Medicine and Health Sciences Commons^™

Breaking Boundaries: Unveiling A Cardiac Fistula From The Right Coronary Artery To The Sinus Venosus And From The Sinus Venosus To The Left Subclavian; A Singular Encounter, Maria Eugenia Torres Perez, Carlos Luis Alejos, Jose Romeo Villareal Calderon, Jennifer Rojas Huen, Kamesh Sivagnamam

Research Colloquium

Introduction: Coronary artery fistulas are rare congenital or acquired malformations in the coronary circulation, creating abnormal connections between coronary arteries and heart chambers (coronary-cameral fistulas) or systemic/pulmonary vessels (coronary arteriovenous malformations). Although often asymptomatic and discovered incidentally during coronary catheterization, they can lead to life-threatening complications such as congestive heart failure, myocardial infarction, and pulmonary hypertension.

Case presentation: A 47-year-old patient with hypertension, multiparity and previous history of a large pericardial effusion with cardiac tamponade managed with pericardiocentesis and medical management presented to the emergency department one year after her pericardiocentesis complaining of shortness of breath (SOB) and upper back …

Unraveling Dilated Cardiomyopathy Linked To An Enigmatic Mybpc3 Variant, Khiem D. Ngo, Carlos Alejos, Jennifer Rojas, Sobia Memon, James Stone

Research Colloquium

Background: Non-ischemic cardiomyopathy (NICM), can arise from various causes, including hemodynamic pathology, infections, immunologic abnormalities, toxic injuries, and genetic factors. Determining the prevalence of NICM is challenging due to varying definitions and diagnostic criteria, selection bias, and geographic variation. MYBPC3 is the primary gene known to cause restrictive cardiomyopathy, dilated cardiomyopathy, and left ventricular non-compaction. This gene encodes cMyBP-C, a structural protein of the heart muscle that interacts with actin, myosin, and titin to maintain sarcomeric integrity. While loss-of-function mutations are common, MYBPC3 missense variants of uncertain significance (VUS) are also prevalent. Individuals with MYBPC3 missense VUS predicted to disrupt …

A Vascular Puzzle: Identifying High-Output Heart Failure In A Patient With End-Stage Renal Disease And A Fresh Arteriovenous Fistula, Carlos Luis Alejos Aguero, Khiem Ng, Jennifer Rojas Huen, Liza Salloum, James Stone

Research Colloquium

Introduction: We present a case highlighting high-output heart failure secondary to an acquired arteriovenous fistula for dialysis. High-output cardiac failure is a less common form of heart failure characterized by the heart pumping an increased volume of blood but failing to meet the body's metabolic demands.

Case presentation: A 74-year-old female with a history of hypertension, dyslipidemia, type 2 Diabetes, and end-stage renal disease (ESRD) on hemodialysis via a left arteriovenous fistula. She presented with worsening dyspnea over 2-3 months, initially relieved post-dialysis but progressing to dyspnea at rest, orthopnea, and paroxysmal nocturnal dyspnea despite dialysis compliance. Physical exam revealed …

Reactive Oxygen Species In Acute Coronary Syndrome, Fernando Cisneros, Alex Zuo

Research Symposium

Background: Reactive oxygen species (ROS) have diverse functions in biomedicine, providing roles in cellular metabolism and signaling while posing a threat to cellular components through oxidative damage. This poster explores the significance of ROS in various cardiovascular diseases, specifically hypertension, atherosclerosis, and myocardial infarction, all of which are associated with acute coronary syndrome which are the conditions and symptoms caused by ischemia. We have studied over 30 most recent or related literature to the topic and determine important roles of ROS in cardiovascular disease. Correlations have linked ROS culprits, particularly upregulation of NADPH oxidase (NOX) 2 and NOX 4, with …

It Takes A Big Heart To Shape Atrophic Hepatocytes: Hypoxic Hepatitis Secondary To Congestive Heart Failure, Lina Pedraza Sanchez, Jose Rivera, Cynthia Rivas, Grigoriy Rapoport, Michelle Lopez

Research Colloquium

Introduction: Hypoxic hepatitis (HH) also known as ischemic hepatitis is the result of a hypoperfusion state during diffuse hepatic injury¹. The incidence of HH is 2:1000 of patients within any hospital care level. 94% of HH are related to chronic heart failure (HF). In this setting, hepatic dysfunction occurs as a result of passive venous congestion². The most common predisposing factors are acute heart failure and shock states, however, more than half of the cases are not related to any hemodynamic change, thus, underrecognized.

