of DCM. JRCD 2019; 4 (2): 56-58.

Left ventricular non‐compaction (LVNC), or “spongy myocardium”, is a rare cardiac morphological condition detected in 0.05–0.26% of all adults undergoing transthoracic echocardiography, with an increasing prevalence in the recent years. Our clinical case of a 54‐year‐old asymptomatic female illustrates the importance of additional cardiovascular imaging technologies in the diagnostic work‐up of the patient. The patient was referred to a cardiologist due to a left bundle branch block found on routine electrocardiogram examination. Transthoracic echocardiography did not reveal any specific changes, although a single photon emission computed tomography scan revealed a fixed myocardial perfusion defect. This defect was regarded as non‐typical for inducible myocardial ischaemia and indicative of a non‐specific cardiomyopathy. Further investigation using cardiac magnetic resonance imaging confirmed the phenotype of LVNC. JRCD 2018; 3 (8): 271–274

Paragangliomas (PGLs) are a group of rare, slow-growing tumours which are found between the base of the skull and the pelvis. The tumour may be asymptomatic, although a lump on the neck, cranial nerve palsy, or neck pain may be present. The treatment of choice is surgical resection. We present the cases of 7 patients (6 females) diagnosed with 9 PGLs of the carotid body (carotid body tumours – CBTs). These include: one case with known genetic burden, one of an advanced bilateral and recurrent tumour, and one with a malignant tumour. All presented CBTs were surgically removed. The size of a tumour correlates with postoperative complications. Resection of the largest lesion was associated with persistent left recurrent laryngeal, hypoglossal, and partial facial nerve paralysis. Other complications included single cranial nerve palsy and temporary Horner syndrome. JRCD 2018; 4 (1): 9-14.

Renal disease, especially end‐stage renal disease, is associated with possible pericardial involvement. We report the case of a 51‐year‐old patient with a history of end‐stage‐renal disease, currently receiving chronic haemodialysis. The patient was admitted to the ward due decreased exercise tolerance and elevation of inflammatory markers. Features of active exudative‐constrictive pericarditis were detected upon imaging studies (echocardiography, computed tomography). The haemodialysis regimen was intensified and anti‐inflammatory treatment was administered. In the follow‐up examination, the patient presented with improved clinical status and echocardiography revealed a decreased amount of pericardial fluid with no pattern of constriction. The elevation of CRP and evidence of active pericardial inflammation upon contrast enhancement seen in CT may help to identify patients with potentially reversible forms of pericardial con‐ striction. In this group of patients, in addition to intensification of dialysis, anti‐inflammatory therapy should be considered to prevent the need for pericardiectomy. JRCD 2019; 4 (2): 47-50.

Budd‑Chiari syndrome (BCS) is a rare clinical disorder which is caused by obstruction of the major hepatic veins or suprahepatic portion of the inferior vena cava. Either thrombosis or a mechanical venous obstruction may be present. BCS has been shown to be associated with a number of diseases including polycythaemia vera, myeloproliferative disorders, malignancy or congenital web of the gastro‑intestinal tract. Right‑sided cardiac tumours, although rarely reported as a cause for BCS, are generally considered as a surgically curable cause for this otherwise potentially lethal clinical condition. JRCD 2018; 3 (6): 219–221.

Complete atrioventricular block (AVB) is rare during pregnancy. Congenital atrioventricular block is the most common type of heart block in this group of patients. About one‑third of female patients with complete AVB remain asymptomatic until adulthood and may be first diagnosed during pregnancy. We present a case of a 31‑year‑old pregnant woman with complete AVB who was in her final stage of pregnancy. After reviewing the various advantages and disadvantages of feasible approaches with the patient, we decided to use fluoroscopy‑guided temporary backup pacemaker implantation. Estimated radiation skin dose was small and safe. The patient agreed to this treatment plan. Four days prior to scheduled cesarean delivery (39 weeks of gestation), during a one‑day stay in the hospital, the patient underwent single‑chamber temporary pacemaker implantation (using transvenous active fixation lead and external re‑sterilized pacemaker). The abdominal and pelvic regions were covered with a lead shield. The caesarean delivery was uneventful and the baby was healthy with an Apgar score of 10. JRCD 2017; 3 (6): 205–209.

The anthracycline anticancer drug Doxorubicin (Adriamycin) is an effective and frequently used chemotherapeutic agent for various malignancies. The use of doxorubicin is limited by its major adverse effect, cardiotoxicity. Doxorubicin cardiomyopathy, once developed, carries a poor prognosis with a mortality rate of over 50%. Although invasive, histopathologic analysis of myocardial tissue remains the most sensitive and specific method of diagnosing doxorubicin cardiomyopathy. Histopathologic analysis reveals not only the characteristic diagnostic features of the disease but also aids in grading the severity of doxorubicin cardiomyopathy, which guides further therapy. We report the autopsy findings of a 31-year-old man with a history of T-cell Acute Lymphoblastic Leukemia (ALL) who died of severe doxorubicin induced dilated cardiomyopathy after he was given multiple rounds of hyperfractionated Cyclophosphamide, Vincristine, Adriamycin (doxorubicin) and Dexamethasone (hyper-CVAD) over a period of six years. JRCD 2017; 3 (5): 176–179