Cardiology Commons^™

Aortic Aneurysms In Loeys-Dietz Syndrome - A Tale Of Two Pathways?, Frank Davis, Debra L. Rateri, Alan Daugherty

Saha Cardiovascular Research Center Faculty Publications

Loeys-Dietz syndrome (LDS) is a connective tissue disorder that is characterized by skeletal abnormalities, craniofacial malformations, and a high predisposition for aortic aneurysm. In this issue of the JCI, Gallo et al. developed transgenic mouse strains harboring missense mutations in the genes encoding type I or II TGF-β receptors. These mice exhibited several LDS-associated phenotypes. Despite being functionally defective, the mutated receptors enhanced TGF-β signaling in vivo, inferred by detection of increased levels of phosphorylated Smad2. Aortic aneurysms in these LDS mice were ablated by treatment with the Ang II type 1 (AT1) receptor antagonist losartan. The results from this …

Self-Care Of Heart Failure In A House Call Program, Becky Bryant

Doctor of Nursing Practice Program Projects

The incidence and prevalence of persons living with heart failure (HF) is growing in the United States. Heart failure is the most common admission in hospitals among Medicare recipients aged 65 years or older. Self-care of heart failure (SCHF) has been reported to decrease HF hospital admission rates. Elderly patients who are homebound do not have access to typical HF education and follow-up care. The purpose of this evidence-based practice (EBP) project was to implement a SCHF program intervention by nurse practitioners (NPs) with homebound elderly HF patients receiving home visits in a house call program. There were 18 sample …

Twelve Or 30 Months Of Dual Antiplatelet Therapy After Drug-Eluting Stents, L. Mauri, D. J. Kereiakes, R. W. Yeh, P. Driscoll-Shempp, K. N. Garratt, D. P. Lee, T. K. Pow, P. V. Lee, M. J. Rinaldi, J. M. Massaro, +12 Additional Authors

Journal Articles

BACKGROUND Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications, yet the benefits and risks of treatment beyond 1 year are uncertain. METHODS Patients were enrolled after they had undergone a coronary stent procedure in which a drug-eluting stent was placed. After 12 months of treatment with a thienopyridine drug (clopidogrel or prasugrel) and aspirin, patients were randomly assigned to continue receiving thienopyridine treatment or to receive placebo for another 18 months; all patients continued receiving aspirin. The coprimary efficacy end points were stent thrombosis and major adverse cardiovascular and cerebrovascular events (a composite of death, myocardial …

Multi-Detector Coronary Ct Imaging For The Identification Of Coronary Artery Stenoses In A "Real-World" Population, A. N. Makaryus, S. Henry, L. Loewinger, J. N. Makaryus, L. Boxt

Journal Articles

BACKGROUND: Multi-detector computed tomography (CT) has emerged as a modality for the non-invasive assessment of coronary artery disease (CAD). Prior studies have selected patients for evaluation and have excluded many of the "real-world" patients commonly encountered in daily practice. We compared 64-detector-CT (64-CT) to conventional coronary angiography (CA) to investigate the accuracy of 64-CT in determining significant coronary stenoses in a "real-world" clinical population. METHODS: A total of 1,818 consecutive patients referred for 64-CT were evaluated. CT angiography was performed using the GE LightSpeed VCT (GE((R)) Healthcare). Forty-one patients in whom 64-CT results prompted CA investigation were further evaluated, and …

Implications Of Gender Difference In Coronary Calcification As Assessed By Ct Coronary Angiography, A. N. Makaryus, C. Sison, M. Kohansieh, J. N. Makaryus

Journal Articles

BACKGROUND: Arterial calcium as measured by 64-slice computed tomography coronary angiography (64-CT) is a reliable predictor of cardiovascular disease risk. Lipid-rich plaques with lower degrees of calcification may pose greater risk for adverse coronary events than more stabilized calcified plaques as a result of the increased risk of plaque rupture, migration, and subsequent acute coronary syndrome. We sought to examine coronary artery calcium scores as measured via 64-CT to assess the extent of calcification and plaque distribution in women compared to men. METHODS: A total of 138 patients referred for 64-CT were evaluated. Computerized tomographic angiography was performed using the …

