Cardiology Commons^™

Covid-19-Associated Myocarditis: Screening For Early Diagnosis, Yousuf Khan, Salmman Ahmed, Samuel John Wlasowicz, Ronald G. Lott Iii, Xavier C. Zonna

Advances in Clinical Medical Research and Healthcare Delivery

The SARS-CoV-2 virus (causing COVID-19), has infected about 770 million people, and caused the death of about 6.9 million people worldwide in the span of three years (John Hopkins Resource Center). Common symptoms of a patient infected with the virus include shortness of breath, fever, chills, fatigue, loss of taste or smell, and muscle aches. However, recent studies have also shown a prevalence of patients presenting with cardiac inflammation (endocarditis, myocarditis or pericarditis) as a potential comorbidity, both during the infectious stage as well as after the infection has subsided. A pattern of specific clinical markers may be indicative of …

Reducing Food Scarcity: The Benefits Of Urban Farming, S.A. Claudell, Emilio Mejia

Journal of Nonprofit Innovation

Urban farming can enhance the lives of communities and help reduce food scarcity. This paper presents a conceptual prototype of an efficient urban farming community that can be scaled for a single apartment building or an entire community across all global geoeconomics regions, including densely populated cities and rural, developing towns and communities. When deployed in coordination with smart crop choices, local farm support, and efficient transportation then the result isn’t just sustainability, but also increasing fresh produce accessibility, optimizing nutritional value, eliminating the use of ‘forever chemicals’, reducing transportation costs, and fostering global environmental benefits.

Imagine Doris, who is …

Coronary Artery Calcium Scoring In Asymptomatic Patients, Bilal Hussain, Ahmed Mahmood, Michael G. Flynn, Thomas Alexander

HCA Healthcare Journal of Medicine

Coronary artery calcium (CAC) scoring is an important prognostic tool for personalized cardiovascular preventive care and has recently been incorporated into American College of Cardiology/American Heart Association guidelines. CAC provides direct visualization and quantification of CAC burden for risk stratification and primary prevention of cardiovascular events in an asymptomatic population. CAC scoring is recommended for individuals with intermediate 10-year atherosclerotic cardiovascular disease (ASCVD) risk and selective populations with borderline ASCVD risk. In this review, we outline the interpretation of CAC scores for predicting the risk of cardiovascular events, and we highlight the guidelines for starting statin and potentially starting aspirin …

Management Of Asymptomatic Hypertension In The Inpatient Setting., Charles Meadows, Mehiar Elhamdani, Dial Larry, Murad Kheetan, Khaled Al-Baqain

Marshall Journal of Medicine

Hypertension is common in hospitalized patients and is most often asymptomatic. While there are no guidelines for management of such patients, aggressive blood pressure treatment, including the use of intravenous antihypertensives, is often undertaken. While evidence of benefit is lacking, emerging data suggest that treatment of asymptomatic hypertension in the inpatient setting is associated with adverse outcomes, including acute kidney injury and ischemic stroke. In addition, the intensification of a preexisting antihypertensive regimen at hospital discharge significantly increases the risk of readmission without significant improvement in outpatient hypertension control. Such a combination of a common problem with the demonstrable benefit …

Coronary Artery Stent Stenosis Assessment In Coronary Ct Angiography, Mohammad Farouk Aggag, Mahmoud El-Shamy, Ahmed Osama Abbas El-Kattan

Al-Azhar International Medical Journal

Background: Coronary artery stenting is the most important minimally invasive treatment for symptomatic coronary artery disease. But because in-stent restenosis occurs at a somewhat high rate, invasive angiography is now commonly utilised to assess stent patency.Objective: The objective of the study is to examine how multidetector CT scans can assist physicians in making decisions regarding the placement of coronary artery stents in patients who have chronic chest pain or who have myocardial ischemia. Method: A total of 40 individuals had multislice CT angiography of the coronary arteries between February 2022 and August 2022 as part of this study. Such patients …

