Medical Pathology Commons^™

Evaluating The Market Withdrawal Of Andexanet Alfa, Jordyn Linfield, Addisyn Cooper, Alexander Defranco, Emma Gerding, Jessica Kelley, Tyler Henney, Connor Dains, Brenna Hissong, Brittany Bates

Pharmacy and Wellness Review

The coagulation cascade comprises intrinsic, extrinsic, and common pathways that converge when thrombin converts fibrinogen (factor I) into fibrin, leading to fibrin mesh formation, stabilization of the platelet plug, and ultimately thrombus formation. Inhibition of the coagulation cascade can be achieved with a variety of anticoagulant medications, including direct oral anticoagulants (DOACs). The mechanism of action of DOACs is to inhibit either factor Xa or thrombin. Reversal of anticoagulation remains an important clinical consideration when managing patients on DOACs who experience serious bleeding events. Andexanet alfa is a recombinant, modified human factor Xa protein previously indicated for patients receiving rivaroxaban …

Fda Approval Of Etripamil For The Treatment Of Paroxysmal Supraventricular Tachycardia, Kiley Devoll, Daniella Egbujor, Katy Grainger, Katherine Cook, Victoria Niese, Connor Dains, Brenna Hissong, Andrew Roecker

Pharmacy and Wellness Review

Paroxysmal supraventricular tachycardia (PSVT) is characterized by sudden, brief, intermittent episodes that result in a heart rate of 150 to 250 beats per minute (bpm). PSVT is difficult to diagnose, making proper treatment challenging. According to the 2015 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS) guidelines, current pharmacologic recommendations for PSVT include adenosine, verapamil, diltiazem, or nonpharmacologic vagal maneuvers.¹ These treatments each have a variety of adverse effects, contraindications, and dosing considerations, which highlight a need for novel therapies for the acute treatment and maintenance of PSVT.¹ The NODE-301 trial assessed the safety and …

Physician Modified Stent Grafts Created Using 3-Dimensional Printing In The Management Of Aortic Disease: A Systematic Review, Gregory Alfieri, Jack Stensland, Sydney Elness, Khavir Sharieff Do,Mba

HCA-NSU MD Research Day

Objective: This study evaluates the effectiveness and applicability of PMSGs created from 3D-printed models in managing aortic disease. Background: Endovascular treatment of aortic disease can be challenging, especially with complex anatomy. Three-dimensional (3D) printed models, derived from computed tomography (CT) and magnetic resonance imaging (MRI) scans, have been used to create physician-modified stent grafts (PMSGs) for vascular procedures involving the aorta. Methods: A systematic search was conducted in July 2024 across Embase, Ovid Medline, and Web of Science using PRISMA guidelines. Keywords included “aorta”, “3-dimensional printing”, and “implant”. Only studies reporting use of 3D printing-assisted PMSGs in aortic disease repair, …

The Role Of Micrornas In Cellular Senescence, Inflammation, And Cancer Induced By Childhood Obesity, Sarah S. Siddiqi

Honors Undergraduate Theses

Childhood obesity has escalated into a major public health crisis with serious implications for long-term health. As obesity rates among children continue to rise globally, it is crucial to understand its effects on cellular aging and inflammation—key processes that underpin many metabolic diseases. Obesity not only directly contributes to various metabolic disorders but also disrupts fundamental cellular mechanisms, accelerating aging and fostering systemic inflammation. By examining the impact of obesity on cellular aging and chronic inflammation, as well as the regulatory role of microRNAs (miRNAs) in these pathways, we have been able to identify critical biomarkers and molecular mechanisms involved …

Using Noninvasive Calibrated Cuff Plethysmography To Observe The Effects Of Cold-Water Immersion On Arterial Compliance, Rita M. Grigorian

Master's Theses

As the prevalence of cardiovascular diseases continues to exponentially grow in populations across the globe, the necessity of determining underlying factors, effective methods of diagnoses, and universally available preventive measures also grows. Early detection of endothelial dysfunction, a proven precursor of cardiovascular diseases, can be extremely impactful in encouraging preventative measures and early intervention before medical conditions become chronic. In recent years, ice plunging, a form of cryotherapy involving full body immersion in cold water, has gained popularity within circles of fitness and health practitioners, gaining the interest of people of all backgrounds. Certain parallels observed between the human physiological …

