Cardiology Commons^™

Alcohol And Arrhythmias: A Comprehensive Review., Anil George, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

The use of alcohol as a social lubricant has been ubiquitous in human societies since ancient times. It has also long been recognized that alcohol produces undesirable cardiovascular effects, especially when imbibed in excess. Numerous investigators have noted a causal relationship between alcohol and arrhythmias, as well as sudden cardiac death. We have undertaken a comprehensive review of the literature on alcohol as a potential trigger for arrhythmias. We have reviewed the major epidemiological studies undertaken on this subject. We have also explored pathophysiological mechanisms that drive the arrythmogenic effects of alcohol. In conclusion, although there is definite proof in …

Impact Of Delay To Angioplasty In Patients With Acute Coronary Syndromes Undergoing Invasive Management : Analysis From The Acuity (Acute Catheterization And Urgent Intervention Triage Strategy) Trial, Paul Sorajja Md, Bernard J. Gersh Mb, Chb, Dphil, David A. Cox Md, Michael G. Mclaughlin Md, Peter Zimetbaum Md, Costantino Constantini Md, Thomas D. Stuckey Md, James E. Tcheng Md, Roxana Mehran Md, Alexandra J. Lansky Md, Cindy L. Grines Md, Gregg W. Stone Md

Department of Medicine

No abstract provided.

Trpm7-Mediated Ca2+ Signals Confer Fibrogenesis In Human Atrial Fibrillation, Jianyang Du, Jia Xie, Zheng Zhang, Hiroto Tsujikawa, Daniel Fusco, David Silverman, Bruce Liang, Lixia Yue

UCHC Articles - Research

Rationale—Cardiac fibrosis contributes to pathogenesis of atrial fibrillation (AF), which is the most sustained arrhythmia and a major cause of morbidity and mortality. Although it has been suggested that Ca2+ signals are involved in fibrosis promotion, the molecular basis of Ca2+ signaling mechanisms and how Ca2+ signals contribute to fibrogenesis remain unknown.
Objective—To determine the molecular mechanisms of Ca2+-permeable channel(s) in human atrial fibroblasts, and to investigate how Ca2+ signals contribute to fibrogenesis in human AF.
Methods and Results—We demonstrate that the transient receptor potential melastatin related 7 (TRPM7) is the molecular basis of the major Ca2+-permeable channel in human …

Association Of Depression With Newly Diagnosed Type 2 Diabetes Among Adults Aged Between 25 To 60 Years In Karachi, Pakistan., Shazia Perveen, Muhammad S Otho, Muhammad N Siddiqi, Juanita Hatcher, Ghazala Rafique

Section of Cardiothoracic Surgery

Background:The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

Methods:

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from …

Symptom Recognition In Elders With Heart Failure, Barbara Riegel, Victoria V. Dickson, Janette Cameron, Jerry C. Johnson, Stephen Bunker, Karen Page, Linda Worrall-Carter

School of Nursing Departmental Papers

Purpose: Aging is associated with losses in hearing and vision. The objective of this study was to assess whether aging also is associated with less ability to detect and interpret afferent physiological information.

Design: A cross‐sectional mixed methods study was conducted with 29 persons with a confirmed diagnosis of chronic heart failure of at least 6 months duration. The sample was divided at the median to compare younger (<73 years) versus older (≥73 years) patients in the ability to detect and interpret their heart failure symptoms.

Methods: Shortness of breath was stimulated using a 6‐minute walk test (6MWT) and used to assess the ability of heart failure patients to detect shortness of breath using the Borg measure …

The Utility Of Modified Butler-Leggett Criteria For Right Ventricular Hypertrophy In Detection Of Clinically Significant Shunt Ratio In Ostium Secundum-Type Atrial Septal Defect In Adults, Adeel M. Siddiqui, Zainab Samad, Nina Hakacova, James Kinsella, Cary Ward, Michael White, Anna Lisa C. Crowley, Galen S. Wagner, J. Kevin Harrison

Section of Cardiology

Background: This study was performed to test the hypothesis that there exists a correlation between the Butler-Leggett (BL) criterion for right ventricular hypertrophy on the electrocardiogram and the Qp/Qs shunt ratio in adults with ostium secundum atrial septal defects (ASDs).

