Medical Specialties Commons^™

Large Sinus Of Valsalva Aneurysm Complicated By Thrombus Formation, Milan Ravishankar, Ali Ghergherehchi, Jing Liu, Ernesto Jimenez, Umair Khalid

Faculty, Staff and Students Publications

Sinus of Valsalva aneurysm (SOVA) is an unusual cardiac anomaly that is potentially fatal with rupture. It is often asymptomatic but has various presentations. We describe a case of a 67-year-old male who presented with atypical chest pain. Transthoracic echocardiogram and cardiac computed tomography scan confirmed a large SOVA complicated by thrombus formation and compression of the left atrium and left ventricular outflow tract. The patient successfully underwent a Bentall procedure-surgical aortic aneurysm repair with mechanical aortic valve conduit. We discuss several clinical decision-making branch points to highlight the complexity of managing this condition. Even in asymptomatic or minimally symptomatic …

Anticipation, Accompaniment, And A Good Death In Perinatal Care., Bryanna S. Moore, Brian S. Carter, Bryan Beaven, Katie House, Joel House

Manuscripts, Articles, Book Chapters and Other Papers

The ethics of perinatal care, and the experiences of families who receive such care, remains a nascent area of inquiry. It can be hard to see how existing "good death" constructs apply to the experiences of fetal patients and their families. In this paper, we explore two themes raised by a case at our fetal health center: anticipation and accompaniment. In this case, a mother presented to our fetal health center; her unborn son, our fetal patient, was diagnosed with life-threatening hypoplastic left heart syndrome and endocardial fibroelastosis. The parents were told that their son's life expectancy, upon birth, was …

Sex Differences In 10-Year Ischemic Cardiovascular Disease Risk Prediction In Chinese Patients With Prediabetes And Type 2 Diabetes., Lihong Yang, Anne Fish, Yuanyuan Zhu, Xiaodan Yuan, Jianing Li, Xiaoyun Wang, Li Yuan, Zhumin Jia, Chao Liu, Yunchen Xu, Qingqing Lou

Nursing Faculty Works

No abstract provided.

Role Of Echocardiography In Diagnostic Evaluation Of Patients Admitted To Observation Unit., Muhammad Arslan Cheema, Hafez Mohammad Ammar Abdullah, Waqas Ullah, Yasar Sattar, Shujaul Haq, Khadija Cheema, Asrar Ahmad, Zain Ali, Asoka Balaratna

Abington Jefferson Health Papers

BACKGROUND: Syncope is a transient loss of consciousness due to transient decrease in cerebral perfusion. Syncope accounts for a 3-6% of all emergency department visits. Etiology of syncope can be neural, cardiogenic, or vascular. Previous studies have evaluated the types and management of syncope. Echocardiography is a commonly used test in the evaluation of causes of syncope. Whether the benefit compared to financial burden of this diagnostic study is in all subsets of syncope cases remains unclear.

AIM: To evaluate the impact of echocardiography in the diagnostic evaluation of syncope and to evaluate the subset of patients that would benefit …

Nursing Care Plan For Hypertension, Rebecca Hamlin

Articles, Abstracts, and Reports

No abstract provided.

Implementing A Plan Of Care For Hypertension, Rebecca Hamlin

Articles, Abstracts, and Reports

Introduction: Providers routinely document what the next steps in treatment will be for patients who have elevated blood pressure during their office visit. In order for the plan to implemented, the patient must return to see the provider again and often wait up to 6 months before they return. This results in potentially sustained uncontrolled blood pressure.

Fingolimod Plays Role In Attenuation Of Myocardial Injury Related To Experimental Model Of Cardiac Arrest And Extracorporeal Life Support Resuscitation, Naseer Ahmed, Abid Laghari, Bashar Albkhoor, Sobia Tabassum, Sultan Ayoub Meo, Nazeer Muhammad, Daniele Linardi, Abeer A. Al-Masri, Guido Fumagalli, Giovanni Battista Luciani, Giuseppe Faggian, Alessio Rungatscher

Department of Biological & Biomedical Sciences

Background: Sudden cardiac arrest is a major global health concern, and survival of patients with ischemia-reperfusion injury is a leading cause of myocardial dysfunction. The mechanism of this phenomenon is not well understood because of the complex pathophysiological nature of the disease. Aim of the study was to investigate the cardioprotective role of fingolimod in an in vivo model of cardiac arrest and resuscitation.
Methods: In this study, an in vivo rat model of cardiac arrest using extracorporeal membrane oxygenation resuscitation monitored by invasive hemodynamic measurement was developed. At the beginning of extracorporeal life support (ECLS), animals were randomly treated …

