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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 2016 Marshall University School of Medicine

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 2016 Marshall University, Joan C. Edwards School of Medicine

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 2016 Marshall University school of Medicine

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 ...


Restriction Therapy In Acute Heart Failure Is Not Shown To Be Effective, Amrit K. Basi, Colleen W. Harkreader, Nicholus H. Yee M.D., Shadia A. Yeihey M.D., Suraiya K. Azom M.D. 2016 Wayne State University School of Medicine

Restriction Therapy In Acute Heart Failure Is Not Shown To Be Effective, Amrit K. Basi, Colleen W. Harkreader, Nicholus H. Yee M.D., Shadia A. Yeihey M.D., Suraiya K. Azom M.D.

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Travers B, O’Loughlin C, Murphy NF, et al. Fluid restriction in the management of decompensated heart failure: no impact on time to clinical stability. J Card Fail. 2007;13(2):128-132. doi: 10.1016/j.cardfail.2006.10.012


Limitations Of The Perioperative Cardiovascular Evaluation For Assessing Coronary Artery Disease: A Case Report, Rady Ho, MD, Mitul Kanzaria, MD, Paul Walinsky, MD 2016 Thomas Jefferson University Hospital

Limitations Of The Perioperative Cardiovascular Evaluation For Assessing Coronary Artery Disease: A Case Report, Rady Ho, Md, Mitul Kanzaria, Md, Paul Walinsky, Md

The Medicine Forum

INTRODUCTION

The American College of Cardiology (ACC) and the American Heart Association (AHA) publ ished pre-operative risk stratification guidelines in 2014. These guidelines have routinely been used by physicians to pre-operatively risk stratify patients. In this case report, a patient was found to have multi-vessel coronary artery disease post-operatively in the setting of unremarkable cardiac work-up preoperatively. This case highlights a limitation of the 2014 ACC/AHA guidelines.


Case Report: Diagnosis Of Dual-Biopsy Negative Severe Cardiac Amyloidosis, Kristin Lohr, MD, Eric Kasprowicz, MD 2016 Thomas Jefferson University

Case Report: Diagnosis Of Dual-Biopsy Negative Severe Cardiac Amyloidosis, Kristin Lohr, Md, Eric Kasprowicz, Md

The Medicine Forum

INTRODUCTION

Amyloidosis is a rare disorder that involves the deposition of misfolded protein in extracellular tissue. Disease manifestations vary depending on the affected organs. Areas most often involved include the kidneys, gastrointestinal tract, heart, nervous system, and musculoskeletal system. The most common type is AL amyloidosis, in which plasma cells produce an abundance of a monoclonal proteins that affect numerous organ systems. A second variety, AA amyloidosis, is associated with inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease. Finally, a heritable version of amyloidosis mediated by mutations in the transthyretin protein (TTR) has a predilection for deposition in ...


Coronary Subclavian Steal Syndrome, Rady Ho, MD, Jonathan A. Dunn, MD 2016 Thomas Jefferson University Hospital

Coronary Subclavian Steal Syndrome, Rady Ho, Md, Jonathan A. Dunn, Md

The Medicine Forum

INTRODUCTION

Coronary subclavian steal (CSS) syndrome is a rare complication of coronary artery bypass graft surgery (CABG) involving the left internal mammary artery (LIMA) graft to the left anterior descending (LAD) artery. It results from stenosis of the left subclavian artery proximal to the LIMA, which compromises myocardial blood flow. The incidence of CSS syndrome is between 0.1-3.4% in the United States.1 Most cases occur as a result of long-standing subclavian stenosis due to progres-sion of the stenosis following CABG. We report a case of CSS syndrome, which presented as a non-ST elevation myocardial infarction (NSTEMI).


Allergic Inflammatory Mediated Coronary Artery Vasospasm: A Case Report Of Kounis Syndrome, Jonathan Hullman, MS4, Jaehee Kim, MD, Gregary D. Marhefka, MD, FACC, FACP 2016 Thomas Jefferson University

Allergic Inflammatory Mediated Coronary Artery Vasospasm: A Case Report Of Kounis Syndrome, Jonathan Hullman, Ms4, Jaehee Kim, Md, Gregary D. Marhefka, Md, Facc, Facp

The Medicine Forum

INTRODUCTION

Kounis syndrome is an acute coronary syndrome occurring secondary to an anaphylactic reaction. A wide variety of triggers such as drugs and environmental exposures have been described for the so-called allergic myocardial infarction. The pathophysiology of Kounis syndrome is thought to be due to the release of inflammatory mediators such as histamine and cytokines by mast cells and eosinophils resulting in either coronary vasospasm, myocardial infarction or stent thrombosis.


