Medical Specialties Commons^™

Evolving De Winter Presentation Of Acute Myocardial Infarction, Caroline Shepherd, Anthony Furiato

West Florida Division GME Research Day 2020

de Winter ECG pattern first detailed in 2008 in a case series Diagnostic criteria

• Tall, prominent, symmetric T waves in the precordial leads
• Upsloping ST segment depression >1mm at the J-point in the precordial leads
• Absence of ST elevation in the precordial leads
• ST segment elevation (0.5mm-1mm) in aVR

Strongly correlated with acute LAD occlusion

Progressive Collateral Stenosis Leading To Symptomatic Chronic Total Occlusion, Farhan Shah, Andrew Maiolo

Capital Division GME Virtual Research Day 2020

Chronic total occlusion is defined as the complete obstruction of a coronary artery, with TIMI 0 or TIMI 1 flow, and an occlusion duration of greater than 3 months. We present a case of symptomatic chronic total occlusion in a functional 79 year old female with no past history of coronary artery disease, previously asymptomatic due to robust collateral circulation.

Adoption Of A Strategy Of Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Is Associated With Fewer Neurologic Events In A Large Volume Center, Ec Korngold, Eb Kirker, Robert W. Hodson, Ruyun Jin, Kateri Spinelli, Shih-Ting Chiu, S Verburg, V Kumar, Bm Jones

Articles, Abstracts, and Reports

No abstract provided.

Pharmacological Prevention Of Atrial Fibrillation After Cardiac Surgery With And Without The Use Of Nonsteroidal Anti-Inflammatory Drugs, Laura Neubauer, Radhan Gopalani, Faaria Quadri, Mario Pascual, Heidi Clarke, Andrea Marr-Peralto

All Publications

Purpose: Atrial fibrillation after cardiac surgery (AFACS) is the most common complication following open heart procedures, with significantly increased morbidity and mortality associated with its occurrence¹. A previous study done at Baptist Hospital of Miami (BHM) showed a decrease in the incidence of AFACS from 36% to 22% after implementation of a prevention protocol that includes guideline-directed therapy with a beta-blocker and amiodarone. The protocol also includes nonsteroidal anti-inflammatory drugs (NSAIDs) modeled after a study published in 2004 that showed that NSAIDs lowered the incidence of postoperative atrial fibrillation by 65% when they were used in the postoperative …

Investigating Medical Examiners' Practices: Genetic Evaluation For Fatal Acute Aortic Dissection, Bradley Power

Dissertations and Theses (Open Access)

Acute thoracic aortic dissection (TAD) is a life-threatening event with a hereditary component. Currently, pathogenic variants in 11 genes associated with aortic aneurysm and dissection predispose to a heritable form of disease thereby conferring an increased risk for TAD. Genetic testing plays a pivotal role not only in diagnosis, but also in risk stratification for relatives and medical management to prevent premature death from dissection. Due to its high fatality rate, medical examiners and coroners (ME/Cs) may be the first to identify TAD cases and initiate genetic testing for the decedent and at-risk relatives. ME/Cs were surveyed using three clinical …

Dietary Fat And Sugar Differentially Affect Β-Adrenergic Stimulation Of Cardiac Erk And Akt Pathways In C57bl/6 Male Mice Subjected To High-Calorie Feeding, Sadia Ashraf, Gizem Yilmaz, Xu Chen, Romain Harmancey

Faculty, Staff and Student Publications

BACKGROUND: High dietary fat and sugar promote cardiac hypertrophy independently from an increase in blood pressure. The respective contribution that each macronutrient exerts on cardiac growth signaling pathways remains unclear.

OBJECTIVE: The goal of this study was to investigate the mechanisms by which high amounts of dietary fat and sugar affect cardiac growth regulatory pathways.

