Cardiovascular Diseases Commons^™

Nlrp3 Inflammasome Is A Key Driver Of Obesity-Induced Atrial Arrhythmias, Larry Scott, Anke C Fender, Arnela Saljic, Luge Li, Xiaohui Chen, Xiaolei Wang, Dominik Linz, Jilu Lang, Mathias Hohl, Darragh Twomey, Thuy T Pham, Rodrigo Diaz-Lankenau, Mihail G Chelu, Markus Kamler, Mark L Entman, George E Taffet, Prashanthan Sanders, Dobromir Dobrev, Na Li

Faculty, Staff and Students Publications

AIMS: Obesity, an established risk factor of atrial fibrillation (AF), is frequently associated with enhanced inflammatory response. However, whether inflammatory signaling is causally linked to AF pathogenesis in obesity remains elusive. We recently demonstrated that the constitutive activation of the 'NACHT, LRR, and PYD Domains-containing Protein 3' (NLRP3) inflammasome promotes AF susceptibility. In this study, we hypothesized that the NLRP3 inflammasome is a key driver of obesity-induced AF.

METHODS AND RESULTS: Western blotting was performed to determine the level of NLRP3 inflammasome activation in atrial tissues of obese patients, sheep, and diet-induced obese (DIO) mice. The increased body weight in …

Development And Validation Of Machine Learning-Based Race-Specific Models To Predict 10-Year Risk Of Heart Failure: A Multicohort Analysis, Matthew W Segar, Byron C Jaeger, Kershaw V Patel, Vijay Nambi, Chiadi E Ndumele, Adolfo Correa, Javed Butler, Alvin Chandra, Colby Ayers, Shreya Rao, Alana A Lewis, Laura M Raffield, Carlos J Rodriguez, Erin D Michos, Christie M Ballantyne, Michael E Hall, Robert J Mentz, James A De Lemos, Ambarish Pandey

Faculty, Staff and Students Publications

BACKGROUND: Heart failure (HF) risk and the underlying risk factors vary by race. Traditional models for HF risk prediction treat race as a covariate in risk prediction and do not account for significant parameters such as cardiac biomarkers. Machine learning (ML) may offer advantages over traditional modeling techniques to develop race-specific HF risk prediction models and to elucidate important contributors of HF development across races.

METHODS: We performed a retrospective analysis of 4 large, community cohort studies (ARIC [Atherosclerosis Risk in Communities], DHS [Dallas Heart Study], JHS [Jackson Heart Study], and MESA [Multi-Ethnic Study of Atherosclerosis]) with adjudicated HF events. …

Arteriovenous Fistula Formation After Transradial Coronary Intervention, Khader Herzallah, Abdulmohsin Ahmadjee, Yehia Saleh, George S Abela

The Texas Heart Institute Journal

No abstract provided.

Continuous-Flow Left Ventricular Assist Device Explantation After More Than 5 Years Of Circulatory Support And Ventricular Reconditioning, George V Letsou, Andrew C W Baldwin, Andrew B Civitello, William E Cohn, O H Frazier

The Texas Heart Institute Journal

Continuous-flow left ventricular assist devices have proved to be effective, durable, life-saving tools in patients with end-stage heart failure. However, because of the risks associated with mechanical circulatory support (including stroke, infection, gastrointestinal bleeding, and device malfunction), the optimal goal of device therapy is myocardial recovery and device removal. Ventricular reconditioning and pump explantation after continuous-flow support have been reported; however, little is known about variables that govern the pace and degree of myocardial response in patients who experience such recovery. We describe our long-term pump-weaning strategy for a 25-year-old man who had a continuous-flow device implanted and then needed …

Strengths And Weaknesses Of Digital Diaries As A Means To Study Patient Pathways: Experiences With A Study Of Hypertension In The Philippines, Jhaki A. Mendoza, Maureen L. Seguin, Gideon Lasco, Lia M. Palileo-Villanueva, Arianna Maever L. Amit, Alicia Renedo, Martin Mckee, Benjamin Palafox, Dina Balabanova