Squamous Cell Carcinoma Metastatic To The Heart Mimicking St-Elevation Myocardial Infarction, Jason Chen, MD, Colin Craft, MD, Andrew W. Panakos, MD, Gregary D. Marhefka, MD, FACC, FACP 2016 Thomas Jefferson University

Squamous Cell Carcinoma Metastatic To The Heart Mimicking St-Elevation Myocardial Infarction, Jason Chen, Md, Colin Craft, Md, Andrew W. Panakos, Md, Gregary D. Marhefka, Md, Facc, Facp

The Medicine Forum

INTRODUCTION

Heart disease remains the leading cause of mortality in the United States, accounting for about one quarter of all deaths in 20131. Acute ischemic heart disease is a major subpopulation of this group, and typically presents with characteristic electrocardiographic (EKG) changes. The most concerning of these findings are ST-elevations, as ST Elevation Myocardial Infarction (STEMI) typically indicates the need for emergent reperfusion therapy because 30-day mortality of untreated STEMI is approximately 10-15% versus 5% in treated cases2. As a result, clinicians are taught to recognize the symptoms and signs of myocardial ischemia and STEMI in order to achieve timely ...


Incidence Of Pump Thrombosis In Heartmate Ii During Destination Therapy, Rohan Samson, Abhishek Jaiswal, Frank Smart, Thierry H. LeJemtel 2016 Tulane University

Incidence Of Pump Thrombosis In Heartmate Ii During Destination Therapy, Rohan Samson, Abhishek Jaiswal, Frank Smart, Thierry H. Lejemtel

The VAD Journal

Pump thrombosis (PT) occurs during destination therapy (DT) with HeartMate II, a continuous blood flow left ventricular assist device (St Jude, Pleasanton, CA, USA). With adherence to stringent post-operative and long-term anticoagulation a low incidence of PT was initially reported during DT. The increased PT incidence during DT that was reported in early 2013 was attributed to lenient anticoagulation. A wide range of PT incidence during DT is being reported since the return to stringent post-operative and long-term anticoagulation. We searched PubMed from January 2008 to February 2016 for reports of PT during mechanical circulatory support with HeartMate II and ...


Normal Lactate Dehydrogenase Does Not Exclude Pump Thrombosis In Left Ventricular Assist Devices, Julie Shelton DO, Bennet George MD, Amanda Hart BSN, RN, Maya Guglin MD 2016 University of Kentucky

Normal Lactate Dehydrogenase Does Not Exclude Pump Thrombosis In Left Ventricular Assist Devices, Julie Shelton Do, Bennet George Md, Amanda Hart Bsn, Rn, Maya Guglin Md

The VAD Journal

Left ventricular assist device (LVAD) pump thrombosis is a well-known complication of LVAD placement. Elevated lactate dehydrogenase (LDH) has classically been the first objective marker of pump thrombosis. In this case, we present a patient found to have normal serum LDH values but was ultimately found to have significant pump thrombosis.


Providing Cardiology Care In Rural Areas Through Visiting Consultant Clinics, Thomas S. Gruca, Tae‐Hyung Pyo, Gregory C. Nelson 2016 University of Iowa

Providing Cardiology Care In Rural Areas Through Visiting Consultant Clinics, Thomas S. Gruca, Tae‐Hyung Pyo, Gregory C. Nelson

Tippie College of Business Publications

Background Workforce experts predict a future shortage of cardiologists that is expected to impact rural areas more severely than urban areas. However, there is little research on how rural patients are currently served through clinical outreach. This study examines the impact of cardiology outreach in Iowa, a state with a large rural population, on participating cardiologists and on patient access.

Methods and Results Outreach clinics are tracked annually in the Office of Statewide Clinical Education Programs Visiting Medical Consultant Database (University of Iowa Carver College of Medicine). Data from 2014 were analyzed. In 2014, an estimated 5460 visiting consultant clinic ...