Methods: Demographic, cardiac catheterization, ASD closure, and electrocardiographic data were acquired on 70 patients with secundum ASDs closed percutaneously. Simple linear regression and logistic regression models were created to test the hypothesis.

Results: The mean Qp/Qs ratio and BL criterion value were 1.61 +/- 0.46 and 0.11 +/- 0.41, respectively. The BL criterion values correlated with shunt ratios (r(2) = …

Cardioprotection By Regular Ethanol Consumption: Potential Mechanisms And Clinical Application., Masami Miyamae, Kazuhiro Kaneda, Naochika Domae, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Epidemiological studies demonstrate that excessive drinking is associated with hypertension, cerebral bleeding and loss of cardiac contractility. Conversely, studies have shown that mortality rates for people who regularly drink ethanol in moderation are lower than in abstainers, primarily due to decreased fatal ischemic heart disease. Further, moderate ethanol consumers have lower rates of myocardial infarction compared with abstainers. These beneficial cardiac effects may be due to pleiotropic effects of ethanol on lipids, platelets, and fibrinolytic activity. During the past decade, studies conducted in several animal models have revealed that light to moderate regular ethanol consumption renders hearts more tolerant to …

Qrs Duration And Echocardiographic Evidence Of Left Ventricular Dyssynchrony In Patients With Left Ventricular Systolic Dysfunction, Hafeez Ahmed, Javed Majid Tai, Sohail Abrar Khan, Muniza Yousuf

Section of Cardiology

OBJECTIVE: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) < 35% and prolonged ventricular depolarization on electrocardiography.

STUDY DESIGN: A cross-sectional study.

PLACE AND DURATION OF STUDY: The Aga Khan University, Karachi, from June to September 2007.

METHODOLOGY: All patients with LVEF < 35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer's exact test was used to determine the association between QRS duration and left ventricular dyssynchrony.

RESULTS: A total of 60 patients were included. Twenty one patients had QRS duration of > 120 msec. Out of those 21 patients, a total of 6 patients (28.6%) had evidence of dyssynchrony on TDI. Five patients (23.8%) had dyssynchrony on the basis of basal septal and basal lateral velocity difference (p=0.045) …

Gender Differences Of Case-Fatality Rate In A Brazilian Stroke Registry, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Characteristics Of Small Areas With A Higher Stroke Mortality, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Higher Frequency Of Stroke Deaths On Monday And Saturday, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Social Inequalities And The Decline Of Stroke Mortality In The City Of Sao Paulo, Brazil, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Ganglionic Plexus Ablation During Pulmonary Vein Isolation--Predisposing To Ventricular Arrhythmias?, Faizel Osman, Suman Kundu, Jiun Tuan, Jeilan Mohamed, Peter J. Stafford, G. Andre' Ng

Internal Medicine, East Africa

Catheter ablation is increasingly used to treat patients with atrial fibrillation (AF). Ablation of ganglionic plexi is often performed to reduce vagal innervation and has been shown to confer a better long-term outcome in terms of AF recurrence. We report a case of a patient having AF ablation with a profound vagal response, suggesting ganglionic plexus ablation, who subsequently developed ventricular fibrillation after programmed ventricular stimulation. Reduced vagal modulation is known to predispose to ventricular arrhythmias and vagal denervation following AF ablation may predispose to ventricular arrhythmias and requires further study.

Emergency Evaluation Of Acute Chest Pain, Aysha Almas, Om Parkash, Aamir Hameed, Muhammad Islam

Section of Cardiology

OBJECTIVE: To determine the sensitivity and specificity of initial clinical assessment about the diagnosis of acute coronary syndrome (ACS) in patients presenting with acute chest pain by a cardiology resident in the emergency room and assess the 30-day outcome of patients with ACS and non ACS.

STUDY DESIGN: Cohort study.

PLACE AND DURATION OF STUDY: The study was conducted in the emergency department and cardiac care units of the Aga Khan University in 2006-07.