Development Studies Faculty Publications

The rise of digital mobile communications has made possible novel research methods that can provide a better understanding of patients’ experience of non-communicable diseases. This study explores the opportunities and challenges in employing “digital diaries” via mobile phones to track the lived experiences of people with hypertension in the Philippines. Following in-depth interviews, 40 hypertensive adults were invited to submit digital diaries over 12 months. Mobile phones were found to be an efficient way of reaching participants, although it was difficult to collect in-depth narratives about their experiences using the medium beyond nominal responses about symptoms and treatment. Possible explanations …

Flecainide-Induced Atrial Flutter With 1:1 Conduction Complicated By Ventricular Fibrillation After Electrical Cardioversion, Timothy Colangelo, Drew Johnson, Reginald Ho

The Texas Heart Institute Journal

Flecainide, a widely prescribed class IC agent used to treat atrial arrhythmias, can in rare cases cause 1:1 atrial flutter with rapid conduction. We describe the case of a 59-year-old man who was on a maintenance regimen of flecainide for refractory atrial fibrillation. When 1:1 atrial flutter with rapid conduction developed, emergency medical technicians attempted synchronized cardioversion, which caused ventricular fibrillation necessitating defibrillation. The patient ultimately underwent radiofrequency ablation and cryoablation to resolve his symptomatic atrial flutter. We discuss the atrial proarrhythmic effects of flecainide and how to mitigate complications in high-risk patients.

Association Between Morning Surge In Systolic Blood Pressure And Syntax Score I In Patients With Stable Coronary Artery Disease, Alaa Quisi, Gokhan Alici, Hazar Harbalioglu, Omer Genc, Ibrahim Halil Kurt, Murat Cayli

The Texas Heart Institute Journal

A high morning surge in systolic blood pressure poses a risk in people who have cardiovascular disease. We investigated the relationship between this phenomenon and the SYNTAX score I in patients who had stable coronary artery disease.

Our single-center study included 125 consecutive patients (109 men and 16 women; mean age, 54.3 ± 9 yr) in whom coronary angiography revealed stable coronary artery disease. We calculated each patient's sleep-trough morning surge in systolic blood pressure, then calculated the SYNTAX score I.

The morning surge was significantly higher in patients whose score was >22 (mean, 22.7 ± 13.2) than in those …

Near-Field Electrospinning And Characterization Of Biodegradable Small Diameter Vascular Grafts, William E. King Iii

Theses and Dissertations (ETD)

The ideal “off the shelf” tissue engineering, small-diameter (< 6 mm inner diameter (ID)) vascular graft hinges on designing a template that facilitates transmural ingrowth of capillaries to regenerate an endothelized neointimal surface. Previous traditionally electrospun (TES) approaches to create bioresorbable vascular grafts lack the pore sizes required to facilitate transmural capillary ingrowth required for successful in situ neovascular regeneration. Therefore, the ability to create scaffolds with program-specific architectures independent of fiber diameter via the relatively recent sub-technique of near-field electrospinning (NFES) represents a promising solution to create tissue engineering vascular grafts. These programmed large pore sizes are anticipated to promote in situ regeneration and improve the outcomes as well as the quality of life of patients with arterial disease.

In this dissertation, we manufactured via NFES as well as characterized biodegradable polydioxanone (PDO) small-diameter vascular grafts. Chapter 1 introduces the need for off-the-shelf, small-diameter vascular grafts to facilitate in situ regeneration, the process and pore size limitations of TES vascular grafts, and the promising use of NFES to develop precisely tailored PDO vascular grafts. Chapter 2 describes the process of NFES and details the current progress in NFES of biomedical polymers as well as the major limitations that exist in the field. Chapters 3, 4, and 5 contain primary research …

Migration As A Determinant Of Childhood Obesity In The United States And Latin America, Mireya Vilar-Compte, Arturo V. Bustamante, Nancy López-Olmedo, Pablo Gaitán-Rossi, Jaqueline Torres, Karen E. Peterson, Graciela Teruel, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

International migration has economic and health implications. The acculturation process to the host country may be linked to childhood obesity. We use the Community Energy Balance (CEB) framework to analyze the relationship between migration and childhood obesity in Mexican households with international migrants. Using longitudinal data from the Mexican Family Life Survey (MxFLS), we examine how migrant networks affect childhood obesity in origin communities. We also review binational health programs that could be effective at tackling childhood obesity in migrant households from Mexico. Children embedded in migrant networks are at greater risk of developing overweight or obesity, suggesting a significant …