Sars-Cov-2 Infection Triggers Pro-Atherogenic Inflammatory Responses In Human Coronary Vessels, Natalia Eberhardt, Maria Gabriela Noval, Ravneet Kaur, Letizia Amadori, Michael Gildea, Swathy Sajja, Dayasagar Das, Burak Cilhoroz, O'Jay Stewart, Dawn M Fernandez, Roza Shamailova, Andrea Vasquez Guillen, Sonia Jangra, Michael Schotsaert, Jonathan D Newman, Peter Faries, Thomas Maldonado, Caron Rockman, Amy Rapkiewicz, Kenneth A Stapleford, Navneet Narula, Kathryn J Moore, Chiara Giannarelli

Faculty, Staff and Student Publications

Patients with coronavirus disease 2019 (COVID-19) present increased risk for ischemic cardiovascular complications up to 1 year after infection. Although the systemic inflammatory response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely contributes to this increased cardiovascular risk, whether SARS-CoV-2 directly infects the coronary vasculature and attendant atherosclerotic plaques remains unknown. Here we report that SARS-CoV-2 viral RNA is detectable and replicates in coronary lesions taken at autopsy from severe COVID-19 cases. SARS-CoV-2 targeted plaque macrophages and exhibited a stronger tropism for arterial lesions than adjacent perivascular fat, correlating with macrophage infiltration levels. SARS-CoV-2 entry was increased in …

Mavs Signaling Is Required For Preventing Persistent Chikungunya Heart Infection And Chronic Vascular Tissue Inflammation, Maria G Noval, Sophie N Spector, Eric Bartnicki, Franco Izzo, Navneet Narula, Stephen T Yeung, Payal Damani-Yokota, M Zahidunnabi Dewan, Valeria Mezzano, Bruno A Rodriguez-Rodriguez, Cynthia Loomis, Kamal M Khanna, Kenneth A Stapleford

Faculty, Staff and Student Publications

Chikungunya virus (CHIKV) infection has been associated with severe cardiac manifestations, yet, how CHIKV infection leads to heart disease remains unknown. Here, we leveraged both mouse models and human primary cardiac cells to define the mechanisms of CHIKV heart infection. Using an immunocompetent mouse model of CHIKV infection as well as human primary cardiac cells, we demonstrate that CHIKV directly infects and actively replicates in cardiac fibroblasts. In immunocompetent mice, CHIKV is cleared from cardiac tissue without significant damage through the induction of a local type I interferon response from both infected and non-infected cardiac cells. Using mice deficient in …

Genome-Wide Association Study Of Thoracic Aortic Aneurysm And Dissection In The Million Veteran Program, Derek Klarin, Poornima Devineni, Anoop K Sendamarai, Anthony R Angueira, Sarah E Graham, Ying H Shen, Michael G Levin, James P Pirruccello, Ida Surakka, Purushotham R Karnam, Tanmoy Roychowdhury, Yanming Li, Minxian Wang, Krishna G Aragam, Kaavya Paruchuri, Verena Zuber, Gabrielle E Shakt, Noah L Tsao, Renae L Judy, Ha My T Vy, Shefali S Verma, Daniel J Rader, Ron Do, Joseph E Bavaria, Girish N Nadkarni, Marylyn D Ritchie, Stephen Burgess, Dong-Chuan Guo, Patrick T Ellinor, Scott A Lemaire, Dianna M Milewicz, Cristen J Willer, Pradeep Natarajan, Philip S Tsao, Saiju Pyarajan, Scott M Damrauer

Faculty, Staff and Student Publications

The current understanding of the genetic determinants of thoracic aortic aneurysms and dissections (TAAD) has largely been informed through studies of rare, Mendelian forms of disease. Here, we conducted a genome-wide association study (GWAS) of TAAD, testing ~25 million DNA sequence variants in 8,626 participants with and 453,043 participants without TAAD in the Million Veteran Program, with replication in an independent sample of 4,459 individuals with and 512,463 without TAAD from six cohorts. We identified 21 TAAD risk loci, 17 of which have not been previously reported. We leverage multiple downstream analytic methods to identify causal TAAD risk genes and …

