Medicine and Health Sciences Commons^™

Association Between Leg Adiposity & Hypertension Subtypes In Young & Middle-Aged American Adults, David Lo, Aayush Visaria, Pranay Maniar

Rowan-Virtua Research Day

Our research aim was to determine the association between appendicular adiposity and hypertension to better elucidate the role of body fat distribution on blood pressure (BP).

Many studies have provided evidence for the inverse association between leg adiposity and metabolic syndrome criteria.

Hypertension (HT) subtypes have unique age distributions and associated risk factors. BMI ± triglycerides are major risk factors for isolated diastolic hypertension (IDH).

Secondary Stroke Prevention Retrospective Analysis, Mansi Panse, Samantha Plasner, Nasrine Bendjilali

Rowan-Virtua Research Day

Stroke is the leading cause of serious long-term disability among adults in the United States, and there are well recognized modifiable risk factors for stroke. Secondary prevention efforts to reduce the likelihood of recurrent stroke should be top priority in this high-risk patient population. The role of the primary care team in implementing and assisting patients with adherence to secondary prevention efforts is critical. The objective of this retrospective analysis is to examine how successful primary care providers are at implementing secondary stroke prevention guidelines.

Preventing secondary stroke is critical to the welfare of this high-risk population and ultimately saves …

Stroke In Hfref Without Atrial Fibrillation And Concurrent Protein S Deficiency: What Is The Best Treatment?, Rohan Umrani, Trinava Roy, Bhavana Kadiyala, Yvette Wang

Rowan-Virtua Research Day

Hypercoagulable disorders are often the culprit for repeated strokes in young patients, with or without other comorbidities

Medications typically used for stroke prophylaxis:

• Warfarin
• Aspirin
• Direct Oral Anticoagulants (DOACs)

Warfarin is the preferred method of anticoagulation for stroke prophylaxis in patients with hypercoagulable disorders

A deficiency of protein S increases the risk of pro coagulation due to a relative deficiency of anticoagulants.

Patients with protein S deficiency tend to have recurrent venous thromboses and pulmonary emboli

The Cloak Of Invisibility: Subclinical Infective Endocarditis Resulting In Chordae Tendineae Rupture In Mitral Valve Prolapse, Jason Naftulin, Trinava Roy, Anjeli Patel, Steven Silver

Rowan-Virtua Research Day

While Chordae tendineae rupture(CTR) is often caused due to mitral valve prolapse, rheumatic heart disease or infective endocarditis, CTR secondary to a combination of the factors is not often seen. We present a unique case of CTR due to subclinical infective endocarditis(IE) with underlying mitral valve prolapse(MVP).

Myopericarditis In A Patient With Recent Covid-19 Mrna Vaccine, Zamran Masih, Wayne Tamaska, Nicholas Tomasello

Rowan-Virtua Research Day

Myopericarditis after Covid-19 mRNA vaccination is not well described. However, there have been several cases described throughout the pandemic suggesting some correlation between Covid-19 vaccination and myopericarditis. We describe such a case where a patient developed myopericarditis after receiving Johnson & Johnson vaccine.

Diaphragmatic Adjacencies: Pulmonary Embolism Presenting As Abdominal Pain, Joseph Piraneo, Christopher Schwartz, Russell Mordecai

Rowan-Virtua Research Day

Pulmonary embolism is a common yet potentially life-threatening diagnosis that should not be missed in the Emergency Department. Common presenting symptoms include dyspnea, pleuritic chest pain, cough, hemoptysis, syncope or pre-syncope. Less often, however, presenting symptoms can include abdominal pain. A clinician should recognize that pain adjacent to the diaphragm (including the lower chest and upper abdomen), can be secondary to underlying pathology either above or below the diaphragm. Here we describe an unusual case of pleuritic, post-prandial, right upper quadrant abdominal pain that was a result of pulmonary embolism.

A Brief Literature Review On Heparin: To Bolus Or Not To Bolus, That Is The Question, Alex Gechlik, James Espinosa, Alan Lucerna, Kishan Patel

Rowan-Virtua Research Day

Heparin is an anticoagulant medication, used to inhibit the formation of thrombi that pose arteriolar and vein-occlusive risk. The choice between starting a heparin infusion with or without an initial bolus is case dependent based on whether a patient is already anticoagulated and if so, foregoing an initial bolus. In contrast, both anticoagulated and non-anticoagulated patients share the same goal when receiving Heparin for various thromboembolic syndromes, and that is to be within aPTT target range of 1.5-2.5 or 45 to 75 seconds. Falling below goal range leads to a 20-25% recurrence of VTE, and aPTT above goal range has …

Celiac Artery Aneurysm: A Rare Cause Of Abdominal Pain, Duwayne Campbell, Wayne Tamaska, Kevin Dwyer

Rowan-Virtua Research Day

Celiac artery aneurysm is a very rare vascular lesion accounting for only 5.1% of all splanchnic artery aneurysms. Etiology for celiac artery aneurysm includes, but not limited to, infectious diseases, atherosclerosis, trauma, congenital conditions such as median arcuate ligament syndrome and iatrogenic causes.