Marijuana And Its Cardiovascular Implications, Albert Bui, Daniel Powell, Victoria Cho, Kelsey Lindsley, Lindsey Peters

Pharmacy and Wellness Review

As marijuana becomes legalized for medical use, it is important for prescribers and pharmacists to be knowledgeable about the important aspects of marijuana such as mechanism of action, indications and abuse potential. Although marijuana's medicinal benefits are frequently reported, the risks, namely cardiovascular risks, associated with its utilization are often overlooked. Use of marijuana has been reported to increase the risk of myocardial infarction, tachycardia and hypotension, among others. Health care providers must determine if marijuana's benefits outweigh such risks when marijuana therapy is an option. It is also important for pharmacists to understand how to successfully counsel patients using …

Management Of Hypertensive Emergencies In Pediatrics, Jennifer L. Bauer, Jamie L. Amero, Amanda C. Mcdavid, Ryan A. Fischer, Alison L. Huet, Karen L. Kier

Pharmacy and Wellness Review

As hypertension becomes more prevalent in the pediatric population, clinicians are more likely to encounter hypertensive emergencies in children, which require pharmacists and physicians to be educated on the therapeutic options for these emergencies. However, the strict governmental requirements on the testing of these drugs in pediatric patients have limited the amount of available evidence on which to base clinical decisions. This review will highlight the available evidence and preferred treatment options for the management of pediatric hypertensive emergencies.

Single Versus Multi-Center Surgeons' Risk-Adjusted Mitral Valve Repair Procedural Outcomes, Anne Bennett, Thomas Bogue, Samuel Greenberg, Joshua Zhu, Samantha Novotny, Joseph Pizzuti, Lee A. Santore, Robert H. Habib, Annie Laurie Laurie Shroyer, Jonathan Price, Henry Tannous, Thomas Bilfinger

Department of Surgery Faculty Publications

The purpose of this study is to explore strategies to improve mitral valve repair (MVr) outcomes. This research explores postoperative outcomes of patients undergoing MVr surgery by single center surgeons versus patients of multicenter surgeons. Specific outcomes of interest include 30-day operative mortality, major operative complications (e.g., deep sternal wound infection, permanent stroke, renal dysfunction requiring dialysis, reoperation, and prolonged ventilation), length of stay, and 30-day readmissions.

In brief, the serisk-adjusted outcome rates for surgeons that perform mitral valve repair procedures will be compared for surgeons that operate at a single center [i.e. SC surgeons] versus multiple centers [i.e. MC …

A Review Of Dabigatran, An Oral Anticoagulant, Lindsey A. Hallman, Chad A. Rounds, Rebecca A. Carey, Nicole R. Hume, Karen L. Kier, James Spicer

Pharmacy and Wellness Review

Serious clinical complications associated with venous thrombotic embolism (VTE) necessitate prophylaxis in patient groups who are at high risk of VTE, specifically those recovering from orthopedic surgery with atrial fibrillation, with mechanical heart valves, at increased risk for stroke, or recovering post-MI. Currently, prophylaxis with warfarin, enoxaparin, or fondaparinux has been the standard of therapy, but these therapies each have their limitations. Dabigatran etexilate is an orally available pro-drug of dabigatran, a competitive, reversible, direct inhibitor thrombin (Factor lla). The agent is converted by esterases, and, thus, not associated with the complications of the CYP enzyme system. Dabigatran follows a …

Implementation Of Liberate Protocol With Focus On Delirium In An Acute Care Community Hospital’S Medical And Cardiovascular Intensive Care Units, Jasmine M. Hossler, Emily A. Sedio, Karen L. Kier

Pharmacy Faculty Scholarship

No abstract provided.

Play Smart Youth Heart Screening Program Reduces False-Positive Rates For Screening Electrocardiograms, James G Beckerman, M Wang, Lydia Hibsch, Nancy Davis

Articles, Abstracts, and Reports

Play Smart Youth Heart Screening is a free community-based electrocardiogram (ECG) screening program sponsored by Providence Heart Institute in Portland, Oregon. Play Smart goal is to identify youths who may need further follow-up and treatment of undiagnosed, asymptomatic heart disease such as cardiac arrest. For many youths, sudden cardiac arrest is their first symptom of heart disease. Play Smart has sought to systematically improve ECG screening accuracy (specificity) by consistently adopting the most recent ECG interpretation guidelines. More accurate screening (less false-positive screens) enables Play Smart to target recommendations for follow-up treatment only to those individuals with true-positive screening results.

