Medical Specialties Commons^™

Rates Of Ondansetron Administration Prior To Spinal Anesthesia: Evaluating The Practice Of Prophylactic Attenuation Of Spinal-Induced Hypotension And Bradycardia, Clare Santana, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Hypotension and bradycardia are common complications of spinal anesthesia. Intraoperative hypotension and bradycardia may lead to complications that require additional treatment and increase cost. The literature identifies intervention strategies to attenuate spinalinduced hypotension (SIH) and bradycardia.1 Prophylactic administration of ondansetron, a serotonin 5-hydroxytryptamine receptor antagonist, prior to spinal anesthesia is associated with reduced SIH and bradycardia.1,2,3,4,6 The objective of this scholarly project was to report the practice of ondansetron prophylaxis for SIH and bradycardia and the rate of rescue interventions in patients who received ondansetron prior to spinal anesthesia.

Methods Retrospective, multi-center observational evidence-based practice project conducted at Providence …

Myocardial Infarction Can Be Safely Excluded By High-Sensitivity Troponin I Testing 3 Hours After Emergency Department Presentation., W Frank Peacock, Robert Christenson, Deborah B Diercks, Christian Fromm, Gary F Headden, Christopher J Hogan, Erik B Kulstad, Frank Lovecchio, Richard M Nowak, Jon W Schrock, Adam J Singer, Alan B Storrow, Joely Straseski, Alan H B Wu, Daniel P Zelinski

Heart and Vascular Articles

BACKGROUND: The accuracy and speed by which acute myocardial infarction (AMI) is excluded are an important determinant of emergency department (ED) length of stay and resource utilization. While high-sensitivity troponin I (hsTnI) >99th percentile (upper reference level [URL]) represents a "rule-in" cutpoint, our purpose was to evaluate the ability of the Beckman Coulter hsTnI assay, using various level-of-quantification (LoQ) cutpoints, to rule out AMI within 3 hours of ED presentation in suspected acute coronary syndrome (ACS) patients.

METHODS: This multicenter evaluation enrolled adults with >5 minutes of ACS symptoms and an electrocardiogram obtained per standard care. Exclusions were ST-segment elevation …

Platypnea-Orthodeoxia Syndrome Caused By An Intracardiac Shunt, Sanket P Borgaonkar, Wilson W Lam, Mehdi Razavi, Dhaval R Parekh

Faculty, Staff and Students Publications

Platypnea-orthodeoxia syndrome, a rare condition characterized by posture-related dyspnea, is usually caused by an intracardiac shunt, hepatopulmonary syndrome, or shunting resulting from severe pulmonary disease. We report the case of a 33-year-old woman who presented with increasing dyspnea and oxygen desaturation when she sat up or arose. Our diagnosis was platypnea-orthodeoxia syndrome. A lead of a previously implanted pacemaker exacerbated a severe tricuspid regurgitant jet that was directed toward the patient's intra-atrial septum. Percutaneous closure of a small secundum atrial septal defect eliminated right-to-left shunting and substantially improved the patient's functional status. In addition to this case, we discuss this …

Infective Endocarditis Caused By Klebsiella Oxytoca In A Patient With Hemodialysis: A Care-Compliant Case Report And Review Of The Literature, Hanane Aissaoui, Youssef Hdidou, Ramia Bougrine, Nabila Ismaili, Noha Elouafi

Journal of the Saudi Heart Association

The rarity of endocarditis due to Klebsiella species limits its recognition. We report the case of a 63-year-old man, known to have a tight calcified aortic stenosis presenting with acute heart failure associated with high fever. Klebsiella oxytoca endocarditis was diagnosed based on three sets of positive blood cultures together with fluttering vegetation (11 mm x 14 mm) on the middle segment of the anterior leaflet of the mitral valve. After 6 weeks of intravenous ceftriaxone and gentamicin bi-therapy, the patient had completely recovered. This case illustrates how sporadic this condition is, for which early assessment and proper treatment are …

Bad Heart Luck: Myocardial Infarction Related To Iatrogenic Coronary Cameral Fistula In A Heart Transplant Patient, Badre El Boussaadani, Zakaria Raiss, Amine Qat, Pascal Goube

Journal of the Saudi Heart Association

Endomyocardial biopsy (EMB) remains the gold standard method for diagnosis of cardiac allograft rejection. Complications following EMB rarely occur, however, it can lead to coronary cameral fistulae (CCF). We describe the case of a 65-year-old patient admitted for lateral STEMI related to a fistula communicating the distal part of the left anterior descending artery (LAD) with the right ventricle after EMB biopsy, which was incompletely closed with a covered stent.

