Medical Specialties Commons^™

Amniotic Fluid Embolism, Nadia Nawaz, Ahmed Raheem Buksh

Department of Obstetrics & Gynaecology

Amniotic fluid embolism is a rare and severe problem in obstetric patients. We experienced a 21-year primigravida who underwent emergency cesarean section due to sudden collapse and fetal distress after rupture of membranes in labour. Subsequently, she developed intraoperative coagulopathy, hemorrhage, hypotension, and respiratory collapse requiring ventilation. Both maternal and neonatal lives were saved with full recovery and discharged in stable condition. The clinical diagnosis of amniotic fluid embolism (AFE) was made, which is a very rare complication of pregnancy/puerperium with varying presentation, ranging from cardiac arrest, circulatory collapse and death through mild degrees of organ system dysfunction with or …

Catheter Ablation Of Ventricular Tachycardia, Nilesh Mathuria

The Texas Heart Institute Journal

No abstract provided.

New Insights Into Predictors Of Cardiac Implantable Electronic Device Infection, Hossein Sadeghi, Abolfath Alizadehdiz, Amirfarjam Fazelifar, Zahra Emkanjoo, Majid Haghjoo

The Texas Heart Institute Journal

Infection is an important complication of cardiac implantable electronic device procedures. To further study the factors associated with infection, we retrospectively reviewed the records of 3,205 consecutive patients who had undergone de novo or revision cardiac electronic device implantation at our institution from March 2011 through March 2015. We recorded all infections and specified whether they were related to the characteristics of the patient, device, or procedure. To identify predictors of infection, we performed multivariate analysis.

Device infections were identified in 85 patients (2.7%), at a mean follow-up time of 27 ± 11 months. The main predictors of device infection …

Variability Of Extracorporeal Cardiopulmonary Resuscitation Utilization For Refractory Adult Out-Of-Hospital Cardiac Arrest: An International Survey Study., Patrick J. Coppler, Benjamin S. Abella, Clifton W. Callaway, Minjung Kathy Chae, Seung Pill Choi, Jonathan Elmer, Won Young Kim, Young-Min Kim, Michael Kurz, Joo Suk Oh, Joshua C. Reynolds, Jon C. Rittenberger, Kelly N. Sawyer, Chun Song Youn, Byung Kook Lee, David F. Gaieski

Department of Emergency Medicine Faculty Papers

Objective: A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea.

Methods: In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices. This project analyzes the subsection of questions addressing ECPR practices. We summarized survey.

Results: Overall, 9 KORHN and 4 NPARC centers reported having ECPR programs and had complete …

Obstructive Sleep Apnea In Heart Failure: Review Of Prevalence, Treatment With Continuous Positive Airway Pressure, And Prognosis, Himad K Khattak, Faisal Hayat, Salpy V Pamboukian, Harvey S Hahn, Brian P Schwartz, Phyllis K Stein

The Texas Heart Institute Journal

Obstructive sleep apnea is a sleep-related breathing disorder that has a major impact on cardiovascular function. It has been associated with hypertension, coronary artery disease, cardiac arrhythmias, sudden cardiac death, and heart failure. This review focuses on the relationship between obstructive sleep apnea and heart failure with either reduced or preserved ejection fraction. We discuss the pathophysiology of obstructive sleep apnea, as well as its prevalence, treatment outcomes with continuous positive airway pressure, and prognosis in these 2 distinct types of heart failure. We also identify areas in which further work is needed to improve our understanding of this association …

Glucose-6-Phosphate Dehydrogenase Deficiency Is Associated With Cardiovascular Disease In Us Military Centers, John E Thomas, Seungho Kang, Charles J Wyatt, Forest S Kim, A David Mangelsdorff, Fred K Weigel

The Texas Heart Institute Journal

Glucose-6-phosphate dehydrogenase (G6PD) protects erythrocytes from oxidative stress and hemolysis; G6PD deficiency is the most prevalent enzymopathy. The United States military routinely performs tests to prevent exposing G6PD-deficient personnel to antimalarial drugs that might cause life-threatening hemolytic reactions. In addition, G6PD is a key determinant of vascular function, and its deficiency can lead to impaired nitric oxide production and greater vascular oxidant stress—precursors to atherosclerosis and cardiovascular disease. Using military medical records, we performed a retrospective, cross-sectional study to investigate whether deficient G6PD levels are associated with a higher prevalence of cardiovascular disease than are normal levels, and, if so, …

Reframing Medical Education, Herbert L Fred, Jed D Gonzalo

The Texas Heart Institute Journal

No abstract provided.

