Digital Commons Network^™

Lvad Outflow Graft Compression Presenting As Pump Thrombosis, Kelsey Barrett, Barbara A. Ebert Crnp, Nael Hawwa, Sima Y. Hodavance Md, Nauman Islam Md, James Burke Md, Ahmed Nassar, Timothy S. Misselbeck

Department of Medicine

No abstract provided.

Kounis Syndrome: A Rare Mediator Of Acute Coronary Syndrome, Amogh M. Joshi Do, Chun Siu, Zeel Patel Do, Mirza Ali, Amy Lam Do, Tarick Sheikh, Sagar Vadhar Do, Akhil Kher Md, Apurva Vyas Md

Department of Medicine

No abstract provided.

Durability Of Left Bundle Branch Area Pacing – Long-Term Follow Up On A New Technique, Nikhil A. Mehta Md, Syed Rafay A. Sabzwari Md, Bilal Saqi Md, Rahul Gupta Md, Apurva Vyas Md, Jeffrey Gordon Md, Talha Nazir Md, Sergio Cossu Md, Ronald S. Freudenberger Md, Babak Bozorgnia Md

Department of Medicine

No abstract provided.

What’S In The Lv? A Story Of Scad Leading To Anterior Apical Aneurysm With Left Ventricular Thrombus, Lekha Racharla Do, Zeel Patel Do, Tyler Boozel Do, Rahul Gupta Md, Sagar Vadhar Do, Akhil Kher Md, Ellina C. Feiner Md, Yasotha Rajeswaran Md, Daniel J. Makowski Do

Department of Medicine

No abstract provided.

Catastrophic Cardiac Complications Of Takayasu's Arteritis., Sara Godil Md, Bilal Saqi Md, Kareem Godil Md, Syed Rafay Ali Sabzwari, Yasotha Rajeswaran Md

Department of Medicine

Takayasu's arteritis (TA) causes inflammation and necrosis of vessel walls, leading to aneurysm formation, extensive coronary damage and valvular abnormalities. We review a case of recurrent coronary, aortic and mitral valve involvement in a patient with TA and discuss the various treatment options available for such patients.

Cognitive Decline Over Time In Patients With Systolic Heart Failure: Insights From Warcef., Tetz C Lee, Min Qian, Yutong Liu, Susan Graham, Douglas L Mann, Koki Nakanishi, John R Teerlink, Gregory Y H Lip, Ronald S. Freudenberger Md, Ralph L Sacco, Jay P Mohr, Arthur J Labovitz, Piotr Ponikowski, Dirk J Lok, Kenji Matsumoto, Conrado Estol, Stefan D Anker, Patrick M Pullicino, Richard Buchsbaum, Bruce Levin, John L P Thompson, Shunichi Homma, Marco R Di Tullio

Department of Medicine

OBJECTIVES: This study sought to characterize cognitive decline (CD) over time and its predictors in patients with systolic heart failure (HF).

BACKGROUND: Despite the high prevalence of CD and its impact on mortality, predictors of CD in HF have not been established.

METHODS: This study investigated CD in the WARCEF (Warfarin versus Aspirin in Reduced Ejection Fraction) trial, which performed yearly Mini-Mental State Examinations (MMSE) (higher scores indicate better cognitive function; e.g., normal score: 24 or higher). A longitudinal time-varying analysis was performed among pertinent covariates, including baseline MMSE and MMSE scores during follow-up, analyzed both as a continuous variable …

Concomitant Presentation With Cardioembolic Ischemic Stroke And Non St Elevation Myocardial Infarction In A Patient With New Onset Atrial Fibrillation, Amogh M. Joshi Do, Emilee E. Kurtz Do, Kourtney Erickson Do, Margaret R. Kluck Do, Benjamin Sanchez Md

Department of Medicine

Introduction: Although Atrial Fibrillation (AF) is a common cause of ischemic stroke, it rarely causes acute coronary syndromes (ACS). Cardioembolic events from AF cause considerable morbidity and mortality. Concomitant ischemic stroke and ACS remains an exceedingly rare event. We describe the case of a patient presenting with cardioembolic ischemic stroke and acute coronary syndrome.

Case Presentation: An 83 year old male with a prior history of heart failure with preserved ejection fraction, permanent pacemaker for complete heart block, and chronic kidney disease on hemodialysis presented with acute left sided facial and extremity weakness, gait ataxia and profound dysarthria. Physical examination …

Convergent Ablation For The Treatment Of Long Standing Persistent Atrial Fibrillation - A Single Center Experience, Syed Rafay Ali Sabzwari, Lohit Garg Md, Nikhil A. Mehta Md, James R. Kimber, Hiwot Ayele, James K. Wu Md, Babak Bozorgnia Md

Department of Medicine

Introduction: The treatment of long standing persistent atrial fibrillation (AF) is very challenging and conventional catheter ablation strategies have provided only modest success. They often require multiple procedures and anti-arrhythmics to maintain sinus rhythm. The convergent ablation procedure is a hybrid approach, involving a minimally invasive epicardial ablation combined with a traditional transvenous endocardial ablation.

