Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Case Report: Overdrive Pacing In Refractory Ventricular Tachycardia, Alyssa A. Baldini, Kishan B. Patel

Rowan-Virtua Research Day

We report a case of a 67-year-old male who presented to the emergency department (ED) for palpitations and complaint of his automated implantable cardioverter defibrillator (AICD) firing at home who had multiple episodes of persistent ventricular tachycardia (VT) during his course of stay in the ED. Patients with pacemakers and AICDs can present an additional layer of complexity when treating these conditions. Temporary overdrive pacing (TOP) should be considered as a treatment to correct refractory ventricular tachycardia in patients with implanted pacemakers and AICDs presenting to the ED.

Atypical Case Of Recurrent Saddle Pulmonary Embolism With Associated Chronic Hypoxia, Karl Schlicht

Rowan-Virtua Research Day

A saddle pulmonary Embolism (PE) represents a blood clot within the pulmonary artery vasculature that lodges itself between both the left and right pulmonary artery. They can be described as being massive or sub-massive. Massive PE’s cause large clot burden that puts the patient risk for sudden hemodynamic collapse, while sub-massive saddle PE’s typically do not cause hemodynamic collapse nor significant cardiac effects, such as right heart dysfunction. As clinicians, we need to be vigilant about whether a patient is placed into that criteria of sub-massive or massive and act quickly to start management that could be lifesaving.

“Lupus, Marijuana, And Takotsubo: A Perfect Storm”: An Unusual Presentation Of Takotsubo Cardiomyopathy, Matthew Orap, Parth Patel, Haitham Dib

Rowan-Virtua Research Day

Takotsubo cardiomyopathy is a type of myocardial injury that is marked with left ventricular contraction dysfunction. Various regions of the left ventricular wall may exhibit hypokinetic or hypercontractile activity. There is no exact mechanism elucidated for Takotsubo cardiomyopathy, but it is often associated with a triggering stressful event that leads to a catecholamine surge. We describe a 38-year-old female who presented with typical Takotsubo cardiomyopathy, likely in the setting of worsening systemic lupus erythematosus (SLE) exacerbations and excessive cannabis use. The patient described her pain as a tight burning sensation that started on her right side and traveled to the …

Wellen’S Syndrome: An Infamous Example Of Occlusive Myocardial Infarction (Omi), Joseph Maxwell Piraneo, Joseph Pagano, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Wellen’s syndrome is a condition with characteristic ECG changes that can be highly specific for acute myocardial infarction involving the left anterior descending (LAD) artery. Acute myocardial infarctions are one of the leading causes of death in the developed world. Its estimated annual prevalence is nearly 3 million worldwide, with more than 1 million in the United States [1]. The importance of timely diagnosis cannot be understated. Here we describe a case of myocardial infarction secondary to LAD occlusion which presented with the atypical ECG pattern known as Wellen’s syndrome.

Investigating The Link Between Preeclampsia/Eclampsia In Mothers And Cardiovascular Risk Among Their Neurodivergent Children, Jasmine Emanuel, Andrea Iannuzzelli, Venkateswar Venkataraman

Rowan-Virtua Research Day

Preeclampsia/Eclampsia are common gestational conditions among pregnant women. These individuals have hypertension after 20 weeks of gestation, proteinuria/end-stage organ disease, and may have seizures. These conditions can put the mother and fetus at risk.^1,2 A review of literature investigates whether an association exists between congenital heart defects (CHD), and maternal preeclampsia/eclampsia in the neurotypical and neurodivergent population. The Rowan-Virtua Regional Integrated Special Needs (RISN) Center patient population was used to investigate whether maternal preeclampsia/eclampsia is indicative of higher congenital heart disease (CHD) in their neurodivergent children to achieve better quality of care. As a first step towards exploring the …

Outcomes Of Drug-Eluting Stents In Comparison To Bare Metal Stents In Cancer Patients With Percutaneous Coronary Intervention: A Systematic Review And Meta-Analysis, Muhammad Siddiqui, Eric Warner, Joey Junarta, Parker O’Neill, David Signarovitz, Eyad Kanawati, Mohammed Murtaza, David Fischman

Division of Cardiology Faculty Papers

Background: Studies have demonstrated poor prognosis in cancer patients who undergo percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Cancer patients receiving PCI are at increased risk of in-stent thrombosis, bleeding, hospital readmissions, and cardiovascular and noncardiovascular mortality when compared to patients without cancer. It is unclear if the poor outcomes in cancer patients are related to the stent type utilized for PCI. This meta-analysis attempts to identify differences in efficacy and safety outcomes when comparing drug-eluting stents (DESs) with bare metal stents (BMSs) in cancer patients.