The Disappearing Murmur: Systolic Anterior Motion Of The Mitral Valve Leaflet In A Non-Hypertrophic Cardiomyopathy Patient, Syed Rafay Ali Sabzwari, James R. Kimber, Hiwot Ayele, Nimra Khan, Tarick Sheikh, Ghulam Akbar Md, Bruce Feldman Do

Department of Medicine

Systolic anterior motion (SAM) of the mitral valve is a well-known phenomenon associated with left ventricular outflow tract obstruction and hemodynamic compromise. This finding may occur in patients with or without hypertrophic cardiomyopathy. In this report, a patient with no prior medical history presented to the hospital with left-sided chest pain and high-risk echocardiogram (ECG) findings. Left heart catheterization with coronary angiography was negative for coronary artery disease. His initial examination was significant for a systolic murmur due to the underlying SAM, as demonstrated by transthoracic echocardiogram. During his hospitalization, he developed acute heart failure syndrome as a result of …

Study Of Early After Depolarization In A Complex Human Cardiac Cell Model In Tissue, Abouzar Kaboudian, Yanyan Claire Ji, Elizabeth M. Cherry, Flavio H. Fenton

Biology and Medicine Through Mathematics Conference

No abstract provided.

A Rare Case Of Diffuse Alveolar Hemorrhage Secondary To Dabigatran Successfully Treated With Extracorporeal Membrane Oxygenation, C. Hutchinson, F. M. West, H. Hirose

Department of Medicine Posters

Introduction

Dabigatran, a direct thrombin inhibitor, is used for stroke risk reduction in non-valvular atrial fibrillation and for treatment and prevention of venous thromboembolism. Minor side effects include indigestion and stomach pain. Major life threatening bleeding occurs in up to 2% of patients and is largely attributed to gastrointestinal hemorrhage. Here, we describe a case of a dabigatran related diffuse alveolar hemorrhage (DAH) treated successfully with extracorporeal membrane oxygenation.

The Role Of Scarnas In Adjusting Alternative Mrna Splicing In Heart Development., Chloe Nagasawa, Allison Ogren, Nataliya Kibiryeva, Jennifer A. Marshall, James O'Brien, Naoya Kenmochi, Douglas C. Bittel

Manuscripts, Articles, Book Chapters and Other Papers

Congenital heart disease (CHD) is a leading cause of death in childrenyears, most CHDs (~70%) still have an unknown etiology. Conotruncal based defects, such as Tetralogy of Fallot (TOF), a common complex of devastating heart defects, typically requires surgical intervention in the first year of life. We reported that the noncoding transcriptome in myocardial tissue from children with TOF is characterized by significant variation in levels of expression of noncoding RNAs, and more specifically, a significant reduction in 12 small cajal body-associated RNAs (scaRNAs) in the right ventricle. scaRNAs are essential for the biochemical modification and maturation of small nuclear …

A Study Of Acoustically Activated Nanodroplets, Songita Choudhury

Theses & Dissertations

Current treatment of acute myocardial infarction (AMI), which is the main pathophysiological event leading to death in the United States, has advanced considerably with the introduction of emergent percutaneous interventions, but there remains an urgent need for novel techniques to rapidly and accurately detect infarcted or ischemic tissue that results from AMI. Ultrasound contrast agents, also known as microbubbles (MB), have become commonplace in echocardiography. However, MBs are purely intravascular tracers and unable to cross endothelial barriers due to size. The limitations of MBs, namely size and short circulation times within the human body, led to the development of phase-change …

The Synergistic Effects Of Saxagliptin And Metformin On Cd34+ Endothelial Progenitor Cells In Early Type 2 Diabetes Patients: A Randomized Clinical Trial., Fiona J Dore, Cleyton C Domingues, Neeki Ahmadi, Nabanita Kundu, Yana Kropotova, Sara Houston, Carol Rouphael, Aytan Mammadova, Linda Witkin, Anamil Khiyami, Richard L Amdur, Sabyasachi Sen

Surgery Faculty Publications

AIMS: Type 2 diabetes is associated with endothelial dysfunction leading to cardiovascular disease. CD34+ endothelial Progenitor Cells (EPCs) are responsible for endothelial repair and neo-angiogenesis and can be used as a cardiovascular disease risk biomarker. This study investigated whether the addition of saxagliptin, a DPP-IV inhibitor, to metformin, may reduce cardiovascular disease risk in addition to improving glycemic control in Type 2 diabetes patients.

