Cardiovascular Diseases Commons^™

From Skin To Spleen To Brain: Full-Spectrum Embolic Complications In Staphylococcus Aureus Endocarditis, Jose J. Loayza Pintado, Jorge Aboytes Trevino, Julian Galindo, Mohammad Aqeel, John Cauba, Joshua Nwose, Andres Suarez Parraga

Research Symposium

Background: Infective endocarditis (IE) results from bacterial adhesion to endocardial tissue and valvular apparatus. While viridans group streptococci and Enterococcus species are associated with subacute disease, Staphylococcus aureus, including methicillin-resistant strains (MRSA), is a leading cause of more acutely destructive presentations. The entry of these pathogens can occur through surgical and dental procedures, intravenous drug use, or less apparent etiology. Classic peripheral stigmata (Osler nodes, Janeway lesions, splinter hemorrhages, Roth spots) are now uncommon but clinically meaningful. Current guidelines emphasize rapid multimodality imaging to detect cerebral and systemic emboli in symptomatic IE. We present a 50-year-old man with S. aureus …

The Triple Threat: Hiv, Nonadherence, And Substance Use Driving Premature Coronary Events, Jose J. Loayza Pintado, Taiwo Ajani, Angelica Lopez Jesus, Aura Calderon, Jose Pena

Research Symposium

Background: People living with HIV (PLWH) experience nearly double the risk of premature atherosclerotic cardiovascular disease and often present with acute coronary syndromes at younger ages [1]. Chronic inflammation, immune activation, and drug–drug interactions between antiretrovirals and antiplatelet agents further contribute to accelerated atherosclerosis and poor outcomes after percutaneous coronary intervention (PCI) [2,3]. Importantly, in-stent restenosis (ISR) remains disproportionately frequent in PLWH despite modern drug-eluting stents, with medication nonadherence compounding risk [4]. We present a young woman with HIV and recurrent myocardial infarction due to rapid ISR, underscoring the impact of inflammation, adherence, and pharmacologic interactions on secondary prevention.

Case …

From Risk Factor To Cause Of Death: Hypertensive Heart Disease And The Changing Composition Of Heart Disease Mortality In Texas Compared With The United States, 1999–2020, Jose J. Loayza Pintado, Angelica Lopez Jesus, Aura Calderon, Jorge Aboytes Trevino, Daniela Hernandez

Research Symposium

Background: Heart disease mortality has declined nationwide, but Texas continues to experience higher rates than the United States overall. At the same time, hypertensive heart disease (HHD) has become more prominent within cardiovascular mortality statistics. Whether this shift reflects a growing hypertension-driven contribution to the Texas–U.S. gap has not been well quantified. We compared long-term trends in HHD mortality and the presence of HHD on death certificates among heart disease deaths in Texas versus the United States.

Methods: We analyzed CDC WONDER Underlying Cause of Death and Multiple Cause of Death files, 1999–2020, restricted to decedents aged ≥25 years. HHD …

Management Of Libman-Sacks Endocarditis: The Role Of Anticoagulation And Immunosuppressive Therapy, Klaudia Matanaj, Demi Poulathas, David Altimore

Rowan-Virtua Research Day

Background: Libman-Sacks endocarditis (LSE) is a nonbacterial thrombotic endocarditis detected in 10-40% of patients with systemic lupus erythematosus (SLE), depending on imaging modality. LSE is strongly associated with antiphospholipid syndrome (APS). The condition significantly increases the risk of cerebrovascular accidents and inpatient mortality compared to SLE without cardiac involvement. Despite these serious complications, optimal management remains uncertain. Objective: To review the current evidence on the pathophysiology and management of LSE. Methods: A literature review was conducted using 12 peer-reviewed articles addressing LSE pathophysiology, clinical outcomes, and treatment strategies. Results: Combination anti-inflammatory and antithrombotic therapy achieved 76% …

How Do Adverse Social Determinants Of Health Influence 30-Day Hospital Readmission Rates Among Patients With Heart Failure?, Noor Baig

Rowan-Virtua Research Day

Heart failure is one of the leading causes of hospitalization in the United States, with nearly 1 in 4 patients readmitted within 30 days of discharge. Clinical severity largely accounts for this risk, but social determinants of health (SDOH), including income, housing stability, transportation access, and health literacy, also play a role in post-discharge outcomes. This review synthesized seven cohort, observational, and qualitative studies from PubMed (2018–2025) examining the relationship between SDOH and 30-day readmission in heart failure patients.

