Medicine and Health Sciences Commons^™

Role Of A Multidisciplinary Pulmonary Embolism Response Team And Impact Of Interventional Therapy In The Management Of Patients With Intermediate-High Risk Pulmonary Embolism, Juan N Pulido, Robert Fletcher, Michelle A. Poitevin, Kristina Pratt, Paul P Huang, Eric J Lehr, George P Pappas

Articles, Abstracts, and Reports

Background: Despite emerging interventional options for pulmonary embolism (PE), the mortality rate for intermediate high-risk PE (IHR-PE) remains high and the optimal therapeutic approach unclear due to a lack of robust outcomes data. We describe the outcomes of patients presenting with IHR-PE managed by a multidisciplinary PERT program with all available reperfusion options.

Methods: This single center retrospective study included EMR data from patients that were a part of the multidisciplinary PERT program from January 2012 to June 2023. PERT was activated if risk of death was intermediate or higher. The simplified pulmonary embolism severity index (sPESI) and Bova score …

Outcomes Of Patients With Intermediate Risk Pulmonary Embolism Treated With A Multidisciplinary Pulmonary Embolism Response Team. The Emergent Role Of Percutaneous Catheter Thrombectomy And The Importance Of Cardiac Surgery Engagement, Juan N Pulido, Robert Fletcher, Michelle A. Poitevin, Kristina Pratt, Paul P Huang, George P Pappas, Eric J Lehr

Articles, Abstracts, and Reports

Background: Management of Intermediate Risk Pulmonary Embolism (IRPE) remains controversial due to the dynamic nature of the disease and the lack of correlative outcomes with large clot burden. We describe the outcomes of patients presenting with IRPE managed by a multidisciplinary Pulmonary Embolism Response Team (PERT).

Methods: This single center retrospective study included EMR data from patients that were a part of the multidisciplinary PERT program from January 2012 to June 2023. PERT was activated if risk of death was intermediate or higher. The simplified pulmonary embolism severity index (sPESI) and Bova score were used as risk stratification tools. Patients …

Poster: Clinical Practice Panel: Don't Skip A Beat, Follow The Sheet! Designing A Clinical Care Map For Open Heart Patients In The Icu, Danielle Fogel, Nico Vargas

2023 South Division Nursing Research Conference

No abstract provided.

The Brink Of The Abyss: From Transcatheter Aortic Valve Implantation, To Impella, To Left Ventricular Assist Device Destination Therapy, Jake Kieserman, Megan Sheehan, Marisa Cevasco, Brian Mccauley, Ryan Prentice, Jay Giri, Joyce Wald

Journal of Shock and Hemodynamics

Acute valvular emergencies are common causes of cardiogenic shock. Patients with critical aortic pathologies causing shock frequently undergo percutaneous interventions for valve replacement. However, in cases of persistent cardiogenic shock after valve replacement, there are limited options for further mechanical support. In this case study, we report a patient with a prior history of aortic valve replacement who presented in cardiogenic shock. After a transcatheter aortic valve-in-valve replacement, he remained in persistent shock with worsening clinical parameters requiring escalating inotropic and vasopressor support. With input from a multidisciplinary care team, an Impella 5.5 (Abiomed, Inc.) was placed through the valve …

Heart Failure Burden In Oman As A Mid-East Exemplar Versus Global Perspectives: An Integrative Review, Maryam Alharrasi, Chandrani Isac, Joy Kabasindi Kamanyire

Journal of the Saudi Heart Association

Heart failure (HF), a clinical syndrome caused by a structural and functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and pulmonary congestion. This study intends to investigate the state of heart failure (HF) in Oman and assess it in comparison of global trends. Ten published literatures from the past 20 years were included after a thorough search of databases (Arab World Research Source, EBSCOhost, Medline, and Google Scholar). These studies were reviewed considering the global literature. We have observed an increase in HF cases especially in older adults, over the past two decades in Oman. Acute coronary syndrome …