Chewed Versus Swallowed Ticagrelor In P2y12 Inhibitor-Naïve Patients Undergoing Percutaneous Coronary Intervention, Thomas F. Wilson, Muddasir Ashraf, M. Fuad Jan, Tonga Nfor, Louie Kostopoulos, Joaquin Solis, Jayant Khitha, Ahmad Khraisat, Anthony C. Defranco, Tanvir Bajwa, Suhail Q. Allaqaband

Journal of Patient-Centered Research and Reviews

Purpose: Dual antiplatelet therapy is standard for patients undergoing percutaneous coronary intervention (PCI) with stents. Traditionally, patients swallow the loading dose of a P2Y12 inhibitor before or during PCI. Time to achieve adequate platelet inhibition after swallowing the loading dose varies significantly. Chewed tablets may allow more rapid inhibition of platelet aggregation. However, data for this strategy in patients with stable ischemic heart disease or non-ST-elevation acute coronary syndrome (NSTE-ACS) are less robust.

Methods: In this single-center prospective trial, 112 P2Y12-naïve patients with stable ischemic heart disease or NSTE-ACS on aspirin therapy and who received ticagrelor after coronary angiography but …

Assessment Of The Right Ventricular Function Before And After Coronary Artery Bypass Surgery By Conventional And Tissue Doppler Echocardiography, Emmanuel L. Aziz, Mohamed Abbas, Ashraf Abd-Elaziz, Wayel S. Bebawy

Journal of Medicine in Scientific Research

Aim of the work To study the extent of right ventricular (RV) dysfunction in ischemic patients after coronary artery bypass grafting (CABG). Patients and methods RV function was studied preoperatively and followed for 1 month postoperatively in 40 patients who were scheduled for elective coronary artery bypass surgery and in other 40 controls. We evaluated RV function by tissue Doppler study of the tricuspid annulus and the basal septum, tricuspid annular plane systolic excursion, and RV dimensions. Both LV dimensions, left atrium dimensions, and aortic root dimensions were also measured before and after surgery. Results RV function was significantly reduced …

The Prognostic Value Of Serum St2 In Patients With Non-St Segment Elevation Acute Coronary Syndrome, Ahmed Shehata Mohamed, Mohamed Hesham Hassan, Mohamed Abdelhady Abu Ahmed, Yousri Zaki Ali Alzohery

Al-Azhar International Medical Journal

Background: Myocardial necrosis improved while cardiac biomarkers were reduced among individuals with NSTEMI, which was identified as the lack of ST-segment elevation. Myocardial ischemia at rest or during mild activity without cardiac myocyte necrosis characterizes unstable angina. Myocardial ischemia is characterized by an increase in the soluble form of ST2 and the inflammatory cytokine IL-1β in cardiac myocytes. Aim of work: The goal of this study was to asses and determine whether or not serum ST2 levels were predictive of six-month mortality in cases with non-ST segment elevation ACS (by comparing plasma ST2 levels among survivors and non-survivors of NSTE-ACS …

Efficacy And Safety Of Catheter Ablation In Patients With Scar Related Ventricular Tachycardia, Mohamed Ahmed Muharram, Mohammed Sami Abdel Samie, Hatem Abdel Latief Kholief, Ahmed Mohammed Fahmi El-Damaty

Al-Azhar International Medical Journal

Background: In individuals with structural heart disease, catheter ablation of ventricular tachycardia (VT) is an important treatment option.

The study aimed to evaluate the safety and outcomes of scar related VT ablation in Egyptian population.

Patients and methods: this observational study included 22 male patients referred for scar related VT ablation from November 2015 to December 2022, ablation was done under general anesthesia using 3D mapping system in 3 tertiary hospitals in Cairo, Egypt. Clinical, procedural and follow up data were reviewed. Substrate modification in sinus rhythm was the main ablation strategy.