Several patterns emerged across the literature. Neighborhood socioeconomic disadvantage, measured through ADI and SDI, was independently associated with higher readmission and …

Ai-Augmented Digital Auscultation For Point-Of-Care Screening Of Valvular Heart Disease: A Systematic Review And Meta-Analysis, Harshal Parmar, Akhila Archakam, Nikhila Archakam, Wesley Kim, Eduard Koman Md

Rowan-Virtua Research Day

Background: Valvular heart disease (VHD) affects >10% of adults aged 75+ yet remains underdiagnosed when asymptomatic due to declining auscultatory proficiency. AI-augmented digital auscultation offers a point-of-care screening solution, though no meta-analysis has pooled diagnostic accuracy across VHD subtypes in adults using echocardiography as the reference.

Methods: A systematic review and meta-analysis were conducted per PRISMA guidelines. PubMed, Embase, Cochrane, IEEE Xplore, and Scopus were searched without date restriction. Studies applying AI or machine learning to digital auscultation or phonocardiography for VHD classification in adults with echocardiographic reference and patient-level diagnostic metrics were included. Studies using only public datasets, pediatric …

Incidence Of Stroke Post Pulmonary Thrombectomy: Implications For Periprocedural Management, Rohan Umrani, Rameez Shahid, Luai Tabaza

Rowan-Virtua Research Day

Background: The incidence of stroke after pulmonary thrombectomy (PT) remains unknown. Given the incidence of patent foramen ovale (PFO) of 25% in autopsy studies, the concern for paradoxical embolus in this patient population warrants evaluation of periprocedural management.

Methods: We queried the EPIC EHR at Virtua Health in New Jersey for all patients who underwent PT from 2021-2025, categorized by utilization of the Inari Flowtriever system or the Penumbra thrombectomy device. We assessed post-PT cerebrovascular accident (CVA), PFO presence by transthoracic echocardiogram (TTE), and gender via descriptive statistics. Age, average anesthesia time and procedure supply cost were assessed via two-sided …

Methadone-Associated Qt Prolongation: The Importance Of Early Recognition And Monitoring In The Emergency Department, Uma Murrugappan, Kelsey Murray, James Espinosa Md, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 43-year-old female with cervical cancer and bilateral percutaneous nephrostomy tubes receiving high-dose methadone maintenance therapy who presented to the emergency department with bilateral flank and abdominal pain. She denied cardiac symptoms. Electrocardiogram obtained during evaluation revealed marked QT prolongation (QTc 596 ms) following recent methadone dose escalation. The patient was placed on continuous cardiac monitoring and intravenous magnesium was ordered. While intravenous access was being obtained, she developed polymorphic ventricular tachycardia consistent with torsades de pointes and became pulseless. Advanced cardiac life support was initiated including defibrillation and magnesium administration, with return of spontaneous …

Case Report: Termination Of Svt Using A Modified Vagal Maneuver With A 10-Cc Syringe, Romina Noormohammadi, Kelsey Murray, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Supraventricular tachycardia (SVT) is a common cardiac arrhythmia encountered in emergency departments and is characterized by a rapid regular rhythm originating above the ventricles. Initial management of hemodynamically stable SVT typically includes vagal maneuvers followed by pharmacologic therapy such as adenosine if non-pharmacologic methods fail. However, vagal maneuvers are frequently unsuccessful due to improper patient execution or insufficient vagal stimulation. We present the case of a 76-year-old female with a history of gastroesophageal reflux disease (GERD), hypertension (HTN), and hyperlipidemia (HLD) who presented with palpitations and was found to have SVT at 156 beats per minute on electrocardiogram. A Valsalva …

Case Report: Vertebral Artery Dissection After Cervical Manipulation, Devin Hoover, Emily Bolinger, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report the case of a 22-year-old female who presented with dizziness and vomiting after recent cervical manipulation who was diagnosed with a dissection of the vertebral artery. Dizziness can have a variety of causes including vascular etiologies, cerebellar and brainstem lesions, ocular problems, trauma, and others. In the setting of a known trauma and acute vestibular symptoms, it is prudent to consider vascular injuries.