METHODOLOGY: A total of 202 patients, who presented to the emergency room with chest pain, were given an initial ECG and troponin check. Patients were assigned …

Lead Extraction In The Contemporary Setting: The Lexicon Study. An Observational Retrospective Study Of Consecutive Laser Lead Extractions, Oussama Wazni, Md, Laurence M. Epstein, Md, Roger G. Carrillo, Md, Charles Love, Md, Stuart W. Adler, Md, David W. Riggio, Md, Shahzad S. Karim, Md, Jamil Bashir, Md, Arnold J. Greenspon, Md, John P. Dimarco, Md, Phd, Joshua M. Cooper, Md, John R. Onufer, Md, Kenneth A. Ellenbogen, Md, Stephen P. Kutalek, Md, Sherri Dentry-Mabry, Msn, Carolyn M. Ervin, Phd, Bruce L. Wilkoff, Md

Division of Cardiology Faculty Papers

Objectives: This study sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients.

Background: The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices.

Methods: Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included.

Results: Between January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5% of the …

Partial And Transitional Atrioventricular Septal Defect Outcomes., L Luann Minich, Andrew M. Atz, Steven D. Colan, Lynn A. Sleeper, Seema Mital, James Jaggers, Renee Margossian, Ashwin Prakash, Jennifer S. Li, Meryl S. Cohen, Ronald V. Lacro, Gloria L. Klein, John A. Hawkins, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Surgical and perioperative improvements permit earlier repair of partial and transitional atrioventricular septal defects (AVSD). We sought to describe contemporary outcomes in a multicenter cohort.

METHODS: We studied 87 patients undergoing primary biventricular repair of partial or transitional AVSD between June 2004 and February 2006 across seven North American centers. One-month and 6-month postoperative data included weight-for-age z-scores, left atrioventricular valve regurgitation (LAVVR) grade, residual shunts, and left ventricular ejection fraction. Paired methods were used to assess 6-month change.

RESULTS: Median age at surgery was 1.8 years; median weight z-score was -0.88. Median days for ventilation were 1, intensive …

Emergency Evaluation Of Acute Chest Pain., Aysha Almas, Om Parkash, Aamir Hameed, Muhammad Islam

Department of Medicine

Objective: To determine the sensitivity and specificity of initial clinical assessment about the diagnosis of acute coronary syndrome (ACS) in patients presenting with acute chest pain by a cardiology resident in the emergency room and assess the 30-day outcome of patients with ACS and non ACS.

Study Design: Cohort study.

Place and Duration of Study: The study was conducted in the emergency department and cardiac care units of the Aga Khan University in 2006-07.

Methodology: A total of 202 patients, who presented to the emergency room with chest pain, were given an initial ECG and troponin check. Patients were assigned …

Role Of Cardiac Magnetic Resonance Imaging In The Detection Of Cardiac Amyloidosis, Imran S. Syed Md, James F. Glockner Md, Dali Feng Md, Philip A. Araoz Md, Matthew W. Martinez, William D. Edwards Md, Morie A. Gertz Md, Angela Dispenzieri Md, Jae K. Oh Md, Diego Bellavia Md, Phd, A Jamil Tajik Md, Martha Grogan Md

Department of Medicine

No abstract provided.

Stroke Prevalence In A Poor Neighbourhood Of Sao Paulo, Brazil: Applying A Stroke Symptom Questionnaire, Paulo A. Lotufo

Paulo A Lotufo

Background Brazil has one of the highest stroke mortality rates in the world, these rates are most endemic in the poor. We verified the prevalence of stroke in a deprived neighbourhood in the city of Sa˜ o Paulo, Brazil and compared it with other surveys worldwide. Methods A questionnaire with six questions concerning limb and facial weakness, articulation, sensory disturbances, impaired vision, and past diagnosis of stroke was completed door-to-door in a well-defined area of 15 000 people. Questionnaires were considered positive when a participant answered two or more questions about stroke symptoms or the presence of stroke being confirmed …

An Open Letter To The Citizens Of Northwest Louisiana, Frederick J. White Iii

Frederick J White III

We, the undersigned physicians, want to publicly address our community regarding the health system debate in Congress. This is a historic time, and decisions made in these next days will impact you as citizens and as patients for generations. We recognize that the health system needs change. But the path that the Congress has taken is unwise and unnecessary. And although the American Medical Association has endorsed both the House and Senate bills, (1) we want to be clear—the AMA does not speak for us on these issues.