Cardiology Commons^™

Recurrent Cyanotic Spells In An Octogenarian, Chin Tong Kwok, Chun Kit Wong

Journal of the Hong Kong College of Cardiology

We report rare case of an octogenarian who, after years of diagnostic delay, was found to have a patent foramen ovale, and due to an ascending aortic aneurysm that anatomically facilitated right-to-left shunt, presenting with life-threatening cyanotic attacks. The characteristic orthodeoxia-platypnea syndrome and high alveolar arterial gradient hint to the diagnosis. She was eventually treated successfully with urgent percutaneous PFO closure. Routine ordering of a transthoracic echocardiogram, without agitated saline injection under provocation maneuvers, may not be sufficient to rule out shunts.

Roles Of Exercise Treadmill Test In The Diagnosis & Risk Stratification Of Cardiac Channelopathies, Kit Chan

Journal of the Hong Kong College of Cardiology

Channelopathies are the leading causes of SCD in patients without structural heart disease. Missing the diagnosis of high-risk but concealed channelopathies could have lethal clinical consequences. However, the diagnosis of channelopathies is often challenging due to the dynamic clinical presentations and elusive ECG manifestations of these diseases. An integrated approach including clinical assessment, repeated electrocardiography, drug provocation tests, exercise stress test and genetic studies is often required for establishing the diagnosis. Pharmacological provocation tests may have limited sensitivity and may be associated with false positive results. Wide-spread use of genetic studies are limited by low yield, cost-effectiveness and availability issue. …

The Impact Of Renal Insufficiency Upon Admission On The Clinical Outcome Of Patients With Acute St-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention, Wai Lun Kwong, Kwok Ho Yau, Eugene Sin, Kwok Keung Chan

Journal of the Hong Kong College of Cardiology

Background: Coronary artery disease is common in patients with renal insufficiency. In acute coronary syndrome, impaired renal function is present in approximately 30-40% of patients and is associated with worse prognosis. Local data regarding the risks and benefits for those patients suffering from acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) is scarce. We evaluated the clinical outcomes of patients suffering from STEMI with and without renal insufficiency upon admission who underwent PPCI.

Methods: From 1^st January 2009 to 30^th September 2017, all patients with STEMI treated with PPCI were identified. The primary …

Predictors Of Neurological Complications Of Pediatric Post-Cardiotomy Extracorporeal Life Support, Hala Mounir Agha, Amr Fathalla, Giuseppe Isgro, Mauro Cotza

Journal of the Saudi Heart Association

Background: Post-cardiotomy extracorporeal membrane oxygenation (ECMO) was associated with significant neurological complications affecting the overall outcome. The aim of the work is to determine the incidence and the predictors of neurological events during pediatric extracorporeal life support after cardiac surgery. Patients & Methods: This is a retrospective study that encompassed all neonates, infants, and children (<18 years of age) who need extracorporeal life support following cardiac surgery between January 2015 and December 2018 at San Donato Hospital, Italy. Data as regards surgical procedure of congenital heart disease, in-hospital mortality, length of ECMO, hospital stay durations, short-term neurological ECMO complications and outcome were analyzed. Results: The sixty-three patients who received post-cardiotomy ECMO, Neurological complications were evident in 31.7% in the form of ischemic stroke in 17.5% and hemorrhagic stroke in 11.1%. By multivariable analysis, the older age of cyanotic cases, the need for a venting cannula, and the rapid CO2 drop in the first 24 h were the most independent risk factors for neurological complications. Prolonged ECMO support and hospital stay duration were associated with neurological sequelae. Conclusion: Neurological complications either ischemic or hemorrhagic strokes were common during pediatric postcardiotomy ECMO and were significantly related to prolonged ECMO support and hospital stay. Predictors of these neurological sequelae are the older cyanotic cases, the need for a venting cannula, the oxygenator thrombosis, and the rapid CO2 drop in the first 24 h of ECMO.