Methods: This meta-analysis is reported according to the Preferred Reporting Items for …

If1 Promotes Cellular Proliferation And Inhibits Oxidative Phosphorylation In Mouse Embryonic Fibroblasts Under Normoxia And Hypoxia, Lothar Lauterboeck, Sung Wook Kang, Donnell White, Rong Bao, Parnia Mobasheran, Qinglin Yang

School of Graduate Studies Faculty Publications

ATP synthase inhibitory factor subunit 1 (IF1) is an inhibitory subunit of mitochondrial ATP synthase, playing a crucial role in regulating mitochondrial respiration and energetics. It is well-established that IF1 interacts with the F1 sector of ATP synthase to inhibit the reversal rotation and, thus, ATP hydrolysis. Recent evidence supports that IF1 also inhibits forward rotation or the ATP synthesis activity. Adding to the complexity, IF1 may also facilitate mitophagy and cristae formation. The implications of these complex actions of IF1 for cellular function remain obscure. In the present study, we found that IF1 expression was markedly upregulated in hypoxic …

Early Renal Denervation Attenuates Cardiac Dysfunction In Heart Failure With Preserved Ejection Fraction, Jake E. Doiron, Zhen Li, Xiaoman Yu, Kyle B. Lapenna, Heather Quiriarte, Timothy D. Allerton, Kashyap Koul, Andrew Malek, Sanjiv J. Shah, Thomas E. Sharp, Traci T. Goodchild, Daniel R. Kapusta, David J. Lefer

School of Graduate Studies Faculty Publications

BACKGROUND: The renal sympathetic nervous system modulates systemic blood pressure, cardiac performance, and renal function. Pathological increases in renal sympathetic nerve activity contribute to the pathogenesis of heart failure with preserved ejection fraction (HFpEF). We investigated the effects of renal sympathetic denervation performed at early or late stages of HFpEF progression. METHODS AND RESULTS: Male ZSF1 obese rats were subjected to radiofrequency renal denervation (RF-RDN) or sham procedure at either 8 weeks or 20 weeks of age and assessed for cardiovascular function, exercise capacity, and cardiorenal fibrosis. Renal norepinephrine and renal nerve tyrosine hydroxylase staining were performed to quantify denervation …

Recent Studies In The Surgical Treatment Of Tetralogy Of Fallot, Emma C. Gardner

Mako: NSU Undergraduate Student Journal

No abstract provided.

Same Day Surgery And Discharge After Cardiac Device Implantation, Aakash Patel, Abraheim Al-Nasseri, Usman Kazi, Mahyar Doraji

West Florida Division GME Research Day 2024

No abstract provided.

Early Outcome Of Mini-Mvs Surger Y Elsherif Et Al., Mahmoud Abdullghany Amin Elsherif, Rasha Hosny, Mohamed Ramadan Mohamed

Journal of Medicine in Scientific Research

Background: The conventional incision adopted to for mitral valve replacement is the full sternotomy, with proved over time and experience to be a simple and safe method. Minimal invasive mitral valve surgery (Mini-MVS) is an alternative approach for elective mitral surgeries that proved over the last years to be a promising option.

Aim of the study: Assessment of the early outcome of minimally invasive mitral valve surgery with or without tricuspid surgery.

Methods: A retrospective study on 100 consecutive patients who underwent minimal invasive mitral valve surgery from January 2021 to June 2023 at National Heart Institute in Egypt.

Results: …

Positive Airway Pressure And Mask Factors Affective Adherence In Patients With Obstructive Sleep Apnea, Rutvi Sheth, Michel Audette, Soham Sheth

Electrical & Computer Engineering Faculty Publications

Purpose: Sleep apnea is a major risk factor for cardiovascular disorders. CPAP (Continuous Positive Airway Pressure) therapy is the main treatment for sleep apnea. However, adherence with CPAP remains a concern. Although there are various factors attributed to failure of CPAP therapy, mask related factors are not well studied.

Methods: The study recruited patients with obstructive sleep apnea using CPAP from neurology outpatient clinic at Progressive Neurology and Sleep Center. An IRB (Institutional Review Board) approved questionnaire was administered to evaluate factors affecting CPAP compliance.

