Medical Specialties Commons^™

Altered Mental Status And Hyponatremia After 20 Hours Of Amiodarone Therapy, Andrea Qi, John C Moscona, Justin Reed, Thierry H Le Jemtel

The Texas Heart Institute Journal

A 66-year-old woman with no relevant medical history presented at the emergency department with new-onset atrial fibrillation. We initiated intravenous amiodarone therapy. At 20 hours, the patient experienced severe neurologic symptoms, hyponatremia, and syndrome of inappropriate antidiuretic hormone. We discontinued amiodarone, infused saline solution, and restricted the patient's fluid intake. She recovered in 3 days. This case illustrates that amiodarone-induced syndrome of inappropriate antidiuretic hormone with hyponatremia can occur far earlier than expected during acute amiodarone therapy.

Cardiac Involvement By Burkitt Lymphoma In A 49-Year-Old Man, Kainat Khalid, Nadeen Faza, Nasser M Lakkis, Rashed Tabbaa

The Texas Heart Institute Journal

Malignant metastases are among the most common cardiac masses. We report a rare case of cardiac involvement by Burkitt lymphoma in a 49-year-old man who presented with a 2-month history of dyspnea and palpitations. A transthoracic echocardiogram revealed 2 intracardiac masses in the right atrium (one of which partially encased the tricuspid valve), myocardial infiltration, and pericardial disease. Results of pleural fluid cytology and flow cytometry confirmed involvement by Burkitt lymphoma. Subsequent chemotherapy markedly reduced the intracardiac tumor burden and resolved the patient's presenting symptoms. Our case highlights the importance of cardiac imaging in diagnosing systemic illness, initiating early and …

Optimizing P2 Neochordal Length And Stability In Mitral Valve Repair With Use Of A Polypropylene Loop, Anil Ozen, Ertekin Utku Unal, Hamdi Mehmet Ozbek, Gorkem Yigit, Hakki Zafer Iscan

The Texas Heart Institute Journal

Determining the optimal length of artificial chordae tendineae and then effectively securing them is a major challenge in mitral valve repair. Our technique for measuring and stabilizing neochordae involves tying a polypropylene suture loop onto the annuloplasty ring. We used this method in 4 patients who had moderate-to-severe mitral regurgitation from degenerative posterior leaflet (P2) prolapse and flail chordae. Results of intraoperative saline tests and postoperative transesophageal echocardiography revealed only mild insufficiency. One month postoperatively, echocardiograms showed trivial regurgitation in all 4 patients. We think that this simple, precise method for adjusting and stabilizing artificial chordae will be advantageous in …

Brain Abscess And The Nonfenestrated Fontan Circulation, Bethany Runkel, William B. Drake, Geetha Raghuveer

Manuscripts, Articles, Book Chapters and Other Papers

Brain abscess is a rare but life-threatening condition. Intracardiac or extracardiac right-to-left shunting in patients with unrepaired cyanotic congenital heart disease, pulmonary arteriovenous malformations, or venovenous collaterals allows microbes unfiltered access to the brain. Brain abscess must be considered when cyanotic patients present with headache.

Impact Of Cardiopulmonary Resuscitation On Survival In Cancer Patients: Do Not Resuscitate Before Or After Cpr?, Dana E Giza, Jordan Graham, Teodora Donisan, Dinu V Balanescu, John Crommet, Gregory Botz, Cristina Gutierrez, Mariberta Vidal, Rodrigo Mejia, Cezar Iliescu

Faculty, Staff and Student Publications

No abstract provided.

As The Covid-19 Pandemic Drags On, Where Have All The Stemis Gone?, Waqas Ullah, Yasar Sattar, Rehan Saeed, Asrar Ahmad, Margot I. Boigon, Donald C. Haas, M. Chadi Alraies

Abington Jefferson Health Papers

In the midst of current pandemic individuals with all sorts of medical ailments are afraid to venture into health-care settings and risk contracting Coronavirus disease 2019 (COVID-19). Irrespective of the inherent thromboembolic risks associated with COVID-19, this puts patients at high risk of cardiac complications

Multivessel Coronary Artery Fistula Presenting As Coronary Steal Syndrome Leading To Cardiac Arrest, Muhammad F Ahmed, Anaam Mubin, Rumman Syed, Abdullah K Mahmood, Sonu Sahni