The Prevention And Cardiac Rehabilitation Group Of The Saudi Heart Association Recommendations Regarding Establishing A Cardiac Rehabilitation Service, Abdulhalim Jamal Kinsara, Raghdah Aljehani, Jadwiga Wolszakiewicz, Adam Staron, Muteb A. Alsulaimy

Journal of the Saudi Heart Association

Cardiac rehabilitation (CR) is a cornerstone in the secondary prevention of cardiovascular disease (CVD). Comprehensive cardiac rehabilitation has obtained the highest class of recommendation and the level of evidence for the treatment of patients with ST-segment elevation myocardial infarction, after myocardial revascularization, with chronic coronary syndromes, and in patients with heart failure (HF). Comprehensive cardiac rehabilitation should be implemented as soon as possible, be multi-phasic, and adjusted to the individual needs of the patient. CR is still suboptimally used, and many cardiac centers do not have such services (2). The provision of CR services should be based on standards and …

Early Identification And Management Of Heart Failure In Patients With Diabetes Mellitus In The United Arab Emirates: A Call To Action, Firas Al Badarin, Lina Yasine, Rabih Hijazi, Susan Abu Khalaf, Wael Al Mahmeed, Yosef Manla, Feras Bader

Journal of the Saudi Heart Association

Heart failure (HF) is a common and serious complication of diabetes mellitus (DM) that remains widely under-recognized. Multidisciplinary management protocols for patients with concurrent DM and HF are not widely utilized in the Middle East/ Gulf region, particularly in the United Arab Emirates. Since early identification of patients with DM and HF will likely lead to initiation of therapies known to prevent adverse cardiovascular events and subsequently improve patient prognosis, we aim to highlight the importance of early recognition of HF in diabetic patients. We will also describe existing management challenges in the region, especially the lack of multidisciplinary care …

Leiomyosarcoma Of The Inferior Vena Cava Extending To The Right Atrium And Ventricle, Naif Saad Alghasab, Mohammad Alruwayeh, Abdulaziz A. Algharras, Amin Mulji

Journal of the Saudi Heart Association

Primary tumors originating from the inferior vena cava (IVC), namely leiomyosarcoma, present significant challenges due to their poor prognostic features, including extensive extension and a substantial tumor burden. In this case, we present a 55-year-old female patient complaining of abdominal discomfort and vague abdominal pain. Additionally, we provide a comprehensive summary encompassing key aspects related to symptomatology, diagnostic approaches, treatment, and prognostic indicators. We also discuss the complexities involved in managing primary tumors of the inferior vena cava, emphasizing the critical significance of adopting a multidisciplinary team-based approach.

The Value Of Right Heart Catheterization: Case Series Showing Benefits In A Variety Of Diagnoses, Max Ruge, David Fischman, Indranee Rajapreyar, Yevgeniy Brailovsky

Division of Cardiology Faculty Papers

Although the right heart catheterization (RHC) was first introduced in 1945, its use in the quantitative hemodynamic assessment of patients has remained of questionable benefit. With recent advances in pharmacotherapies and mechanical support devices, RHC has been increasingly used to assess and help tailor the management of more complex patient scenarios. We present a case series in which the use of the RHC was helpful in making complex medical decisions.

Bi-Atrial Thrombus Via Patent Foramen Ovale With Medical Noncompliance: A Case Report, Reid Mccullough, Ayesha Cheema, Owesh Contractor, Krystal Tomsky-Jackson

Advances in Clinical Medical Research and Healthcare Delivery

Numerous diagnoses in the hospital setting require anticoagulation. With different etiologies, certain specific assessments may not have a treatment plan that is studied extensively in evidence-based medical texts. In these uncommon situations, management may not have clear medical guidelines for successful treatment. We present a case of bi-atrial thrombus via PFO with concurrent pulmonary embolism, extensive clot burden history, and the plan to move forward with Angiovac. In patients with this specific history and pathology, modern procedures like Angiovac should be considered and discussed.

