Lyme disease can have cardiac involvement and can subsequently present with various types of atrio ventricular (AV) block. Sinus node dysfunction (SND) and accelerated junctional rhythm are highlighted in this case as an uncommon presentation for Lyme Carditis. This case highlights the importance of having a high index of suspicion for cardiac involvement with Lyme disease when atypical arrhythmias are present.

Background: We describe a novel case of treating severe distal aorto-illiac occlusive disease and endovascular aortic repair with kissing endoluminal lithoplasty balloons. This ensured a safe conduit to facilitate thoracic endovascular aortic repair. Case Presentation: A patient with multiple comorbidities including coronary artery disease and peripheral artery disease (Rutherford 4 symptoms bilaterally) presented to the emergency room with chest pain and dyspnea on exertion. The patient was found to have a 3.5 cm descending thoracic aortic aneurysm, multiple penetrating aortic ulcers (PAU’s) within the descending thoracic aorta which was felt to be the cause of her chest pain along with heavily calcified occlusive aorto-iliac disease. The patient was deemed high surgical risk for open repair and the patient’s severe calcific distal aortic stenosis and bilateral severe ostial iliac stenosis was deemed a barrier for endovascular repair. Therefore, the patient was successfully treated with kissing balloon lithoplasty for lesion preparation of the heavy calcification and placement of an endovascular stent graft (EVAR) in the distal aorta, which ensured a safe conduit for thoracic endovascular aortic repair (TEVAR) procedure. Conclusion: As patients become more and more complex it is important to explore endovascular treatment options especially when surgical risk is high. Balloon lithoplasty and graft placement of calcified aorto-iliac bifurcation is a safe approach to develop a clear conduit for TEVAR.

Background: Ranolazine (RAN) reduces cardiac sodium channel 1.5’s late sodium current(INaL ) in congestive heart failure (CHF), reducing myocardial calcium overload, potentially improving left ventricular ejection fraction(LVEF) and reducing arrhyth- mogenic after potentials. RAN blocks neuronal sodium channel 1.7(Nav 1.7), potentially altering parasympathetic and sympathetic (P&S) activity. RAN also selectively blocks inactivated atrial Nav 1.8, as well as ventricular IKr and ICaL, affecting atrial and ventric- ular arrhythmias. Methods: (1)Matched CHF patients were given RAN (1000 mg p.o. b.i.d.) added to guideline-driven therapy (RANCHF, 41 systolic, 13 diastolic) or no adjuvant therapy (control, NORANCHF, 43 systolic, 12 diastolic). Echocardiographic LVEF and P&S measures were obtained at baseline and follow-up (mean 23.7 months). (2)A total of 59 patients with symptomatic PVCs were identified from full-disclosure Holters. Doses of 500 - 1,000 mg RAN b.i.d. were given to 34% and 66% of patients, respectively, and Holters were repeated (mean 3.1 months). Congestive heart failure (CHF) was defined as symptoms including dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and edema, with a brain natriuretic peptide> 400. Systolic heart failure with reduced ejection fraction (HFr EF) vs. diastolic CHF (HFpEF) depended upon LVEF= 40%. Results: (1)LVEF increased in 70% of RANCHF patients, an average of 11.3 units. Mean LVEF remained unchanged in NORANCHF pa- tients. P&S measures indicated cardiovascular autonomic neuropathy (P<0.10 bpm2) in 20% of NORANCHF patients at baseline and 29% at follow-up (increasing in both groups). At baseline, 28% of patients had high sympathovagal balance (SB), RAN normalized SB in over 50% of these; in contrast, the NORANCHF group had a 20% increase in patients with high SB. (2)Upon repeat Holters at a mean of 3.1 months after initiating RAN, 95% (56/59) of the patients had their PVC count reduced: 24% (14/59) had more than 90% decrease, 34% (20/59) had 71 to 90% decrease, and 17% (10/59) had 50 to 70% decrease. In the entire group, RAN reduced PVCs by 71% (mean 13,329 to 3,837; p < 0.001). Ventricular bigeminy was reduced by 80% (4,168 to 851; p < 0.001), ventricular couplets were reduced by 78% (374 to 81; p < 0.001), and ventricular tachycardia (VT) was reduced by 91% (56 to 5; p < 0.001). The PVC reduction was dose dependent without proarrhythmia. Conclusions: (1)RAN preserves or improves LVEF and decreases high SB in CHF. (2)RAN offers an effective and safe pharmacologic treatment for symptomatic PVCs.

Phonocardiogram (PCG) signal is one of the useful approach to explore cardiac activity, and extract many features to help researchers to develop technic that may serve medical stuff to the diagnosis of several cardiac diseases. For people when it comes to a heart activity problem it is a serious health matter that need special care. In this paper, the importance is given to heart murmurs to highlight their impact. Heart murmurs are very common disease in world and depend on their severity they could be life-threatening point; therefore, the purpose of this paper is focused on three essential steps: first is to design an algorithm to extract only heart murmurs from a pathological phonocardiogram signal (PCG) as a basic background to the whole work. Than calculate their severity based on energy ratio (ER) which is recommended by recent studies as an effective factor, in order to classify them to mild, medium and severe murmurs. In other hand, this classification will served to study the impact of severity of systolic and diastolic murmurs on cardiac variability, which is very important indicator on general health of human body. This study is done on consider number of patients and its reveal on very interesting results.

Primary percutaneous coronary intervention (pPCI) is considered as the preferred treatment for acute ST-Elevation myocardial infarction (STEMI). However, its availability is limited to less than 10% in rural and sub urban population in India (1). Therefore, Pharmaco-Invasive Therapy (PIT) (Thrombolysis first followed by planned coronary stenting) as an alternative to pPCI for acute STEMI has more recently been explored. A retrospective observational study of 60 patients with acute STEMI treated at the Dedicated Heart Attack Treatment Centre of SKY Hospital & Research Centre, Imphal, India over a period of 2 years has shown that Pharmaco-Invasive Therapy improved survival of patients with acute STEMI to 100% and increased Left Ventricular Ejection Fraction (LVEF) by 5.08% at the time of discharge and may be used as a viable alternative to pPCI in the treatment of patients with acute STEMI when pPCI cannot be performed within recommended time.