Medicine and Health Sciences Commons^™

Be Aware Of The Unexpected : Interrupted Inferior Vena Cava With Azygos Continuation, Tit Kei Ng, Tommy King-Him Ma, Chi-Chun Au, Janice Woon-Yan Wong, Jenny Nga-Lai Chow, Andrew Vincent Li, Adrian Yin-Cheung Luk, Candy Ming-Yan Cheuk, Jaclyn Chi-Lin Chan, Li-Wah Tam

Journal of the Hong Kong College of Cardiology

Interrupted inferior vena cava with Azygos continuation is a rare anomaly. Nevertheless, being a high-volume operator of endovascular procedures, a cardiologist should have knowledge about this anomaly. We reported a case of incidental finding of this anomaly during an intended Leadless pacemaker (Micra) implantation. Embryological development, anatomy and procedural implication of this condition were discussed. In particular, management options when confronted by this anomaly during Micra implantation were explored.

Phaeochromocytoma-Induced Takotsubo Cardiomyopathy Presented With Cardiogenic Shock, Wong Lai Sze Alice, Yu Cheuk-Man, Hong Kam Fai Jeffrey, Tsang Man Wo, Wat Yiu Kin Jason, Tong Mei Wa Gensy

Journal of the Hong Kong College of Cardiology

Background: Phaeochromocytoma, on its own, is a rare endocrine condition. Patient that presents with cardiogenic shock as a result of phaeochromocytoma-induced Takotsubo cardiomyopathy is even rarer, as phaeochromocytoma classically presents with hypertension. Clinical awareness and understanding of this disease entity is important for early identification and appropriate management of this endocrine emergency. Case presentation: A 39-year-old woman presented with one day history of repeated vomiting associated with epigastric pain. Her condition deteriorated rapidly with acute cardiac and renal failure with cardiogenic shock after intravenous fluid infusion, requiring high flow oxygen and high dose inotropic support in intensive care unit. Subsequent …

Prehabilitation-Reconditioning Of Teenage Heart Transplant Candidates, Chan Myr, Hui Ww, Chan Ww, Lun Ks

Journal of the Hong Kong College of Cardiology

Progression of Dilated Cardiomyopathy to advanced heart failure necessitates the use of a Left Ventricular Assistive Device (LVAD) as a bridge to heart transplantation (1,8,10). Two teenagers with cardiomyopathy who were on the waiting list for heart transplantation and had LVADs were given a physical training intervention tailored by physiotherapist. This case report reviewed the efficacy of prehabilitation conducted by physiotherapists at the Hong Kong Children's Hospital. After the prehabilitation program both patients demonstrated significant improvements in functional capacity, respiratory effort, and hand strength. Physical training is a promising approach for patients who have undergone heart transplantation.

Ticagrelor Related Anaphylactic Shock In A Stemi Patient, Lam Man Tat, Ip Man Fai, Mok Toi Meng, Chang Tou, Lam U. Po

Journal of the Hong Kong College of Cardiology

An ST elevation myocardial infarction is life-threatening and requires urgent management. Before coronary intervention, preoperative loading a P2Y12 receptor antagonist is warranted. We present a case in which urgent coronary angiography was performed after given loading dose of Aspirin and Ticagrelor. Two and a half hours after loading Ticagrelor, patient developed hypotension with swollen face and diffuse rash on the trunk. Consideration of the anaphylactic shock, a steroid bolus and an inotropic infusion were administered and patient became hemodynamically stable. The allergic manifestations disappeared a few hours later, Ticagrelor was changed to Clopidogrel to avoid the severe allergic reaction.