Inappropriate Implantable Cardioverter-Defibrillator Shocks Attributed To Alternating-Current Leak In A Swimming Pool, J. N. Makaryus, J. Angert-Gilman, M. Yacoub, A. Patel, B. Goldner

Journal Articles

Implantable cardioverter-defibrillators (ICDs) are the standard of care for preventing sudden cardiac death in patients who are predisposed to malignant ventricular arrhythmias. Causes of inappropriate ICD shock include equipment malfunction, improper arrhythmia evaluation, misinterpretation of myopotentials, and electromagnetic interference. As the number of implanted ICDs has increased, other contributors to inappropriate therapy have become known, such as minimal electrical current leaks that mimic ventricular fibrillation. We present the case of a 63-year-old man with a biventricular ICD who received 2 inappropriate shocks, probably attributable to alternating-current leaks in a swimming pool. In addition, we discuss ICD sensitivity and offer recommendations …

Takotsubo Cardiomyopathy As A Sequela Of Elective Direct-Current Cardioversion For Atrial Fibrillation, J. S. Siegfried, S. Bhusri, N. Guttenplan, N. L. Coplan

Journal Articles

In takotsubo cardiomyopathy, the clinical appearance is that of an acute myocardial infarction in the absence of obstructive coronary artery disease, with apical ballooning of the left ventricle. The condition is usually precipitated by a stressful physical or psychological experience. The mechanism is unknown but is thought to be related to catecholamine excess. We present the case of a 67-year-old woman who experienced cardiogenic shock caused by takotsubo cardiomyopathy, immediately after undergoing elective direct-current cardioversion for atrial fibrillation. After a course complicated by left ventricular failure, cardiogenic shock, and ventricular tachycardia, she made a complete clinical and echocardiographic recovery In …

Surgical Management Of Ascending Aortic Aneurysm And Its Complications, S. Sran, M. Sran, N. Ferguson, A. N. Makaryus

Journal Articles

Ascending aortic aneurysms involving the proximal aortic arch, arising anywhere from the aortic valve to the innominate artery, represent various problems in which open surgery is generally required. Surgical options include excision of the aortic pathology or wrapping the aneurysm shell with an aortic Dacron graft. Intervention using the latter method can lead to extravasation of blood along the suture lines resulting in continuous bleeding within the periprosthetic space. The Cabrol technique was developed as a method for decompression of postoperative leaks by the formation of a conduit system from the periprosthetic space to the right atrium. The coronary ostia …

Outcomes Registry For Better Informed Treatment Of Atrial Fibrillation Ii: Rationale And Design Of The Orbit-Af Ii Registry, B. A. Steinberg, R. G. Blanco, D. Ollis, S. Kim, D. N. Holmes, P. R. Kowey, G. C. Fonarow, J. Ansell, B. Gersh, J. P. Piccini, +6 Additional Authors

Journal Articles

Background Recent clinical trials have demonstrated the safety and efficacy of several non-vitamin K oral anticoagulants (NOACs) for the treatment of atrial fibrillation (AF). However, there are limited data on their use and outcomes in routine clinical practice, particularly among patients newly diagnosed as having AF and patients with AF recently transitioned to a NOAC. Methods/Design ORBIT-AF II is a multicenter, national registry of patients with AF that is enrolling up to 15,000 newly diagnosed patients with AF and/or those with AF recently transitioned to a NOAC from 300 US outpatient practices. These patients will be followed for up to …

Electromagnetic Interference With Implantable Cardioverter Defibrillators Causing Inadvertent Shock: Case Report And Review Of Current Literature, M. Akhtar, T. Bhat, M. Tantray, C. Lafferty, S. Faisal, S. Teli, H. Bhat, M. Raza, M. Khalid, S. Biekht

Journal Articles

As the number of patients having implantable cardioverter defibrillator (ICD) devices is increasing, it is important for the physicians and patients to be aware of situations and conditions that can result in interference with normal functioning of these devices. There are multiple cases of malfunction of ICDs reported in literature and it may be of great significance to have an overview of these incidents for appropriate recognition and future prevention. Here we are reviewing the available literature as well as reporting an interesting case of electromagnetic interference (EMI) resulting from leak of current in pool water causing firing of ICD.