Implementation Of Childhood Obesity Prevention And Control Policies In The United States And Latin America: Lessons For Cross-Border Research And Practice, Rafael Perez-Escamilla, Mireya Vilar-Compte, Elizabeth Rhodes, Olga L. Sarmiento, Camila Corvalan, Rachel Sturke, Susan Vorkoper

Department of Public Health Scholarship and Creative Works

Progress has been made in the development and widespread implementation of effective interventions to address childhood obesity, yet important challenges remain. To understand how the United States and Latin American countries achieved success in implementing obesity policies and programs (PAPs) and identify improvement opportunities using implementation science principles. We identified three comparative case studies: (1) front-of-food package labeling (Mexico and Chile); (2) Open Streets/play streets (Colombia and the United States); and (3) the Baby-Friendly Hospital Initiative (Brazil and the United States). Information from multiple sources (e.g., scientific and gray literature and key informant interviews) was synthesized to describe barriers, facilitators, …

Reducing Stroke Burden Through A Targeted Self-Management Intervention For Reducing Stroke Risk Factors In High-Risk Ugandans: A Protocol For A Randomized Controlled Trial, Shirley Moore, Carol Blixen, Martha Sajatovic

Faculty Scholarship

Introduction: Stroke burden is rapidly increasing globally. Modifiable risk factors offer an opportunity to intervene, and targeting hypertension is a key actionable target for stroke risk reduction in sub-Saharan Africa. This 3-site planned randomized controlled trial builds on promising preliminary data. Methods: A total of 246 Ugandan adults will be recruited randomized to experimental intervention vs. enhanced treatment control. Intervention participants will receive six weekly group-format stroke risk reduction self-management training sessions, and the controls will receive information on cardiovascular risk. The primary study outcome is systolic B.P. measured at baseline, 13-week, 24 weeks (6 months). Secondary outcomes include other …

Speckle-Tracking Echocardiography For Detecting Subclinical Left Ventricular Dysfunction In Patients With Familial Hypercholesterolemia, Rongjuan Li, Jinjie Xie, Bo Jiang, Zhonghua Sun, Lvya Wang, Zhaoting Leng, Yueli Wang, Ya Yang

The Texas Heart Institute Journal

Myocardial ischemia and left ventricular dysfunction have been documented in young adults with familial hypercholesterolemia. We investigated whether speckle-tracking echocardiography can be used to detect subclinically impaired global and regional myocardial function in patients with this lipid disorder. This single-center study included 47 patients with familial hypercholesterolemia and 37 healthy control subjects who underwent transthoracic Doppler echocardiography and speckle-tracking echocardiography from January 2003 through December 2016. Conventional echocardiographic and strain parameters in the 2 groups were analyzed and compared. Left ventricular dimensions were significantly larger at end-diastole (P=0.02) and end-systole (P=0.013), left ventricular walls were significantly thicker (P

Patient Perceptions And Use Of Non-Statin Lipid Lowering Therapy Among Patients With Or At Risk For Atherosclerotic Cardiovascular Disease: Insights From The Palm Registry, Angela Lowenstern, Shuang Li, Ann Marie Navar, Salim S Virani, Veronique L Roger, Jennifer G Robinson, Anne C Goldberg, Wendy Kampman, Eric D Peterson, Tracy Y Wang

Faculty, Staff and Students Publications

BACKGROUND: Non-statin lipid lowering therapies (LLTs) provide additional treatment options for patients. Use patterns and patient perceptions of non-statin LLT remain incompletely described.

HYPOTHESIS: The guideline-recommended statin intensity remains underutilized in patients treated with and without non-statin LLT.

METHODS: The PALM Registry collected LLT information on patients with or at risk of ASCVD treated at 125 US clinics in 2015. We compared patient perceptions, lipid levels and statin use among patients treated with and without non-statin LLT.