Outcomes Of External Repair Of Heartmate Ii™ Lvad Percutaneous Leads, Jay D. Pal, Claudius Mahr, Jason W. Smith, Todd F. Dardas, Jay Pinette, David J. Farrar, Nahush A. Mokadam 2016 University of Washington

Outcomes Of External Repair Of Heartmate Ii™ Lvad Percutaneous Leads, Jay D. Pal, Claudius Mahr, Jason W. Smith, Todd F. Dardas, Jay Pinette, David J. Farrar, Nahush A. Mokadam

The VAD Journal

Background: The HeartMate II Left Ventricular Assist Device (LVAD) receives power via a percutaneous lead connected to an external controller and batteries. At times, this lead can be damaged during normal wear, as well as by traumatic fracture, which may jeopardize the functionality of the LVAD. If there is significant internal damage, surgical replacement of the LVAD is required. However it is possible to repair externally damaged leads by replacing the distal portion of the lead to avoid pump replacement. We report the overall experience and outcomes in patients with external lead repairs.

Methods: A procedure for full external lead ...


Clinical Outcomes Of Unprotected Left Main Coronary Artery Stenting In Nonsurgical Patients: A Single-Center Experience, John-Paul Pham, Abdelazim Hashim, Naoyo Mori, Mohamed Taha, Mohamed Djelmami-Hani, Joaquin Solis, Suhail Allaqaband, Tanvir Bajwa, Anjan Gupta 2016 Center for Urban Population Health, University of Wisconsin-Milwaukee

Clinical Outcomes Of Unprotected Left Main Coronary Artery Stenting In Nonsurgical Patients: A Single-Center Experience, John-Paul Pham, Abdelazim Hashim, Naoyo Mori, Mohamed Taha, Mohamed Djelmami-Hani, Joaquin Solis, Suhail Allaqaband, Tanvir Bajwa, Anjan Gupta

Mohamed Djelmami-Hani, MD

Purpose: Coronary artery bypass graft is the standard treatment for unprotected left main disease; however, some patients are poor surgical candidates due to comorbidities. We assessed the safety and clinical outcome of elective, unprotected left main coronary artery stenting in nonsurgical patients.

Methods: Between October 2004 and June 2006, 50 consecutive patients underwent elective, unprotected left main coronary artery stenting at our institution. Patients were followed for a median of 16 and 96 months and clinical outcomes monitored.

Results: Median logistic euroSCORE was 28.6 (interquartile range: 14.6-43.4). Median baseline left ventricular ejection fraction (LVEF) was 50%. Procedural ...


Real-World Relevance Of Manual Electrocardiography Qt Interval Measurement, Satish Velagapudi, Zahra Nur Khaled, Bilal Omery, Firas Zahwe, Michael Anigbogu, Sarah Zukkoor, Indrajit Choudhuri 2016 Aurora Health Care

Real-World Relevance Of Manual Electrocardiography Qt Interval Measurement, Satish Velagapudi, Zahra Nur Khaled, Bilal Omery, Firas Zahwe, Michael Anigbogu, Sarah Zukkoor, Indrajit Choudhuri

Indrajit Choudhuri

Background: Electrocardiography (ECG) QT interval (QTI) prolongation independently predicts sudden death. Hospitalized patients are commonly exposed to multiple QT-prolonging drugs, and manual measurement of ECG QTI based on identifying the intersection of isoelectricity with the tangent to the terminal phase T-wave slope (QTTTT) is advocated due to inaccuracies in automated detection algorithms that may imprecisely identify QT duration.

Purpose: We evaluated the performance of QTTTT compared to a standard automated (12SL, GE Healthcare) method (QT-12SL).

Methods: Consecutively obtained ECGs of 250 hospitalized patients were reviewed. The QTI in leads II, aVR, V5 and V6 determined by QT-12SL and QTTTT were ...


Feasibility Of Atrial Delivery And Tracking Of Stem Cells In A Porcine Model, Nina Garlie, Timothy Hacker, Eric G. Schmuck, Jill Koch, Jayant Khitha, Amish Raval, Indrajit Choudhuri 2016 Regenerative Medicine Center, Aurora Research Institute, Aurora Health Care

Feasibility Of Atrial Delivery And Tracking Of Stem Cells In A Porcine Model, Nina Garlie, Timothy Hacker, Eric G. Schmuck, Jill Koch, Jayant Khitha, Amish Raval, Indrajit Choudhuri

Indrajit Choudhuri

Background: Many patients undergoing open heart surgery have sinus node dysfunction and atrial fibrillation, leading to adverse outcomes. Mesenchymal stem cells (MSC) delivered at the time of surgery may have a reparative effect on atrial tissue, thereby improving sinus node function and reducing or preventing atrial fibrillation. Stem cell delivery to the atrium is entirely unstudied. This is a significant gap in medical research, as atrial disease contributes significantly to health care costs. Purpose: The purpose of this pilot study is to establish a technique to deliver MSC to the atria through an open-chest model, to assess the safety of ...