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Assessment Of Left Ventricular Mechanics In Patients With Severe Aortic Stenosis After Transcatheter Aortic Valve Implantation: 2-D Speckle Tracking Imaging Study, Hesham A. Naeim, Reda Abuelatta, Faisal O. Alatawi, Lamiaa Khedr

Journal of the Saudi Heart Association

Background: Chronic pressure overload secondary to severe aortic stenosis causes impairment of left ventricular myocardial deformation and associated with adverse outcome. The present study aimed to assess the response of myocardial mechanics after transcatheter aortic valve implantation (TAVI).

Methods: Assessment of myocardial mechanics by quantification of LV longitudinal, circumferential strain and rotational deformation (apical, basal rotation and twist) by 2-D Speckle-tracking echocardiography at baseline and at midterm follow-up post-TAVI. The patients were divided into 2 groups based on baseline left ventricular ejection fraction. 46 patients had preserved LV EF ≥50% preserved ejection fraction (PEF) and 34 patients had reduced left …

Impact Of Ramadan Fasting On Biochemical And Exercise Parameters Among Patients Undergoing Exercise-Based Cardiac Rehabilitation, Hazem Khorshid, Adel Shabana, Osama Rifaie, Yasser Abdellatif

Journal of the Saudi Heart Association

Background: Ramadan fasting is an important worship activity for Muslims. It is not known if fasting could have deleterious effect on cardiac patients joining cardiac rehabilitation (CR) program, especially during summer season.

Aim: To assess the effect of Ramadan fasting on biochemical and exercise parameters among patients undergoing 12- week exercise-based CR program. Patients and methods: 53 patients joining CR program in university hospital were included in the study. The patients were divided into two groups according to their Ramadan fasting status. Fasting group included 32 patients, while nonfasting group included 21 patients. All patients underwent supervised exercise-based CR during …

Percutaneous Coronary Interventions In Chronic Total Occlusion - Profile, Technique And Outcome -The Malabar Experience, Desabandhu Vinayakumar, Madhusudan Pramod Raikar, Kurukkanparampil Sreedharan Mohanan

Journal of the Saudi Heart Association

Introduction: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) remains a challenge. The reasons being that these procedures may be lengthy and complex, with elevated radiation exposure, increased contrast load, lower procedural success rate, and a higher risk of complication when compared with non-CTO elective PCI. Clarifying the long-term clinical outcomes of CTO-PCI is very important to justify potential investments in training and technology. However, there is a paucity of data from Indian subcontinent. Hence we decided to report the outcomes from a real-life cohort of consecutive patients undergoing elective PCI for CTO at our institution.

Materials and methods: …

Characterizing Recurrence Following Hybrid Ablation In Patients With Persistent Atrial Fibrillation, David C. Kress, Lynn Erickson, Tadele W. Mengesha, David Krum, Jasbir Sra

Journal of Patient-Centered Research and Reviews

Purpose: It is It is widely accepted that atrial fibrillation (AF) accounts for half of arrhythmia recurrences following endocardial catheter ablation of AF. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study is aimed at characterizing recurrence following hybrid ablation for patients with persistent AF.