Results: The study recruited 24 patients. It showed that almost 50% of the patients did …

Reducing Food Scarcity: The Benefits Of Urban Farming, S.A. Claudell, Emilio Mejia

Journal of Nonprofit Innovation

Urban farming can enhance the lives of communities and help reduce food scarcity. This paper presents a conceptual prototype of an efficient urban farming community that can be scaled for a single apartment building or an entire community across all global geoeconomics regions, including densely populated cities and rural, developing towns and communities. When deployed in coordination with smart crop choices, local farm support, and efficient transportation then the result isn’t just sustainability, but also increasing fresh produce accessibility, optimizing nutritional value, eliminating the use of ‘forever chemicals’, reducing transportation costs, and fostering global environmental benefits.

Imagine Doris, who is …

Temporal Artery Pseudoaneurysm In A Pediatric Patient, Gowri Gowda, Donald Mendoza, Amanda Tullos, Jessica Zagory, Malachi Sheahan

School of Medicine Faculty Publications

Superficial temporal artery pseudoaneurysms are an uncommon vascular pathology that can present after head or facial trauma. Furthermore, they are rarely reported in the pediatric population. Ultrasound can be a useful tool in the diagnosis because it is easily accessible and can be rapidly acquired. We report a case that demonstrates the utility of ultrasound in the diagnosis of a superficial temporal artery pseudoaneurysm.

Left Juxtaposition Of The Right Atrial Appendage: Pitfalls In Diagnosis, Kanya Singhapakdi, Wesam Sourour, Thomas Kimball

School of Medicine Faculty Publications

Several congenital anomalies of the right atrial appendage (RAA) have been described including aneurysm, herniation (in association with a pericardial defect), and left juxtaposition. The left juxtaposition of the RAA (LJRAA), first described by Birmingham in 1893 and subsequently introduced by Dixon in 1954, is usually associated with complex cardiac malformations such as obstruction of the left ventricular outflow tract. In this case report, we will describe an unusual variant of LJRAA in the absence of any other cardiac defects, which was initially misinterpreted as an aortic dissection. The correct diagnosis was made after careful reinterpretation and the use of …

Left Pulmonary Artery Occlusion Following Device Closure Of Patent Ductus Arteriosus In Premature Infants, Jesus C. Jaile, Ernest Siwik, Sergio Bartakian

School of Medicine Faculty Publications

Background: Device closure of a patent ductus arteriosus (PDA) is rapidly evolving, with the Amplatzer Piccolo Occluder (Abbott) receiving US Food and Drug Administration approval and becoming the first device approved for PDA closure in patients ≥700 g. We report on the first known cases of complete left pulmonary artery (LPA) occlusion following Piccolo closure of a PDA in premature infants. Methods: Retrospective chart analysis of PDA closures. Results: We have performed over 50 cases of Piccolo device closure of the PDA in preterm neonates in the past 2 years, with these 2 cases representing our only complications (4%). This …

Self-Administered Intranasal Etripamil Using A Symptom-Prompted, Repeat-Dose Regimen For Atrioventricular-Nodal-Dependent Supraventricular Tachycardia (Rapid): A Multicentre, Randomised Trial, Bruce S Stambler, A John Camm, Marco Alings, Paul Dorian, Hein Heidbuchel, Jaco Houtgraaf, Peter R. Kowey, Jose L Merino, Blandine Mondésert, Jonathan P Piccini, Sean D Pokorney, Philip T Sager, Atul Verma, J Marcus Wharton, David B Bharucha, Francis Plat, Silvia Shardonofsky, Michael Chen, James E Ip

Department of Medicine Faculty Papers

BACKGROUND: Etripamil is a fast-acting, intranasally administered calcium-channel blocker in development for on-demand therapy outside a health-care setting for paroxysmal supraventricular tachycardia. We aimed to evaluate the efficacy and safety of etripamil 70 mg nasal spray using a symptom-prompted, repeat-dose regimen for acute conversion of atrioventricular-nodal-dependent paroxysmal supraventricular tachycardia to sinus rhythm within 30 min.

METHODS: RAPID was a multicentre, randomised, placebo-controlled, event-driven trial, conducted at 160 sites in North America and Europe as part 2 of the NODE-301 study. Eligible patients were aged at least 18 years and had a history of paroxysmal supraventricular tachycardia with sustained, symptomatic episodes …

Improving Imaging Practices Following Arterial Switch Operation, Mollie Walton, Nir Atlas, Sanket Shah

Research Days

Problem Statement/Question: Long-term risk in post-operative cardiac patients exists, and morbidity may be avoided with advanced imaging surveillance.