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

The coronary steal phenomenon refers to myocardial ischemia caused by the diversion of blood away from normal myocardial circulation. A coronary artery fistula (CAF) is an abnormality of the coronary anatomy characterized by the aberrant termination of a coronary artery or its branches into cardiac chambers or great vessels. Although CAFs are often thought to be asymptomatic, fistulas that diverge a significant amount of blood flow and decrease the normal perfusion of myocardial tissue can cause ischemia and can present with acute coronary syndrome. We describe a unique case of a 70-year-old woman with no coronary artery disease (CAD) undergoing …

Post-Operative Atrial Fibrillation And Anticoagulation, J. Vojnika, Md, P. Varano, Md, S. Melnick, Do, Matthew Metzinger, Mba, Cphq, K. Patel, Rn, Msn, Mba, Cphq

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Overall aim: Improve recognition of need for anticoagulation in post-operative atrial fibrillation.

• Increase recognition that thromboembolic risk in post-op atrial fibrillation is similar to that of non-valvular atrial fibrillation
• Increase the rate of appropriate anticoagulation initiation in patients with post-op atrial fibrillation

Identifying Women With Coronary Artery Disease Using Non-Cardiac Ct Imaging, Rachel Redfield, Md, Rani Rajaram, Md, Kathryn Anderson, Ba, Sarah Kamel, Md, Matthew Metzinger, Mba, Lydia Liao, Md, Katherine Sherif, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims

• Identify the percentage of female patients with prior CT scans done for noncardiac reasons who should have the diagnosis of CAD.
• Collaborate with primary care, cardiology and breast imaging to determine how best to integrate this incidental finding into clinical practice.
• Determine current barriers that may prevent providers from taking action on patients with new CAD.

Detection Of Coronary Artery Disease On Ct Chest Imaging, K. Mirzozoda, Md, Mba, J. Vojnika, Md, R. Mohammed, Md, H. Landon, Md, C. Murphy, Y. Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Overall aim: Improve diagnosis and management of CAD based on CT chest imaging.

• Improve diagnosis of silent CAD based on CT chest imaging: more patients who have findings of CAC on CT chest imaging will be diagnosed with CAD.
• Increase the number of appropriate statin prescriptions based on CAD findings on CT chest imaging.

A Novel 3d Model To Learn Coronary Angiography, N. Haroian, S. Chandragiri, M. Ho, M. Fields, D. Fischman, M. Savage, N. Ruggiero, A. Vishnevsky

Health Equity and Quality Improvement (HEQI) Summit

The limitations of 2D imaging creates challenges for cardiology fellows learning the basics of coronary angiography.

Using a 3D model to simulate a coronary angiogram outside the cath lab could shorten the learning cure and improve understanding of this essential procedure.

Time To Defibrillation After Onset Of Ventricular Fibrillation And Ventricular Tachycardia Cardiac Arrest At Thomas Jefferson University Hospital And Jefferson Hospital For Neurosciences., Sairamya Bodempudi, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Improve average time to defibrillation after VFib/pVTach cardiac arrest to < 2 minutes within an 8 month interval at TJUH and JHN.
• Improve the percent of VFib/pVTach cardiac arrests that are defibrillated within the recommended 2 minute interval by 30% at TJUH/JHN within an 8 month interval

Sglt2 Inhibitors In Patients With Diabetes And Cardiovascular Disease, Cristina Calogero, Md, Jillian Cooper, Md, Mathew Francis, Md, Joseph Grogg, Md, Shuwen Lin, Md, Patrick Prior, Md, Bo Hyung Yoon, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition: Multiple studies (e.g. EMPA-REG, CANVAS) demonstrate that SGLT2 Inhibitors (Inh) improve cardiac outcomes in patients with Type II Diabetes (DM2) with comorbid Cardiovascular Disease (CVD) including Heart Failure and Coronary Artery Disease. SGLT2 Inhibitors are considered standard of care for patients with DM2 and CVD. Based on literature published in European Journal of Preventative Cardiology and JACC HF, our prediction is that physicians at Thomas Jefferson University Hospital Ambulatory Practices (TJUH) under-utilize SGLT2 Inh for patients with co-morbid CVD and DM2.