METHODS: Male C57BL/6 mice (9 wk old; n = 20/group) were fed a standard rodent diet (STD; kcal% protein-fat-carbohydrate, 29-17-54), a high-fat diet (HFD; 20-60-20), a high-fat and high-sugar Western diet (WD; 20-45-35), a high-sugar diet with mixed carbohydrates (HCD; 20-10-70), or a high-sucrose diet …

Network Meta-Analysis To Compare Venaseal With Other Superficial Venous Therapies For Chronic Venous Insufficiency., Raghu Kolluri, Janice Chung, Sue Kim, Nibir Nath, Bhoomika Bajaj Bhalla, Tarun Jain, Joseph Zygmunt, Alun Davies

Heart and Vascular Articles

OBJECTIVE: Several randomized controlled trials (RCTs) have compared different interventions for chronic venous insufficiency (CVI) management, but mixed comparison of these interventions is lacking. The aim of this network meta-analysis was to compare VenaSeal closure system (Medtronic, Minneapolis, Minn) with endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemical ablation, sclerotherapy, and surgery for management of CVI to achieve anatomic success (complete closure of treated vein within 6 months after intervention) as the primary outcome and health-related quality of life (HRQoL; EuroQol-5 Dimension, Aberdeen Varicose Vein Questionnaire), Venous Clinical Severity Score (VCSS), pain scores, and adverse events as secondary outcomes.

METHODS: …

Successful Completion Of Pregnancy After Mustard Procedure For Transposition Of Great Arteries: A Rare Case From The Developing World, Muhammad Kamran Younis Memon, Ayesha Malik, Saleem Akhtar

Department of Paediatrics and Child Health

Surgical repair of transposition of great arteries has undergone various evolutionary changes over the years. The initial of these treatment options was atrial septectomy followed by atrial switch and the current preferred treatment option is arterial switch operation worldwide. Due to various reasons, like lack of medical and surgical expertise atrial switch operation was commonly in practice in developing countries until few years back. Pregnancy in a patient with history of atrial switch operation poses a unique haemodynamic challenge. We report the case of a successful pregnancy in a 26 years old lady who had undergone Mustard repair surgery in …

Prosthetic Valve Endocarditis From Trichosporon Asahii In An Immunocompetent Patient, Lizy Marial Paniagua, Deepthi Sudhakar, Lara Erika Perez, David Miranda, Pedro Urena, Igor Gregoric, Biswajit Kar, Hani Jneid, Jonalis Ramirez, David Paniagua

Faculty, Staff and Students Publications

Fungal endocarditis is a rare clinical entity. This report describes an unusual case of fungal endocarditis caused by infection with Trichosporon asahii in a 20-year-old immunocompetent man who received the diagnosis 1 year following biological aortic valve replacement. (Level of Difficulty: Beginner.)

Myocardial Work Index: A Novel Method For Assessment Of Myocardial Function In South Asian Recreational Athletes, Shantanu Sengupta, Renuka Jain, Nitin Burkule, Susan Olet, Bijoy K. Khandheria

Journal of Patient-Centered Research and Reviews

Purpose: We used a novel noninvasive method based on speckle-tracking echocardiography to evaluate myocardial performance in South Asian recreational athletes who completed a half marathon.

Methods: Transthoracic echocardiography was performed on 24 recreational athletes 48 hours before they took part in a half marathon (premarathon), within 2 hours of half marathon completion (postmarathon), and 72 hours after completion. Clinical, laboratory, and echocardiographic variables were collected. Speckle-tracking echocardiography was performed in all subjects to characterize myocardial mechanics.

Results: Mean age of participants was 41.8 ± 7.4 years, and 23 (95.8%) were male. No subject had a prior history of coronary artery …

Cardiovascular Recovery From Emotional Stress: An Operationalization Of Equanamity Following Mindfulness-Based Emotional Stress, Emma Mcbride

Theses and Dissertations

Theoretical models of mindfulness suggest that meditation may improve health, in part, by regulating stress physiology, including faster recovery of heart rate (HR) and blood pressure (SBP/DBP) after emotional stress. Furthermore, improved cardiovascular recovery (CR) may be a marker of equanimity, defined as increased acceptance of and reduced reactivity to stress. No studies have tested this hypothesis, partly because methodology for assessing CR remains controversial. Using a novel operationalization of equanimity and several methods of measuring CR, this project investigated whether (1) equanimity is associated with improved CR, (2) Mindfulness-Based Stress Reduction (MBSR) is associated with improved CR, and (3) …

Association Of Intensive Lifestyle Intervention, Fitness, And Body Mass Index With Risk Of Heart Failure In Overweight Or Obese Adults With Type 2 Diabetes Mellitus: An Analysis From The Look Ahead Trial, Ambarish Pandey, Kershaw V Patel, Judy L Bahnson, Sarah A Gaussoin, Corby K Martin, Ashok Balasubramanyam, Karen C Johnson, Darren K Mcguire, Alain G Bertoni, Dalane Kitzman, Jarett D Berry, Look Ahead Research Group

Faculty, Staff and Students Publications

BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with a higher risk for heart failure (HF). The impact of a lifestyle intervention and changes in cardiorespiratory fitness (CRF) and body mass index on risk for HF is not well established.