The Correlation Between Neonatal Intensive Care Unit Safety Culture And Quality Of Care, Karan Sud, Navneet Narula, Elena Aikawa, Eloisa Arbustini, Philippe Pibarot, Giampaolo Merlini, Robert S Rosenson, Surya V Seshan, Edgar Argulian, Amir Ahmadi, Fang Zhou, Andre L Moreira, Nancy Côté, Sotirios Tsimikas, Valentin Fuster, Sam Gandy, Robert O Bonow, Olga Gursky, Jagat Narula

Faculty, Staff and Student Publications

Calcific aortic valve disease (CAVD) and stenosis have a complex pathogenesis, and no therapies are available that can halt or slow their progression. Several studies have shown the presence of apolipoprotein-related amyloid deposits in close proximity to calcified areas in diseased aortic valves. In this Perspective, we explore a possible relationship between amyloid deposits, calcification and the development of aortic valve stenosis. These amyloid deposits might contribute to the amplification of the inflammatory cycle in the aortic valve, including extracellular matrix remodelling and myofibroblast and osteoblast-like cell proliferation. Further investigation in this area is needed to characterize the amyloid deposits …

Perioperative Risks Of The Patient With Heart Failure, Gabrielle Metoyer

Nursing Student Class Projects (Formerly MSN)

Perioperative Risks of the Patient with Heart Failure

Gabrielle Metoyer

Department of Nursing, Otterbein University

NURS 6810 – Advanced Pathophysiology

Dr. Deanna Batross and Dr. Shivani Bhatnagar

August 5, 2022

Abstract

According to the CDC (2020), heart failure occurs when the heart cannot pump enough blood and oxygen to support other organs in your body. Heart failure is an epidemic disease affecting 1-2% of the population worldwide (Schwinger, 2020). It is one of the leading causes of morbidity and mortality worldwide with an estimated 6.5 million adults with heart failure in the United States (Lo et al., 2021). Medical advances …

Clinicopathological Correlations In Heart Transplantation Recipients Complicated By Death Or Re-Transplantation, Michelle M Mcdonald, Maks Mihalj, Bihong Zhao, Sriram Nathan, Stanislava Matejin, Giulia Ottaviani, Mateja K Jezovnik, Rajko Radovancevic, Biswajit Kar, Igor D Gregoric, L Maximilian Buja

Faculty, Staff and Student Publications

PURPOSE: This study aimed to identify and correlate pathological findings with clinical outcomes in patients after orthotopic heart transplantation (OHT) who either died or underwent a re-transplantation.

METHODOLOGY AND STUDY DESIGN: Single-center retrospective analysis of primary OHT patients who died or were re-transplanted between October 2012 and July 2021. Clinical data were matched with corresponding pathological findings from endomyocardial biopsies on antibody-mediated rejection, cellular rejection, and cardiac allograft vasculopathy. Re-assessment of available tissue samples was performed to investigate acute myocardial injury (AMI) as a distinct phenomenon. These were correlated with clinical outcomes, which included severe primary graft dysfunction. Patients were …

Evaluation Of Contemporary Echocardiographic And Histomorphology Parameters In Predicting Mortality In Patients With Endomyocardial Biopsy-Proven Cardiac Al Amyloidosis, Efstratios Koutroumpakis, Adam Niku, Christopher K Black, Abdelrahman Ali, Humaira Sadaf, Juhee Song, Nicolas Palaskas, Cezar Iliescu, Jean-Bernard Durand, Syed Wamique Yusuf, Hans C Lee, L Maximilian Buja, Anita Deswal, Jose Banchs

Faculty, Staff and Student Publications

INTRODUCTION: This study examined the role of echocardiographic and cardiac histomorphology parameters in predicting mortality in patients with cardiac AL amyloidosis.

METHODS: Patients with endomyocardial biopsy-proven cardiac AL amyloidosis treated at MD Anderson Cancer Center between 6/2011 and 6/2020 were identified. Stored echocardiographic images and endomyocardial biopsy samples were processed for myocardial strain analysis and a detailed histomorphology characterization.