Mammographically Detectable Breast Arterial Calcification And Atherosclerosis, N. Shah, V. Chainani, P. Delafontaine, A. Abdo, J. Lafferty, N. Abi Rafeh

Journal Articles

Breast arterial calcification (BAC), observed as an incidental finding on screening mammograms, represents degenerative calcific changes occurring in the mammary arteries, with increasing age. The aim of this review is to discuss relevant literature examining relation between BAC and atherosclerosis. After a thorough literature search, in OVID and PubMed, 199 studies were identified, of which 25 were relevant to our review. Data were abstracted from each study and statistical analysis was done, including calculation of odds ratios and construction of forest plots. A total of 35,542 patients were enrolled across 25 studies looking at an association between BAC and coronary …

Aspirin Use And Knowledge In The Community: A Population- And Health Facility Based Survey For Measuring Local Health System Performance., Gregory A Roth, Catherine W. Gillespie, Ali A Mokdad, Danny D Shen, David W Fleming, Andy Stergachis, Christopher J L Murray, Ali H Mokdad

Pediatrics Faculty Publications

BACKGROUND: Little is known about the relationship between cardiovascular risk, disease and actual use of aspirin in the community.

METHODS: The Measuring Disparities in Chronic Conditions (MDCC) study is a community and health facility-based survey designed to track disparities in the delivery of health interventions for common chronic diseases. MDCC includes a survey instrument designed to collect detailed information about aspirin use. In King County, WA between 2011 and 2012, we surveyed 4633 white, African American, or Hispanic adults (45% home address-based sample, 55% health facility sample). We examined self-reported counseling on, frequency of use and risks of aspirin for …

The Effects Of Heart Disease, Teresa Wallace

Nebraska College Preparatory Academy: Senior Capstone Projects

• Physical: The physical risks and complications for contracting cardiovascular disease and how to prevent it.

• Social: Being social with the patient is a good way to lead the patient to the right path of recovery whereas if the patient had some family problems and had no family to comfort them.

• Emotional: The family is affected as well as the patient and I will be discussing how they act and feel before the surgeries of their child/family members and after the surgery.

Achieving High-Value Cardiac Imaging: Challenges And Opportunities., David H Wiener

Division of Cardiology Faculty Papers

Cardiac imaging is under intense scrutiny as a contributor to health care costs, with multiple initiatives under way to reduce and eliminate inappropriate testing. Appropriate use criteria are valuable guides to selecting imaging studies but until recently have focused on the test rather than the patient. Patient-centered means are needed to define the true value of imaging for patients in specific clinical situations. This article provides a definition of high-value cardiac imaging. A paradigm to judge the efficacy of echocardiography in the absence of randomized controlled trials is presented. Candidate clinical scenarios are proposed in which echocardiography constitutes high-value imaging, …

Assessing Prevalence Of Known Risk Factors In A Regional Central Kentucky Medical Center Heart Failure Population As An Approach To Assessment Of Needs For Development Of A Program To Provide Targeted Services To Reduce 30 Day Readmissions, Christeen Ivy Broaddus

DNP Projects

Abstract

Objectives:

1. Determine demographic, physiologic, and laboratory characteristics at time of admission of the heart failure (HF) population in a regional acute care facility in Central Kentucky through review of patient electronic medical records.
2. Determine which HF population characteristics are significantly associated with readmissions to the hospital.
3. Provide identification of the statistically significant common characteristics of the HF population to this facility so that they may work towards development of an electronic risk for readmission predictive instrument.

Design: Retrospective chart review.

