Aim and objective: To estimate the two-dimensional echocardiographic study of left ventricular volume and function in chronic obstructive pulmonary disease (COPD) patients admitted in tertiary care hospital. Introduction: COPD affects pulmonary blood vessels, right ventricle, as well as left ventricle leading to the development of pulmonary hypertension (PH), cor pulmonale (COR-P), right and left ventricular dysfunction. The present study was conducted to determine the relation between severity of airway obstruction (stages) of COPD and left ventricular dysfunction. Secondary objective was to assess the correlation between smoking and left ventricular (LV) dysfunction. Materials and methods: A cross-sectional descriptive study was conducted in the tertiary Medical College and Hospital. A total of 52 COPD patients were included by convenience sampling into the study. The echo study addressed pericardial condition, cardiac dimensions, LV systolic and diastolic function, and hemodynamic of pulmonary circulation. LV dysfunction was outcome variable and IBM SPSS version 22 were used for statistical analysis. Results: Majority of the participants were aged between 61 and 70 years. LV diastolic dysfunction was observed in eight (15%) participants and LV systolic dysfunction was observed in five (10%) participants. The mean E/A ratio significantly decreased as the severity of COPD increased (p = 0.024). A weak negative correlation was observed between duration of smoking and E/A ratio and left ventricular end diastolic diameter. Conclusion: LV defects, specifically E/A ratio was inversely proportional to the severity of the COPD.

It can affect young athletes. It may present with microscopic alteration of cardiomyocytes leading to cardiac failure. It has been found that early diagnosis may play a pivotal role in guiding treatment decisions, improving quality of life.

Breathing circuit leak, obstruction, or misconnects contribute to around 20% of the critical incidents occurring during anesthesia which if not immediately identified may result in serious harm. Circuit damage can occur due to extra-manipulation of the circuit after fixing it inside the tube holder or mishandling of the tube holder with the circuit in situ. Damage to the breathing circuit can be prevented by making the edge of the tube holder groove blunt or by adding some cushion material over the edge of the groove. The anesthesiologist must be vigilant about circuit leaks while administrating anesthesia.

Background: Spontaneous splenic rupture during pregnancy is usually misdiagnosed as abruptio placentae and uterine rupture. Case description: A 35-year-old G2P1L1 with a previous cesarean section at 38 weeks of gestation was referred to our emergency obstetrics department with a diagnosis of uterine rupture. She had sudden onset of epigastric pain following lifting of a heavy container without any direct trauma on her abdomen. Severe pallor with tachycardia was there on examination. She did not complain of labor pains. Uterine contour could not be made out due to guarding; however, it was found intact on bedside transabdominal ultrasonography, a large amount of free fluid and fetal demise without any evidence of retroplacental clots was also confirmed. She was taken up for emergency laparotomy. Massive hemoperitoneum due to splenic rupture was evident during laparotomy, the site of rupture was covered with hematoma with an absence of active bleeding thus left undisturbed. She received multiple blood transfusions with successful recovery. Conclusion: Sudden epigastric pain, pallor, and hypotension following abdominal strain may be a sign of splenic rupture. Resuscitation of patients with immediate laparotomy should be done in these patients to avoid fetal and maternal morbidity and mortality. Key message: Sudden epigastric pain with pallor and hypotension following abdominal strain may be a sign of splenic rupture. Hence, it should be one of the differential diagnoses in addition to abruptio placentae and scar rupture in suspected hemorrhagic shock. Resuscitation of patients with immediate laparotomy should be done in these patients to avoid fetal and maternal morbidity and mortality.