Background/Project Intent (Aim Statement): The Appropriate Use Criteria (AUC) for Multimodality Imaging During Follow-Up Care of Patients with Congenital Heart Disease (CHD) was published in 2020 by the American College of Cardiology Foundation. This includes a subsection for D-Looped Transposition of the Great Arteries (D-Loop TGA). The arterial switch operation (ASO) is the preferred method for surgical repair of D-Loop TGA. Appropriate and timely use of advanced imaging is essential in optimizing long-term postsurgical outcomes. The objective of this quality improvement (QI) …

Center Based Cardiac Rehabilitation Outcomes Associated With Covid-19 Pandemic: A Retrospective Comparative Cohort Study, Haley Williams, Kayla Woodworth

Doctor of Nursing Practice Projects: College of Nursing

Background: Traditional cardiac rehabilitation (CR) is a multidisciplinary, multifaceted program for cardiac patients. Throughout the Covid-19 pandemic, health care, including center-based CR (CBCR) programs, were closed to in-person sessions. Even with the return to CBCR participation, patient outcomes may have been affected by this disruption in care. The goal of this study was to determine if CR participation outcomes differed before and after CBCR program closure due to Covid-19.

Methods: A retrospective comparative cohort design was used to examine CR participant outcome data before and after the Covid-19 pandemic. Convenience sampling of CR participants at a large, urban …

Inflammatory Marker Levels Among Patients Diagnosed With Autism Spectrum Disorder And Congenital Heart Defects, Patrick Pearce, Venkateswar Venkataraman, Andrea Iannuzzelli, Jennifer Lecomte

Rowan-Virtua Research Day

Autism Spectrum Disorder (ASD) and congenital heart defects (CHD) are conditions that both confer an immense increase in standard of care, and utilization of medical resources addressing comorbidities. One shared symptom that has been consistently cited is inflammation. This review sought to explore the levels of Tumor Necrosis Factor-�� (TNF-��) and Interleukin-6 (IL-6) between patients diagnosed as having either ASD or CHD. By compiling published data containing the mean values of these two inflammatory markers within these populations, it was shown that while both have significantly elevated levels compared to a phenotypically normal demographic, there is no significant difference between …

Mixed Beri’S: High Output Heart Failure From Severe Anemia And Thiamine Deficiency, Rohan Umrani, Hiral Amin, Ashley Pinckney, Charles Yang, Daniel Tran

Rowan-Virtua Research Day

Background: Severe anemia and thiamine deficiency can independently result in high output heart failure (HOHF) through different mechanisms. Data on the threshold and timeframe at which these etiologies may precipitate HOHF is unclear.

Case: A 63-year-old male with alcohol use disorder consuming 18 drinks/week presented with progressive shortness of breath and lower extremity edema for a few months. Physical exam revealed tachycardia, anasarca, jugular venous distension, Lancisi’s sign, and a midsystolic murmur. Echocardiogram demonstrated EF of 30-35%, dilated left ventricle, and cardiac index of 4.2L/min/m2.

Decision-Making: Heart failure can independently precipitate anemia while severe alcoholism can induce myelosuppression and promote …

A Rare Case Of Left Main Vasospasm Resulting In Sudden Cardiac Death, Trinava Roy, Anjeli Patel, Tania Maheshwari, Vasu Palli

Rowan-Virtua Research Day

Background: Coronary artery vasospasm (CAV) is transient spasm of a coronary artery that can lead to cardiac ischemia. We present a case with left main (LM) CAV identified on electrocardiogram (ECG) and cardiac catheterization resulting in appropriate therapy.

Case: A 52 year old female with months of spontaneously resolving episodic neck pain, flushing, and diaphoresis presented to the emergency department after a resuscitated cardiac arrest. Initial ECG was without evidence of ischemia, however high-sensitivity troponin (522) was elevated. Telemetry monitoring and ECG showed transient ST elevations in V1 and diffuse ST depressions with left bundle branch block. LV Function was …

Dislodged Endovascular Heat-Induced Thrombus Resulting In Pulmonary Embolus Following Post-Operative Ultrasound Compression, Danielle Park, Aghilas Belkadi, Luke Perry, Michael Kachmar, Holly Graves

Rowan-Virtua Research Day

Introduction: Venous insufficiency and consequent varicose veins are common problems faced by many patients. Fortunately, there are many treatment options available including a minimally invasive method known as radiofrequency ablation (RFA). RFA is not without complications; amongst those are endovascular heat induced thrombosis (EHIT). This rare complication is typically managed conservatively; however, in rare occasions, the thrombus can detach and embolize causing further issues for patients.