Pseudo-Wellens Syndrome: A Rare Entity Associated With Cocaine Use, Mohamed Salah Mohamed, Syed Hamza Waheed, Amir Mahmoud, Anas Hashem, Bipul Baibhav, Abdullah M. Firoze Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Wellens syndrome usually indicates critical left anterior descending artery (LAD) occlusion. Pseudo-Wellens syndrome consists of criteria of Wellens syndrome in the absence of critical LAD occlusion. We report a case of Pseudo-Wellens syndrome related to cocaine use. A 52-year-old male with a medical history of hypertension and diabetes, presented with acute retrosternal chest pain of 3 days duration. Physical examination was unremarkable. EKG on presentation showed deep T-wave inversions in leads V2 to V5. Highly sensitive troponin was elevated. The patient admitted to using cocaine daily for the past two months. Due to concerns for Wellens syndrome, the patient had …

Hydroxychloroquine Induced Cardiomyopathy, Mohamed Salah Mohamed, Katrina Wojciechowski, Scott Feitell, Muhammad Osama, Anas Hashem, Jayesh Patel, Amir Mahmoud, Ali Abdelhay, Prakash Upreti, Soidjon Khodjaev

Advances in Clinical Medical Research and Healthcare Delivery

Hydroxychloroquine (HCQ) is one of the immunomodulatory medications used in treatment of autoimmune diseases. Rarely, HCQ can cause serious complications, such as cardiotoxicity. We present a rare case of HCQ-induced cardiomyopathy. 60-year-old female patient with a medical history of SLE on chronic HCQ therapy for 28 years, preexisting non-ischemic cardiomyopathy and heart failure with reduced ejection fraction for 7 years, and complete heart block status post pacemaker insertion presented with acute chest pain and severe weight loss. Patient underwent coronary angiogram that showed normal coronaries and right-sided heart catheterization that showed acute heart failure. Echocardiogram showed LVEF of 30% with …

Tav-In-Tav And Beyond: How Far Can We Go?, Taramasso Maurizio, Ana Paula Tagliari, David L. Fischman

Division of Cardiology Faculty Papers

No abstract provided.

Atrial Fibrillation Management In Hispanic Adults, Tania Borja

Dissertations

Background: Research has found atrial fibrillation (AF) to be the primary or a contributing cause of death on 183,321 death certificates, and an underlying cause of death for 26,535 Americans in 2019. Findings indicate an increased AF diagnosis in White people compared to racial and ethnic minorities, contrasting widespread findings of increased prevalence of cardiovascular disease and ischemic strokes in minorities. Significant disparities—by race and socioeconomic status in disease distribution and access to testing and lifesaving treatments—have been documented, specifically associated with social determinants of health (SDOH); i.e., the conditions in which people are born, grow, live, work, and age. …

Seeing Into The Future: Heartmate 3 To The Systemic Right Ventricle In A Completely Blind Patient With Congenitally-Corrected Transposition Of The Great Arteries, Juhi Ramchandani, Chirag Dipak Shah, Kashif Saleem, Maya Guglin, Roopa Rao

The VAD Journal

A 24-year-old, blind male with congenitally-corrected transposition of the great arteries and systemic right ventricular failure presented with New York Heart Association class IV heart failure despite home inotropic therapy. He was not a transplant candidate due to psychosocial issues. He underwent a successful HeartMate 3 (Abbott Laboratories) placement with the implementation of techniques to guide home ventricular assist device care despite blindness.

Utilization Of Prophylactic Antibiotics For Cardiac Patients Undergoing Dental Procedures In Saudi Arabia: A Retrospective Study., Fayez Elshaer, Abdulelah (Hamad) Alsaeed, Sultan (Nasser) Alfehaid, Hassan (Mohammad) Aloraini, Turki (Eid) Alshammari, Fakhir Alayoubi

Journal of the Saudi Heart Association

Objectives: This study aimed to determine the characteristics of antibiotic prophylaxis (AP) utilization and the level of adherence of King Saud University Medical City (KSUMC) staff to the latest American Heart Association (AHA) guidelines for AP for infective endocarditis (IE) in cardiac patients undergoing dental procedures. Methods: The study was conducted as a retrospective cohort study to investigate the relationship between AP in dental procedures and cardiac patients admitted in the surgical wards of KSUMC between 2015 and 2021. All cardiac patients who underwent dental procedures were included in the study. We excluded patients with long-term or concurrent antibiotic use …