Methods: Patients with persistent AF (N = 108) received both endocardial and epicardial ablation of the posterior left atrial wall using catheter ablation and a small midline surgical approach (hybrid). Presence of …

Efficacy Of Manual Hemostasis For Percutaneous Axillary Artery Intra-Aortic Balloon Pump Removal, Rajiv Tayal, Michael Divita, Christoph W. Sossou, Alexis K. Okoh, Kelly Stelling, James M. Mccabe, Amir Kaki, Najam Wasty, David A. Baran

School of Medicine Faculty Research

Background. The prevalence of peripheral vascular disease has led to the re-emergence of percutaneous axillary vascular access as a suitable alternative access site to femoral artery. We sought to investigate the efficacy and safety of manual hemostasis in the axillary artery. Methods. Data were collected from a prospective internal registry of patients who had a Maquet® (Rastatt, Germany) Mega 50 cc intra-aortic balloon pumps (IABP) placed in the axillary artery position. They were anticoagulated with weight-based intravenous heparin to maintain an activated partial thromboplastin time (aPTT) of 50-80 seconds. Anticoagulation was discontinued 2 hours prior to the device explantation. Manual …

Percutaneous Intervention Or Bypass Graft For Left Main Coronary Artery Disease? A Systematic Review And Meta-Analysis, Waqas Ullah, Yasar Sattar, Irfan Ullah, Ammu Susheela, Maryam Mukhtar, M Chadi Alraies, Mamas A Mamas, D L Fischman

Abington Jefferson Health Papers

Background: The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial.

Methods: Digital databases were searched to compare the major adverse cardiovascular and cerebrovascular events (MACCE) and its components. A random effect model was used to compute an unadjusted odds ratio (OR).

Results: A total of 43 studies (37 observational and 6 RCTs) consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were identified. The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42-0.76;

Conclusion: PCI might offer early safety advantages, while CABG provides greater …

Coronary Artery Ectasia With Acute Myocardial Infarction, A Case Report, Maysan Mohammed Almegbel, Fawaz Qabel Almutairi

Journal of the Saudi Heart Association

Coronary artery ectasia (CAE), also known as aneurysmal coronary artery disease, is defined as an abnormal diffuse (ectasia) or segmental (aneurysmal) dilatation of any branch of the coronary arteries. It is a well-recognized entity with 1.2-4.9% prevalence. Our case is a 46year old male with no prior medical problem who presented to the ER with inferior ST elevation myocardial infarction (STEMI). The Coronary angiogram revealed multiple ectatic segments in the right coronary artery (RCA) with 100% stenosis in the middle segment. Upon wiring the RCA a big clot burden was noted on the ectatic segment. We planned to keep him …

Post Myocardial Infarction Papillary Muscle Rupture In The Context Of Coronavirus Disease-2019 Pandemic, Nooraldaem Yousif, Vinayak Vadgaonkar, Helen Saunders, Mohammad Amin, Habib Tareif, Fuad Abdulqader

Journal of the Saudi Heart Association

Papillary muscle rupture is a very rare but often catastrophic complication of acute myocardial infarction. In this case we are sharing our experience in the context of the current COVID-19 pandemic, which rendered the management extremely challenging.

Giant Ascending Aortic Aneurysm With Painless Dissection In A Patient With Marfan Syndrome, Khaled D. Algarni, Amr A. Arafat, Adam I. Adam, Claudio Pragliola

Journal of the Saudi Heart Association

A female patient aged 17 years old presented with dyspnea grade III with no chest pain. The patient has Marfan Syndrome, and there was a history of mitral valve repair six years ago. Echocardiography showed an ejection fraction of 55%, severe aortic regurgitation, dilatation of the ascending aorta, and moderate tricuspid regurgitation. CT scan showed an ascending aortic aneurysm (92 mm in its maximum diameter) with dissection flap (Figure 1A and B). We performed a Bentall operation with an axillary cannulation (Figure 1C). The postoperative course was complicated with bleeding requiring re-exploration, and the patient was discharged with stable hemodynamics …

The Echocardiography Society Of Saudi Heart Association Recommendation On Quality And Laboratory Accreditation Guideline And Standards, Abdulhalim Jamal Kinsara, Sami Ghazal, Ahmad S. Omran, Esra Aleid

Journal of the Saudi Heart Association

Objective: To create the Saudi Arabian Society of Echocardiography Accreditation Commission Guidelines and Standards.