The Effects Of Nicotine And Cigarette Smoking On Cardiac Electrophysiology., Affan B. Irfan

Electronic Theses and Dissertations

Cigarette smoking is a leading cause of preventable disease and premature death worldwide. The adverse effects of cigarette smoking, including proarrhythmia, are related to the mixture of chemicals, including nicotine (which sustains tobacco addiction). However, it remains unclear which individual tobacco smoke constituents and biological pathways mediate this increased risk. The purpose of this research was to explore the chronic effects of cigarette smoking, as well as compare the acute effects of nicotine and cigarette smoking, and the possible role of β-adrenoreceptors, on human cardiac electrophysiology. Chapter 1 is a comprehensive literature review of (a) the ex vivo and in …

Retrospective Review Of Ticagrelor And Clopidogrel Use In Adult Patients Receiving Dual Antiplatelet Therapy After Percutaneous Coronary Intervention In A Community Hospital, Jessica Hernandez, Laura Neubauer, Radhan Gopalani, Heidi Clarke, Marcus St. John

All Publications

No abstract provided.

Results Of A Phase 1 Multicentre Investigation Of Dexmedetomidine Bolus And Infusion In Corrective Infant Cardiac Surgery, Athena F Zuppa, Susan C Nicolson, Nicole S Wilder, Juan C Ibla, Erin A Gottlieb, Kristin M Burns, Mario Stylianou, Felicia Trachtenberg, Hua Ni, Tera H Skeen, Dean B Andropoulos

Faculty, Staff and Students Publications

BACKGROUND: Dexmedetomidine (DEX) is increasingly used intraoperatively in infants undergoing cardiac surgery. This phase 1 multicentre study sought to: (i) determine the safety of DEX for cardiac surgery with cardiopulmonary bypass; (ii) determine the pharmacokinetics (PK) of DEX; (iii) create a PK model and dosing for steady-state DEX plasma levels; and (iv) validate the PK model and dosing.

METHODS: We included 122 neonates and infants (0-180 days) with D-transposition of the great arteries, ventricular septal defect, or tetralogy of Fallot. Dose escalation was used to generate NONMEM® PK modelling, and then validation was performed to achieve low (200-300 pg ml …

The Early "Unnatural" History Following Surgical Repair Of Ventricular Septal Defects., Sathish M. Chikkabyrappa, Justin T. Tretter, Arpan R. Doshi, Sujatha Buddhe, Puneet Bhatla, Achi Ludomirsky

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Surgical outcomes for simple ventricular septal defects (VSD) have been excellent in the past three decades. For this project, the timing of resolution of left-sided dilation and mitral regurgitation (MR) following VSD repair was assessed.

Methods: Echocardiographic data surrounding surgery of 42 consecutive children who underwent surgical patch repair of a VSD were reviewed. The echocardiograms were reviewed up to a mean of 12 months post-operatively (range 9 - 14 months). Quantitative data indexed to body surface area including left atrial (LA) volume, mitral valve annulus diameter, and left ventricular end-diastolic dimension (LVEDD) was analyzed.

Results: The majority of …

Concomitant Presentation With Cardioembolic Ischemic Stroke And Non St Elevation Myocardial Infarction In A Patient With New Onset Atrial Fibrillation, Amogh M. Joshi Do, Emilee E. Kurtz Do, Kourtney Erickson Do, Margaret R. Kluck Do, Benjamin Sanchez Md

Department of Medicine

Introduction: Although Atrial Fibrillation (AF) is a common cause of ischemic stroke, it rarely causes acute coronary syndromes (ACS). Cardioembolic events from AF cause considerable morbidity and mortality. Concomitant ischemic stroke and ACS remains an exceedingly rare event. We describe the case of a patient presenting with cardioembolic ischemic stroke and acute coronary syndrome.

Case Presentation: An 83 year old male with a prior history of heart failure with preserved ejection fraction, permanent pacemaker for complete heart block, and chronic kidney disease on hemodialysis presented with acute left sided facial and extremity weakness, gait ataxia and profound dysarthria. Physical examination …

Diseases Of The Aorta, Maria Mazalkova

Faculty Works: AHS (2004-2023)

Aortic diseases are very common, however , for many years they might be undiscovered. It is very important to raise awareness of aortic diseases in order to provide a highest quality patient care through education, research and treatment.