Results: Mean age was 56.2±13.9 yrs., 14 patients …

Outcome Of Suture Annuloplasty (De Vega) Versus Ring Annuloplasty For Functional Tricuspid Valve Regurgitation Concomintant With Mitral Valve Surgery, Tarek Elshazly Omran, Ashraf Zahra

Journal of Medicine in Scientific Research

Background: The optimal surgical technique for functional tricuspid regurgitation (TR) repair is still a topic for ongoing research. The DeVega technique is still used frequently in developing countries. Thus, this study aimed to compare the outcomes of tricuspid valve repair using DeVega vs. ring annuloplasty for managing severe functional TR during mitral valve surgery. Methods: This retrospective chart review included 66 patients. The study included patients with simultaneous tricuspid valve repair during mitral valve intervention. The patients were recruited from 2018 to 2022. The study had two groups: the first group included 50 patients who underwent the DeVega technique (Group …

The Relation Between Heart Rate Response During Exercise And Angiographic Severity In Patients With Chronic Coronary Syndrome, Emmanuel Louka

Journal of Medicine in Scientific Research

Introduction Ellestad and colleagues, in 1975, reached to the conclusion that impaired heart rate response to exercise carries a similar risk for future coronary events such as ischemic ‘ST’ segment changes. Mc Neer and colleagues went beyond these observations to include a survival benefit in patients who achieve a higher peak heart rate (PHR), a more advanced level of exercise, and have a normal exercise electrocardiogram. Aim The aim of this work is to clarify the relation between the chronotropic response to exercise and the severity of coronary artery disease in patients with chronic coronary syndrome. Patients and methods The …

Impact Of Deferred Stent Insertion On Elevated St Segment Myocardial Infarction Patients With A Big Thrombus Load, Monir Osman, Mostafa Elswasany, Ahmed Yahya Hegab, Amro Abozeid

Al-Azhar International Medical Journal

Background: No clear recommendations as regard deferred stenting in ST-segment elevation myocardial infarction (STEMI) patients with big thrombus load.

Aim of the study: our study might answer the question that deferred stenting might reduce no-reflow and in-hospital major adverse cardiac events (MACE) compared to immediate stenting in primary percutaneous coronary intervention (PCI) for STEMI patients with high thrombus burden.

Patients and Methods: a prospective double blinded control non-randomized study which included fifty Patients presented by STEMI with high thrombus load and undergoing primary PCI, 25 patients (group number 1) managed with deferred stenting, and 25 patients (group number 2) managed …

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 …

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) …

Cardiovascular Disease Awareness Program On Risk Factors For Cardiovascular Disease Among Adolescents In Selected Schools, In New Delhi, Komal Kumari

Manipal Journal of Nursing and Health Sciences

Introduction: Cardiovascular disease (CVD) is the main cause of mortality worldwide. The main risk factors include tobacco chewing/smoking, higher blood cholesterol, high blood pressure, physical inactivity, obesity, excessive alcohol use, age, sex, and heredity. Although CVDs commonly develop in middle age or later, risk factors are highly impacted by childhood practices that are continued into maturity. Knowledge gaps on CVD and its risk factors are major obstacles to effective prevention and treatment. Hence, a CVD awareness program was organized in order to educate adolescents about CVD and its risk factors. Objective: The objectives of the study were to identify students’ …

Sinus Pauses And Asystole As A Rare Presentation Of Thyrotoxic Crisis: A Case Report, Christian Akem Dimala, Charnjeet Sandhu, Oreoluwa Oladiran, Agnieszka Mochon, William Finneran Iii

Transformative Medicine (T-Med)

Introduction

Thyroid crisis is a rare and life-threatening endocrine emergency characterized by exaggerated clinical manifestations of hyperthyroidism with cardiovascular manifestations being the most severe. Rhythm disturbances, sinus tachycardia and atrial fibrillation, are the commonest cardiac manifestations of severe thyrotoxicosis; however, asystole remains a very atypical and uncommon presentation. We present a case of thyrotoxicosis due to Grave’s disease complicated by multiple episodes of asystole.