Persistent Hypotension Following Viral Illness- Pocus For Pericardial Effusion, Peter Killian, Kelsey Murray, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

A pericardial effusion is defined as a build up of fluid in the pericardial space, the lining around the heart. Normal physiologic fluid can consist of approximately 15-50mL in an otherwise healthy adult . Larger amounts of fluid can be detected on radiographs, but are able to be seen on ultrasound when just exceeding physiologic conditions . Here we report a case of persistent hypotension assessed by point of care ultrasound (POCUS) in order to lead to a diagnosis.

Stroke Mimics And Stroke Chameleons: Leveraging The False Positive/False Negative Diagnostic Schema In Resident Teaching, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Stroke mimics and stroke chameleons contribute significantly to diagnostic uncertainty in Emergency Medicine. Traditional teaching often relies on enumerating examples, yet residents struggle to internalize these distinctions.

Objective

To present a conceptual teaching framework that maps stroke mimics to false positives and stroke chameleons to false negatives, leveraging pre-existing diagnostic schemas.

Methods

Using representative cases—including hypoglycemic hemiparesis and spinal epidural lipomatosis presenting as stroke mimic—we developed an explanation for residents involving framing mimics as false positives and chameleons as false negatives.

Results

Framing mimics as false positives and chameleons as false negatives activates existing learner schemas related to sensitivity …

Developing A Computational Pipeline For Biomarker Discovery In Ischemic Reperfusion Injury, Surabhi Panda, Kaitlyn Insana, Dimitri Pestov

Rowan-Virtua Research Day

Background: Ischemia-reperfusion injury (IRI) contributes significantly to tissue damage in cardiovascular disease. During IRI, stressed and dying cells release ribosomal RNA, which exhibits distinct fragmentation patterns that may serve as potential diagnostic biomarkers. Although these patterns have been observed using low-resolution biochemical techniques, there is currently no standardized computational approach to quantify and visualize RNA fragmentation for clinical interpretation.

Hypothesis: A computational pipeline can be developed to visualize and analyze ribosomal RNA fragmentation patterns, enabling identification of distinct fragmentation hotspots associated with ischemic conditions and potential biomarker discovery.

Methods: RNA fragmentation datasets generated from ribosomal RNA experiments in a Saccharomyces …

Acute Coronary Syndrome Presenting As Pericarditis, Oliwia A. Dalek, Zamin Kazmi, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 71-year-old male with a past medical history of myocardial infarction (MI) who initially presented to the emergency department (ED) with a chief complaint of chest pain and shortness of breath.  After consultation with Cardiology in the ED, the presumed diagnosis was pericarditis, and heparin drip was not initiated.  The patient subsequently developed a complete heart block indicating an atrioventricular (AV) nodal knock out, likely due to an ischemic event.  This case highlights the importance of identifying acute coronary syndrome (ACS) as early as possible in order to intervene and achieve the best possible outcomes …

Quantifying Qtc Prolongation Risk At Scale: Cardiac Safety Implications Of Moxifloxacin-Based Tb Regimens, Wesley Augustus Kim, Nikhila Arcakam, Brandon Velazquez

Rowan-Virtua Research Day

Tuberculosis treatment is undergoing its most significant transformation in decades. In recent years, updated ATS/CDC/ERS/IDSA guidelines introduced a new 4-month drug-susceptible TB regimen that incorporates moxifloxacin as a core component. These landmark guideline shifts mean that moxifloxacin exposure among TB patients globally is set to expand dramatically. This drug replaces the ethambutol component of standard TB regiment commonly associated with optic neuritis as a side effect. Yet there is a critical blind spot: while individual studies have documented moxifloxacin’s QT interval-prolonging effects, no research has modeled what happens when this drug is rolled out to millions of patients who simultaneously …