METHODS: In 12 week, double-blind, randomized placebo-controlled trial, 42 subjects already taking metformin 1-2 grams/day were randomized to placebo or saxagliptin 5 mg. Subjects aged 40-70 years with diabetes for < 10 years, with no known cardiovascular disease, BMI 25-39.9, HbA1C 6-9% were included. We evaluated EPCs number, function, surface markers and gene expression, in addition to arterial stiffness, blood biochemistries, resting energy expenditure, and body composition parameters. A mixed model regression to examine saxagliptin vs placebo, accounting for within-subject autocorrelation, was done with SAS (p < 0.05).

RESULTS: Although there was no significant …

Extraction And Analysis Of Vector Flow Imaging Data In A Pediatric Population, Bailey Stinnett

Biomedical Engineering Undergraduate Honors Theses

Vector flow imaging (VFI) is a new ultrasound technology that provides real time, angle-independent visualization of flow velocities in the heart and great vessels. Thus far, VFI has been used for superficial applications due to the limited penetration depth of available transducer probes; however, this depth in smaller pediatric patients enables adequate aortic views. In this project, VFI was used to study pediatric aortic stenosis (PAS)—a congenital heart defect that results in the narrowing of the aorta and/or aortic valve. The decision to refer PAS patients for surgical or catheter-based intervention is initially based on Doppler ultrasound. VFI is potentially …

Percutaneous Non-Stenting Approach For Distal Simultaneous Multivessel Acute Coronary Occlusions, Nasir Rahman, Bilal Hussain

Section of Cardiology

The occurrence of distal coronary lesions causing simultaneous occlusion of two coronary arteries in the setting of ST elevation myocardial infarction is a rare occurrence. This can occur due to simultaneous plaque rupture at more than one site or embolisation in coronary arteries. We describe a case of a middle-aged man who presented with acute inferoposterior lateral wall ST elevation myocardial infarction with simultaneous occlusion of distal left anterior descending artery and distal left circumflex artery on angiogram. The patient was treated with intracoronary streptokinase, followed by glycoprotein (GP) IIb/IIIa inhibitor and Factor X inhibitor (Rivaroxaban) with full resolution of …

Transplantation Of Thioredoxin-1 Exosomes In A Murine Model Of Hind-Limb Ischemia: A Novel Therapeutic Approach, Shubham Kanake

Honors Scholar Theses

Peripheral artery disease is one of the most prevalent cardiovascular diseases in the United States and worldwide. It is estimated that over 8 million people in the United States are affected with peripheral artery disease, and up to 40% of people over 80 years old may have some degree of the disease. Peripheral artery disease can increase one’s chances for having other cardiovascular co-morbidities such as coronary artery disease, among others. Current interventional strategies are endovascular treatments such as transluminal angioplasty and stenting, or in more advanced cases peripheral artery bypass grafting. Medical interventions focus on managing symptoms and treating …

Intestinal Permeability And Microbial Dysbiosis In Acute Coronary Syndrome (Miacs Study), Tarik Z. Alhmoud

Biomedical Sciences ETDs

Background: Acute Coronary Syndrome (ACS) is a leading cause of morbidity and mortality. Metabolic syndrome and obesity are major risk factors for atherosclerosis and ACS. Dysbiosis plays an important role in metabolic syndrome and obesity. Studies show a markedly increased risk of heart attacks in patients with high levels of the pro-atherogenic metabolite trimethylamine-N-Oxide (TMAO). TMAO is produced by the intestinal microbial flora through metabolism of dietary phospholipids; Gram-negative bacteria (Phylum Proteobacteria) is the major source of TMAO metabolism. Patients with obesity and metabolic syndrome have a defective intestinal tight-junctional (TJ) barrier, which allows paracellular permeation of luminal antigens such …

A Case Of Flash Pulmonary Edema Caused By Iliac Artery Stenosis, Grace Chong Do, Joseph Moran Do, Fnu Vikram Md, Benjamin Sanchez Md

Department of Medicine

No abstract provided.