Aims for Improvement: Within the Jefferson Healthcare System, we sought to determine: Future Interventions

1. The percentage of …

Use Of Epic Emr For Early Identification And Management Of Patients At Risk Of Cardiac Implantable Electronic Device (Cied) Infection, Priya Rajagopalan, Md, Yair Lev, Md, Arnold J. Greenspon, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Aim of our project was early identification of 100% of patients with a CIED IMPLANT presenting with bacteremia
• Process involves use of EPIC EMR to automatically identify patients with positive blood cultures
• Traditionally, cardiologists are alerted by the care team using the CONSULT system for management of these patients
• EPIC EMR as an adjunct to the CONSULT system

Improving Evaluation And Follow-Up Of Patients Diagnosed With Left Bundle Branch Block, Naman Upadhyay, Md, Alvin George, Md, John Schanz, Ms, Behzad Pavri, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Left bundle branch block (LBBB) is a pathologic finding on electrocardiogram (ECG).

• Most commonly present in patients with antecedent hypertension, cardiac enlargement, coronary artery disease or a combination of these
• Class 1B recommendation: Those with findings of LBBB on ECG should undergo transthoracic echocardiography for evaluation of underlying heart disease
• LBBB is prevalent (33%) in patients with heart failure
• Cardiac resynchronization therapy can improve left ventricular mechanical function in patients with LBBB (QRS >150 msec)

This study aims to understand how effectively we are evaluating and following up these patients at Thomas Jefferson University Hospital.

The Echo Of An Unanswered Ring: Improving The Rate Of Reporting Abnormal Findings On Echocardiography At Tjuh, Tanuka Datta, Md, Bharaniabirami Rajaram, Md, Alvin George, Md, Madeleine Norris, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aim: To improve the rate of reporting abnormal echo findings verbally to primary patient care teams.

Goal: Increase the rate of attending reported abnormal echo findings to a patient's primary team by 75% in 6 months.

Does Discharge Pharmacy Affect Outcomes After Percutaneous Coronary Intervention?, Patrick Prior, Md, Lisa Moss, Abhinav Nair, Md, Preya Simlote, Md, David Fischman, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

To reduce the rate of this institution’s readmission rate in patients discharged after PCI, by identifying the current trends in readmission in relation to prescription and medication delivery practices over the past 1 year.

Detection Of Coronary Artery Disease On Ct Chest Imaging, K. Mirzozoda, Md, Mba, J. Vojnika, Md, R. Mohammed, Md, H. Landon, Md, C. Murphy, Md, Y. Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Overall aim: Improve diagnosis and management of CAD based on CT chest imaging.

• Improve diagnosis of silent CAD based on CT chest imaging: more patients who have findings of CAC on CT chest imaging will be diagnosed with CAD.
• Increase the number of appropriate statin prescriptions based on CAD findings on CT chest imaging.

Effectiveness And Safety Of Oral Anticoagulants Among Nvaf Patients With Obesity: Insights From The Aristophanes Study, Steve Deitelzweig, Allison Keshishian, Amiee Kang, Amol Dhamane, Xuemei Luo, Xiaoyan Li, Neeraja Balachander, Lisa Rosenblatt, Jack Mardekian, Xianying Pan, Manuela Di Fusco, Alessandra B. Garcia Reeves, Huseyin Yuce, Gregory Y. H. Lip

Publications and Research

This ARISTOPHANES analysis examined stroke/systemic embolism (SE) and major bleeding (MB) among a subgroup of nonvalvular atrial fibrillation (NVAF) patients with obesity prescribed warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) in order to inform clinical decision making. A retrospective observational study was conducted among NVAF patients who were obese and initiated apixaban, dabigatran, rivaroxaban, or warfarin from 1 January 2013–30 September 2015, with data pooled from CMS Medicare and four US commercial claims databases. Propensity score matching was completed between NOACs and against warfarin in each database, and the results were pooled. Cox models were used to evaluate the …

A Rare Case Report And Literature Review Of Anabolic-Androgenic Steroids (Aas)-Induced Acute Myocardial Infarction, Qian Zhang, Khine S. Shan, Ahmad Raza, Neelima Manda, Travis Nace

Abington Jefferson Health Papers

Anabolic-androgenic steroids (AAS) are synthetic drugs manufactured to mimic the male sex hormone testosterone [1]. They are usually prescribed for medical conditions including but not limited to impotence in males, endometriosis, hypogonadism, and aplastic anemia [2]. It has also been used historically by athletes and bodybuilders to enhance performance as it can stimulate protein synthesis leading to an increase in muscle size and strength [3]. However, the use of AAS has become a serious global public health dilemma as it has been used widely by the general population to improve physical strength and appearance [1]. In …

Outcomes Of Open Mitral Valve Replacement Versus Transcatheter Mitral Valve Repair; Insight From The National Inpatient Sample Database., Waqas Ullah, Yasar Sattar, Maryam Mukhtar, Hafez M. Abdullah, Vincent M. Figueredo, Donald C. Haas, David L. Fischman, M. Chadi Alraies

Abington Jefferson Health Papers

Background: Transcatheter mitral valve repair and replacement (TMVR) is a minimally invasive alternative to conventional open-heart mitral valve replacement (OMVR). The present study aims to compare the burden, demographics, cost, and complications of TMVR and OMVR.