Cardiogenic Shock Among Patients With Acute Myocardial Infarction In A Middle Eastern Country: A Single-Centre Experience, Ghada Shalaby, Azmat Khadija Niazi, Sheeren Khaled

Journal of the Saudi Heart Association

BACKGROUND: Cardiogenic Shock (CS) remains the most common cause of death in hospitalized acute ST-segment elevation myocardial infarction (STEMI) patients. Predictors of outcomes in those patients include clinical, laboratory, radiologic variables, and management strategies. The present study aimed to evaluate the incidence, characteristics, predictors of cardiogenic shock and mortality among acute ST-segment elevation myocardial infarction patients in our center METHODS: This was a retrospective, single-center study conducted at KAMC, Makkah during 2015-2020. All acute ST-segment elevation myocardial infarction patients during this era were divided into two groups CS group and non-CS group. RESULTS: In this study total 3074 acute ST-segment …

The Challenges Of Conducting Clinical Trials For Patients With Cardiogenic Shock, Sunil Rao

Journal of Shock and Hemodynamics

Cardiogenic shock due to ST-segment elevation myocardial infarction is associated with high morbidity and mortality. Patients in shock are acutely ill, and clinicians may lack equipoise, thus presenting a challenge to developing high-quality evidence to guide practice. This review will summarize these challenges and offer possible solutions.

Validation Of Various Prediction Scores For Cardiac Surgery-Associated Acute Kidney Injury, Anwar Abdullatif Alhulaibi, Abdulrahman Mashatel Alruwaili, Abdullah Saad Alotaibi, ​Fatima Nabih Alshakhs​, Habib Samir Alramadhan, ​Mohammed Salman Koudieh

Journal of the Saudi Heart Association

Background and Objectives: Following cardiac surgery, acute kidney injury (AKI) is a well-known complication that increases morbidity and mortality. This study was carried out to determine the factors associated with acute kidney injury and to assess the predictive value of three predictive scores for the development of AKI post-cardiac surgery in the Saudi community. Methods: In this retrospective study, the medical records of patients aged 18 years and above who underwent cardiac surgery on cardiopulmonary bypass (CPB) at Saud Albabtin Cardiac Center between January 2018 and March 2021 were reviewed. The first stage of both Kidney Disease Improving Global Outcomes …

Persistent Fdg Uptake At Apical Aneurysm In A Patient With Cardiac Sarcoidosis, Chaitanya Rojulpote, Shivaraj Patil, Mahesh K. Vidula, Robert Kotloff, Stuart Prenner, Paco E. Bravo

Einstein Health Papers

We present a case of cardiac sarcoidosis with persistent, focal fluorodeoxyglucose uptake at the left ventricular apical aneurysm concerning for ongoing active inflammatory injury, prompting aggressive immunosuppressive therapy. This case highlights the importance of understanding the various clinical entities that may resemble disease activity on fluorodeoxyglucose positron emission tomography/computed tomography imaging. (Level of Difficulty: Intermediate.)

Using Hierarchy Of Needs To Build Care Team Engagement, Cathy Palleschi, Katherine Skroski, Sam Canonico, Hailey Frager, Mary Beeaker, Suneela Nayak, Natalia Johnson, Rebecca Brookes

Operational Excellence

Cardiology Intensive Care & Cardiovascular Interventional Care teams provide superb care to critically ill cardiac patients at Maine Medical Center. Covid Pandemic revealed the importance of caregiver physical and mental health wellbeing, as well as engagement in order to continue to provide outstanding care to patients. Leadership devised innovative ways to improve team engagement and ensure that care team members' needs are met.