Hypothesis: Convergent ablation is an overall safe and effective procedure for the treatment of long standing persistent AF.

Methods: From February 2015 to September 2017, 30 patient (20 males) with long standing persistent AF underwent convergent ablation at a large tertiary care center. Rest of …

Radiation Induced Symptomatic Critical Left Main Lesion And Symptomatic Aortic Stenosis In An Inoperable Candidate: Role Of Percutaneous Intervention, Fnu Vikram Md, Ghulam Akbar Md, Mohammed Ameen Md, Roshni N. Patel, Lohit Garg Md, Deborah W. Sundlof Do, Nainesh C. Patel Md

Department of Medicine

No abstract provided.

Trends And Predictors Of Implantable Cardioverted Defibrillator In Patients With Cardiac Arrest, Lohit Garg Md, Syed Rafay Ali Sabzwari Md, Aakash Garg Md, Manyoo Agarwal Md, Sahil Agrawal Md, Sima Y. Hodavance Md, Raman Dusaj Md, Nainesh C. Patel Md, Jeffrey Gordon Md

Department of Medicine

No abstract provided.

Large Coronary Arteries Mean No Chance Of A Heart Attack, Right? An Acute Myocardial Infarction In The Setting Of Holding Anticoagulation For A Routine Colonoscopy, Nathan Brewster Do, Jennifer Nesfeder, Ryan Murphy Do, Brian J. Holahan, Syed Rafay Ali Sabzwari

Department of Medicine

Coronary artery ectasia (CAE) is an uncommon pathology, which is sometimes incidentally found on left heart catheterization (LHC). CAE is occasionally treated with systemic anticoagulation to prevent thrombosis or progression of the clot in the coronary arteries. We present a 63-year-old male with known CAE on warfarin who presented to the hospital with myocardial infarction after a routine colonoscopy for which anticoagulation was held. His myocardial infarction was attributed to a likely coronary thromboembolic event. This case highlights the need for consideration of bridging anticoagulation therapy before and after procedures in patients with CAE to prevent adverse coronary events.

Treating Postpartum Refractory Long Qt Syndrome With Cervical Ganglion Sympathectomy, Nikhil A. Mehta Mbbs, Mario Caruso Do, Syed Rafay Ali Sabzwari Md, Lohit Garg Md, Jeffrey Gordon Md, Talha Nazir Md

Department of Medicine

No abstract provided.

Sudden Cardiac Death Associated With Malignant Mitral Valve Prolapse, Damon Mcenroe Md, Fnu Vikram Md, Kailyn Mann Do, Lohit Garg Md, Syed Rafay Ali Sabzwari, Nael Hawwa Md

Department of Medicine

No abstract provided.

Traumatic Tricuspid Regurgitation: When To Operate, Ghulam Akbar Md, Lohit Garg Md, Syed Rafay Ali Sabzwari, Fnu Vikram Md, Raman Dusaj Md

Department of Medicine

No abstract provided.

Isolated Bicuspid Pulmonic Valve: “Forgotten Valve” And A Rare Anomaly, Ghulam Akbar Md, Fnu Vikram Md, Lohit Garg Md, Larry E. Jacobs Md, Matthew W. Martinez Md

Department of Medicine

No abstract provided.

Outcomes Of Catheter Ablation For Atrial Fibrillation In Patients With Hypertrophic Cardiomyopathy, Lohit Garg Md, Syed Rafay Ali Sabzwari Md, Ghulam Akbar Md, Hiwot Ayele Md, Sahil Agrawal Md, Manyoo Agarwal Md, Jeffrey Gordon, Raman Dusaj Md, Talha Nazir Md, Babak Bozorgnia Md, Matthew W. Martinez Md

Department of Medicine

No abstract provided.

Development Of A Cardio-Oncology Program In A Community Hospital, Deborah W. Sundlof Do, Brijesh D. Patel Md, Kelly C. Schadler Msn, Crnp, Ross G. Biggs Do, Cheri A. Silverstein Fadlon Md, Mscr, Paul S. Corotto Md, Sameer Tolay Md, Ahmed J. Nadeem Do, Ranju Gupta Md, Nadeem V. Ahmad Md

Department of Medicine

No abstract provided.