Characteristics And Outcomes Of Patients Who Underwent Coronary Atherectomy In Centers With And Without On-Site Cardiac Surgery, Mohamed Dafaalla, Muhammad Rashid, Saadiq Moledina, Tim Kinnaird, Peter Ludman, Nick Curzen, Sarah Zaman, James Nolan, Mamas A. Mamas

Department of Medicine Faculty Papers

We aimed to describe the clinical characteristics and outcomes of patients who underwent atherectomy at the time of percutaneous coronary intervention in centers with on-site surgical centers (SCs) versus nonsurgical centers (NSCs). Patients treated with coronary atherectomy between January 1, 2006, to December 31, 2019, from the British Cardiovascular Society Intervention (BCIS) registry were included. Primary outcomes were in-hospital all-cause mortality and major adverse cardiovascular and cerebrovascular events. A total of 20,833 patients were treated with coronary atherectomy, of which 7,983 (38%) were performed at NSC. The proportion of coronary atherectomies performed in NSC increased from 12.5% in 2006 to …

"Reducing Heart Failure Readmission Rates Through Implementation Of Heart Failure Diuretic", Caley Tatrn, Yvonne Weideman, Venkatraman Srinivasan

Doctor of Nursing Practice (DNP) Manuscripts

Background and significance: heart disease was the number one cause of death in the United States in 2021, with 696, 962 deaths (Leading Causes of Death, 2022). There are about 6.2 million individuals in the U.S. total with heart failure (Kilgore et al., 2017). About one-quarter of patients with heart failure are readmitted within thirty days of discharge, while one-quarter of hospital readmissions are preventable. Between 2010-2017, over seven million patients were admitted for heart failure in the United States. Eighteen percent had a readmission within thirty days and thirty-one percent had a readmission within ninety days (Khan et …

Major Cardiovascular Events After Covid-19, Event Rates Post-Vaccination, Antiviral Or Anti-Inflammatory Therapy, And Temporal Trends: Rationale And Methodology Of The Corona-Vte-Network Study, Behnood Bikdeli, Candrika D Khairani, Darsiya Krishnathasan, Antoine Bejjani, Andre Armero, Anthony Tristani, Julia Davies, Nicole Porio, Ali A Assi, Victor Nauffal, Umberto Campia, Zaid Almarzooq, Eric Wei, Aditya Achanta, Sirus J Jesudasen, Bruce C Tiu, Geno J. Merli, Orly Leiva, John Fanikos, Aditya Sharma, Alec Vishnevsky, Judith Hsia, Mark R Nehler, James Welker, Marc P Bonaca, Brett J Carroll, Zhou Lan, Samuel Z Goldhaber, Gregory Piazza

Division of Cardiology Faculty Papers

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with excess risk of cardiovascular and thrombotic events in the early post-infection period and during convalescence. Despite the progress in our understanding of cardiovascular complications, uncertainty persists with respect to more recent event rates, temporal trends, association between vaccination status and outcomes, and findings within vulnerable subgroups such as older adults (aged 65 years or older), or those undergoing hemodialysis. Sex-informed findings, including results among pregnant and breastfeeding women, as well as adjusted comparisons between male and female adults are similarly understudied.

METHODS: Adult patients, aged ≥18 years, with polymerase chain reaction-confirmed COVID-19 …

An Unusual Cardiomegaly Culprit: Case Report Of A Hemodynamically Significant Portosystemic Shunt, Zoetta L. Mcloughlin Md, Melanie Kathol, Amanda Mcintosh