Method: A review of available the North American and European accreditation guidelines was conducted and a model, locally appropriate for Saudi echocardiography laboratories and applicable in the current settings, was developed.

Results: The document specifies the organizational setting as well as the following categories of personnel: medical director, technical director, medical staff, and technical staff. The guideline team also examined aspects related to the facility and the facility safety policies and protocols. Examination and procedural issues for Adult transthoracic echocardiography including instrumentation, archiving media, examination interpretation …

Atrial High-Rate Episodes, Subclinical Atrial Fibrillation And Short-Duration Clinical Atrial Fibrillation: Different Names For The Same Arrhythmia Or A New Player On The Pitch?, Juan Benezet-Mazuecos, Alvaro Lozano Rosado, Julian Crosa, Jose Antonio Iglesias

Journal of the Saudi Heart Association

No abstract provided.

Infected Coronary Artery Aneurysm - A Rare But Fatal Complication Of Percutaneous Coronary Intervention, Ajit Pal Singh, Harnoor Singh Pruthi

Journal of the Saudi Heart Association

A 43 year old male underwent successful Percutaneous Coronary Intervention (PCI) to LCX. 3 months after the procedure, he presented with NYHA class III-IV angina associated with low grade fever and reduced appetite. Biochemical parameters including complete blood count and renal function tests were normal. ECG showed ST segment depression in lateral leads. Echocardiography showed lateral wall hypokinesia with moderate Mitral valve regurgitation. Coronary angiogram revealed large mycotic aneurysms in LAD and LCX coronary arteries (Image 1). Blood culture showed growth of Pseudomonas aeruginosa. Infected coronary aneurysms are a rare and potentially fatal complication after drug eluting stent implantationand …

Disseminated Varicella-Zoster Virus Infection Complicated By Encephalitis And Ramsay Hunt Syndrome In An Hiv Patient, Amro Elshereye, Burak Erdinc, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Varicella-zoster virus (VZV) is a human α-herpesvirus which cause primary varicella infection (chicken pox) or herpes zoster infection (shingles) after reactivation of the dormant virus. VZV infection is usually self-limited but disseminated infection can be seen in immunocompromised individuals. It can also get complicated by central nervous system (CNS) involvement. We describe a case of a 51-year-old male with human immunodeficiency virus (HIV) who presented with altered mental status and deficits in his right-sided cranial nerves of VI, VII, and VIII. The patient also had disseminated vesicular-pustular rash all over his body at different stages of healing. A diagnosis of …

Wet Labs: A Useful Tool In Training Surgical Residents In A Third World Country, Hina Inam, Narmeen Asif, Abdul Ahad Sohail, Saulat Fatimi

Section of Cardiothoracic Surgery

•Wet labs are a useful, cost-effective and safe tool in teaching of Cardiothoracic Surgery residents.•In a third world country where advance real life simulators are not available.•It improves resident's tissue handling and surgical skills.•Allows faculty members to give continuous feedback to their residents.

A Rare Case Of Constrictive Pericarditis As Initial Manifestation Of Paediatric Anaplastic Large Cell Lymphoma Requiring Urgent Pericardiectomy, Sara Iqbal, Abdul Ahad Sohail, Narmeen Asif, Muhammad Rahil Khan, Sabeehuddin Siddique, Saulat Fatimi

Section of Cardiothoracic Surgery

Constrictive pericarditis (CP) is a rare end stage inflammatory disorder affecting both parietal and visceral pericardium leading to a right heart failure. Malignancy is the least common cause of CP. Anaplastic large cell lymphoma (ALCL) accounts for 10-15% of all Non-Hodgkin lymphomas in children. Very few case reports have reported ALCL that is involving the heart and only two have been published involving pericardium but all were managed medically. We present an interesting case of an 11 year old child who presented with an effusive CP that required urgent Pericardiectomy for managing right heart failure. His histopathology was positive for …

Perioperative Management Of Pheochromocytoma Resection In A Patient With A Continuous Flow Left Ventricular Assist Device, Arif Albulushi Md, Ronald Zolty Md Phd, Brian Lowes Md, Phd, Amy L. Duhacheck-Stapleman Md, Tal Sandler Md, James N. Sullivan Md, Douglas Stoller Md Phd