Methods: The United States National Inpatient Sample (US-NIS) for the year 2017 was queried to identify all cases of TMVR and OMVR. Categorical and continuous data were analyzed using Pearson chi-square and independent t-test analysis, respectively. An adjusted odds ratio (aOR) based on the ordinal logistic regression (OLR) model was calculated to determine the association between outcome variables.

Results: Of 19,580 patients, 18,460 …

Paraneoplastic Pemphigus: An Indication For Treatment In Chronic Lymphocytic Leukemia, Ifeanyichukwu Onukogu, Preethi Ramachandran, Joshua Narh, Sonu Sahni, Gardith Joseph

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

Paraneoplastic disorders are rare multiorgan diseases associated with hematological malignancies such as chronic lymphocytic leukemia (CLL). Some of these paraneoplasms manifest as cutaneous lesions, appearing as a simple rash, ulcers or skin thickening. The pathogenesis for this process has been described as development of certain autoimmune reactions against cell wall antigens and proteins. An example is paraneoplastic pemphigus (PNP) which manifests as cutaneous bullae. Bullae may occur anytime during the course of the malignancy i.e. acute phase or remission. Diagnosis involves evaluation of clinical findings, serology and presence of characteristic histological findings. Its pathogenesis is described as development of auto-antibodies …

Nanoparticle-Mediated Drug Delivery For The Treatment Of Cardiovascular Diseases, Rajasekharreddy Pala, Vt Anju, Madhu Dyavaiah, Siddhardha Busi, Surya M. Nauli

Pharmacy Faculty Articles and Research

Cardiovascular diseases (CVDs) are one of the foremost causes of high morbidity and mortality globally. Preventive, diagnostic, and treatment measures available for CVDs are not very useful, which demands promising alternative methods. Nanoscience and nanotechnology open a new window in the area of CVDs with an opportunity to achieve effective treatment, better prognosis, and less adverse effects on non-target tissues. The application of nanoparticles and nanocarriers in the area of cardiology has gathered much attention due to the properties such as passive and active targeting to the cardiac tissues, improved target specificity, and sensitivity. It has reported that more than …

Longitudinal Evaluation Of The Effects Of Illness Perceptions And Beliefs About Cardiac Rehabilitation On Quality Of Life Of Patients With Coronary Artery Disease And Their Caregivers, Patricia Thomson, Neil J. Angus, Federico Andreis, Gordon F. Rushworth, Andrea R. Mohan, Misook L. Chung, Stephen J. Leslie

Nursing Faculty Publications

Background

Patients’ negative illness perceptions and beliefs about cardiac rehabilitation (CR) can influence uptake and adherence to CR. Little is known about the interpartner influence of these antecedent variables on quality of life of patients with coronary artery disease (CAD) and their family caregivers. The aims of the study were: 1) to assess differences in illness perceptions, beliefs about CR and quality of life between patients with CAD and their family caregivers upon entry to a CR programme and at 6 months follow-up; and 2) to examine whether patients’ and caregivers’ perceptions of the patient’s illness and beliefs about CR …

Progress In The Seasonal Variations Of Blood Lipids: A Mini-Review., Xiaochun Ma, Haichen Yan, Haizhou Zhang, Mansen Wang, Qunye Zhang, Xiaoming Zhou

Articles, Abstracts, and Reports

The seasonal variations of blood lipids have recently gained increasing interest in this field of lipid metabolism. Elucidating the seasonal patterns of blood lipids is particularly helpful for the prevention and treatment of cardiovascular and cerebrovascular diseases. However, the previous results remain controversial and the underlying mechanisms are still unclear. This mini-review is focused on summarizing the literature relevant to the seasonal variability of blood lipid parameters, as well as on discussing its significance in clinical diagnoses and management decisions.