RESULTS: Of 43 patients; 44% were women and 63% white. Median age was 65 years; 51% underwent stem cell transplantation (SCT). Thirty patients (70%) died during follow up (median follow up: 4.1 years). Lower LA strain (

CONCLUSION: Lower LA strain …

Routine Screening For Abdominal Aortic Aneurysm: Is It For Everyone?, Catherine E. Nowak

Physician Assistant Capstones, 2016 to 2019

Objective: Determine whether routine abdominal ultrasound screening in all men ages 65 and over, not just those who are symptomatic or at risk, would be beneficial in reducing the mortality rate from abdominal aortic aneurysms (AAA). Design: Systematic literature review. Methods: The clinical question investigated is whether routine ultrasound screening of AAA for men over age 65 reduces AAA-related mortality as compared to not routinely screening. Searches were done through PubMed using the keywords: screening, abdominal aortic aneurysm, reduce, and mortality. Citations used by the USPSTF AAA screening guidelines were also added to the literature search. In PubMed, further limitations …

Non-Valvular Atrial Fibrillation And Stroke: Novel Oral Anticoagulants Versus Vitamin K Antagonists, Kathryn A. Viglietta

Nursing Student Class Projects (Formerly MSN)

Atrial fibrillation (afib) is the most common sustained cardiac arrhythmia and second most common cardiovascular condition in adults in the United States (Zarraga & Kron, 2012). •2.2 million affected, increases risk of stroke 4 to 6 times (National Institute of Neurological Disorders and Stroke [NINDS], 2015). •Vitamin K antagonists (VKAs) have been mainstay of therapy for over 60 years (King, Holley& Moores, 2013). •Limitations with VKAs such as variability in response, need for frequent lab draws, food and drug interactions which decrease patients adherence and under prescribing by physicians (Halperin & Goyette, 2012). •Novel oral anticoagulants (NOACs) have been approved …

Thrombotic Thrombocytopenia Purpura, Ann Oliva

Nursing Student Class Projects (Formerly MSN)

Patients with Thrombotic Thrombocytopenia Purpura, or TTP, are often times seen in the emergency department and subsequently admitted to the inpatient or the critical care unit. The problems that TTP patients can present with vary greatly and astute nursing assessment plus knowledge of the pathophysiology behind the diagnosis is vital to deliver excellent nursing care. Thrombotic Thrombocytopenia Purpura or TTP is a rare but potentially fatal condition that occurs as result of decreased levels of ADAMTS-13, a cleaving protease for von Willebrand factor (vWF), which causes platelet aggregation and microvascular thrombi and subsequent end-organ damage, along with thrombocytopenia, hemolytic anemia, …

Gout As A Significant Risk Factor For Cardiovascular Disease: A Case Study, Emily Leonhard

Nursing Student Class Projects (Formerly MSN)

Gout, an inflammatory arthritis caused by elevated serum uric acid levels, is emerging as a significant risk factor for cardiovascular disease (CVD). Recently, a nurse practitioner (NP) was caring for a patient who was suffering from a particularly severe gout attack while being treated in the ICU for new onset Atrial Fibrillation. The patient reported that he had never had an attack this severe before. He asked the NP if his history of gout could be related to his recent heart problems. The nurse practitioner, in order to answer the patient’s question, spent time researching the disease process of gout, …

Deep Venous Thrombosis In Surgical Orthopedic Patients, Kelly Marsh

Nursing Student Class Projects (Formerly MSN)

•The term venous thromboembolism (VTE) is defined as a syndrome that collectively comprises both deep vein thrombosis (DVT) and pulmonary embolism (PE). Each year approximately 350,000-900,000 people in the United States develop VTE and approximately 100,000 people die according to this cause (Streiff et al., 2014). Unfortunately, the reoccurrence rate for VTE remains very high, with an estimated risk of 10%-30% of VTE patients will develop another VTE within five years of the first incident (Streiff et al., 2014). •Deep vein thrombosis (DVT) is blood clot that forms in a large vein, usually in areas of slow blood flow such …

Effects Of Enhanced External Counter Pulsation Therapy On Patients With Angina, Valerie Jones

Nursing Student Class Projects (Formerly MSN)