A Stemi That Wasn’T: Staphylococcus Aureus Bacteremia Presenting With Troponin Elevation And Pericardial Involvement, Taqi A. Khan, Kelsey A. Murray, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

A 75-year-old female presented to the emergency department (ED) with vomiting, weakness, and altered mental status. Initial evaluation revealed a markedly elevated troponin level and an electrocardiogram (ECG) demonstrating diffuse ST-segment depressions with relative ST elevation in lead aVR, prompting activation of a STEMI alert. After cardiology consultation, emergent catheterization was deferred. Computed tomography (CT) imaging demonstrated an anterior mediastinal fluid collection extending toward the pericardial space with a loculated pericardial effusion. Splenic infarctions were also identified. Blood cultures later grew Staphylococcus aureus. The patient was treated with broad-spectrum antibiotics and transferred to a tertiary care center for further management. …

Gram-Negative Infective Endocarditis : A Rare Case Of Escherichia Coli Pulmonic Valve Endocarditis, Caroline Nguyen, Philip Willsie, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Infective endocarditis (IE) is most commonly caused by gram-positive organisms, while Escherichia coli accounts for less than 1% of reported cases. Pulmonic valve involvement is particularly rare, representing fewer than 2% of IE cases. We report a case of E. coli infective endocarditis involving the pulmonic valve complicated by spinal epidural abscess and ascending cholangitis in a patient with intravenous drug use. Blood cultures demonstrated persistent E. coli bacteremia, and further evaluation with echocardiography and MRI revealed pulmonic valve vegetations and epidural abscess. This case highlights the importance of evaluating persistent gram-negative bacteremia for infective endocarditis and metastatic infection.

Case Report: Reverse Takotsubo Cardiomyopathy, Aveen Saed, Dhara Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Reverse Takotsubo cardiomyopathy (rTTC) is a rare variant of stress-induced cardiomyopathy characterized by basal and mid–left ventricular (LV) akinesis with apical sparing. It may mimic acute coronary syndrome and can present with cardiogenic shock. We present a 32-year-old female with substance use disorder who presented with severe abdominal pain and hypertensive emergency (SBP >240 mmHg), found to have reverse Takotsubo cardiomyopathy with an ejection fraction (EF) decline to 25% complicated by cardiogenic shock requiring inotropic support. Her course was notable for dynamic LV mid-cavity obstruction during recovery and complete normalization of LV systolic function (EF 65%) within two weeks. This …

Arrhythmic Syncope And Brugada Syndrome: Critical Identification Of High-Risk Patterns At The Ed Frontline, Kristine Rubi, Brittany Fera, Kelsey Murray, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Brugada Syndrome (BrS) is a premier cause of sudden cardiac death (SCD) in structurally normal hearts, particularly in Southeast Asia (SEA) where it is historically recognized as Sudden Unexplained Nocturnal Death Syndrome (SUNDS). We report the case of a 55-year-old male of Vietnamese descent who presented to the emergency department (ED) after a sudden, non-prodromal syncopal episode at rest. The event was significant for urinary incontinence and diaphoresis, classic red flags for arrhythmic syncope. Bedside electrocardiogram (EKG) demonstrated the pathognomonic Type 1 coved ST-segment elevation in leads V1 and V2. This symptomatic presentation following a six-year "follow-up gap" since a …

Case Report: Acute Cerebrovascular Accident With An Initial Absence Of Infarct Findings On Mri, Alyssa Baldini Md, Brittany Fera

Rowan-Virtua Research Day

We report a case of a 42-year-old female whose diffusion-weighted magnetic resonance imaging (MRI) performed 28 hours after symptom onset was negative for acute infarction. Repeat MRI 3 days later demonstrated left-sided corona radiata infarction.