Case Presentation

A 65-year-old female recently diagnosed with Grave’s disease presented to the hospital with recurrent episodes of syncope. Her hospital course was significant for atrial fibrillation with subsequent progression to sinus pauses and asystole spontaneously …

An Assessment Of The Diagnostic Value In Syncope Workup: A Retrospective Study, Ashan T. Hatharasinghe, Kayvon Etebar, Ryan Wolsky, Hossein Akhondi, Napatkamon Ayutyanont

HCA Healthcare Journal of Medicine

Background

Patients with syncope often undergo costly testing, despite current guidelines and data supporting the contrary.

Objective

To determine the diagnostic value through positivity rate of electrocardiogram (EKG), computed tomography (CT) of the brain, magnetic resonance imaging (MRI) of the brain, transthoracic echocardiogram, nuclear and pharmacologic cardiac stress test, tilt table test and carotid ultrasound in patients diagnosed with syncope.

Methods

This is a retrospective study of 10,036 adults presenting to the emergency department or hospitalized with a primary diagnosis of syncope at 8 acute care facilities in the southwest United States from January 1, 2019, to December 31, 2019. …

Integrating Patient-Reported Outcomes Into Clinical Genetic Testing For Familial Hypercholesterolemia, Rachele M. Hendricks-Sturrup, Robert Block, Christine Y. Lu

Journal of Patient-Centered Research and Reviews

Patient-reported outcomes (PROs) and PRO measures (PROMs) are often used to help clinicians and researchers understand patients’ personal concerns, feelings, experiences, and perspectives following the implementation of an intervention. Notably, PROs and PROMs can inform health systems, health policy, and payers on the utility of clinical genetic testing based on each patient’s personal values, perspectives, and potential health behaviors subsequent to testing. In this topic synopsis, we discuss the underexplored role of and implications for PROs and PROMs following genetic testing for familial hypercholesterolemia (FH), an autosomal dominant genetic disorder of cholesterol metabolism that can lead to highly premature fatal …

Mental Health Or Cardiac Health. Is There A Reason To Choose? Cardiac Arrhythmias Induced By Atomoxetine And Methylphenidate, Gabriel Cismaru, Viorel Lupu

Journal of Mind and Medical Sciences

The current treatment of Attention Deficit Disorder and Attention Deficit with Hyperactivity consists mainly in the administration of Straterra (Atomoxetine) Concerta and Ritalin (Methylphenidate). The FDA warned that the products might increase systolic, diastolic blood pressure, and lead to ventricular arrhythmias. Arrhythmic events and sudden cardiac death were described in adults with preexistent heart disease. However, studies on children have failed to demonstrate a clear association between the arrhythmic events and these drugs, as demonstrated in adults. What should the attitude of the pediatric psychiatrist be towards the administration of these products? What examination should be made by the psychiatrist …

Therapeutic Efficacy Of Mesenchymal Stem Cells For Cardiovascular Diseases, Dragana Radoje Miloradovic, Dragica Radoje Pavlovic, Miodrag Bozidar Stojkovic, Sanja Bratislav Bojic, Vladislav Bogdan Volarevic, Marina Milosav Gazdic Jankovic, Biljana Tomislav Ljujic

Journal of Mind and Medical Sciences

Despite the improvements in pharmacological and surgical treatments, cardiovascular diseases (CVDs) are the number one cause of death worldwide. During the last two decades, the search for new therapies has been revolutionized with the growing knowledge of stem cell biology. Due to their huge differentiation capacity and paracrine effects, mesenchymal stem cells (MSCs) are a promising tool for the treatment of CVDs. The encouraging outcomes of preclinical studies using MSCs as a treatment for diseased myocardium have set the scene for worldwide clinical trials. In this review, we overview either complete or ongoing clinical trials using MSCs for the therapy …

Incidental Finding Of Anomalous Pulmonary Venous Return Of The Left Upper Lobe, A Rare Anatomical Variation, Anika Dutta, Loren Zuiderveld