According to the literature, coronary heart disease (CHD) is responsible for 370,000 deaths annually in the United States (Centers for Disease Control and Prevention [CDC], 2015). A symptom commonly associated with CHD is angina (US Department of Health & Human Services, National Institute of Health, National Heart, Lung, and Blood Institute [NIH], 2011). An estimated 300,000 to 900,000 patients in the United States have refractory angina pectoris (RAP), with nearly 100,00 new cases diagnosed yearly (Manchanda, Aggarwal, Aggarwal, & Soran, 2011). Kones describes refractory angina as continued angina class III/IV, in the nonsurgical candidate, with objective evidence of ischemia despite …

The Pathology Of Heart Failure, Kevin Ahman

Nursing Student Class Projects (Formerly MSN)

The topic I have chosen to research is heart failure. I have chosen this topic because I have treated many patients in the ICU with this condition, and find it an interesting pathology. Heart failure affects a significant portion of the patient population, and the rates are increasing. 5.1 million Americans ≥20 years of age have heart failure, projections show that by 2030, the prevalence of HF will increase 25% from 2013 estimates. At 40 years of age, the lifetime risk of developing HF for both men and women is 1 in 5. At 80 years of age, remaining lifetime …

Takotsubo Cardiomyopathy, Angela J. Occidental

Nursing Student Class Projects (Formerly MSN)

Takotsubo cardiomyopathy is a rare, reversible form of cardiomyopathy. First cases of takotsubo cardiomyopathy were described in Japan, twenty years ago (Milinis, & Fisher, 2012). takotsubo cardiomyopathy is a transient left ventricular dysfunction, typically triggered by severe emotional or physical distress. Left ventricular ballooning is characteristic of Takotsubo syndrome. Images of this ballooning resemble a takotsubo vessel used in Japan for collecting octopus, thus the reason for the syndrome name (Pelliccia, et. al, 2014). In recent years, this cardiomyopathy has been described as “Broken heart syndrome” because severe emotional stress has been implicated as the cause of this cardiomyopathy in …

Cardiac Tamponade, Ashley Miner

Nursing Student Class Projects (Formerly MSN)

The topic the author chose to research is cardiac tamponade. Cardiac tamponade occurs when fluid builds up in the pericardial cavity, which is the cavity that surrounds the heart. Cardiac tamponade can occur due to various reasons, including myocardial infarctions, pericarditis, traumas, and placement of pacer wires. Palpitations, chest pain, and shortness of breath are common symptoms that occur with cardiac tamponade. Pericardiocentesis and a pericardial window are two interventions that are commonly used to treat cardiac tamponade. Cardiac tamponade is a medical emergency and without any intervention, may lead to cardiac arrest and possible death. The author chose cardiac …

Abdominal Aortic Aneurysm: A Silent Killer, Kristen Springer

Nursing Student Class Projects (Formerly MSN)

Rupture of an abdominal aortic aneurysm (AAA) is a significant cause of mortality in the United States. “Often asymptomatic, AAA is considered a silent killer because it frequently remains undiagnosed until the time of rupture or the patient’s death” (Gordon & Toursarkinssian, p. 242). As healthcare professionals, being aware of the pathophysiology, risk factors and symptoms influencing this disease is important in aiding early diagnosis and treatment, helping to reduce complications and mortality rates of those affected.

Accurate Intervention In Visceral Aneurysms, Megan Hoying

Nursing Student Class Projects (Formerly MSN)

A 30 year old male presented to the ED with a one week history of fever, abdominal pain, and poor PO intake due to nausea and emesis. He was given a GI cocktail and sent home for a presumed diagnosis of gastritis. After having persistent pain the patient returned to the ER the following day and was admitted for further testing. The patient died 3 days later. This is an interesting case presentation, and was in no way straightforward.