Abstract 13987: Underutilization Of Oral Anticoagulant Therapy In At-Risk Patients With Atrial Fibrillation—Insights From A Multistate Healthcare System, Tyler J Gluckman, Amir Ali, Mansen Wang, Howard Mun, Sally Alfred, John L. Petersen

Articles, Abstracts, and Reports

Introduction: Oral anticoagulant (OAC) therapy significantly reduces the risk of thromboembolism among at-risk patients with atrial fibrillation (AF). Current guidelines provide strong support for an OAC in men and women with AF and CHA2DS2-VASc scores of >2 and >3, respectively. In spite of this, previous data has suggested that up to 40% of these patients are not treated in accordance with guideline recommendations.

Hypothesis: We hypothesized that OAC therapy continues to remain significantly underutilized among at-risk patients with AF in real-world settings.

Methods: We sought to evaluate the prevalence of OAC underuse and contributing factors in an ambulatory population of …

Abstract 14012: Opportunities To Improve The Efficacy And Safety Of Oral Anticoagulant Therapy In Atrial Fibrillation—Insights From A Multistate Healthcare System, Tyler J Gluckman, Amir Ali, Mansen Wang, Howard Mun, Sally Alfred, John L. Petersen

Articles, Abstracts, and Reports

Introduction: Vitamin K antagonists (VKAs) effectively reduce thromboembolic risk in atrial fibrillation (AF), but are limited by a narrow therapeutic window. Patients with reduced time in the therapeutic range (TTR) also face an increased risk of bleeding and ischemic events. Based in part on this, current guidelines give preference to direct-acting oral anticoagulants (DOACs) over VKAs in AF.

Hypothesis: We hypothesized that DOACs are underutilized among those on oral anticoagulant therapy and that TTR remains suboptimal for large numbers of individuals on VKAs in real-world settings.

Methods: We sought to evaluate a) the breakdown of OAC type and b) TTR …

Changes In Ventricular Depolarisation Vectors During Exercise Caused By Regional Myocardial Ischaemia, Cameruddin Vellani, Satwat Hashmi, Sadia Mahmud, Mohammad Yusuf, Safia Awan, Khawar Kazmi

Section of Cardiology

Research at the Aga Khan University for several years has been directed to find a reliable, low-cost, portable, non-invasive method for identification of coronary artery disease, its location and extent. A new method has been devised to measure the magnitude and direction of cardiac electrical vectors in three perpendicular planes during physical exercise to identify reduction in myocardial excitability as the electrophysiological marker of hypoxia. This report shows that changes in electrical forces due to exercise-induced regional hypoxia serve as indicators of reversible myocardial ischaemia. Changes in the magnitude and direction of vectors at stages of the Bruce protocol were …

Failure To Rescue As An Outcome Metric For Pediatric And Congenital Cardiac Catheterization Laboratory Programs: Analysis Of Data From The Impact Registry., Michael L. O'Byrne, Kevin F. Kennedy, Natalie Jayaram, Lisa J. Bergersen, Matthew J. Gillespie, Yoav Dori, Jeffrey H. Silber, Steven M. Kawut, Jonathan J. Rome, Andrew C. Glatz

Manuscripts, Articles, Book Chapters and Other Papers

Background Risk-adjusted adverse event (AE) rates have been used to measure the quality of pediatric and congenital cardiac catheterization laboratories. In other settings, failure to rescue (FTR) has demonstrated utility as a quality metric. Methods and Results A multicenter retrospective cohort study was performed using data from the IMPACT (Improving Adult and Congenital Treatment) Registry between January 2010 and December 2016. A modified FTR metric was developed for pediatric and congenital cardiac catheterization laboratories and then compared with pooled AEs. The associations between patient- and hospital-level factors and outcomes were evaluated using hierarchical logistic regression models. Hospital risk standardized ratios …

Effect Of Increasing Age On Percutaneous Coronary Intervention Vs Coronary Artery Bypass Grafting In Older Adults With Unprotected Left Main Coronary Artery Disease: A Meta-Analysis And Meta-Regression, Mahin R. Khan, Waleed T. Kayani, Waqas Ahmad, Malalai Manan, Ravi S. Hira, Ihab Hamzeh, Hani Jneid, Salim S. Virani, Neal Kleiman, Nasser Lakkis