Posters

Background: Cardiomegaly discovered in the fetal or neonatal period may be the first sign of cardiac disease. However, the differential diagnosis for cardiomegaly with a structurally and functionally normal heart includes cardiomyopathies as well as non-cardiac etiologies, including extracardiac shunt lesions and vascular malformations, among others. Thus, unexplained cardiomegaly requires further investigation for extracardiac anomalies. In this case, we focus on an unusual etiology of diffuse cardiac dilatation – intrahepatic portosystemic shunt – that was initially misdiagnosed as dilated cardiomyopathy. Case Description: A 9-year-old male with history of learning difficulty and tall stature was seen for follow-up of diffuse cardiomegaly …

Multi-Disciplinary Collaboration And The Use Of Technology In The Reduction Of Cardiac Surgical Site Infections, Kelly Fehlhafer, Tiffany Mullen, Elizabeth Chang, Stacy Reynolds, Shannon Lysaught, Stephanie Doughty, Jessica Nichols

Posters

No abstract provided.

Identification Of Critical Illness-Related Corticosteroid Insufficiency After Congenital Heart Surgery With Next Generation Sequencing, Juan S. Farias, Nicholas Diehl, Lori A. Erickson, Jenny Marshall, Nataliya Kibiryeva, Kelly S. Tieves, Jorge Cross-Bu, Jaime Silva-Gburek

Posters

Introduction: Critical illness-related corticosteroid insufficiency (CIRCI) which is characterized by relative inadequate cortisol levels in relation to increased demand during periods of severe stress is common after cardiac surgery and is a cause of hemodynamic instability. The purpose of this study was to identify possible genetic abnormalities related to CIRCI in pediatric patients after congenital heart surgery. Methods: Single-center retrospective study of neonates who underwent cardiac surgery between August 2018 to July 2020. We included patients who had obtained postoperative cortisol levels and next gen DNA-sequencing (NGS) as previous standard of care. Analysis methods are displayed in Figure 1. Results: …

Standard Atrial Epicardial Wire Placement Leads To Improved Atrial Signal Identification And Pacemaker Sensing, Nir Atlas, William Gibson, J Hermsen, A Harmon, J Torgeson, Lindsey Malloy-Walton, N Von Bergen

Posters

Background: Atrial arrhythmias are common after pediatric cardiac surgery and are associated with increased morbidity and mortality. Atrial epicardial wires (AEW), utilized to diagnose and treat atrial arrhythmias, are known to malfunction during post-operative care. There are no pediatric prospective studies examining ideal placement of AEW. Methods: This prospective multicenter pilot study compared atrial amplitudes, pacing sensitivities and thresholds via AEW placed at Bachmann’s Bundle (BB) and the right-sided interatrial groove (RSIG) versus the surgeon’s standard placement (control locations) in 26 patients aged less than six years old undergoing cardiac surgery. Participants received four total AEW - two at the …

Development Of A Kineisophobia Scale For Adolescents With Heart Disease: A Preliminary Analysis Of Validity And Reliability, David A. White, Jami Gross-Toalson, Emily Cramer, Lindsey Malloy-Walton, Mollie Walton, Laura Martis, Brandy Enneking, Kelli M. Teson, Jessica S. Watson, Dara Watkins, William R. Black

Posters

No abstract provided.

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 …

A Chinese Scoring System For Predicting Successful Retrograde Collateral Traverse In Patients With Chronic Total Coronary Occlusion, Qiu Yu Li, Xiao Long Lin, Fan Qi Li, Zi Chao Cheng, Jia Yu Tian, Dong Hui Zhao, Wayne Bond Lau, Jing Hua Liu, Qian Fan

Department of Emergency Medicine Faculty Papers

BACKGROUND: Retrograde approach technique has been challenging in percutaneous coronary interventional treatment of chronic total occlusion (CTO) coronary disease. The present study endeavors to determine a novel Chinese scoring system for predicting successful collateral channels traverse via retrograde approach.

METHODS: The demographic characteristics and angiographic characteristics of 309 CTO patient were analyzed by univariable and multivariable analysis for selecting potential predictors. And the nomogram was used to establish the scoring system. Then it was evaluated by the internal and external validation.

