Cardiology Commons^™

A Case Of Occlusive Myocardial Infarction Caused By Nephrotic Syndrome In A 26-Year-Old Type 1 Diabetic, Kyle Admire, Charlotta Jornlid, Chelsea Ryan, Rebecca Pauly

Marshall Journal of Medicine

Nephrotic syndrome is a rare condition distinguished by proteinuria exceeding 3g per day. Other associated characteristics include hematuria, hypoalbuminemia, edema, and hyperlipidemia. There is an array of complications of this syndrome, which are primarily due to the profound losses of protein in the urine. One such complication is thromboembolism, with most documented cases in the form of venous thromboembolism of the extremities which is in part due to urinary loss of antithrombin III and increased synthesis of prothrombotic factors. There are limited available data regarding arterial thrombi and especially few reports about coronary thromboses, which can be life-threatening. In this …

Management Of Cryptogenic Stroke Secondary To Large Asd With Percutaneous Occluder Device And Antiplatelet Drugs., Riya Gupta, Naveed Iqbal

Marshall Journal of Medicine

Atrial septal defects (ASD) represent the most common congenital heart disease diagnosed in adult population and can present with variable clinical findings. Recent literature emphasizes the importance of management of ASD especially if it is associated with structural right heart changes such as RV dysfunction, right ventricular enlargement, arrythmias or paradoxical embolism.

The decision between medical therapy versus surgical closure of ASD is a common clinical conundrum especially in the setting of cryptogenic stroke.

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 …

Male Breast Enlargement After Automated Implantable Cardioverter-Defibrillator Placement, Anisha Valluri, Lynne J. Goebel

Marshall Journal of Medicine

Placement of implantable cardioverter-defibrillators (ICDs) are increasing in frequency due to their indication for the prevention of sudden cardiac death in patients prone to life-threatening arrhythmias. Primary care physicians should be aware of the possible complications so they can treat their patients appropriately. This article describes a rare case of chronic unilateral breast enlargement after the placement of an ICD in a male patient with Tetralogy of Fallot.

Prasugrel Inappropriate Use In Patients Post-Percutaneous Coronary Intervention (Pci). A Single Center Study, Ahmed Amro, Kanaan Mansoor, Mohammad Amro, Amal Sobeih, Obadah Aqtash, Hisham Hirzallah, Alaa Gabi, Madhulika Urella, Waseem Ahmed, Sandra Shenouda, Dr. Rameez Sayyed, Md

Marshall Journal of Medicine

Prasugrel is a thienopyridine that was approved by the US Food and Drug Administration (FDA) in combination with aspirin for the reduction of thrombotic events as well as stent thrombosis in patients with ACS who undergo PCI. This retrospective study aims to assess the frequency of inappropriate use of prasugrel and to emphasize that prasugrel still needs more attention as inappropriate use may result in significant morbidity.

Trans-Radial Coronary Intervention (Tci) Using 5-Fr Versus 6-Fr Guiding Catheters In The Setting Of Acute Coronary Syndrome (Acs)., Ahmed Amro, Mohammad Amro, Amal Sobeih, Obadah Aqtash, Hisham Hirzallah, Majd Kanbour, Adee El-Hamdani, Alaa Gabi, Yazan Numan, Mark Studeny, Mehiar El-Hamdani

Marshall Journal of Medicine

Background:

As in any vascular access the size of guiding catheter is an operator preference. Although multiple studies showed the use of 5-Fr versus 6-Fr guiding catheters for Transradial coronary intervention (TCI) have similar vascular safety profile and can be performed safely and successfully with both of them, the data comparing the 5-Fr vs 6-Fr guiding catheters for TCI in terms of fluoroscopy time, procedure time and contrast amount in the setting of ACS is limited. We conducted this study to compare the use of 5-Fr versus 6-Fr guiding catheters for TCI in the settings of ACS.

Method:

Our study …

Percutaneous Transluminal Balloon Venoplasty: A Less Invasive Technique For Implantation Of Cardiac Leads In Patients With Limited Venous Access To The Heart, Waiel Abusnina, Zachary O. Curtis, Emilia C. Leigh, Eric Y. Auyoung, Dr. Mehiar El-Hamdani, Esam Baryun

Marshall Journal of Medicine

Since its inception, cardiac pacing has made a significant advancement in cardiology. As new therapies and devices emerge, the number of implantations is steadily increasing which requires up-to-date clinical guidelines for management. Although advanced, these mechanical devices often require maintenance and revisions to achieve optimal performance. One of the most common deteriorations is the lead failure.

In the case of lead failure requiring revision, new lead implant, or upgrading to a more advanced pacing system, venous stenosis resulting in partial or complete obstruction of the vessel can pose a real problem. This case series report introduces the technique of percutaneous …

Outcomes Of Transcutaneous Aortic Valve Replacement Among High Risk Wv Sample Population., George M. Yousef, Julia Poe, Cameron Killmer, Basel Edris, Jason Mader, Ellen A. Thompson, Daniel Snavely, Silvestre Cansino, Joseph I. Shapiro, Mark A. Studeny

Marshall Journal of Medicine

Introduction:Transcatheter aortic valve replacement (TAVR) is a relatively new strategy for replacing the aortic valve. We elected to review our early experience to see if we could identify clinical characteristics at baseline or immediately following the procedure that would predict death within one year.