METHODS: Participants from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. Time-to-event analyses were used to compare the risk of incident HF between the intensive lifestyle intervention and diabetes support and education groups. The associations of baseline measures of CRF estimated from a maximal treadmill test, body mass index, and longitudinal changes in these …

Iatrogenic Pulmonary Artery Dissection In Patient With Ostium Secundum Interatrial Septum Defect, Daniela Di Lisi, Giovanni D. Aquaro, Francesca Macaione, Salvatore Novo, Giuseppina Novo

Journal of the Saudi Heart Association

Pulmonary artery dissection is a rare and lethal condition. Few cases are reported in the literature, and most are derived from autopsies. In most cases, pulmonary artery dissection is a complication of chronic pulmonary hypertension leading to pulmonary artery aneurysm but there are other causes. We describe a case of iatrogenic pulmonary artery dissection in an elderly patient with ostium secundum defect. In particular, we describe the role of cardiac magnetic resonance in making this diagnosis and guiding future therapeutic decisions.

Thrombus In Transit Through A Patent Foramen Ovale, An Unusual Cause Of Cardiac Embolism, Carlos Minguito-Carazo, Tomas Benito-Gonzalez, Julio C. Echarte-Morales, Miguel Rodríguez-Santamarta, Mario Castano-Ruiz, Felipe Fernandez-Vazquez

Journal of the Saudi Heart Association

A 78-year-old woman with a history of transient ischemic attack was admitted for sudden aphasia. In order to assess the potential cardioembolic source an echocardiogram was performed, which revealed a large mass consistent with a thrombus in transit through a patent foramen ovale. Because of the high risk of systemic embolism, emergent surgical thrombectomy was performed with the intention to discharge the patient safely without any new embolic events. This case report highlights the importance of echocardiography in the evaluation of cardioembolic stroke and the requirement of an emergent approach in case of impending paradoxical embolism.

Acute Pulmonary Embolism As An Initial Presentation Of Klinefelter Syndrome: A Case Report, Ghizlane El Ouazzani, Chaimae Toutai, Ikbal Alla, Nabila Ismaili, Noha El Ouafi

Journal of the Saudi Heart Association

Venous thromboembolism (VTE) includes deep vein thrombosis and its complications and pulmonary embolism. Cancer, surgery, prolonged immobilization, fractures, paralysis, use of oral contraceptives, and hereditary coagulopathies are classic risk factors for VTE. An increased incidence of VTE has been reported in patients with Klinefelter syndrome (KS), with a reported prevalence of 0.1e0.2% in the general population and up to 3.1% in infertile men. Despite the high rate of thromboembolic disease in patients with KS, the etiology of this phenomenon is not well understood, and most of our current knowledge is limited to small sample studies. We present the case of …

Left Ventricular Aneurysmectomy In A Young Female Of Unknown Etiology With Pseudoaneurysm: A Case Report, Tariq Ashraf, Rashid Aziz, Amin M. Khuwaja, Syed M. Afaque, Musa Karim

Journal of the Saudi Heart Association

A left ventricular pseudoaneurysm is formed when there is free wall rupture of the myocardial wall with discontinuity and roof covered by pericardium mural thrombus or fibrous tissue without any myocardium. A left ventricular pseudoaneurysm is a rare and life-threatening event. We report a young 22-year-old female with unknown etiology of a pseudoaneurysm, who was previously managed as a psychiatric case and for musculoskeletal pain. On subsequent investigation and confirmation with cardiac magnetic resonance imaging, aneurysmectomy was done. This is a rare case in a young 22-year-old woman with a ventricular pseudoaneurysm of unknown etiology. Considering the high risk for …