Case description: A 77-year-old woman is admitted to the hospital for acute …

A Case Of Device Lead Induced Severe Tricuspid Regurgitation And Right-Sided Heart Failure, Nina Shyama Appareddy, Michaela Iglesia, Ayman Khaddam, Henry Kwang, Eduardo D. Flores

Research Colloquium

Background: Interference of device leads with closure of the tricuspid leaflets can cause severe tricuspid regurgitation (TR) and right-sided heart failure, as can heart failure with reduced LV function (HfrEF), and left sided valve disease.

Case Presentation: A 78-year-old male with history of coronary artery disease s/p remote coronary bypass, ischemic cardiomyopathy with left ventricular ejection fraction 35-40%, and inducible ventricular tachycardia status post defibrillator presented with worsening dyspnea on exertion, easy fatigue, lower extremity pitting edema, anasarca, abdominal bloating and new systolic murmurs at the right upper and left lower sternal borders. An Echocardiogram demonstrated severe aortic stenosis with …

Fat Distribution And Differential Effects On Metabolic Liver Fat Infiltration In Young Mexicans In Reynosa, Mexico: A Collaborative Study Across The U.S.-Mexico Border, Esperanza Milagros Garcia-Oropesa, Adriana Leticia Perales-Torres, Estrella Martinez-Lopez, Claudia Munguia-Cisneros, Edna Nava-Gonzalez, Monserrat Perez-Navarro, Marisol Rosas-Diaz, Neyla Baltazar, Alvaro Diaz-Badillo, Octelina Castillo-Ruiz, Joselin Hernandez-Ruiz, Srinivas Mummidi, Laura Yanneth Ramirez-Quintanilla, Carlos Ramirez-Pfeiffer, Juan Carlos Lopez-Alvarenga

Research Symposium

Introduction: Metabolic-associated fatty liver disease (MAFLD) is a descriptive term for NAFLD (Non-alcoholic) physiopathology associated with obesity. The age of onset linked to body fat distribution is poorly studied. Therefore, we aimed to assess the body fat effect on liver fat infiltration and stiffness (LSt) mediated by insulin resistance (IR).

Methods: After obtaining informed consent, five hundred freshmen from two universities in Reynosa, Mexico (UMAN & UAT) were enrolled in the study. They completed a questionnaire focused on familial cardiometabolic risk and provided anthropometric measurements. In a subset of N=200, we obtained blood samples for biochemical measurements, body fat percentage …

Variant Of Fii Gene Plays A Critical Role In Coagulation Potential In Mexican-Americans, Hoang Anh T. Nguyen, Shuchita Vijay Jhaveri, Marcio A. Almeida, Vincent P. Diego, Satish Kumar, Juan M. Peralta, Joanne E. Curran, Bernadette W. Luu, Donna M. Lehman, Ralph A. Defronzo, Laura Almasy, Sarah Williams-Blangero, Ravi Duggirala, John Blangero, Tom Howard

Research Symposium

Background: Disruption in the balance between coagulation and bleeding can result in varying phenotypes such as hypercoagulability and can lead to the development of cardiovascular disease. In our study utilizing extended families of Mexican-Americans from South Texas, we performed a search for protein-altering variants influencing coagulation potential.

Methods: Mexican-Americans in the study were genotyped using Illumina-(human)-exome-24 chip to screen for protein-altering variants. Variants were analyzed for their association with FII activity, aPTT, and PT. Linear-mixed-model analysis was performed to estimate trait heritabilities and to interrogate single nucleotide variations (SNV) for evidence of genetic association. To control for multiple testing, associations …

Characterization Of Epithelial Growth Factor Transcripts Identified In Crotalus Atrox Venom, Ivan Lopez, Ying Jia

Research Symposium

Epithelial Growth Factor (EGF) is the primary source in regeneration and stimulation of essential fibroblasts cells commonly found in epithelium. Studies have shown that snake venom components are becoming a growing factor in treating illnesses such as cancer, muscular dystrophy, chronic pain, blood pressure, blood clotting, etc. EGF in human cells contains a promising quaternary structure that can bind to snake venom metalloproteinases, proposing a means of activating biochemical responses through protein-protein interactions to regulate unwanted cellular functions. This supports promising research in achieving a greater understanding of regulation along cellular pathways through ligands, increasing the likelihood of targeting unwanted …