Hypertrophic Obstructive Cardiomyopathy, Tiffany Branson

Nursing Student Class Projects (Formerly MSN)

Hypertrophic obstructive cardiomyopathy or HOCM, is a genetic disease that is described as hypertrophy or enlargement of the left ventricle which obstructs the blood flow to the body (Yue-Cheng et al., 2012). HOCM is a disease that cannot be cure, but can be treated. One of the main goals of treatment is to focus on treating the symptoms. HOCM can be asymptomatic or symptomatic and can cause some major complications. Some of the complications of HOCM are arrhythmias and sudden cardiac death, “which is defined as natural death to due cardiac causes, heralded by abrupt loss of consciousness within one …

Dvt And Economy Class Syndrome, Troy Perkins

Nursing Student Class Projects (Formerly MSN)

Traveling long distances can be very stressful on the body. Deep vein thrombosis (DVT) has often been linked to long air flights or long distance travel in a vehicle. DVT is a blood clot usually formed in the legs. Economy Class Syndrome (ECS) has been referred to as the formation of a DVT occurring during (or just after) a long airplane flight, especially in economy class where there is the least space allotted per passenger and one’s legs especially tend to be immobilized for lack of leg room (MedicineNet, 2012). Developing a DVT can lead to other life-threatening illnesses such …

Therapeutic Hypothermia Following Cardiac Arrest, Cassandra Patrick

Nursing Student Class Projects (Formerly MSN)

According to the Sudden Cardiac Arrest Foundation (2014), each year, 424,000 people in the U.S. (more than 1,000/day) experience EMS-assessed out-of-hospital non-traumatic sudden cardiac arrest. This is roughly equivalent to the number of people who die from Alzheimers’ disease, assault with firearms, breast cancer, cervical cancer, colorectal cancer, diabetes, HIV, house fires, motor vehicle accidents, prostate cancer and suicides combined (Sudden Cardiac Arrest Foundation, 2014). It is estimated that the likelihood of surviving an out-of-hospital cardiac arrest (OHCA) to hospital discharge can be as low as 6% to 8% (Williams, Calder, Cocchi & Donnino, 2013). Additionally an estimated 200,000 hospitalized …

Takotsubo Cardiomyopathy, Kari Patterson

Nursing Student Class Projects (Formerly MSN)

Term Takotsubo was introduced in 1991 to describe the shape of the left ventricle during an episode of cardiomyopathy. Takotsubo is a Japanese term for a narrow-necked fishing pot used to catch octopus. The left ventricle assumes the shape of the octopus pot during Takotsubo cardiomyopathy. Takotsubo cardiomyopathy is commonly known as Broken Heart Syndrome due to its association with an emotional stressor. Mimics acute coronary syndrome without coronary artery blockage/stenosis. Affects more women than men. Occurs mainly in postmenopausal women (women over the age of 50) Believe a hormonal effect on catecholamine release plays a role.

Cardiomems Heart Failure System: Keeping Patients Out Of The Hospital, Michelle Leyland

Nursing Student Class Projects (Formerly MSN)

It is well known that heart disease is the leading cause of death in the United States, with about 670,000 new diagnoses of congestive heart failure (CHF) each year (Suh et al., 2011). CHF results from a number of different causes, produces many different symptoms and occurs when the heart muscle cannot efficiently pump blood to the rest of the body (Suh et al., 2011). In the United States, heart failure (HF) and associated hospitalizations are leading contributors to high health care costs (Feltner et al., 2014). Up to one fourth of patients hospitalized with HF are readmitted within 30 …

Spontaneous Coronary Artery Dissection Among Women, Stacy Hudepohl

Nursing Student Class Projects (Formerly MSN)

It has been noted that women often place their own health care on the bottom of their priority lists. Many times, they ignore simple pain and dismiss symptoms that may be troubling to health care providers. Health care providers especially to young women may dismiss complaints of chest pain as heartburn or anxiety. Changes seen in pregnancy and with menses can mimic some of these same complaints. As both an female professional in health care and as a patient it is very easy to get busy with the day and not recognize simple signs and symptoms that may lead to …

Diagnosis, Pathophysiology, And Clinical Treatment Of A Patient With A Pheochromocytoma, Tricia L. Hale

Nursing Student Class Projects (Formerly MSN)

Hypertension is an extremely common diagnosis today. This condition can be caused by a multitude of factors, and can inversely cause numerous unfavorable processes in the body. One rare but significant source of hypertension is a tumor known as a pheochromocytoma, or PCC. This usually benign tumor is most often located on an adrenal gland, and can have a grave impact on the cardiovascular system. The tumor intermittently secretes an excess of the catecholamine norepinephrine, and if large enough, also secretes epinephrine [9]. These episodic bursts can cause extreme hypertension and tachycardia, leading to, at times fatal results. By understanding …