Journal of Patient-Centered Research and Reviews

Partial anomalous pulmonary venous return (PAPVR) is a rare congenital abnormality in which 1 to 3 of the pulmonary veins connect to the right atrium rather than the left atrium. In this synthesis of the literature on PAPVR of the left upper lobe, we attempt to illustrate this clinical entity using a case detected incidentally on chest computed tomography, explain the anatomical aspects of this anomaly, and summarize the reported incidence and etiology of left-sided PAPVR. Lastly, differential diagnoses, clinical relevance, and management of left-sided PAPVR are presented. The identification of this variant is important, as it may have serious …

Dexrazoxane Decreases The Cardiotoxic Effects Of Doxorubicin In Osteosarcoma Patients Without Increasing Mortality From Secondary Malignant Neoplasms, Thomas S. Przybycien

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Schwartz CL, Wexler LH, Krailo MD, et al. Intensified chemotherapy with dexrazoxane cardioprotection in newly diagnosed nonmetastatic osteosarcoma: A report from the Children’s Oncology Group. Pediatr Blood Cancer. 2016;63(1):54-615. https://doi.org/10.1002/pbc.25753

for a patient with osteosarcoma and concerns about the risk of secondary malignant neoplasms that attend use of dexarazoxane.

Methamphetamine Associated Cardiomyopathy In Pregnancy: The Distinctions And The Implications, Ashan Hatharasinghe, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction

Methamphetamine associated cardiomyopathy (MAC) and peripartum cardiomyopathy (PPCM) are both rare obstetric conditions. Literature regarding methamphetamine associated cardiomyopathy in the obstetric population is limited, and it can be difficult to make the distinction between the two given the similarities in clinical presentation. However similar, there are significant distinctions in the pathophysiology of these two that can help clinicians with the management process.

Clinical Findings and Outcomes

This case involves a 35-year-old Hispanic G6P5005 at 37 weeks gestation presenting with acute respiratory failure secondary to acute decompensated heart failure with reduced ejection fraction and superimposed preeclampsia leading to urgent cesarean …

Covid-19 And Arrhythmias: A Review Of Cardiac Electrophysiology Associated With Sars-Cov-2, Kashmala Khan, Francis Dimtri, Carlos Vargas, Thomas Alexander

HCA Healthcare Journal of Medicine

Coronavirus infectious disease 2019 (COVID-19) has become one of the most recognized viral illnesses to date. Most people infected with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have a benign clinical course, but there have also been catastrophic outcomes. Although, notoriously known to affect the respiratory system, extra-pulmonary manifestations have also been established. An increasing number of people have been reported to present with cardiac manifestations, which include but are not limited to arrhythmias. The cardiac conduction system can be damaged by various mechanisms in patients infected with SARS-CoV-2. In this review, we will attempt to briefly describe the arrhythmogenic …

Characterizing Recurrence Following Hybrid Ablation In Patients With Persistent Atrial Fibrillation, David C. Kress, Lynn Erickson, Tadele W. Mengesha, David Krum, Jasbir Sra

Journal of Patient-Centered Research and Reviews

Purpose: It is It is widely accepted that atrial fibrillation (AF) accounts for half of arrhythmia recurrences following endocardial catheter ablation of AF. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study is aimed at characterizing recurrence following hybrid ablation for patients with persistent AF.

Methods: Patients with persistent AF (N = 108) received both endocardial and epicardial ablation of the posterior left atrial wall using catheter ablation and a small midline surgical approach (hybrid). Presence of …

Myocardial Work Index: A Novel Method For Assessment Of Myocardial Function In South Asian Recreational Athletes, Shantanu Sengupta, Renuka Jain, Nitin Burkule, Susan Olet, Bijoy K. Khandheria

Journal of Patient-Centered Research and Reviews

Purpose: We used a novel noninvasive method based on speckle-tracking echocardiography to evaluate myocardial performance in South Asian recreational athletes who completed a half marathon.