Journal of the Saudi Heart Association

Current generation LVADs provide continuous blood flow which has been shown to increase sympathetic tone. Pheochromocytoma is a rare neuroendocrine tumor which classically presents with episodic hypertension, palpitations and headaches. Careful perioperative management with alpha blockade is required to prevent cardiovascular complications, specifically hypertensive crisis. Here we present a description of perioperative management of pheochromocytoma in a patient with a continuous flow LVAD. Traditional assessment of sympathetic tone is challenging in LVAD patients due to the presence of continuous circulatory flow. Invasive management via an arterial line was useful in perioperative management, allowing for accurate circulatory monitoring and hemodynamic control. …

Association Of Cardiovascular Risk Factor Profile And Financial Hardship From Medical Bills Among Non-Elderly Adults In The United States, Gowtham R. Grandhi, Javier Valero-Elizondo, Reed Mszar Reed Mszar, Eric J. Brandt, Amarnath Annapureddy, Rohan Khera, Anshul Saxena, Salim S. Virani, Ron Blankstein, Nihar R. Desai

Office of the Provost

Background: While optimal cardiovascular risk factor (CRF) profile is associated with lower mortality, morbidity, and healthcare expenditures among individuals with atherosclerotic cardiovascular disease (ASCVD), less is known regarding its impact on financial hardship from medical bills. Therefore, we assessed whether an optimal CRF profile is associated with a lower burden of financial hardship from medical bills and a reduction in cost-related barriers to health.
Methods: We used a nationally representative sample of adults between 18 and 64 years from the National Health Interview Survey between 2013 and 2017. We assessed ASCVD status and the number of risk factors to categorize …

Fatal Heart Failure Induced By Pazopanib In A Sarcoma Patient Previously Treated With Gemcitabine, Daniela Di Lisi, Girolamo Manno, Clarissa Filorizzo, Tommaso Guarino, Giulia Santanelli, Monica Lunetta, Giuseppe Badalamenti, Antonio Russo, Giuseppina Novo

Journal of the Saudi Heart Association

Gemcitabine is commonly used for various solid organ malignancies with rarely reported cardiac side effects such as cardiomyopathy. Pazopanib usually can cause arterial hypertension but cases of heart failure have recently been reported. We describe a case of fatal heart failure after treatment with gemcitabine and pazopanib in a 55-year-old female with sarcoma. Patient developed left ventricular dysfunction after gemcitabine treatment and acute heart failure after 22 days of pazopanib treatment which led to death. Physicians should be aware of the cardiotoxicity risk when managing the use of pazopanib especially in patients previously treated with other cardiotoxic drugs.

Anomalous Drainage Of Persistent Left Superior Vena Cava To The Left Atrium: Case Series And Literature Review, Mustafa Abdulwahab, Abdulhameed Ali Alnajja, Ali Edris Jelly, Aitizaz Eldien Syed, Mohamed Mofeed Fawaz Morsy, Mansour Bader Al-Mutairi, Alassal Ahmad Alkodami

Journal of the Saudi Heart Association

Persistent left superior vena cava (PLSVC) draining into the coronary sinus is not uncommon, but to the left atrium is a rare condition. Such anomaly may be a cause of unexplained hypoxia in all age groups. It is often diagnosed accidentally during cardiovascular diagnostic work-up or in a contest of other cardiac investigations. We report two cases of these rare PLSVC associations with subsequent medical and surgical management.

