We present a 49-year-old man who required extraction of a cardiac resynchronization device due to lead infection. While 2 leads were successfully retrieved by a transvenous approach the third one with active fixation and entrapped into a coronary sinus side-branch, required surgical intervention. During the operation, performed on cardiopulmonary bypass on a beating heart, lead extraction was greatly facilitated by employment of a tissue stabilizer routinely used for off-pump coronary surgery.

Blood pressure is the pressure the blood in arteries applies on vessels. Abnormal blood pressure is a major public health problem commonly encountered in the population with normal blood pressure and intensive care patients. The two types of action that the heart performs are pumping blood and relaxing. The pressure exerted when the heart is pumping blood is the “systolic” blood pressure, and the pressure applied during the relaxation of the heart is the “diastolic” pressure. Although blood pressure is not always at the same level (with slight fl uctuations), normal blood pressure in adults is 120/80 mmHg. Lower blood pressure of 90/60 mmHg is hypotension, while higher blood pressure of 140/90 mmHg is hypertension [1]. Circulating high catecholamines (epinephrine and norepinephrine) can lead to a hypertensive crisis [2]. Renalase, a recently discovered fl avoprotein, degrade catecholamines [3, 4, 5]. Here it has been therefore claimed that blocking or enhancing the action of renalase migt help a strict control of regulating blood pressure.

The “omics” technologies represent a new model of approach in the study of human disease. It consists of general approaches on molecules (such as genes, transcripts, proteins and metabolites) of which a cell, tissue or organism is made. Although the interactions between the ‘omes’ mean that omic strategies are complementary, there are differences in terms of their molecular properties, and therefore, the technologies required for preparation and analysis [1]. Metabolomics is defined as the quantitative measurement of the dynamic metabolic response of living systems to genetic, physical, pathological or developmental factors. The technology has emerged in numerous fi elds of research, including fetal medicine aiming to facilitate the understanding of fetal disease pathophysiology and discovery of redictive biomarkers [2].

We describe an interesting case of a 52 year-old patient affected by thyrotoxicosis crisis, in whom sinoatrial blocks were associated with syncope and treated effi ciently with beta-blockers. We hypothesized the Bezold-Jarisch refl ex as the mechanism which leads to bradycardia and hypotension with syncope related to prolonged tachycardia. This hypothesis has not been, to our knowledge, considered in previous studies and offers therapeutic methods, as the patient was not treated with permanent pacing.

Dear Editor, the Zika virus infection becomes a big global problem at present. The clinical manifestation of this infection can be from asymptomatic to severe acute febrile illness with hemorrhagic complication. Focusing on cardiovascular effect, there are some reports on the problem. Recently, the problem of carditis due to Zika virus infection becomes a big concern in cardiology. The report by Aletti et al. [1], on transient myocarditis leads to the great concern by the cardiologist. Aletti et al. [1], noted that “We recommend an electrocardiogram and an troponin if any cardiac symptoms are present in a patient with acute Zika infection.”

Background: Ventricular septal rupture is a rare but fatal mechanical complication of acute myocardial infarction. Although the incidence has decreased, the mortality rate from ventricular septal rupture has remained extremely high. Objectives: The aim of this study was to assess the patient with acute myocardial infarction complicating with ventricular septal rupture and to identify the risk factors for ventricular septal rupture in a tertiary level hospital of Nepal.