Non-Invasive Imaging For The Assessment Of Cardiac Dose And Function Following Focused External Beam Irradiation, Omar El-Sherif 2016 The University of Western Ontario

Non-Invasive Imaging For The Assessment Of Cardiac Dose And Function Following Focused External Beam Irradiation, Omar El-Sherif

Electronic Thesis and Dissertation Repository

Technological advances in imaging and radiotherapy have led to significant improvement in the survival rate of breast cancer patients. However, a larger proportion of patients are now exhibiting the less understood, latent effects of incidental cardiac irradiation that occurs during left-sided breast radiotherapy. Here, we examine the utility of four-dimensional computed tomography (4D-CT) for the accurate assessment of cardiac dose; and a hybrid positron emission tomography (PET) magnetic resonance imaging (MRI) system to longitudinally study radiation-induced cardiac effects in a canine model.

Using 4D-CT and deformable dose accumulation, we assessed the variation caused by breathing motion in the estimated dose ...


Echocardiographic Predictors Of Admission Among Patients With Heart Failure With Reduced Ejection Fraction, Chi C. Cho, Yang Shi, Robyn Shearer, Nasir Z. Sulemanjee, Dianne L. Zwicke, T. Edward Hastings, Omar M. Cheema, Vinay Thohan 2016 Aurora Research Institute, Aurora Health Care

Echocardiographic Predictors Of Admission Among Patients With Heart Failure With Reduced Ejection Fraction, Chi C. Cho, Yang Shi, Robyn Shearer, Nasir Z. Sulemanjee, Dianne L. Zwicke, T. Edward Hastings, Omar M. Cheema, Vinay Thohan

Omar Cheema

Background: Congestive heart failure afflicts 5.7 million people in the United States with annual incidence of 600,000 and mortality of 280,000. Heart failure accounts for greater than 1 million hospitalizations annually and the single largest inpatient Medicare expense. As the U.S. population ages and greater emphasis is placed on population health as a means to bend projected health care expenditures, large health care organizations will need to develop algorithms to identify patients at high risk with heart failure and possibly preempt hospitalizations. Doppler echocardiography is routinely performed in clinical assessment of severe heart failure.

Purpose: We ...


Lead Burden As A Factor For Higher Complication Rate In Patients With Implantable Cardiac Devices, Christopher Kolibash, Naoyo Mori, Jasbir Sra, Masood Akhtar, M. Eyman Mortada 2016 Aurora Sinai/Aurora St. Luke’s Medical Centers, Aurora Health Care

Lead Burden As A Factor For Higher Complication Rate In Patients With Implantable Cardiac Devices, Christopher Kolibash, Naoyo Mori, Jasbir Sra, Masood Akhtar, M. Eyman Mortada

Masood Akhtar

Purpose

Lead revisions have increased over the last decade. Patients who do not undergo lead extraction face an increased lead burden. Consequences of increased lead burden have not been fully defined. We sought to characterize the complication rate and outcomes in patients with sterile redundant leads.

Methods

We retrospectively reviewed 242 consecutive patients [mean age 74 ± 12 years; 66.9% male] who underwent lead revision that resulted in an abandoned lead from January 2005 to June 2010. Patients were placed in a cohort based on number of leads after last recorded procedure (Group A: ≤2 [n=58]; Group B: 3-4 ...


A 35-Year Perspective (1975 To 2009) Into The Long-Term Prognosis And Hospital Management Of Patients Discharged From The Hospital After A First Acute Myocardial Infarction, Han-Yang Chen, Joel Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Jerry H. Gurwitz, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

A 35-Year Perspective (1975 To 2009) Into The Long-Term Prognosis And Hospital Management Of Patients Discharged From The Hospital After A First Acute Myocardial Infarction, Han-Yang Chen, Joel Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Jerry H. Gurwitz, Catarina I. Kiefe, Robert J. Goldberg

Robert J. Goldberg

There are limited population-based data available describing trends in the long-term prognosis of patients discharged from the hospital after an initial acute myocardial infarction (AMI). Our objectives were to describe multidecade trends in post-discharge mortality and their association with hospital management practices in patients discharged from all medical centers in Central Massachusetts after a first AMI. Residents of the Worcester, Massachusetts, metropolitan area discharged from all hospitals in Central Massachusetts after a first AMI from 1975 to 2009 comprised the study population (n = 8,728). Multivariable-adjusted logistic regression analyses were used to examine the association between year of hospitalization and ...


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