Comparison Of Primary Percutaneous Coronary Intervention (Ppci) Vs. Pharmacoinvasive Strategy As Reperfusion Strategies In Patients With St-Elevation Myocardial Infarction (Stemi), Siu Wai For

Journal of the Hong Kong College of Cardiology

Background – Guidelines recommended primary percutaneous coronary intervention (PPCI) as the preferred reperfusion strategy in the treatment of patients with ST-elevation myocardial infarction (STEMI). However, PPCI might not be readily available in the real-world situations due to the limitation of resources. A pharmacoinvasive strategy consisting of early thrombolytic therapy followed by PCI was suggested as an alternative reperfusion approach. Prior studies had shown that clinical outcomes of pharmacoinvasive strategy were comparable to PPCI. The purpose of this retrospective study was to assess the outcomes of reperfusion strategies in patients with STEMI in the North Territories East of Hong Kong, comparing …

Case Report: Apical Hypertrophic Cardiomyopathy Of An Elite Athlete In The Hong Kong Sports Institute, Bryan Lau

Journal of the Hong Kong College of Cardiology

This case report is about an elite athlete in the Hong Kong Sports Institute who was diagnosed apical hypertrophic cardiomyopathy through periodic medical assessment with history taking, physical examination, 12-lead resting ECG and subsequent imaging investigations. The challenge of differentiating pathological condition from physiological adaptation of athlete ECG was solved by using the latest international consensus which was advanced by new emerging research data.

Serum Endothelin-1 Level Among Adult Indonesian Females With Obesity: A Nested Cross-Sectional Study From Universitas Gadjah Mada Health And Demographic Surveillance System, Sleman, Indonesia, Anggoro Budi Hartopo, Maria Patricia Inggriani, Jajah Fachiroh, Fatwa Sari Tetra Dewi

Journal of the Hong Kong College of Cardiology

Background The increased obesity prevalence is seen among adult Indonesian females. Obesity is linked to increased endothelin-1 levels, which contribute to endothelial dysfunction, inflammation and insulin resistance. This study aimed to investigate the association between serum endothelin-1 levels with obesity among Indonesian females. Methods This was a cross-sectional study. The subjects were population of Universitas Gadjah Mada Health and Demographic Surveillance System (HDSS) Sleman, Indonesia. We collected venous blood, measured obesity parameters and performed the standardized questionnaire from 124 males and females. Endothelin-1 level was measured from serum by ELISA-methods. Endothelin-1 level was compared between subjects according to obesity category …

Diagnosing Hypertrophic Cardiomyopathy In Athletes, Chalisa Srisukajorn, Tamonwan Megan Jirakulaporn, Helen C Huang, Erik Fung, Polakit Teekakirikul

Journal of the Hong Kong College of Cardiology

Sudden cardiac death (SCD) in a young asymptomatic individual is a devastating, unpredictable event, with a widespread impact on the public health system. Hypertrophic cardiomyopathy (HCM) is the most common form of genetic heart disease, and considered one of the leading causes of SCD affecting young and frequently asymptomatic patients. A diagnosis of HCM is challenging particularly in young athletes due to overlapping clinical phenotypesbetween pathological left ventricular hypertrophy (LVH) and exercise-induced physiological LVH. Severalinvestigational tools have been used to differentiate these two distinct entities. This review article focuses upon the diagnosis of HCM in young athletes, SCD risk assessment, …

Procedural And Clinical Outcomes Of Dedicated Venous Stents In Acute And Chronic Venous Obstruction: A Retrospective Single Center Study, Guangming Tan, Madeleine G Yan, Bryan Py Yan

Journal of the Hong Kong College of Cardiology

Background Endovenous angioplasty with stenting is an accepted treatment for patient with venous obstruction. Dedicated venous stents have been developed to improve the efficacy and safety of the venoplasty procedure. We report the procedural as well as clinical outcomes of these new generation stents in the treatment of acute and chronic venous obstruction. Method This is a single centre retrospective cohort study of patients who received venous stenting for either acute or chronic venous obstruction. Baseline demographics, procedural details, clinical outcomes including 30 day all-cause mortality, 90 day primary patency rate, and change in Villalta score were reported. Result 41 …

Institute Of Cardiovascular Science And Medicine Faculty Of Medicine The University Of Hong Kong

Journal of the Hong Kong College of Cardiology

No abstract provided.