Etiology for abdominal pain is extensive. Patients should be evaluated for both intra-abdominal and extra-abdominal causes for pain, as presentations of a different pathophysiology vary widely. CT scan has become a mainstay part of the work for abdominal pain in the Emergency department, and often elicit pathologies that would otherwise be missed on blood work and other …

Digoxin Toxicity And Acute Renal Failure In A 75 Year-Old Female, Daniel Zaayenga, Andrew Caravello, Nicholas Tomasello

Rowan-Virtua Research Day

Digoxin toxicity can present with varying manifestations. While pathognomonic symptoms such as xanthopsia (object appearing yellow) are a board favorite it is not a required finding and is in fact not seen with most patients. Rather digoxin toxicity presents with more non-specific symptoms such as GI distress (anorexia, N/V) neurological distress (lethargy, fatigue, delirium, confusion, disorientation, weakness. EKG findings are varied and include premature ventricular contractions, bradycardia, atrial tachyarrhythmias with AV block, ventricular bigeminy, junctional rhythms, various degrees of AV nodal blockade, ventricular tachycardia, and ventricular fibrillation. Although rarely seen, digoxin is one of the only causes of bidirectional ventricular …

Evaluating The Relationship And Outcomes Of Ischemic Stroke In Patients With Covid-19 While Also Reviewing Overall Incidence And Mortality Of Stroke In Vulnerable Populations In The Us, Jaime Dougherty

Rowan-Virtua Research Day

COVID-19 has affected the worldwide population since early 2020 and has remained a health issue. Among the various symptoms and outcomes people are encountering when infected with COVID-19, this virus has also been connected to severe vascular insults involving large vessel occlusions.

Current stroke statistics indicate a nearly twice as high risk of stroke in African Americans when compared to whites. This brings into question how social determinants of health are affecting COVID-19 and stroke incidence.

The purpose of this review is to investigate the relationship between COVID-19 and ischemic stroke while advocating for a more robust primary prevention approach …

Arterial Thromboembolism As A Sequela Of Mild Covid-19 Pneumonia With Resultant Gangrene Of The Right Lower Extremity, Sean Coulson, Brian Thomas, Christopher Chhoun

Rowan-Virtua Research Day

Hypercoagulable states leading to stroke, pulmonary embolism, and acute limb ischemia are well documented phenomena secondary to moderate-to-severe COVID-19 infections that produce significant respiratory morbidity.

Incidence is largely unknown with additional emerging clinical manifestations including, but not limited to: Viral and secondary bacterial pneumonia, respiratory failure, sepsis, stroke, acute kidney injury, pulmonary embolism, disseminated intravascular coagulation (DIC), as well as arterial and venous thromboembolism.

Alternate Site Pacing And The Impact On Intracellular Calcium Handling During The Post-Extrasystolic Cardiac Cycle, Kent Ozcan, Lawrence Mulligan

Rowan-Virtua Research Day

Objective: Previous work has shown that alternate site (RV apex) results in myocardial dysfunction. With the development of tools to place endocardial pacing leads in locations that create physiological pacing activation, we sought to evaluate how ventricular trans-septal or left ventricular apical placement pacing differs from right atrial pacing. We will evaluate how these chronic pacing modes impact the PR and RF at baseline, 0, and 16 weeks in the canine heart.

Methods: Quantitative analysis will be performed on previously generated data. The data set includes pacing of 15 dogs total (8 with trans-septal leads & 7 with left ventricular …

Case Report And Review: Spontaneous Coronary Artery Dissection (Scad), Michael Morris, Wayne Tamaska, James Espinosa, Alan Lucerna, Trent Malcolm

Rowan-Virtua Research Day

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome or sudden death. SCAD has a high incidence in a younger, female population with an association with peripartum or postpartum status. Connective tissue disorders and vasculitides are also associated with SCAD. The purpose of this poster will be to examine the presentation and risk factors associated with SCAD and to discuss optimal treatment strategies.

A Case Of Akinetic Mutism In Patient With Unilateral Anterior Communicating Artery Stroke, David Ho, Or Shachar, James Espinosa, Alan Lucerna, James Lee

Rowan-Virtua Research Day

Akinetic mutism, a rare neurological condition involving sensory, motor, language, behavior, and emotional changes, mimicking locked-in syndrome, should be considered in acute stroke patients presenting with speech deficits. This condition, although debilitating initially, does have prospects for recovery. In this case report, we present the case of a patient presenting to the ER for altered mental status, found to be in DKA, NSTEMI, suspected narcotic overdose, and unilateral acute ischemic stroke of the left anterior communicating artery (ACA), who was found to have Akinetic Mutism. In stroke patients presenting with aphasia and dysarthria, it is worth considering akinetic mutism in …

Case Report: The Heart Breaking Tale Of Takotsubo In The Ed, Richard Baluyot, James Espinosa, Alan Lucerna, Sergey Medlenov, Joseph Pagano, Bhumi Shah

Rowan-Virtua Research Day

Chest pain is one of the most common chief complaints that emergency room physicians deal with on a daily basis. Here we present a rare cause of chest pain on a patient diagnosed with takotsubo cardiomyopathy. This is a condition that has been on the rise since its initial discovery and therefore clinicians should consider this on their differential when assessing patients with chest pain, especially postmenopausal women.