Chemo-Coronaries: A Rare Form Of Coronary Vasospasm Following 5-Fu Infusion, George Prousi Md, Joseph Moran Do, Ross Biggs Do, John Mannisi Md

Department of Medicine

No abstract provided.

Takotsubo Cardiomyopathy Presenting With Sinoatrial Disease: A Rare Presentation, Syed Rafay Ali Sabzwari, Khurram Butt, Nimra Khan, Kailyn Mann Do, Tarick Sheikh, Chandra Bomma

Department of Medicine

Takotsubo cardiomyopathy (TCM), or apical ballooning syndrome, is a distinct nonischemic cardiomyopathy mimicking acute coronary syndrome. A 76-year-old female presented with ST elevation in the inferior lead and a troponin level of 0.81 ng/dL. An immediate coronary angiography showed non-obstructive coronary artery disease. A subsequent ventriculogram and echocardiogram showed anteroapical and distal inferior wall hypokinesis suggestive of TCM. Despite therapy with beta blocker, she was observed to have two significant sinus pauses, one eight-second, and a second 29-second pause. An urgent transvenous pacemaker was put in place and later followed by a permanent pacemaker. The patient was discharged on carvedilol …

Syncopal Episodes Of Arrhythmogenic Right Ventricular Cardiomyopathy In A Patient With Pre-Existing Seizure Disorder, James Kimber, Syed Rafay Ali Sabzwari, Hiwot Ayele

Department of Medicine

Arrhythmogenic right ventricular cardiomyopathy (ARVC), is a heritable condition that is an important, and under-recognized cause of sudden cardiac death. Microscopically, it is represented by fibrofatty replacement of myocardium involving the right ventricular inflow area, apex, and infundibulum. Common clinical manifestations of ARVC include palpitations, syncope, chest pain, dyspnea, and sudden cardiac death. This is a case of a 25-year-old male with a history of thalassemia, and tonic-clonic seizure status post head trauma with cystic encephalomalacia in left parietal lobe who described recurrent syncope. He was followed by neurology and maintained only on Lamotrigine. Episodes occurred within the span of …

The Disappearing Murmur: Systolic Anterior Motion Of The Mitral Valve Leaflet In A Non-Hypertrophic Cardiomyopathy Patient, Syed Rafay Ali Sabzwari, James R. Kimber, Hiwot Ayele, Nimra Khan, Tarick Sheikh, Ghulam Akbar Md, Bruce Feldman Do

Department of Medicine

Systolic anterior motion (SAM) of the mitral valve is a well-known phenomenon associated with left ventricular outflow tract obstruction and hemodynamic compromise. This finding may occur in patients with or without hypertrophic cardiomyopathy. In this report, a patient with no prior medical history presented to the hospital with left-sided chest pain and high-risk echocardiogram (ECG) findings. Left heart catheterization with coronary angiography was negative for coronary artery disease. His initial examination was significant for a systolic murmur due to the underlying SAM, as demonstrated by transthoracic echocardiogram. During his hospitalization, he developed acute heart failure syndrome as a result of …

A Case Of Flash Pulmonary Edema Caused By Iliac Artery Stenosis, Grace Chong Do, Joseph Moran Do, Fnu Vikram Md, Benjamin Sanchez Md

Department of Medicine

No abstract provided.

Ten Lifestyle Modification Approaches To Treat Atrial Fibrillation, Syed Rafay Ali Sabzwari, Lohit Garg Md, Dhanunjaya Lakkireddy, John Day

Department of Medicine

Atrial fibrillation (AF) is the most common arrhythmia affecting three million people in the United States (US). Across different races in the US, the incidence of other races was comparable to that of Caucasian population. This points towards the importance of certain lifestyle modifications that can help prevent and treat this disorder. This article discusses 10 such factors. Smoking has been linked to AF, with almost 36% risk reduction if quit. Hypertension has 56% increased risk of atrial fibrillation in which the role of lifestyle changes is well known. Similarly, alcohol-induced atrial fibrillation has 10% increased risk of atrial fibrillation. …

Obesity Is Not Associated With A Differential Outcome Following Coronary Artery Bypass Surgery, Lohit Garg Md, Sahil Agrawal Md, Amitoj Singh, Raman Dusaj, Jamshid Shirani

Department of Medicine

Background: Conflicting data exists regarding the impact of obesity on mortality and morbidity following coronary artery bypass graft (CABG) surgery with some suggesting a paradoxical reduction in adverse outcomes. We aimed to compare the in-hospital outcomes of CABG in obese and non-obese subjects.

Methods: The Nationwide Inpatient Sample for years 2003- 2014 was used to identify adults (age ≥18 years) who underwent isolated CABG.