RESULTS: Among 7720 patients, 1930 (25.0%) were treated with a non-statin LLT (1249 fish oil, 417 fibrates, 329 ezetimibe, 196 niacin). Concurrent statin …

Young Athletes: Preventing Sudden Death By Adopting A Modern Screening Approach? A Critical Review And The Opening Of A Debate, Paolo Angelini, Raja Muthupillai, Alberto Lopez, Benjamin Cheong, Carlo Uribe, Eduardo Hernandez, Stephanie Coulter, Emerson Perin, Silvana Molossi, Federico Gentile, Scott Flamm, Giovanni Lorenz, Flavio D'Ascenzi, Jonathan Tobis, Roberto Sarnari, Antonio Corno, James Furgerson, Amedeo Chiribiri, Adriana D M Villa, Fulvio Orzan, Pedro Brugada, John Jefferies, Pierre Aubry, Jeffrey Towbin, Gaetano Thiene, Robert Tomanek

Faculty, Staff and Students Publications

Preventing sudden cardiac death (SCD) in athletes is a primary duty of sports cardiologists. Current recommendations for detecting high-risk cardiovascular conditions (hr-CVCs) are history and physical examination (H&P)-based. We discuss the effectiveness of H&P-based screening versus more-modern and accurate methods. In this position paper, we review current authoritative statements and suggest a novel alternative: screening MRI (s-MRI), supported by evidence from a preliminary population-based study (completed in 2018), and a prospective, controlled study in military recruits (in development).

We present: 1. Literature-Based Comparisons (for diagnosing hr-CVCs): Two recent studies using traditional methods to identify hr-CVCs in >3,000 young athletes are …

Identifying Opportunities For Implementing Home Blood Pressure Monitoring In Newly Diagnosed Or Worsening Hypertension At A Family Health Clinic, Catherine Liikala

Doctor of Nursing Practice Final Manuscripts

Abstract

The literature is clear that the diagnosis, treatment, and plan of care for hypertension in adults should rely, at least in part, on ambulatory blood pressure. Using in-office blood pressures alone risks inaccurate measurements and can result in inappropriate treatments. Many clinics, however, do not adhere to this recommendation and will fall back on clinic readings which puts the patient at risk of mismanaged hypertension and polypharmacy. This project was formulated to identify the extent to which hypertensive patients were diagnosed and managed without the use of home blood pressure monitoring in a small local community clinic. This …

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …

An Update On Cardiovascular Disease, Susan H. Davide, Audra E. Haynes

Publications and Research

In the United States, cardiovascular is the leading cause of death in men and women, and most racial and ethnic groups. There are several types of heart conditions; the most common type is coronary heart disease, also known as coronary artery disease or ischemic heart disease, which can cause acute myocardial infarction. Other heart conditions which can lead to heart failure include a past history of myocardial infarction, abnormal heart valves, heart muscle disease, or congenital heart muscle disease. In adults ages 65 and younger, approximately 2 in 10 deaths are caused from coronary artery disease and about 18.2 million …

Atrial Standstill In A Pediatric Patient With Scn5a Mutation Following Procainamide Challenge, Anmol Goyal

Research Days

Background: Atrial standstill (AS) is a rare arrhythmia characterized by absence of electrical and mechanical atrial activity associated with SCN5A channelopathy.

Case: An 18 year old male with structurally normal heart, frequent sinus pauses, nonsustained atrial tachycardia and high-grade block was found to have SCN5A mutation c.3823G>A (p.Asp1275Asn). An electrophysiology study (EPS) with high density voltage mapping of the right atrium was done (Fig 1a). Nonsustained multifocal atrial tachycardia was induced without ablative targets (Fib 1b). Procainamide challenge was negative for Brugada, however induced AS (Fig 1c-d). No atrial capture could be achieved at maximal output. Empiric atrial lead …

Inflammation, Diet, And Depression, Kareem F. Hamada

College Honors Program

Although it is well established that inflammation contributes to cardiovascular disease (CVD), this thesis considers the potential for dietary-induced inflammation to also play a role in the development of depression. Even though the association between inflammation and depression was initially proposed over 100 years ago, treatment of depression has focused on psychopharmacological and psychotherapy. In addition to the increases in the chronic diseases that are the leading causes of death, including CVD, diabetes, and several forms of cancer, consumption of meat, dairy, and highly processed foods have also increased dramatically in recent decades. The resulting Standard American Diet (S.A.D.) is …

Pediatric Pulmonary Artery Aneurysms Causing Pulmonary Hemorrhage: A Case Of Transcatheter Intervention While On Va Ecmo Support, Igor Areinamo

Research Days

Background: The incidence of pulmonary artery aneurysm (PAA) in children remains unknown. There are few reports of a transcutaneous interventional approach to address this type of pathology. Management of PAAs while on VA ECMO has not been described in pediatrics.