Endocrine Significance Of Sars-Cov-2'S Reliance On Ace2, Eric Lazartigues, Mirza Muhammad Fahd Qadir, Franck Mauvais-Jarvis

School of Medicine Faculty Publications

The current COVID-19 pandemic is the most disruptive event in the past 50 years, with a global impact on health care and world economies. It is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a coronavirus that uses angiotensin-converting enzyme 2 (ACE2) as an entry point to the cells. ACE2 is a transmembrane carboxypeptidase and member of the renin-angiotensin system. This mini-review summarizes the main findings regarding ACE2 expression and function in endocrine tissues. We discuss rapidly evolving knowledge on the potential role of ACE2 and SARS coronaviruses in endocrinology and the development of diabetes mellitus, hypogonadism, and pituitary and …

Catastrophic Cardiac Complications Of Takayasu's Arteritis., Sara Godil Md, Bilal Saqi Md, Kareem Godil Md, Syed Rafay Ali Sabzwari, Yasotha Rajeswaran Md

Department of Medicine

Takayasu's arteritis (TA) causes inflammation and necrosis of vessel walls, leading to aneurysm formation, extensive coronary damage and valvular abnormalities. We review a case of recurrent coronary, aortic and mitral valve involvement in a patient with TA and discuss the various treatment options available for such patients.

Acute Effusive Pericarditis: A Late Complication Of Covid-19., Kelli Fox, Jessica A Prokup, Kyle Butson, Kim Jordan

Heart and Vascular Articles

As the COVID-19 pandemic evolves, the medical community continues to discover novel clinical manifestations of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Often, extrapulmonary manifestations occur simultaneously with pulmonary disease. However, there is a paucity of literature describing the cardiac manifestations of COVID-19 in the absence of pulmonary findings. We report a rare case of acute pericarditis presenting with pericardial effusion and cardiac tamponade in a 43-year-old man diagnosed with COVID-19. This case emphasizes the importance of continued investigation regarding diagnosis and treatment of COVID-19 and its related symptoms.

A Counterpoint Paper: Comments On The Electrocardiographic Part Of The 2018 Fourth Universal Definition Of Myocardial Infarction Endorsed By The International Society Of Electrocardiology And The International Society For Holter And Noninvasive Electrocardiology, Yochai Birnbaum, Miguel Fiol, Kjell Nikus, Javier Garcia Niebla, Ljuba Bacharova, Sergio Dubner, Wojciech Zareba, Peter W Macfarlane, Antonio Luiz Ribeiro, Iwona Cygankiewicz, Antoni Bayes De Luna

Faculty, Staff and Students Publications

The Fourth Universal Definition of Myocardial Infarction (FUDMI) focuses on the distinction between nonischemic myocardial injury and myocardial infarction (MI), along with the role of cardiovascular magnetic resonance, in order to define the etiology of myocardial injury. As a consequence, there is less emphasis on updating the parts of the definition concerning the electrocardiographic (ECG) changes related to MI. Evidence of myocardial ischemia is a prerequisite for the diagnosis of MI, and the ECG is the main available tool for (a) detecting acute ischemia, (b) triage, and (c) risk stratification upon presentation. This review focuses on multiple aspects of ECG …

Cardiac Surgery During The Coronavirus Disease 2019 Pandemic: Perioperative Considerations And Triage Recommendations, Vivek Patel, Ernesto Jimenez, Lorraine Cornwell, Trung Tran, David Paniagua, Ali E Denktas, Andrew Chou, Samuel J Hankins, Biykem Bozkurt, Todd K Rosengart, Hani Jneid

Faculty, Staff and Students Publications

The coronavirus disease 2019 pandemic, caused by severe acute respiratory syndrome coronavirus-2, represents the third human affliction attributed to the highly pathogenic coronavirus in the current century. Because of its highly contagious nature and unprecedented global spread, its aggressive clinical presentation, and the lack of effective treatment, severe acute respiratory syndrome coronavirus-2 infection is causing the loss of thousands of lives and imparting unparalleled strain on healthcare systems around the world. In the current report, we discuss perioperative considerations for patients undergoing cardiac surgery and provide clinicians with recommendations to effectively triage and plan these procedures during the coronavirus disease …

A Complication Of Acute Myocardial Infarction, Nakeya Dewaswala, Robert Dean Chait

HCA Healthcare Journal of Medicine

Ventricular septal rupture (VSR) is a rare complication after acute myocardial infarction (MI). The case presents an apical four chamber echocardiogram showing mid-septal discontinuity with lateral to medial movement of the transected ventricular septum during systole and diastole. Color Doppler demonstrates flow across the septum with extensive anatomic destruction of the ventricular septum.