RESULTS: The predictors of Age, Connections between collateral channels and recipient vessels, and Channel Tortuosity (ACT) were identified with …

Cardiovascular Disease In Saudi Arabia: Facts And The Way Forward, Adel Abdulkader Tash, Rasha Fahad Al-Bawardy

Journal of the Saudi Heart Association

While some risk factors for cardiovascular diseases (CVDs) are non-modifiable, other determinants like obesity, hypertension, type-2 diabetes and dyslipidemia can be mitigated by a wide plethora of measures to control CVD morbidity/mortality. Those determinants have been on the rise in Saudi Arabia, exacerbated by sedentary lifestyle. The Saudi Vision 2030 focuses include the reduction of CVD clinical and economic burden to scale-up vitality and longevity; in a new era of comprehensive healthcare. From a health economics standpoint, CVDs entail a burden on healthcare systems directly through expenditure and indirectly through years living with the disease, low productivity, premature morbidity and …

Natriuretic Peptide Biomarkers In The Imminent Development Of Preeclampsia., Stefanie Marek-Iannucci, Estefania Oliveros, Yevgeniy Brailovsky, Preethi Pirlamarla, Amanda Roman, Indranee Rajapreyar

Division of Cardiology Faculty Papers

Preeclampsia is the most common cause of morbidity and mortality in pregnancy, the incidence being significantly higher in low-income countries with reduced access to health care. Women with preeclampsia are at a higher risk of developing cardiovascular disease with a poorer long-term outcome. Early recognition and treatment are key to improving short- and long-term outcomes. Approximately 3%-5% of pregnant women will develop preeclampsia, with potentially fatal outcomes. Despite ongoing research, the exact pathophysiologic mechanism behind its development remains unclear. In this brief report, we describe the potential role of natriuretic peptides as biomarkers in the imminent development of preeclampsia. In …

The Role Of Neutrophil To Lymphocyte Ratio And Its Common Clinical Outcomes Among Patients With Non-St Elevation Acute Coronary Syndrome, Javed Jalbani, Khalid Iqbal Bhatti, Muhammad Tariq Sallar, Ahsan Mujtaba Baig, Palwasha Tariq, Faisal Ahmed, Ali Ammar, Vicky Kumar

Journal of the Saudi Heart Association

Objectives: To evaluate the admission neutrophil-to-lymphocyte ratio (NLR) for risk stratification for in-hospital outcomes and complications in non-ST-elevation acute coronary syndrome (non-ST-ACS) patients. Methods: We recruited consecutive patients with non-ST-ACS. The NLR was obtained and stratified as low, intermediate, and high-risk based on6.0, respectively. The new ST-T changes, arrhythmias, contrast-induced nephropathy (CIN), and mortality were recorded. Results: Median NLR was 3 [2.1-5.3] for 346 patients with 19.9% and 30.6% in high- and intermediate-risk group. New ST-T changes were observed in 3.5%(12) out of which 8, 3, and 1 patient in low, intermediate, and high-risk group (p=0.424), respectively. Arrhythmias were observed …

Effect Of Implantable Cardiac Monitors On Preventing Stroke: A Systematic Review And Meta-Analysis Of Randomized Clinical Trials, Jialing He, Yaxin Jiang, Yangchun Xiao, Pengfei Hao, Tiangui Li, Liyuan Peng, Yuning Feng, Xin Cheng, Haidong Deng, Peng Wang, Weelic Chong, Yang Hai, Lvlin Chen, Chao You, Lu Jia, Fang Fang, Shui Yu, Yu Zhang

Department of Medical Oncology Faculty Papers

BACKGROUND AND AIM: Implantable cardiac monitors (ICM) can facilitate the detection of asymptomatic atrial fibrillation episodes. We performed a systematic review and meta-analysis to investigate whether ICM can prevent stroke in patients with prior stroke and risk factors for stroke.

METHODS: This study included randomized controlled trials comparing ICM with conventional (non-ICM) external cardiac monitoring in patients with prior stroke and risk factors for stroke. We searched Medline, Embase, and CENTRAL from inception until January 5, 2022, without language restriction. Quantitative pooling of the data was undertaken using a random-effects model. The primary outcome was ischemic stroke at the longest …