Case Description: A 48-year-old male underwent an uneventful RFA procedure for a CEAP 4a venous insufficiency. On the post-operative ultrasound venous duplex evaluation, the patient was found to have EHIT type 2 in the …

Importance Of Serial Ekgs In The Emergency Room Setting, Swet Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Chest pain is one of the most common chief complaints that presents to the emergency department. More than 8 million patients with chest related complaints present each year with about 10% of all ED visits comprise of cardiovascular emergencies. Immediate evaluation is the standard of care to differentiate between life threatening conditions and non-life threatening ones with the use of 12-lead electrocardiograph (EKG) and bedside monitors. The 12 lead EKG remains gold standard for initial screening and evaluating patients with chest pain and angina equivalents. The test is fairly inexpensive and noninvasive with providing vital information about cardiac rhythm. The …

Brash Syndrome Case Report And Brief Review, Kelly Schuitema

Rowan-Virtua Research Day

BRASH syndrome is an acronym that stands for bradycardia, renal failure, AV node blocker, shock and hyperkalemia. The syndrome is precipitated by synergism from AV nodal blocking agents and hyperkalemia. The combination of the AV nodal blockade and renal failure leads to a cycle of severe bradycardia and hyperkalemia. We will discuss a case of BRASH syndrome with a 68 year old female who presented with generalized weakness and was found to be hypotensive, bradycardia, in acute renal failure with hyperkalemia likely related to metoprolol and amlodipine use.

The Angiovac® Device Limits Lethal Complications Of Sepsis And Severe Infective Endocarditis With A Large Tricuspid Valve Vegetation: A Case Report, Dua Xiao, Raeann Dalton, Adam Fineman, Michael Benz, Antonios Tsompanidis

Rowan-Virtua Research Day

Introduction: Infectious endocarditis of the tricuspid valve is a common complication of intravenous drug use. Endocarditis caused by viridans streptococci can lead to heart valve vegetations which may be life threatening due to the potential for embolism and obstruction. Management of large valvular vegetations is often difficult due to the risks involved with open heart surgery, especially in patients with comorbid conditions. The AngioVac® device has been shown in rare cases to be effective at debulking vegetations without the need for invasive surgery.

Case Presentation: We present a patient with a history of intravenous heroin use disorder, hepatitis C, spinal …

Infective Endocarditis Secondary To Needle Embolization To The Heart, Tony Elias, David Barsoum, Robert Malak, Veyola Rezkalla, Maziyar Daneshvar, Howard Weinberg, Rafail Beshai

Rowan-Virtua Research Day

Needle embolisms in the heart are very rare, even though the number of intravenous drug users (IVDUs) has increased over the past 10 years.Due to varied symptomology-chest pain, dyspnoea, fever, or asymptomatic, this remains a complex and likely underdiagnosed condition. We describe a 31-year-old female with past medical history of IV drug use who presented to the emergency room with heart palpitations and described it as her “heart feels funny” and shortness of breath. She acknowledged intravenous (IV) heroin use and stated that the last time to use IV drugs was 2 days before coming to the hospital.

To our …

Spontaneous Iliac Arteriovenous Fistula, High-Output Heart Failure, And Cardiac Arrest, J. Maxwell Piraneo, Russell Mordecai, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

High-output heart failure is a potentially life-threatening condition that can lead to cardiac arrest. The most common causes of this condition are obesity, liver disease, arteriovenous shunts, lung disease, and myeloproliferative disorders, however the exact prevalence remains uncertain [1]. Here we describe an unusual case of cardiac arrest as a consequence of high-output heart failure, secondary to rupture of an iliac artery aneurysm into the common iliac vein, with arteriovenous (AV) fistula formation.

New Onset Lichen Planus And Back Pain Leading To Discovery Of A Peri Aortic Abscess, Monica Diep, Wayne Tamaska, Philip Carhart, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Back pain is a common chief complaint in the emergency department. With the differential ranging from musculoskeletal pain to cauda equina, there are a plethora of diagnoses. Differentiating between benign back pain and back pain that warrants further evaluation and even possible emergent surgical intervention is often a challenge in the acute setting. In this case report, a strange combination of all new symptoms including lichen planus, fevers, chills and atraumatic back pain lead to the eerie and very unexpected diagnosis of a peri-aortic abscess.

Best Practice For Post-Operative Surgical Site Infection Prevention, Scott Cavinder

Evidence-Based Practice Project Reports

It is estimated that 300 million surgical procedures take place annually throughout the globe (Gillespie et al., 2021). However, the incidence of surgical site infections (SSI) developing in surgical patients within 30 days of surgery have been estimated to be upwards of 11% (Gillespie et al., 2021). The purpose of this evidence-based practice project was to address the PICOT question: In patients who have undergone cardiothoracic or vascular surgery (P) does implementation of an evidence based post-operative care bundle (I) as compared to current clinical agency practice standards (C) result in a decrease of SSI (O) over a 12-week period …