Perioperative Management Of Wilms’ Tumor With Intracardiac Extension: Report Of Two Cases With Review Of Literature, Hayan Altwaeel, Mohamed S. Kabbani, Ahmad Al Shammari, Mohammed Al- Namshan, Abdullah A. Alghamdi

Journal of the Saudi Heart Association

Wilms’ tumor (WT) is one of the solid tumor that affects children. It involves the kidney and may extend to the lungs and liver. WT conquers the adjacent blood vessels such as renal veins and inferior vena cava (IVC); its extension to IVC and right-sided heart chambers is unusual. Furthermore, when the tumor extends to heart chambers, its surgical management becomes challenging and demands multidisciplinary medical and surgical specialties including pediatric cardiac surgery. In this report, we discuss the surgical management and perioperative treatment of two unusual cases of WT with IVC and intracardiac extension.

Mitral Valve Replacement In Dilated Cardiomyopathy: A Valid Option?, Mohamed H. Mashali, Nashwa Badawi, Mohammed O. Galal

Journal of the Saudi Heart Association

Background: Dilated cardiomyopathy (DCM) is characterized by left ventricular dilation and dysfunction. The association with significant mitral regurgitation worsens the prognosis. Case report: A 2-year-old girl presented withDCMand severe mitral regurgitation. She had a history of viral myocarditis at the age of 4 months, necessitating recurrent hospital admissions for management of intractable heart failure, pneumonia, and failure to thrive. The decision was taken to proceed for mitral valve surgery, which ended with mitral valve replacement. Over 3 years of follow-up after surgery, there was significant improvement in her weight gain and she improved clinically. There were still recurrent admissions, but …

Cardiac Amyloidosis—An Underdiagnosed Cause Of Heart Failure In The Elderly, Tahir Nazir, Mahmud Nuffati

Journal of the Saudi Heart Association

Amyloidosis is a rare, generally multisystem disease that can also involve the heart. Infiltration of the myocardium with amyloid proteins is an important and underappreciated cause of heart failure with preserved ejection fraction in the elderly. We present the case of an 84-year-old man with chest tightness, dyspnoea, and ascites. He had a history of dyslipidaemia and ischaemic heart disease. Initial investigations showed severe diastolic dysfunction and elevated pulmonary artery systolic pressure on echocardiogram along with elevated serum natriuretic peptides. Further evaluation by a magnetic resonance imaging scan of the heart and endomyocardial biopsy confirmed the diagnosis of senile systemic …

Treatment Of Severe Mitral Regurgitation That Mimics A Para-Ring Mitral Regurgitation After Failed Annuloplasty Ring With Mitraclip: A Case Report, Hesham Abdo Naeim, Waleed Saeed, Abeer Mahmood, Lamiaa Khedr, Ramy Elrowiny, Reda Abuelatta

Journal of the Saudi Heart Association

Background: Progressive remodelling of the left ventricle with lateral and apical displacement of one or both papillary muscles can lead to recurrence of severe mitral regurgitation (MR) in the presence of the mitral valve (MV) ring. The MitraClip (Abbott, USA) is the only option in cases with annuloplasty rings too large for implantation of a Sapien prosthesis in high surgical-risk patients. We present a case where the MR jet was directed toward a para-ring hole, and the MitraClip system was used successfully to treat this severe MR. Case summary: An 80-year-old woman underwent coronary artery bypass surgery plus MV repair …

Impact Of Stent Of Ductus Arteriosus And Modified Blalock–Taussig Shunt On Pulmonary Arteries Growth And Second-Stage Surgery In Infants With Ductus-Dependent Pulmonary Circulation, Bana A. Nasser, Mesned Abdulrahman, Abdullah A.L Qwaee, Ali Alakfash, Tageldein Mohamad, Mohamed S. Kabbani

Journal of the Saudi Heart Association

Introduction: Ducts-dependent pulmonary circulation is spectrum of congenital heart diseases that need urgent intervention to augment pulmonary blood. Systemic to pulmonary shunt is the classical surgical management. Stenting of ductus arteriosus emerged in the last 2 decades as an alternative plausible intervention. Objectives: To evaluate and compare the short and midterm effects of PDA stenting in compared to surgically placed shunt for augmentation of pulmonary blood flow looking to pulmonary artery (PA) branches growth, oxygen saturation and suitability for second stage repair. Methods: We conducted this prospective study in Cardiac Surgical Intensive Care Unit . Cases were divided into “stent …