Abstracts For Lectures

Journal of the Hong Kong College of Cardiology

No abstract provided.

9th Asian Preventive Cardiology And Cardiac Rehabilitation Conference Symposia

Journal of the Hong Kong College of Cardiology

No abstract provided.

9th Asian Preventive Cardiology And Cardiac Rehabilitation Conference

Journal of the Hong Kong College of Cardiology

No abstract provided.

Old But Not Vain : Two Cases Of Refractory Polymorphic Ventricular Tachycardia Associated With Coronary Artery Disease Successfully Treated With Quinidine, Tit-Kei Ng, Tommy King-Him Ma, Chi-Chun Au, Janice Woon-Yan Wong, Jenny Nga-Lai Chow, Andrew Vincent Li, Adrian Yin-Cheung Luk, Sze-Wah Lai, Candy Ming-Yan Cheuk, Jaclyn Chi-Lin Chan, Li-Wah Tam

Journal of the Hong Kong College of Cardiology

Post myocardial infarct polymorphic Ventricular Tachycardia (VT) triggered by injured Purkinje fibres can cause VT storms that are refractory to various treatment even after successful reperfusion or revascularization. We reported such recurrent polymorphic VT in two post myocardial infarct patients after Percutaneous Coronary Intervention. Both of them responded readily to Quinidine. We also discussed the pathophysiology of this arrhythmia and the treatment option of it, namely catheter ablation and antiarrhythmics

Recurrent Cyanotic Spells In An Octogenarian, Chin Tong Kwok, Chun Kit Wong

Journal of the Hong Kong College of Cardiology

We report rare case of an octogenarian who, after years of diagnostic delay, was found to have a patent foramen ovale, and due to an ascending aortic aneurysm that anatomically facilitated right-to-left shunt, presenting with life-threatening cyanotic attacks. The characteristic orthodeoxia-platypnea syndrome and high alveolar arterial gradient hint to the diagnosis. She was eventually treated successfully with urgent percutaneous PFO closure. Routine ordering of a transthoracic echocardiogram, without agitated saline injection under provocation maneuvers, may not be sufficient to rule out shunts.

Roles Of Exercise Treadmill Test In The Diagnosis & Risk Stratification Of Cardiac Channelopathies, Kit Chan

Journal of the Hong Kong College of Cardiology

Channelopathies are the leading causes of SCD in patients without structural heart disease. Missing the diagnosis of high-risk but concealed channelopathies could have lethal clinical consequences. However, the diagnosis of channelopathies is often challenging due to the dynamic clinical presentations and elusive ECG manifestations of these diseases. An integrated approach including clinical assessment, repeated electrocardiography, drug provocation tests, exercise stress test and genetic studies is often required for establishing the diagnosis. Pharmacological provocation tests may have limited sensitivity and may be associated with false positive results. Wide-spread use of genetic studies are limited by low yield, cost-effectiveness and availability issue. …

Retrospective Observational Study Comparing Two Reperfusion Strategies In Patients With Acute Stemi Presenting Outside Office Hours, Derek Pok-Him Lee, Kam-Tim Chan, Michael Kang-Yin Lee, Eric Chi-Yuen Wong

Journal of the Hong Kong College of Cardiology

Introduction : A pilot cluster-based 24-hour PPCI service in a phased expansion program was launched in October 2018. This study aimed to compare the 30-day mortality and major bleeding event in acute STEMI patients presenting outside office hours who received historical thrombolytic therapy and PPCI under the newly implemented 24-hour service model. Methods and results : A single center retrospective study was conducted on consecutive STEMI patients presenting outside office hours, who received urgent thrombolytic therapy or PPCI between 2016-2019. The primary endpoints were 30-day mortality and major bleeding event. The secondary endpoints were thrombolytic failure rate and hospital length …