Objectives/Goal:

Methods/Design:

Case: 9-year-old previously healthy male presented with MRSA associated ARDS and sepsis requiring urgent VA ECMO cannulation. Chest CT done on ECMO day 22 showed development of right sided PAAs. Patient had an episode of significant pulmonary hemorrhage. Angiogram demonstrated two fusiform right PAAs, one of which had ruptured and was bleeding into the lung parenchyma. Patient had …

Prenatal Diagnosis Of An Uncommon Form Of A Hypoplastic Left Heart Syndrome Variant., Anmol Goyal

Research Days

Background: Mitral valve dysplasia syndrome (MVDS) is a rare form of congenital heart disease, similar to hypoplastic left heart syndrome (HLHS). Prenatal identification is important for counseling, delivery planning and postnatal management.

Case: A 39 year-old woman underwent fetal echocardiography at ~34 weeks gestation for evaluation of fetal cardiomegaly and hydrops revealing: biatrial enlargement, mild-to-moderate mitral and tricuspid valve insufficiency, echobright mitral valve apparatus, biventricular dilation, severe LV fibroelastosis (EFE) and systolic dysfunction, mild hypoplasia of aortic valve annulus and aortic arch, and a thick restrictive atrial septum (RAS) with left to right flow (Fig 1a-c).

Decision‐making: Although critical aortic …

Standardized Point-Of-Care Ultrasound (Pocus) Set-Up For Cardiac Evaluation During Covid-19 Pandemic In A Pediatric Population., Anmol Goyal

Research Days

Background: The novel coronavirus SARS-CoV2 is known to cause significant cardiac dysfunction, effusion, thromboembolism and coronary dilation. Currently no pediatric specific guidelines exist from ACC or ASE for use of POCUS. Our objective was to identify ideal pediatric appropriate POCUS equipment and standardize its use.

Methods: A Phillips Lumify probe paired with Android-Samsung tablet and a Butterfly iQ probe paired with an iPad were considered. A workflow algorithm and cleaning instructions were created. If the POCUS scan answered the clinical question, then a detailed echo was deferred. If the POCUS scan revealed findings requiring comprehensive evaluation, a follow-up echo was …

Machine Learning In The Health Industry: Predicting Congestive Heart Failure And Impactors, Alexandra Norman, James Harding, Daria Zhukova

SMU Data Science Review

Cardiovascular diseases, Congestive Heart Failure in particular, are a leading cause of deaths worldwide. Congestive Heart Failure has high mortality and morbidity rates. The key to decreasing the morbidity and mortality rates associated with Congestive Heart Failure is determining a method to detect high-risk individuals prior to the development of this often-fatal disease. Providing high-risk individuals with advanced knowledge of risk factors that could potentially lead to Congestive Heart Failure, enhances the likelihood of preventing the disease through implementation of lifestyle changes for healthy living. When dealing with healthcare and patient data, there are restrictions that led to difficulties accessing …

Tricuspid Atresia With Totally Anomalous Pulmonary Venous Connection: An Uncommon Finding, Anmol Goyal

Research Days

Background: Tricuspid atresia comprises 3-4% of all congenital heart disease (CHD). Anatomic findings are no true connection between the right atrium (RA) and right ventricle (RV) with concomitant findings of a ventricular septal defect (VSD), right ventricular hypoplasia, abnormalities of right ventricular outflow tract, pulmonary valve and pulmonary arteries. Common associated lesions have been described including transposition of great vessels, hypoplasia of aortic arch, double outlet ventricle or a common arterial trunk. Total anomalous pulmonary venous connection (TAPVC) is relatively rare and we present a case in addition to the six previously described cases in literature.