Rota Ablation – When There Is No Other Option. A Complex Case Of 86 Years Old Male With Multiple Comorbids Presenting With Stemi, Tooba Sahar, Asaad Akbar Khan, Taha Abdul Rehman, Danish Iltaf Satti

Journal of Community Hospital Internal Medicine Perspectives

The aim of this report is to explore the direct and long-term outcome in a high risk patient who was treated with rotational atherectomy (RA) to assist the placement of drug eluting stents in heavily calcified lesions. The patient presented with acute STEMI and had severely calcified Left main stem (LMS) disease, requiring plaque modification before coronary angioplasty and stent implantation. As the patient was elderly, with multiple comorbids including a number of coronary interventions, a decision of conservative management was made. Patient then re-presented with typical chest pain and pulmonary edema. A Heart Team meeting was called and high …

Feasibility Of Mediastinal Radiation Use In Heartmate 3 Lvad Recipients With Cancer., Nausharwan Butt, Farooq H Sheikh

Division of Cardiology Faculty Papers

The HeartMate 3 left ventricular assist device possesses the unique feature of having its electronics and software located within the housing of the pump, which may predispose it to malfunction from radiation exposure during cancer treatment. We investigated this association in a case series of two patients at our institution.

Association Of The Bb Genotype Of The Abo Gene With The Risk Of Acute Myocardial Infarction In Hospital-Based Study, Farzana Abubakar Yousuf, Iqbal Azam Syed, Asal Khan Tareen, Khawar A. Kazmi, Jibran Sualeh Muhammad, Mohammad Perwaiz Iqbal

Department of Biological & Biomedical Sciences

Objectives: The ABO gene locus has been identified to be associated with myocardial infarction in patients with coronary heart disease. The primary focus of this hospital-based study was to explore the relationship of ABO blood groups and ABO genotypes with acute myocardial infarction (AMI) in Karachi, Pakistan.
Methods: In a comparative cross-sectional study, an equal number of adult AMI patients and healthy controls (n=275 in each group; age range 30-70 years, both males and females) were recruited from the Aga Khan University and NICVD, Karachi, with informed consent. The blood samples were analyzed for ABO blood groups and other biomarkers. …

“I Have A Lot Of Pvcs And I Need To See A Cardiologist”, Ravi Choxi, Arun Kundra

Transformative Medicine (T-Med)

No abstract provided.

Gender Dysphoria In Adolescents With Ehlers-Danlos Syndrome., Jordan T. Jones, William R. Black, Christine Moser, Eric T. Rush, Lindsey Malloy-Walton

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Ehlers-Danlos Syndrome represents a family of heritable connective tissue disorders that include joint hypermobility, tissue fragility, and skin hyperextensibility. Ehlers-Danlos Syndrome presents with clinical sequela across multiple body systems that require multidisciplinary care. Little is known about adolescents with Ehlers-Danlos Syndrome who are transgender and gender diverse. To date, there have been no reports of transgender and gender diverse youth in pediatric patients with Ehlers-Danlos Syndrome. The objective of this study was to characterize transgender and gender diverse adolescents with Ehlers-Danlos Syndrome seen in a pediatric multidisciplinary specialty clinic.

METHODS: A retrospective chart review was performed and it was …

Case Study: Abnormal Presentation Of Infective Endocarditis With Streptococcus Canis And Chiari Network, Shahbaz Afzal, Ryan Russell, Alexander Chekhov

Advances in Clinical Medical Research and Healthcare Delivery

Here we present a rare case of infective endocarditis (IE) with Streptococcus canis and Chiari network in an 85 year old female living with multiple dogs and open skin of lower extremity predisposing her to bacteremia. Underlying abnormalities of the cardiac chambers such as Chiari network predisposes to a higher incidence of bacterial seeding and causing IE. A Chiari network is usually asymptomatic and of no clinical significance but can worsen prognosis in IE. IE carries a significant morbidity and mortality burden and when diagnosed early can be a lifesaving diagnosis. Due to the wide range of complications, early diagnosis …

Advancing Global Equity In Cardiac Care As Cardiac Implantable Electronic Device Reuse Comes Of Age, Daniel Alyesh, Behzad B. Pavri, William Choe, Mam Chandara, Mahmoud U. Sani, Phong Dinh Phan, Aime Bonny, Paul Khairy, Sunil K. Sinha, Uma Srivatsa, Joseph E. Marine, Kim Eagle, Thomas C. Crawford, Dhanunjaya Lakkireddy, Sri Sundaram