Setting: Regional acute care facility in Central Kentucky.

Participants: All patients (n = 175) with a diagnosis or history …

Medical Tourism: Comparing Coronary Bypass Surgery In The U.S. And Abroad, William K. Willis, Alberto Coustasse

Management Faculty Research

Rising health care costs have employers searching for remedies to the increasing rates they pay for employee health insurance. The development of U.S. health insurance policies, with the option of utilizing medical tourism as a low cost care provider for treatment of cardiac coronary bypass surgery provides a method for receiving treatment. The medical tourism approach to providing treatment for bypass surgery has prompted hospitals in India, Thailand, and Singapore to seek U.S. patients. A comparison of costs for bypass treatment between the U.S. and these countries illustrates some of the issues and concerns that arise when making such comparisons. …

A Novel And Practical Cardiovascular Magnetic Resonance Method To Quantify Mitral Annular Excursion And Recoil Applied To Hypertrophic Cardiomyopathy, S. G. Saba, S. Chung, S. Bhagavatula, R. Donnino, M. B. Srichai, M. Saric, S. D. Katz, L. Axel

Journal Articles

BACKGROUND: We have developed a novel and practical cardiovascular magnetic resonance (CMR) technique to evaluate left ventricular (LV) mitral annular motion by tracking the atrioventricular junction (AVJ). To test AVJ motion analysis as a metric for LV function, we compared AVJ motion variables between patients with hypertrophic cardiomyopathy (HCM), a group with recognized systolic and diastolic dysfunction, and healthy volunteers. METHODS: We retrospectively evaluated 24 HCM patients with normal ejection fractions (EF) and 14 healthy volunteers. Using the 4-chamber view cine images, we tracked the longitudinal motion of the lateral and septal AVJ at 25 time points during the cardiac …

Effectiveness Of Fluorography Versus Cineangiography At Reducing Radiation Exposure During Diagnostic Coronary Angiography, B. Shah, X. C. Mai, L. Tummala, C. Kliger, S. P. Sedlis, F. Feit, M. Liou, M. Attubato, J. Coppola, J. Slater, +2 Additional Authors

Journal Articles

Coronary angiography is the gold standard for defining obstructive coronary disease. However, radiation exposure remains an unwanted hazard. Patients referred for coronary angiography with abdominal circumference60 ml/min were randomized to the fluorography (n = 25) or cineangiography (n = 25) group. Patients in the fluorography group underwent coronary angiography using retrospectively stored fluorography with repeat injection under cineangiography only when needed for better resolution per operator's discretion. Patients in the cineangiography group underwent coronary angiography using routine cineangiography. The primary end point was patient radiation exposure measured by radiochromic film. Secondary end points included the radiation output measurement of kerma-area …

Hemodynamic Consequences Of Hypertrophic Cardiomyopathy With Midventricular Obstruction: Apical Aneurysm And Thrombus Formation, A.E., Arai, W.P., Bandettini, E., Bodurian, M.Y., Chen, A.W., Ertel, P., Kellman, S.G., Saba, M. Siegenthaler

Journal Articles

No abstract provided.

A Rare Case Of Double-Chambered Right Ventricle Associated With Ventricular Septal Defect And Congenital Absence Of The Pulmonary Valve, G. Khoueiry, T. Bhat, M. Tantray, M. Meghani, N. Abi Rafeh, M. Abdallah, W. Hoyek

Journal Articles

Double-chambered right ventricle (DCRV) is a rare congenital heart disorder involving 2 different right ventricle (RV) pressure compartments that is often associated with ventricular septal defect (VSD). Usually, the obstruction is caused by an anomalous muscle bundle crossing the RV from the interventricular septum to the RV free wall. We are reporting a case of double-chambered right ventricle associated with ventricular septal defect and congenital absence of the pulmonary valve, a rare form of congenital infundibular pulmonary stenosis. In addition to ventricular septal defect, our patient had congenital absence of the pulmonary valve, which is very unusual and has never …