Recognizing Fatal Electrocardiography Rhythm Changes In A Patient With Severe Hyperkalemia And Prevention Of Cardiac Arrest With Medical Management In Small Hospitals, Semenawit B. Burka, Eduardo Flores, Johnathan Gyebi-Agyepong

Research Symposium

Background: Hyperkalemia is one of the most potentially lethal electrolyte disorders. Severe hyperkalemia is defined as a serum potassium level of >6.5 mEq/L. The risk of arrhythmias increases with potassium values >6.5 mEq/L. Small elevation above this value can cause peaked T waves to quickly progress to ventricular fibrillation or asystole. The longer the patient has elevated potassium concentrations, the greater the risk of sudden deterioration. Therefore, recognizing ECG changes and acting quickly to decrease potassium concentration is important to prevent hyperkalemic cardiac arrest.

Case Presentation: A 26-Year-old man with a history of congenital hypoaldosteronism presented to the emergency department …

Taking The Load Off: Device Lead-Induced Severe Tricuspid Regurgitation And Right-Sided Heart Failure Treated With Transcatheter Aortic Valve Implantation (Tavi), Nina Shyama Appareddy, Michaela Iglesia, Ayman Khaddam, Henry Kwang, Eduardo Flores

Research Symposium

Background: Interference of device leads with closure of the tricuspid leaflets can cause severe tricuspid regurgitation (TR) and right-sided heart failure, as can heart failure with reduced ejection fraction (HFrEF) and left sided valve disease. We report a case treated with transcatheter aortic valve implantation (TAVI) with improved TR.

Case: A 78-year-old male with coronary artery disease status post remote myocardial infarction and coronary bypass, HFrEF with left ventricular ejection fraction 35-40%, and inducible ventricular tachycardia status post AICD placement presented with worsening dyspnea on exertion, easy fatigue, lower extremity edema, anasarca and abdominal bloating. Transthoracic echocardiography demonstrated severe aortic …

Subtotal Iliac Vein Occlusion Secondary To May-Thurner Syndrome, Nina Shyama Appareddy, Jose Ramos, Usman Sheriff

Research Symposium

Background: May Thurner Syndrome (MTS), an anatomical variant present in over 20% of the population, can present with iliofemoral deep venous thrombosis (DVT) caused by compression of the common iliac vein by the adjacent iliac artery.

Case: An 86 year old male with coronary artery disease presented with left lower extremity swelling. Ultrasound revealed acute iliofemoral region DVT. This clot, extending from the groin to the ankle, placed him at high risk for pulmonary embolism and post-thrombotic syndrome.

Decision-making: Patient was placed on heparin drip. Venogram performed at 48 hours showed extensive clot in the superficial femoral, common femoral and …

Socio-Contextual Factors Predicting Pericardial Effusion And Mortality In Patients With Confirmed Sars-Cov2 In A South Texas Hospital. A Preliminary Analysis, Nina Shyama Appareddy, Cesar Peralta, Juan Carlos Alvarenga, Charles Mild

Research Symposium

Introduction: Few pericardial effusion (PEf) cases have been reported in the literature amongst adult hospitalized patients with SARS-CoV2. The goal of our study is to determine the frequency and risk factors of PEf amongst adult hospitalized patients with SARS-CoV2 and its effect on mortality.

Methods: This preliminary analysis included 48 consecutive patients with confirmed SARS-CoV2 admitted from 08/01-08/31/2021. Socio-demographic data and risk factors for coronary artery disease were recorded. Echocardiography was reviewed for evidence of PEf. A comparison of patients with effusion, no effusion, and no echo was performed with chi-square, t-test, ANOVA, and probability of death using logistic regression …

Using Cartesian Coordinate Systems To Create, Classify, And Retrieve Biomedical Time-Series: Applications To 24-Hour Ambulatory Blood Pressure Monitoring, Antonio Garcia, Gladys E. Maestre, John Blangero, Jesus D. Melgarejo, Julio Facelli

Research Symposium

Background: Ambulatory Blood Pressure Measurement (ABPM) allows physicians to monitor blood pressure variability under everyday living conditions and predicts clinical outcomes better than conventional blood-pressure measurement. ABPM can demonstrate mean arterial pressure (MAP) behavior over 24 hours relevant to clinical practice, such as nocturnal hypertension or increased blood pressure variability. We hypothesized that individuals with the same cardiovascular health status would have the same MAP signal (MAPs) waveform.

Methods: This study reutilizes a data subset from the IDACO Consortium to create 24-hour MAPs. We assigned all the MAPs to data matrix X, performed principal components analysis (PCA) to X, and …