Division of Cardiology Faculty Papers

A nation’s health and economic development are inextricably and synergistically connected. Stark differences exist between wealthy and developing nations in the use of cardiac implantable electronic devices (CIEDs). Cardiovascular disease is now the leading cause of death in low- and middle-income countries (LMIC), with a significant burden from rhythm-related diseases. As science, technology, education, and regulatory frameworks have improved, CIED recycling for exportation and reuse in LMIC has become possible and primed for widespread adoption. In our manuscript, we outline the science and regulatory pathways regarding CIED reuse. We propose a pathway to advance this technology that includes creating a …

Cardiac Conditions, Ana Paula Coelho Figueira Freire, Mark R. Elkins

All Faculty Scholarship for the College of Education and Professional Studies

This Editorial introduces another of Journal of Physiotherapy’s article collections.These are collections of papers on a particular topic, published in the Journal of Physiotherapy within the past decade and compiled to: facilitate access to important recent findings on the topic; highlight trends in research designs, methods, populations and interventions; and suggest avenues for further research. The studies in this article collection relate to physiotherapy management of cardiac conditions.

Clinical Characteristics And Electrophysiologic Properties Of Scn5a Variants In Fever-Induced Brugada Syndrome, Gan-Xiao Chen, Hector Barajas-Martinez, Giuseppe Ciconte, Cheng-I Wu, Michelle M Monasky, Hao Xia, Bian Li, John A Capra, Kai Guo, Zhong-He Zhang, Xiu Chen, Bo Yang, Hong Jiang, Gary Tse, Chloe Miu Mak, Yoshiyasu Aizawa, Michael H Gollob, Charles Antzelevitch, Arthur A M Wilde, Carlo Pappone, Dan Hu

Division of Cardiology Faculty Papers

Background: Brugada syndrome (BrS) is a severe inherited arrhythmia syndrome that can be unmasked by fever.

Methods: A multicentre clinical analysis was performed in 261 patients diagnosed with fever-induced BrS, including 198 (75.9%) and 27 (10.3%) patients who received next-generation genetic sequencing and epicardial arrhythmogenic substrate (AS) mapping, respectively.

Findings: In fever-induced BrS patients, pathogenic or likely pathogenic (P/LP) SCN5A variant carriers developed fever-induced BrS at a younger age, and more often in females and those of Caucasian descent. They exhibited significant electrophysical abnormalities, including a larger epicardial AS area, and more prolonged abnormal epicardial electrograms. During a median follow-up …

Intercellular Communication Via Gap Junctions Influences Cell Survival During Hypoxia, Lauren E. Harmon, David L. Geenen

Student Summer Scholars Manuscripts

Stem cell therapy can be beneficial following myocardial infarction. However, when murine bone marrow-derived mesenchymal stem cells (mBM-MSCs) are injected into the ischemic area, a large percentage of these cells undergo apoptosis resulting in decreased therapeutic benefits. We hypothesize that the loss of these mBM-MSCs is regulated by intercellular channels or gap junctions (GJs) that provide apoptotic signals passed between ischemic cardiomyocytes and mBM-MSCs. Our research aims to attenuate these GJs by suppressing Connexin-43 (Cx43) expression, the predominant channel-forming protein. We will accomplish this by transiently transfecting a Cx43 siRNA into mBM-MSCs. Our data demonstrate that intracellular fluorescent dyes and …

Partial Outpatient Oral Antibiotic Treatment Of Infective Endocarditis Is Non-Inferior To Inpatient Intravenous Antibiotic Therapy, Nicholas J. Murphy

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Iversen K, Ihlemann N, Gill SU, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med. 2019; 380:415-424. https://doi.org/10.1056/NEJMoa1808312

for a patient with infective endocarditis and intravenous drug use with desire to leave the hospital.