Preoperative Blood Urea Nitrogen-To-Left Ventricular Ejection Fraction Ratio Is An Independent Predictor Of Long-Term Major Adverse Cardiac Events In Patients Undergoing Coronary Artery Bypass Grafting Surgery, Turan Erdogan, Mustafa Çetin, Goksel Çinier, Savas Ozer, Ahmet S. Yõlmaz, Ozan Karakisi, Tuncay Kõrõs

Journal of the Saudi Heart Association

Background: Long-term mortality rate following coronary artery bypass grafting (CABG) procedure is still considered to be high despite advances in surgical techniques and perioperative management. Identifying high-risk patients by using cost-effective and clinically useful parameters is needed. Methods: Patients who were admitted to our cardiology clinic with the diagnosis of coronary artery disease and underwent CABG between January 2008 and August 2010 were included. Study patients were followed-up for 112.6 ± 17.8 months for major adverse cardiac events (MACE) which were defined as all-cause mortality and new-onset decompensated heart failure (HF). Results: Patients in MACE (þ) group were older ( …

Left And Right Ventricular Speckle Tracking Study Before And After Percutaneous Atrial Septal Defect Closure In Children, Hala M. Agha, Islam S. Mohammed, Hassan A. Hassan, Hassan S. Abu Seif, Ibrahim M. Abu Farag

Journal of the Saudi Heart Association

Objectives: To analyze the acute and short-term deformation changes of both right (RV) and left (LV) ventricular wall before and after transcatheter closure of atrial septal defect (ASD) secundum in children. Outcome measures: To determine the feasibility of tissue Doppler and myocardial deformation imaging for evaluating RV and LV functions in children undergoing transcatheter ASD closure. Patients and methods: A prospective study was performed for 32 children with hemodynamic significant ASD secundum before and 6 months after percutaneous ASD closure in the Pediatric Cardiology Division of Specialized Pediatric Hospital, Cairo University. Speckle tracking echocardiography (STE) of LV and RV global …

N-Terminal Pro-Brain Natriuretic Peptide As A Biomarker For Differentiating Cardiac And Pulmonary Disease In Term Neonates With Respiratory Distress, Azza M. Ahmed, Nagwa Abd El-Ghffar Mohamed, Enas M. Abdelhamid, Randa I. Taha, Maha M.A. Abo-Hashish

Journal of the Saudi Heart Association

Objective: Brain natriuretic peptide (BNP) is synthesized in the cardiac ventricles and released in response to volume or pressure load. The aim of the study was to determine whether plasma level of N-terminal pro BNP (NT-pro BNP) can distinguish between cardiac and pulmonary disease (PD) among neonates with respiratory distress (RD). Patients and methods: The study included 48 term neonates in the first month of life with signs of RD. They were recruited from Neonatal Intensive Care Unit of Al-Galaa Teaching Hospital. Twenty-six healthy neonates were included as a control group. The degree of RD was assessed using SilvermaneAnderson score. …

Systemic Immune-Inflammation Index Predicts Mortality In Infective Endocarditis, Hicaz Z. Agus, Serkan Kahraman, Cagdas Arslan, Ceren Yildirim, Mehmet Erturk, Ali K. Kalkan, Mustafa Yildiz

Journal of the Saudi Heart Association

Objectives: The aim of our study was to evaluate the usefulness of systemic immune-inflammation index (SII) at admission in predicting in-hospital mortality in patients with infective endocarditis. Methods: 133 definite IE patients (≥18 years) according to modified Duke criteria, treated in our tertiary care hospital between December 2009 and May 2019, were retrospectively analysed. Symptoms, comorbidities, predisposing valvular diseases, prosthetic valve, device, history of injectable drug use, blood culture results, echocardiography findings, and complications were collected. We calculated the SII as follows: SII¼platelet count£neutrophil count/lymphocyte count at admission. Results: The median age of the patients was 56 (40e66) years. Prosthetic …