Diffusion-weighted MRI imaging may not be sensitive or specific enough in early stages of acute stroke. Caution should be used in relying on imaging alone to make the diagnosis of ischemic stroke. Clinical assessment likely should be given priority in determining appropriate initial treatment and the need for secondary stroke prevention treatment when imaging is negative. Consideration should be given to the timing of initial …

A Rare Intervention: Emergency Ultrasound-Guided Pericardiocentesis Using A Central Line Kit, Alec Mirchandani, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Cardiac tamponade is a life-threatening emergency requiring rapid diagnosis and drainage.

Point-of-care ultrasound (POCUS) expedites recognition and guides pericardiocentesis. We report a case of acute large pericardial effusion with hemodynamic collapse in a previously healthy 46-year-old female, managed emergently with ultrasound-guided pericardiocentesis using a central line introducer and subsequent pigtail catheter exchange; the clinical course was complicated by presumed septic pulmonary emboli and death.

Brief Review: Quantifying The Risks Of Snow Shoveling: Cardiac, Musculoskeletal, And Environmental Hazards, James Espinosa, Swet A. Patel, James Lee, Alan Lucerna

Rowan-Virtua Research Day

Snow shoveling is a common winter activity in cold-weather regions, yet it uniquely combines intense physical exertion, cold exposure, and environmental hazards. Emergency Departments routinely observe seasonal increases in snow-shoveling–related musculoskeletal injuries, falls, and acute cardiovascular events. Despite this, the cardiovascular risk of snow shoveling is not well emphasized in medical education or patient counseling. Snow shoveling is associated with quantifiable and clinically significant risks, including musculoskeletal injury, falls, and acute cardiovascular events, which are reviewed here.

Ice Water Immersion–Associated Syncope: A Case Report With Mechanistic Review And Public Safety Implications, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Sudden ice water immersion can provoke syncope in otherwise healthy individuals, particularly during first-time exposure. We present a case of a 56-year-old man with mild hypertension and hyperlipidemia who experienced abrupt syncope during entry into cold water at a charitable group immersion event. Emergency department evaluation, including electrocardiography and cardiac biomarkers, was normal. Observation and cardiology consultation supported a diagnosis of provoked, immersion-related syncope. This case highlights the physiologic mechanisms of cold shock and autonomic conflict, the potential drowning risk associated with loss of consciousness during water entry, and the opportunity for improved discharge counseling and public safety messaging.

Effect Of Sauna On Cardiovascular Health In Patients With Heart Failure, Rikuto Abe, Piotr Domaszewski, Safe Elhakeem

Rowan-Virtua Research Day

Abstract

Heart failure (HF) is one of the hallmark diseases that represent a decline of cardiovascular function. Heart failure is characterized by a decrease in the ability of the heart to pump blood throughout the body, leading to symptoms such as fatigue, dyspnea, and swelling. HF is shown to decrease quality of life and increase mortality. Traditional treatments include pharmacology, lifestyle modifications, and surgery. Among the treatments, deliberate heat exposure in the form of dry saunas has been highlighted as a potential treatment option for HF. Dry saunas, especially infrared saunas, are shown to increase body temperature which improves circulation …

Determining The Impact Fitness Training Has On Cardiovascular Health Program For New Jersey Women With Socioeconomic Disadvantages, Aishwarya Muppoor, Amy Glasofer, Lisa Rosenberry, Emma Palma, Dawn Mcmath

Rowan-Virtua Research Day

WISEWOMAN is a 3-year federally funded program offered through Virtua Health to address lifestyle changes in women age 35-64 at risk for heart disease. The purpose of this project was to evaluate the additional of a fitness program to the standard nutrition program offered through Virtua Health’s WISEWOMAN program. Nutrition programming occurred during years 1 and 2 of the WISEWOMAN program, and fitness programming was offered to women in program year 3. Women who received nutrition + exercise (intervention) will have improved outcomes compared to those who receive nutrition programming only (control). We conducted a retrospective chart review to compare …

Mid- To Long-Term Durability Of Thoracic Endovascular Aortic Repair For Blunt Thoracic Aortic Injury: Outcomes In ≥ 45 Comparator Cohort, Andrew Lawrence Frankini, Gianna Rose Zanghi, Margaret Schwab, Valentina Sara Sica, Larry Andrew Frankini Md

Rowan-Virtua Research Day

Blunt traumatic thoracic aortic injury (BTAI) is a primary cause of mortality in blunt trauma injuries, with motor vehicle collisions representing the majority of cases.^1-4 Thoracic endovascular aortic repair (TEVAR) is the standard of care for managing this vascular emergency.⁵ While TEVAR demonstrates favorable short-term outcomes, there is an insufficient characterization of cumulative mid- to long-term reinterventions and device-related complications in BTAI patients.