Results: A total of 2,297,932 patients underwent CABG of which 554,857 (28.2%) surgeries were for acute coronary syndrome (ACS) and 1,743075 (74.2%) were elective. Obese patients in either group were younger, were more likely to be …

Outcomes Of Catheter Ablation For Supraventricular Tachycardia In Adult Patients With Congenital Heart Disease, Lohit Garg Md, Sahil Agrawal Md, Manyoo Agarwal Md, Brijesh Patel Md, Mahek Shah Md, Aakash Garg Md, Sudip Nanda Md, Facp, Talha Nazir Md, Raman Dusaj Md

Department of Medicine

Background: Supraventricular tachyarrhythmias (SVT) are common in adult patients with congenital heart disease (CHD). There is paucity of data regarding the safety and outcomes associated with catheter ablation in these patients.

Methods: We queried the National Inpatient Sample (NIS) to identify all adults patients > 18 years with CHD undergoing catheter ablation for SVT.

Results: Between 2003-2013, 5,966 patients with CHD underwent catheter ablation for SVT. Of these 4,769 were performed for atrial fibrillation or atrial flutter and rest for other SVTs. The mean age of these patient was 47+/- 15 years, 59.9% were males. 18% of patients experienced procedure related …

Cardiac Amyloidosis Masquerading As Hypertrophic Obstructive Cardiomyopathy, Lohit Garg Md, Naveen Sablani, Amy Ahnert, Bruce Feldman Do

Department of Medicine

Background: Cardiac amyloidosis (CA) remains a diagnostic challenge and is associated with significant morbidity and mortality.

Case: A 67-year old male was referred for septal myomectomy for hypertrophic obstructive cardiomyopathy (HOCM) due to worsening symptoms despite medical therapy. His medical history included chronic diastolic heart failure, and atrial fibrillation post pulmonary vein isolation. His examination revealed mid peaking crescendo-decrescendo systolic murmur, worse on Valsalva. An electrocardiogram revealed normal sinus rhythm and normal voltage. Transthoracic and transesophageal echocardiogram revealed asymmetric septal hypertrophy, chordal systolic anterior motion (SAM), and left ventricular (LV) obstruction with a peak gradient of 40 mmHg at rest. …

Type Ii Brugada Syndrome Syncopal Seizure: A Diagnostic Dilemma, Syed Rafay Ali Sabzwari, Nghia Hoang

Department of Medicine

Background: Type II Brugada syndrome is a rare entity that can present as syncope, sudden cardiac death, palpitations and nocturnal agonal respiration as a manifestation of ventricular tachyarrythmia. Although patients can experience a syncopal seizure, the dilemma between epileptic seizure and syncopal seizure due to type II Brugada syndrome is rarely encountered and reported in literature.

Case: 45 years old caucasian male with history of bicuspid aortic valve and no family history of sudden cardiac death or arrhythmia presented with generalized body shaking, unresponsiveness, mouth frothing and rolling of eyes for 4 minutes during sleep followed by 30 minutes of …

Risk Scores-Medical Derivatives., Ronald S. Freudenberger Md

Department of Medicine

No abstract provided.

Death During Exercise Testing In A Patient With Asymptomatic Severe Aortic Stenosis, Mahek Shah Md, Anuraj Sudhakaran, Baburaj Aparna, Muhammad Qasim Md, Brijesh Patel Md, Lohit Garg Md, Bruce Feldman Do

Department of Medicine

Introduction: Patients with symptomatic severe aortic valve stenosis (AS) experience short and long-term survival benefit with aortic valve replacement (AVR). Among patients with asymptomatic severe AS (ASAS) current guidelines recommend exercise stress testing (ETT) as a safe and effective method to risk stratify patients and to assist with the timing of AVR. We discuss the course of disease in AS, review the role of ETT and express concerns about the safety of performing stress tests in asymptomatic patients with severe AS. Case Report: We describe the case of a 69-year-old male with left bundle branch block and ASAS who underwent …

A Reversible Cause Of Complete Heart Block Causing Chest Pain And Syncope., Syed Rafay Ali Sabzwari, Zoltan Varga, Khurram Butt, Nimra Khan

Department of Medicine

Vasospastic angina (VSA), also known as variant or Prinzmetal's angina, is a relatively uncommon cause of retrosternal chest pain with transient ST segment elevation, mainly due to vasospasm in the coronary arteries. This is a case of 37-year-old female who presented with chest pain and syncope. Her initial workup, including echocardiogram, was negative. Subsequently, she was sent home with an event monitor. During the next two weeks, she continued to have recurrent episodes of similar chest pains and presented to her cardiology appointment with a heart rate of 45 bpm and blood pressure of 100/60 mmHg and was taken to …