Methods: Transthoracic echocardiography was performed on 24 recreational athletes 48 hours before they took part in a half marathon (premarathon), within 2 hours of half marathon completion (postmarathon), and 72 hours after completion. Clinical, laboratory, and echocardiographic variables were collected. Speckle-tracking echocardiography was performed in all subjects to characterize myocardial mechanics.

Results: Mean age of participants was 41.8 ± 7.4 years, and 23 (95.8%) were male. No subject had a prior history of coronary artery …

Comparison Of Long-Term Oral Anticoagulation Therapies Including Newly Approved Reversal Agent For Dabigatran, Mackenzie Devine, Natalie Lennartz, Michaela Wolford, Rebecca Worden, Joelle Farano, Erin Petersen

Pharmacy and Wellness Review

Anticoagulants are a well-known class of agents essential for the prevention of blood clots, which may further develop into deep vein thrombosis, pulmonary embolism or stroke. Individuals at a high risk of clotting, such as those with atrial fibrillation, multiple risk factors or recent hip/knee surgery, are in need of long-term anticoagulation therapy. The purpose of this review is to highlight the pros and cons for each available anticoagulant as well as discuss pivotal clinical trials that evaluated the safety and efficacy of these agents. Warfarin, the oldest anticoagulant, requires the patient to attend frequent appointments with a health care …

Triple Therapy Or Triple Threat: An Analysis Of Triple Antiplatelet Therapy Compared To Dual Antiplatelet Therapy, Isabel E. Cwikla, Kara C. Horvath, Elaina Gollmar, Austin Hilverding, Erin Petersen

Pharmacy and Wellness Review

Triple antiplatelet therapy (TAPT, or triple therapy), is an oral medication regimen designed to reduce the risk of major cardiovascular events. It consists of aspirin, clopidogrel or an alternative, and an oral anticoagulant (OAC). It differs from dual antiplatelet therapy (DAPT) due to inclusion of an OAC. Multiple clinical studies have indicated that triple therapy is more effective at clot prevention, when compared to aspirin monotherapy and DAPT, but is associated with a higher risk of major bleeding. Pharmacists have a key role in determining candidates for DAPT and TAPT regimens. Other opportunities for pharmacists include patient monitoring, counseling and …

Pcsk9 Inhibitors: A Novel Class Of Pharmacotherapy For Hypercholesterolemia, Angela Chu, Austin Hilverding, Elizabeth Kramer, Brendan Rasor, Boyd Rorabaugh

Pharmacy and Wellness Review

The recent U.S. Food and Drug Administration (FDA) approval of two new drugs, alirocumab (Praluent®) and evolocumab (Repatha®) is a breakthrough in the treatment of familial hypercholesterolemia. These drugs are a part of a new class called the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors that act by increasing the number of low density lipoprotein receptors (LDL-R) recycled to hepatocyte membranes. The increased density of LDL-R facilitates greater clearance of low density lipoproteins from the blood. Numerous clinical trials have demonstrated the efficacy of these agents, particularly for patients in whom standard cholesterol-lowering therapy is insufficient. However, data on long-term …

Combined Neprilysin And Angiotensin Inhibitor For The Treatment Of Heart Failure, Albert Bui, Victoria Cho, Rebecca Worden, Haley Armstrong, Rachel Pucel, Lindsey Peters

Pharmacy and Wellness Review

Heart failure (HF) is a highly prevalent disease state worldwide that can progress into a disabling condition. It is pertinent to have a treatment regimen that is effective in lowering the number of HF exacerbations and, therefore, hospital readmission rates. A novel medication currently in clinical trials, LCZ696, blocks both neprilysin and angiotensin type I receptors. The overall effects are an inhibition of the breakdown of natriuretic peptides which leads to a decrease in renin and aldosterone release. This, combined with the antagonization of angiotensin type I receptors, leads to a decrease in blood pressure, blood volume and systemic vascular …