Case: A 33-year-old woman …

Fucoxanthin: A Review Of Potential Benefits Relative To Human Health, Michael R. White

Masters Theses, 2020-current

Fucoxanthin is a carotenoid sourced and extracted mainly from dark orange and brown seaweeds found in the pacific ocean, such as the wakame algae. The allenic bonds and unique oxygen groups give fucoxanthin its unique structure and are thought to be part of the reason fucoxanthin has unique physiological functions. Fucoxanthin has potentially numerous effects on the physiology of human health, ranging from skin health to metabolic health, which have been demonstrated in animal model research. The goal of this review is to examine current literature to discuss fucoxanthin’s potential application as a nutraceutical, treatment for obesity, type 2 diabetes, …

Invasive Therapies For Acute Coronary Syndromes In The Covid-19 Era, Sanket Borgaonkar, Joshua Hahn, Marilyne Daher, Waleed Kayani, Hani Jneid

Faculty, Staff and Students Publications

PURPOSE OF REVIEW: To identify and address the challenges associated with the care of ACS patients during the coronavirus 2019 pandemic.

RECENT FINDINGS: The COVID-19 pandemic has had a considerable global impact with over 2.0 million deaths worldwide so far. There has been considerable evidence suggesting that COVID-19 increases the risk of acute coronary syndromes (ACS). We propose characterizing ACS patients into 3 distinct categories to better assist in appropriate triage and management: critically ill patients, non-critically ill ST elevation myocardial infarction (STEMI) patients, and non-critically ill non-ST elevation myocardial infarction (NSTEMI)/unstable angina (UA) patients. We thoroughly review treatments strategies, …

Syncope Or Seizure?, Joseph Heron, Kevin Dwyer

Rowan-Virtua Research Day

Syncope is a common complaint in the emergency departments, accounting for 1-2% of visits, and can approach admission rates of a staggering 85%. The causes and conditions can be numerous, ranging from benign to life threatening. A good background history can go a long way in determining the etiology of the patient’s syncope. We describe a case of an elderly male who presented with a reported chief complaint of seizures, another syncope-mimic seen in the emergency department. He had a history of CAD, HTN, AAA, and osteoarthritis but no prior history of cardiac arrhythmia, MI, or structural heart disease. The …

Use Of Point Of Care Ultrasound In The Emergency Department For Diagnosis Of Femoral Pseudoaneurysm, Stephen Janssen, Jeffrey Gardecki, Giovanna Finocchio

Rowan-Virtua Research Day

Iatrogenic pseudoaneurysm after puncture or intervention of the femoral artery is a rare complication of arterial surgical intervention occurring in 0.05-0.50% of diagnostic and therapeutic catheterizations and can present weeks after initial presentation. Today we present a 57-year-old gentleman 3 months status post femoral artery stent who presented with swelling to his right groin. Point of care ultrasound was used to diagnose an actively bleeding pseudoaneurysm with hematoma that ultimately led to repeat stenting. This case shows how point of care ultrasound can expedite diagnosis and intervention and is a useful tool for the emergency physician at initial presentation.

A Peculiar Presentation Of Cardiac Sarcoidosis As Third-Degree Atrioventricular Heart Block Complicated By Right Ventricle Perforation, Yash Suthar, Pooja Patel, Nikhita Kothari, Kristofer Hillegas

Rowan-Virtua Research Day

• Cardiac sarcoidosis is a rare, inflammatory multisystem disorder that manifests as noncaseating granulomas of multiple organs.

• The clinical presentation of sarcoidosis is variable and may be underrecognized by clinicians.

• Individuals may be asymptomatic during their lifetimes and may be incidentally diagnosed with the disease for the first-time during autopsy.

• Patients with cardiac involvement of sarcoidosis may initially present with complications including arrhythmias, heart block, bundle branch block, congestive heart failure, pericardial effusion, pulmonary hypertension, and/or sudden cardiac death.

Cushing’S Reflex And Bradycardic Arrest In Cryptococcal Meningitis, Scott Briggs, Trent Malcolm

Rowan-Virtua Research Day

Cushing’s reflex is a physiologic response to maintain cerebral perfusion pressure with elevated systolic blood pressure, widened pulse pressure, and bradycardia occurring in the setting of elevated intracranial pressure (ICP). The proposed mechanisms for reflexive bradycardia include ischemia to medullary brain tissue and compression of the intracranial segment of the vagus nerve leading to parasympathetic activation. (1) In acutely elevated ICP, bradycardia is a late finding of worsening intracranial pathology suggestive of impending herniation and cardiovascular collapse.

Cryptococcal meningitis has been identified by Infectious Disease Society of America for its association with elevated ICP. (2) Variety of pathogenic mechanisms occurring …