We conducted a meta-analysis/systematic review of studies reporting outcomes after TEVAR for BTAI in patients ≥45 years. This review was conceptualized as a comparator to the previously reviewed outcomes in younger patients (< 45 years) performed by Frankini et al. (2026)⁶, …

The Impact Of Diet Modification And Physical Exercise On Chronic Htn Outcomes Compared To Typical Prescription Treatment Regimen, Artem Duda, Aishwarya Muppoor, Ahson Haider, Meshva Patel, Katherine Xie, Faiqa Ali

Rowan-Virtua Research Day

Hypertension remains a leading global cause of cardiovascular morbidity and mortality, affecting over one billion individuals worldwide. While pharmacologic therapy remains the standard of care, growing evidence supports the role of lifestyle modification as an effective strategy for hypertension control. This literature review evaluates the effectiveness of dietary interventions and physical exercise versus standard antihypertensive medication regimens in adults with chronic hypertension. Following PRISMA guidelines, a comprehensive search of PubMed and Embase (2015–2025) identified 5,178 citations, with 12 systematic reviews and meta-analyses meeting inclusion criteria. Across studies, structured exercise and dietary interventions consistently reduced systolic blood pressure by approximately 3–12 …

Hormonal Contraceptives And Menstrual Symptom Severity Among Women With Elevated Cardiovascular Disease Risk: Global And Daily Assessment, Maria Cox, Danielle Arigo, Gabrielle M. Salvatore

Rowan-Virtua Research Day

Hormonal contraceptive (HC) use is primarily for pregnancy prevention and may reduce menstrual symptoms in some individuals, though evidence is inconsistent. The aim of the study was to examine differences in symptom presence and severity among 64 menstruating women with ≥1 CVD risk factor (e.g., hypertension), including HC users (20.63%) and non-users (79.37%; sample M_age= 31.88 ± 9.89, M_bmi= 31.79 ± 7.6). Participants completed the global Premenstrual Screening Tool at baseline and then reported the presence and severity of 16 menstrual symptoms (1=Not Present to 4 = Severe) in end-of-day surveys over 45 days. In a …

Optimizing Continuous Renal Replacement Therapy (Crrt) In The Icu: A Qsen-Based Framework For Nursing Decision-Making Support, Leslie Okhirkhian

Knowledge and Creativity Expo

Nurses in critical care environments must exercise precise clinical judgement to recognize patient destabilization cues while managing the complex biomedical technologies that support failing physiological systems. Continuous Renal Replacement Therapy (CRRT) is a modality for hemodynamically unstable patients requiring fluid overload management and waste removal; however, it is a complex technology that demands nurses navigate a “tightrope” between renal perfusion and hemodynamic stability. Despite its prevalence, there is no concise decision-making support for nursing care in the current literature based on the Quality and Safety Education for Nurses (QSEN) strategies. This presentation addresses this gap by proposing a QSEN-based, standardized …

Myocardial Pi3k-Akt Pathway And Cardiovascular Disease Etiology, Bryson Lovorn, Brennan Kaplan

Student Scholar Symposium

Cardiovascular diseases (CVD) are the leading causes of death in the United States according to recent data from the Center for Disease Control (CDC). Myocardial infarctions, heart attacks, Coronary Artery Disease, ischemic reperfusion injuries, and hypertrophic cardiomyopathies represent common pathologies leading to the hospitalization of Americans. The etiologies of these diseases vary, however there is a common link. The phosphatidylinositol-3-kinase (PI3K) AKT pathway is a cellular pathway that is commonly overexpressed or repressed in myocytes. The human body is in an active limbo to maintain homeostasis. At a cellular level this can be simplified to a delicate balance between cell …