Regulation Of Myofilament Contractile Function In Human Donor And Failing Hearts, Kerry S. Mcdonald, Laurin M. Hanft, Joel C. Robinett, Maya Guglin, Kenneth S. Campbell

Internal Medicine Faculty Publications

Heart failure (HF) often includes changes in myocardial contractile function. This study addressed the myofibrillar basis for contractile dysfunction in failing human myocardium. Regulation of contractile properties was measured in cardiac myocyte preparations isolated from frozen, left ventricular mid-wall biopsies of donor (n = 7) and failing human hearts (n = 8). Permeabilized cardiac myocyte preparations were attached between a force transducer and a position motor, and both the Ca²⁺ dependence and sarcomere length (SL) dependence of force, rate of force, loaded shortening, and power output were measured at 15 ± 1°C. The myocyte preparation size was …

Cardiac Screening To Mitigate The Risk Of Sudden Cardiac Death In Middle Eastern And African Competitive Athletes. A Systematic Review, Yusuf Hallak, Umberto Battistin, Ahmad Mustafa Al-Masaeed

Journal of the Saudi Heart Association

Objective: The study aims to review the literature regarding abnormalities predisposing to Sudden Cardiac Death (SCD) in young Middle Eastern and African competitive athletes between the years 2009e2019 and aims to assess cardiac pre-participation screening methods.

Methods: A PubMed search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search targeted articles that reported the prevalence of cardiac abnormalities found in Middle Eastern and African athletes, and it also focused on comparing cardiac screening methods for assessment of athletes. Results: our studies fell within the inclusion criteria and were included in the …

The Carpentier-Edwards Classic And Physio Annuloplasty Rings In Repair Of Degenerative Mitral Valve Disease: A Retrospective Study, Abubakari I. Sidiki Md, Alexandr G. Faybushevich Md, Phd, Alexandr N. Lishchuk Md, Phd, Alexandr N. Koltunov Md, Phd, Ekaterina A. Roshchina, Jonas Atulebire Akambase

Journal of the Saudi Heart Association

Objectives. Physio ring (SR) is considered an improved version of the Classic rigid ring (RR). Today, SR is more widely used in mitral valve (MV) repair. We sought to compare the long-term outcomes of repair with RR and SR in degenerative mitral valve disease.

Methods. In a computerized registry of our institution, 306 patients had MV repair with either RR (139 patients) or SR (167 patients) ring between 2005 and 2015. Fifteen of them had concomitant tricuspid valve repair. Ninety-two (30.1%) had Barlow’s disease and 214 (69.9%) had fibroelastic deficiency. The patients had similar demographic and echocardiographic characteristics. …

Tricuspid Valve Regurgitation After Heart Transplantation: A Single-Center 10-Year Experience, Khaled D. Algarni, Amr A. Arafat, Claudio Pragliola, Yahya S. Alhebaishi, Latifa A. Alfayez, Khaled Alotaibi, Abeer M. Bakhsh, Ahmed A. Amro, Adam I. Adam

Journal of the Saudi Heart Association

Background: Tricuspid valve regurgitation may affect the outcomes after heart transplantation. There is a paucity of data reporting the outcomes of heart transplants in our region. The objectives of this study were to report the occurrence of tricuspid regurgitation after heart transplantation, its course, and its effect on survival.

Methods: From 2009 to 2019, 30 patients had heart transplantation at our cardiac center. Their age was 36.73± 13.5 years, and 25 (83.33%) were males. Indications for transplantation were dilated cardiomyopathy (n= 21; 72.41%), ischemic cardiomyopathy (n= 8; 26.67%) and hypertrophic cardiomyopathy (n=1; 3.45%). Cardiopulmonary bypass time was 157.24± 34.6 minutes, …

The Trans-Septal Approach In Transcatheter Mitral Valve-In-Valve Implantation For Degenerative Bioprosthesis, Mohammed Al Otaiby, Turki A. Al Garni, Abdullah Alkhushail, Abdulrahman Almoghairi, Sondos Samargandy, Monirah Albabtain, Amr A. Arafat, Hussein Alamri

Journal of the Saudi Heart Association

Background: Transcatheter Mitral Valve-in-Valve Implantation (TMViVI) has recently emerged as a novel therapy for degenerated mitral valve bioprosthesis. Re-operative mitral valve surgery is associated with a substantial risk of mortality and morbidity. The objective of this study was to describe the outcomes of transcatheter mitral valve-in-valve implantations in our cardiac center.

Methods: Twenty-two patients underwent the valve-in-valve procedure because of bioprosthesis degeneration from March 2017 to October 2018. Clinical, echocardiographic, procedural details and survival at follow up were assessed.

Results: Eight patients refused re-operative cardiac surgery while others were deemed a high risk for conventional re-operative sternotomy. All patients had …