Methods:Charts for all patients assigned to receive TAVR procedure at St Mary’s medical center, Huntington, West Virginia between April, 2013 till November, 2016 were identified and reviewed. A total of seventy-two (72) cases were included.

Results: All cause mortality rate at index hospitalization, 30 days, and 12 months was 5.6%(N=4), 6.9%(N=5), 19.4%(N=14) respectively. Stroke …

Urgent Coronary Artery Bypass Grafting Due To Multi- Vessel Coronary Aneurysm, Obadah Aqtash, Ahmed Amro, Bilal Alam, Amal Sobeih, Melissa Lester, Rameez Sayyed

Marshall Journal of Medicine

Coronary Artery Aneurysm (CAA) is defined as a dilation of more than 1.5 times normal in a segment of the coronary artery. While the incidence of CAA is highest in the Right Coronary Artery (RCA), it is agreed that left main coronary artery or three-vessel involvement is extremely rare. Wide ranges of factors have been implicated in the cause of CAA with atherosclerosis being the most common at 50%. Congenital CAA occurs in 20-30% of cases followed by connective tissue disease at 10%. Blood stagnation and exposure of the underlying collagen make aneurysms prone to thrombosis, dissection, and vasospasm. Depending …

Going Beyond The Final Impression With Radiologic Data In The Era Of Clerical Medicine: A Case Report Of Coronary Artery Disease Found Incidentally On Computed Tomography, Andrea M. Lauffer

Marshall Journal of Medicine

Introduction:

Given the challenges in modern healthcare, physicians find themselves devoting a great deal of mental and emotional energy into executing the appropriate care for patients as well as performing their daily clerical duties. Many clinicians have resorted to innovative ways to minimize their tasks which often leads to narrowing the focus of a patient’s overall care and the birth of medical errors described in the Swiss cheese effect model.

Case Description:

A 66 year old male established care with a new primary care physician. Previous radiologic data revealed a pulmonary nodule that did not have appropriate follow up imaging. …

A Rare Case Of Asystole During A Laparoscopic Appendectomy In A Young Patient, Rachit Gupta, George Yousef, Melissa Lester

Marshall Journal of Medicine

Laparoscopic surgery has become the mainstay of treatment for uncomplicated appendicitis cases. We describe a case of a 29 year old male with a pertinent past medical history of poorly controlled hypertension who was undergoing a routine laparoscopic appendectomy for confirmed appendicitis and developed bradycardia and subsequent asystolic cardiac arrest approximately one hour into the operation. Urgent cardiopulmonary resuscitation and intravenous (IV) atropine were required to reinitiate sinus cardiac rhythm. While the patient was admitted to the intensive care unit for close monitoring following his operation, he ultimately had an uncomplicated postoperative period and an unremarkable cardiac work up and …

A Rare Case Of Paradoxical Left Sided Endocarditis Through Patent Foramen Ovale., George M. Yousef, Paul I. Okhumale, Haytham Aljoudi, Silvestre Cansino

Marshall Journal of Medicine

A 36 -year old woman IV drug abuser admitted with Right-Sided Infective Endocarditis (RSIE) as demonstrated by transthoracic echocardiogram. Patient was admitted 8 weeks later with recurrence of symptoms, moreover signs of systemic embolization were noted. Transthoracic and Transesophageal Echocardiograms revealed tricuspid valve vegetation, severe tricuspid regurgitation, left atrial mass, Patent Foramen Ovale (PFO), severely dilated right atrium and prominent Chiari's network. Systemic embolization included brain and Left iliacus abscesses. Patent Foramen ovale is the proposed mechanism leading to extensive systemic embolization in the present case.

Inferior Stemi Complicated By Retroperitoneal Hemorrhage Due To Ruptured Aaa, Farley B. Neasman Iii, Melissa D. Lester, Nepal C. Chowdhury

Marshall Journal of Medicine

When patients present with life threatening conditions, a rapid cost-benefit analysis prioritizes care and commits treatment to a certain course that, in the case of ST Elevation Myocardial Infarction (STEMI) treated with drug-eluting stents (DES), could be fatal if there is any deviation. Antiplatelet therapy is vital and secondary concerns (i.e. bleeding diatheses) may accept suboptimal outcomes – in rare cases, another life-threatening condition may be unmasked, the treatment for which runs directly counter to the first. We present a case of STEMI with high clot burden treated with multiple DES, complicated by retroperitoneal hemorrhage due to a ruptured abdominal …

Acute Limb Ischemia Due To A Fractured Superficial Femoral Artery Stent, Alaa Gabi, Ahmed Amro, Haytham Aljoudi, Faisal Hayat, Rameez Sayyed