Comparison Between Two Protocols For Deflation Of The Tr Band Following Coronary Procedures Via The Radial Route, Hassan Al Riyami, Adil Al Riyami, Sunil K. Nadar

Journal of the Saudi Heart Association

Aim: Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction. Methods: All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the …

The Use Of Antidepressants In Patients With Heart Failure, Norah Alsumih, Rahaf Alqahtani, Faisal Almutairi, Rakan Faraj, Turki Alsubeai, Ahmed Alghanim, Shmylan Alharbi, Hind Almodaimegh

Journal of the Saudi Heart Association

Background: Heart failure (HF) is a chronic disease affecting patients’ quality of life (QoL) and may cause depression. Recent studies reported that the prevalence of depression in patients with HF is 21.5%. Antidepressants, mainly selective serotonin reuptake inhibitors, are usually prescribed for HF patients diagnosed with depression. Some evidence supports antidepressant’s role in improving symptoms by enhancing the psychological aspect of their QoL. Depression screening and treatment are important in the multidisciplinary management; however, their survival benefits are inconsistent. In our study, we aim to investigate the prevalence of depression and the use of antidepressants in patients with HF as …

Effects Of Cardiopulmonary Bypass Perfusion Temperature On Perioperative Renal Function In Adult Patients Undergoing Cardiac Surgery, Jayavelan Ramkumar, Girish Gopinathan, Karthick Kavin, Ramkumar Shanmugasundaram, George M. Stephen, Annie C. Pragasam, Periyasamy Thangavel

Journal of the Saudi Heart Association

Aims and objective: The primary objective of this investigation was to study the effects of cardiopulmonary bypass (CPB) perfusion temperature on renal function parameters [serum creatinine, creatinine clearance, urine albumin, urine protein, and urine albumin/creatinine ratio (ACR)]. The secondary objective was to detect renal complications of CPB. Materials and methods: This is a prospective longitudinal study of 30 adult patients (17 men, 13 women; mean age, 53.37 ± 16.02 years) who underwent valvular heart surgery [with or without coronary artery bypass grafting (CABG)]. Serum creatinine, creatinine clearance, urine protein, urine albumin, and urine ACR were collected during CPB (at 28 …

Right Ventricular Functions In Subphenotypes Of Sickle Cell Disease, Ilham Youssry, Mohamed F. Shaltout, Antoine F. Abdelmassih, Carolyne Ghobrial, Mohammad Nabih, Ramy Doss, Raghda Fouda, Amal El-Sisi

Journal of the Saudi Heart Association

Objectives: Sickle cardiomyopathy is the most important cause of death in patients with sickle cell disease (SCD). Based on recent evidence, SCD can be divided into two subphenotypes, namely, the viscosity vaso-occlusion (VVO) subphenotype and the hemolysis endothelial dysfunction (HED) subphenotype. The aim of our series is to study right ventricular (RV) functions in both subphenotypes. Methods: Echocardiography including conventional and tissue Doppler imaging as well as speckle tracking echocardiography was performed in 50 patients (23 from the VVO subgroup and 27 from the HED subgroup) based on a serum lactate dehydrogenase (LDH) level below or above 270 U/L, respectively, …

Exercise-Based Cardiac Rehabilitation For Post Coronary Artery Bypass Grafting: Its Effect On Hemodynamics Response And Functional Capacity Using Incremental Shuttle Walking Test: A Retrospective Pilot Analysis, Ahmad Osailan, Walid K. Abdelbasset

Journal of the Saudi Heart Association

Background: Coronary artery bypass grafting (CABG) is a common surgical procedure for the restoration of blood flow into stenotic or blocked coronary arteries. Cardiac rehabilitation has been implemented to some extent worldwide for the management of postoperative CABG. However, studies about the effect of exercise training on hemodynamic responses of the heart using the Incremental Shuttle Walking (ISWT) test are limited in Saudi Arabia. Objectives: To investigate the effect of exercise-based cardiac rehabilitation (Phase 3, hospital-based) on some hemodynamic responses including blood pressure, heart rate (HR) and heart rate recovery (HRR), and rate pressure product (RPP) using ISWT on post-CABG …