The Impact Of Renal Insufficiency Upon Admission On The Clinical Outcome Of Patients With Acute St-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention, Wai Lun Kwong, Kwok Ho Yau, Eugene Sin, Kwok Keung Chan

Journal of the Hong Kong College of Cardiology

Background: Coronary artery disease is common in patients with renal insufficiency. In acute coronary syndrome, impaired renal function is present in approximately 30-40% of patients and is associated with worse prognosis. Local data regarding the risks and benefits for those patients suffering from acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) is scarce. We evaluated the clinical outcomes of patients suffering from STEMI with and without renal insufficiency upon admission who underwent PPCI.

Methods: From 1^st January 2009 to 30^th September 2017, all patients with STEMI treated with PPCI were identified. The primary …

Endovenous Intervention: From The Legs To The Lungs, Guangming Tan, Bryan Py Yan

Journal of the Hong Kong College of Cardiology

Significant advancement in endovascular technology have enabled the treatment of a variety of venous diseases from the deep vein diseases to diseases in the pulmonary vasculatures. Understanding the principles and the limitations of these endovenous interventions is very important in selecting the appropriate patients for optimal clinical outcomes. In this review, the clinical evidence, guideline recommendations from various societies and the approaches to these endovenous procedures will be discussed.

Utilisation Of The Simplified Pulmonary Embolism Severity Index In Prognostication Of Pulmonary Embolism – A Retrospective Study In A Regional Hospital In Hong Kong, Ka-Hung Lau, Chi-Suen Chiu, Liang Chow, Ngai-Yin Chan

Journal of the Hong Kong College of Cardiology

Pulmonary embolism is the most severe form of venous thromboembolism that can result in significant morbidity and mortality, especially if left untreated. Guidelines suggested the use of clinical scoring systems to stratify patients’ risk of mortality, which helps to guide subsequent management strategy. Simplified pulmonary embolism severity index is a well-validated prognostic score that predicts the risk of short term mortality of pulmonary embolism and studies showed that low-risk patients could be safely managed as outpatients. However, local studies on the use of prognostic scores including simplified pulmonary embolism severity index in management of pulmonary embolism are lacking.

Review On Molecular Genetic Basis Of Hypertrophic Cardiomyopathy, Derek Pok Him Lee

Journal of the Hong Kong College of Cardiology

Hypertrophic cardiomyopathy (HCM) is one of the most common types of inherited cardiomyopathy with a wide range of clinical manifestations ranging from subtle myocardial hypertrophy to debilitating heart failure, cardiac arrhythmias, and sudden cardiac death. We reviewed the literature on the latest knowledge regarding the pathophysiology and molecular genetic basis of HCM. This will include laboratory studies on animal models and human pluripotent stem-cell derived cardiomyocytes and the theory of proximal mechanisms involving calcium handling and energy expenditure underlying HCM. The current review will also illustrate the pathogenicity of various associated genetic variants, genotype-phenotype correlation and the optimal approach to …

Leadless Pacing In A Patient With Persistent Left Superior Vena Cava, Pedro Rocha Carvalho, José Paulo Fontes, Inês Silveira, José Ilídio Moreira

Journal of the Hong Kong College of Cardiology

We present the case of a 64-year-old male with complete atrioventricular block and unsuccessful traditional pacemaker lead implantation. Angiography confirmed a persistent left superior vena cava and atresia of the right vena cava draining into a dilated coronary vein. Subsequently, a leadless pacemaker was successfully implanted in the septal wall of the right ventricle, achieving optimal sensing and threshold values. This case highlights the challenges of anatomical anomalies in pacemaker implantation and the successful utilization of leadless pacemakers as an alternative. Awareness of such variations is crucial for decision-making and improved patient outcomes.