Marshall Journal of Medicine

Peripheral Vascular Disease (PVD) is a rapidly growing and recognized disease of the peripheral circulation. Its presentation can vary between asymptomatic state, exercise limiting limb pain, limb loss and even death. Advances have been achieved in the treatment of PVD specially in the field of interventional cardiovascular medicine. Different devices and techniques are used in the treatment of peripheral atherosclerotic disease, which has lowered the need for bypass surgery. Although invasive peripheral intervention has a low rate of complications, there are still well recognized acute and chronic complications that an operator should be aware of. We present an interesting case …

Retrograde Pedal Access For Revascularization Of Infrapopliteal Arterial Occlusive Disease In Critical Limb Ischemia (Cli) Patients As A Primary Approach., Ahmed Amro, Alaa Gabi, Shahed Elhamdani, Haytham Aljoudi, Mehiar El-Hamdani

Marshall Journal of Medicine

Introduction:

We are presenting three cases (out of similar several cases) where tibio-pedal approach was performed as an initial primary approach for limb salvage in patients with CLI secondary to Infra-popliteal (IP) disease. We consider this approach to be a necessary evolution in endovascular intervention.

Discussion:

Retrograde pedal access is safe, feasible with high technical success rate and a relatively low procedural complication rate, with low 30 days mortality and low rate of major adverse cardiac events. Freedom from major adverse limb events and limb salvage are both high at 1 year follow up. It allows quick therapy and short …

Left Ventricular Noncompaction Syndrome: A Rare Congenital Cardiomyopathy, Ashwini V. Mallad, Mbbs, Waseem Ahmed, Md, Madhulika Urella, Md, Dr. Mehiar El-Hamdani, Md, Facc, Fscai

Marshall Journal of Medicine

Isolated left ventricular noncompaction cardiomyopathy (LVNC) is a rare congenital condition occurring due to arrest of myocardial compaction in the first trimester, resulting in a thin layer of compacted epicardium and thick hypertrabeculated myocardium containing deep recesses. This article presents a 44-year-old female with progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and pleuritic chest pain. Examination revealed elevated jugular venous distention, lower extremity edema, and bibasilar crackles on lung auscultation, while the electrocardiogram (EKG) exhibited left bundle branch block. Two-dimensional echocardiography (2D-Echo) showed a dilated left ventricle (LV) with ejection fraction (EF) of 25% and severe diffuse hypokinesia. Cardiac magnetic resonance …

Vitamin K2 (Menaquinone) Supplementation And Its Benefits In Cardiovascular Disease, Osteoporosis, And Cancer, Grant S. Buchanan, Md, Thomas Melvin, Brandon Merritt, Charles Bishop, Md, Franklin D. Shuler, Md, Phd

Marshall Journal of Medicine

Vitamin K is known to play an essential role in the coagulation cascade; however, a growing body of research has found that a subtype of this vitamin, vitamin K₂ (menaquinone) may have a beneficial effect in osteoporosis, cardiovascular disease, and cancer. This purpose of this article is to provide a comprehensive review of recent literature regarding menaquinone and its role in human health. This review discusses the physiology of menaquinone, its clinical benefits in cardiovascular disease, osteoporosis, and cancer, and how it may interact with certain medications. The authors conclude that menaquinone supplementation has been shown to improve carboxylation …

Endovascular Therapy Of Tasc-D Lesion In Critical Limb Ischemia, Ahmed Amro, Md, Alaa Gabi, Md, Dr. Mehiar El-Hamdani, Md, Facc, Fscai

Marshall Journal of Medicine

CLI (Rutherford class IV-VI) is a terminal stage of peripheral artery disease (PAD); it is defined by the presence of resting pain and/or tissue loss for at least two weeks that may require urgent revascularization to promote healing and prevent limb loss.For patients with infrarenal aortoiliac occlusive disease, the revascularization options are surgery like aortofemoral bypass and axillofemoral bypass or percutaneous intervention. Aortoiliac and aortofemoral bypass procedures are associated with 74% to 95% 5-year patency rates, respectively, which are comparable but not superior to percutaneous therapies.These operations may imply a significant morbidity and mortality on CLI patients who usually have …

An Unusual Migration Of A Stent: A Case Report, Fikadu G. Tekleyes Md, Melissa D. Lester Md, Mark A. Studeny Md, Ellen A. Thompson Md, Steven Craig Md

Marshall Journal of Medicine

Stent dislodgment and embolization is a rare complication of coronary stenting.

There are reports of intra-coronary stent entrapment, stripping, and dislodgement

during percutaneous coronary interventions causing potentially life threatening

complications, including intra-coronary or systemic embolization. Reports of

dislodgment and migration of previously placed drug eluting intra-coronary stent

several months after deployment are very limited in the literature. We describe a

drug eluting stent dislodgment and migration in an 88 year-old male 10 months after

its deployment.

Clinical Images - An Incidental Ekg, Ellen A. Thompson, Md, Mark A. Studeny, Md

Marshall Journal of Medicine

A routine employment stress test reveals Brugada syndrome, a rare abnormality.