Office of the Provost

Background: Older adults (≥70-year-old) are under-represented in the published data pertaining to unprotected left main coronary artery disease (ULMCAD).
Hypothesis: Percutaneous coronary intervention (PCI) might be comparable to coronary artery bypass grafting (CABG) for revascularization of ULMCAD.
Methods: We compared PCI versus CABG in older adults with ULMCAD with an aggregate data meta-analyses (4880 patients) of clinical outcomes [all-cause mortality, myocardial infarction (MI), repeat revascularization, stroke and major adverse cardiac and cerebrovascular events(MACCE)] at 30 days, 12-24 months & ≥36 months in patients with mean age ≥70 years and ULMCAD. A meta-regression analysis evaluated the effect of age on mortality …

Electrocardiographic Findings During Standard Hands Only Cpr And Hands Only Cpr Plus Pedal Cpr In Senior Rescuers, Laura Melany Yassa

Master's Theses

The standard first aid for a heart attack resulting in cardiopulmonary arrest is effective cardiopulmonary resuscitation (CPR). Chest compressions are most commonly performed on a flat surface with the rescuer kneeling next to the victim with one hand on top of the other on the sternum and elbows straight. This technique of being on the ground may be challenging for those without the mobility and strength to get up and down from the ground. In 2005, the American Heart Association (AHA) Guidelines listed “pedal”, or heel, compression as an acceptable alternative to standard chest compressions (Trenkamp & Perez, 2015). That …

Convergent Ablation For The Treatment Of Long Standing Persistent Atrial Fibrillation - A Single Center Experience, Syed Rafay Ali Sabzwari, Lohit Garg Md, Nikhil A. Mehta Md, James R. Kimber, Hiwot Ayele, James K. Wu Md, Babak Bozorgnia Md

Department of Medicine

Introduction: The treatment of long standing persistent atrial fibrillation (AF) is very challenging and conventional catheter ablation strategies have provided only modest success. They often require multiple procedures and anti-arrhythmics to maintain sinus rhythm. The convergent ablation procedure is a hybrid approach, involving a minimally invasive epicardial ablation combined with a traditional transvenous endocardial ablation.

Hypothesis: Convergent ablation is an overall safe and effective procedure for the treatment of long standing persistent AF.

Methods: From February 2015 to September 2017, 30 patient (20 males) with long standing persistent AF underwent convergent ablation at a large tertiary care center. Rest of …

An Unusual Case Of Broken Heart, Ammar Hasan, Enrique Rincon

Cardiology

No abstract provided.

The Palpitations That Thumped Us All:, Carolyn Falk Tran Do, Gurmanpal Sandhu Md, Daniel Robitshek Md, Tejas Raiyani Md

Internal Medicine

No abstract provided.

The Role Of The Pharmacy Team In Atrial Fibrillation Detection In Nonclinical Settings, Brian C. Hazelrigg, Monica L. Miller, Sotiris Antoniou, Jagjot Chahal, Sadeer Fhadil

Purdue Journal of Service-Learning and International Engagement

Atrial Fibrillation (AF) is a common cardiac/heart disease that increases a person’s risk of death, making early identification significant in overall disease management. Throughout my time in pharmacy school, I [Brian] have developed an interest in cardiology and research. During my last year of pharmacy school, I spent eight weeks at St. Bartholomew’s Hospital, in London, England, one of the largest cardiac centers within Europe, on an experiential training experience. While there, I had the opportunity to study specifics about many cardiac illnesses, with a focus on atrial fibrillation, and provide education to patients living with this disease. In addition …

Does Perioperative Use Of Renin-Angiotensin System Inhibitors Improve Patient Outcomes In Cardiac Surgery?, Qian Ding, Mark Berguson, Zugui Zhang, Hong Liu, Huang Nie, Jordan E. Goldhammer, Rohinton J. Morris, Jianzhong Sun

Department of Anesthesiology Posters

• 2011 ACCF/AHA Guidelines for CABG: Uncertain about the safety of the preoperative administration of ACE inhibitors or ARBs in patients on chronic therapy and the safety of initiating ACE inhibitors or ARBs before hospital discharge
• 2014 ESC Guidelines: ACE inhibitors might be stopped 1 to 2 days before CABG to avoid the potential deleterious consequences of perioperative hypotension
• Guidelines state that ACE inhibitors or ARBs should be initiated postoperatively in CABG patients who were not receiving them preoperatively if they have an LVEF ≤40%, hypertension, diabetes, or CKD (Level of Evidence: A)
• There is still a lack of large clinical …