The Telltale Of Left Atrial Thrombus Formation In Mitral Stenosis: Revisiting The Virchow’S Triad, Bayushi Eka Putra, Rina Ariani, Anwar Santoso, Prima Almazini, Estu Rudiktyo, Amiliana Mardiani Soesanto

Journal of the Hong Kong College of Cardiology

Aims: This study was conducted to assess the relationship of simple hematological parameters with the incidence of left atrial thrombus in rheumatic mitral stenosis in addition to conventional contributing factors. Methods: A cross-sectional analytical study was conducted in patients with significant rheumatic stenosis from 1 January 2018 to 31 July 2021. Thrombus evaluation was confirmed by transthoracic or transesophageal echocardiography. Lab tests were performed within 10 days prior to the echocardiographic evaluation. Subjects with significant mitral regurgitation will be excluded. Logistic regression analysis was done to evaluate the relationship between each variable to the presence of a thrombus. Results: Of …

The Clinical Outcomes Of Covid-19 Infection With Pre-Existing Heart Failure – A Scientific Review, Ka-Yi Chan, Hiu-Ching Chan, Calvin Ka-Lam Leung, Qing-Wen Ren, Kai-Hang Yiu

Journal of the Hong Kong College of Cardiology

The COVID-19 pandemic has caused major impact to our world in various aspects. Healthy individuals infected with COVID-19 often develop different complications, even more so for patients with medical comorbidities. Various reports and studies have suggested cardiovascular disease as one of the major comorbidities in patients with COVID, and COVID infection could be life threatening in patients with pre-existing heart diseases, such as heart failure. In view of such, we aim to review on the subset of COVID patients who have pre-existing heart failure, in terms of in-hospital mortality, delivery of in-patient care and in-hospital complications. In conclusion, heart failure …

Medical Professionals’ Perspective On Safety And Efficacy Of Early Mobilization In Acute Heart Failure Patients, Kevin Triangto, Febrian M. Santausa, Basuni Radi, Bambang Budi Siswanto

Journal of the Hong Kong College of Cardiology

Acute heart failure (HF) patients most of the time presents with hemodynamic instability, which often leads to prolonged bedrest. Newer studies had shown that early mobilization for HF patients would lead to better outcomes. However, the early mobilization practice has not always been done due to several barriers in the medical professionals’ perspective, especially regarding safety and efficacy. Prior studies had shown that medical professionals’ views would greatly affect patients’ perspectives, especially in HF rehabilitation. This study is aimed to describe medical professionals’ views on the safety of early mobilization for HF. It was then revealed that General Practitioners’ (GP) …

Prediction Of Clinical Atrial Fibrillation By Cardiac Implantable Electronic Device Detected Atrial High Rate Episodes, Shek Joyce, Fung Chi Yan Raymond, Yuen Ho Chuen, Chan Ngai Yin, Yu Lok Man Ellen

Journal of the Hong Kong College of Cardiology

Background Current guidelines mainly address clinical atrial fibrillation and long Atrial Heart Rate Episodes (AHRE). This study focused on the clinical significance of incidental short AHRE detected by Cardiac Implantable Electronic Device (CIED).

Methods A single-centre retrospective observational study recruited patients from CIED clinic of Princess Margaret Hospital from 2015 to 2022, excluding patients with known clinical AF. The primary outcome was clinical AF and/or long AHRE more than 24 hours. Secondary outcomes included non-fatal stroke, admission for heart failure, myocardial infarction and death. AHRE+ vs AHRE- were compared using multivariate analysis, introducing AHRE duration as a time-dependent covariates. A …

30th Annual Scientific Congress Of Hong Kong College Of Cardiology Abstracts

Journal of the Hong Kong College of Cardiology

No abstract provided.

30th Annual Scientific Congress Of Hong Kong College Of Cardiology Proceedings

Journal of the Hong Kong College of Cardiology

No abstract provided.

29th Annual Scientific Congress Of Hong Kong College Of Cardiology Proceedings

Journal of the Hong Kong College of Cardiology

No abstract provided.

24th Asc Of Icsm Proceedings

Journal of the Hong Kong College of Cardiology

No abstract provided.