Longitudinal Measures Of Deformation Are Associated With A Composite Measure Of Contractility Derived From Pressure-Volume Loop Analysis In Children., Shahryar M. Chowdhury, Ryan J. Butts, Carolyn L. Taylor, Varsha M. Bandisode, Karen S. Chessa, Anthony M. Hlavacek, Arni Nutting, Girish S. Shirali, G Hamilton Baker

Manuscripts, Articles, Book Chapters and Other Papers

Aims: The relationship between echocardiographic measures of left ventricular (LV) systolic function and reference-standard measures have not been assessed in children. The objective of this study was to assess the validity of echocardiographic indices of LV systolic function via direct comparison to a novel composite measure of contractility derived from pressure-volume loop (PVL) analysis.

Methods and results: Children with normal loading conditions undergoing routine left heart catheterization were prospectively enrolled. PVLs were obtained via conductance catheters. A composite invasive composite contractility index (ICCI) was developed using data reduction strategies to combine four measures of contractility derived from PVL analysis. Echocardiograms …

Ten Lifestyle Modification Approaches To Treat Atrial Fibrillation, Syed Rafay Ali Sabzwari, Lohit Garg Md, Dhanunjaya Lakkireddy, John Day

Department of Medicine

Atrial fibrillation (AF) is the most common arrhythmia affecting three million people in the United States (US). Across different races in the US, the incidence of other races was comparable to that of Caucasian population. This points towards the importance of certain lifestyle modifications that can help prevent and treat this disorder. This article discusses 10 such factors. Smoking has been linked to AF, with almost 36% risk reduction if quit. Hypertension has 56% increased risk of atrial fibrillation in which the role of lifestyle changes is well known. Similarly, alcohol-induced atrial fibrillation has 10% increased risk of atrial fibrillation. …

Systemic Blood Pressure Trends And Antihypertensive Utilization Following Continuous-Flow Left Ventricular Assist Device Implantation: An Analysis Of The Interagency Registry For Mechanically Assisted Circulatory Support, Adham Elmously, Andreas R. De Biasi, Donald A. Risucci, Berhane Worku, Evelyn M. Horn, Arash Salemi

NYMC Faculty Publications

Background: Elevated systemic blood pressure (SBP) has been linked to complications in Continuous-flow left ventricular assist devices (CF-LVADs), including stroke and pump thrombosis. We queried Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) to describe the response of SBP to CF-LVAD implantation and to delineate contemporary trends in antihypertensive (AH) utilization for patients with these pumps. Methods: We identified all CF-LVAD implantations in patients older than 18 years from 2006-2014, excluding those whose durations were less than 30 days. Pre-implant patient demographics and characteristics were obtained for each record. SBPs [i.e., mean arterial pressures (MAPs)], AH-use data, and vital status …

Urgent Coronary Artery Bypass Grafting Due To Multi- Vessel Coronary Aneurysm, Obadah Aqtash, Ahmed Amro, Bilal Alam, Amal Sobeih, Melissa Lester, Rameez Sayyed

Marshall Journal of Medicine

Coronary Artery Aneurysm (CAA) is defined as a dilation of more than 1.5 times normal in a segment of the coronary artery. While the incidence of CAA is highest in the Right Coronary Artery (RCA), it is agreed that left main coronary artery or three-vessel involvement is extremely rare. Wide ranges of factors have been implicated in the cause of CAA with atherosclerosis being the most common at 50%. Congenital CAA occurs in 20-30% of cases followed by connective tissue disease at 10%. Blood stagnation and exposure of the underlying collagen make aneurysms prone to thrombosis, dissection, and vasospasm. Depending …

Going Beyond The Final Impression With Radiologic Data In The Era Of Clerical Medicine: A Case Report Of Coronary Artery Disease Found Incidentally On Computed Tomography, Andrea M. Lauffer

Marshall Journal of Medicine

Introduction:

Given the challenges in modern healthcare, physicians find themselves devoting a great deal of mental and emotional energy into executing the appropriate care for patients as well as performing their daily clerical duties. Many clinicians have resorted to innovative ways to minimize their tasks which often leads to narrowing the focus of a patient’s overall care and the birth of medical errors described in the Swiss cheese effect model.

Case Description:

A 66 year old male established care with a new primary care physician. Previous radiologic data revealed a pulmonary nodule that did not have appropriate follow up imaging. …

Problems Experienced In The First Month After Discharge From A Heart Failure-Related Hospitalization, Joan S. Grant, Lucinda J. Graven, Kelly Fuller

Journal of Patient-Centered Research and Reviews

Purpose: Heart failure is a global health concern with high morbidity and mortality rates. Individuals with heart failure commonly experience problems that impact daily life. However, little is known regarding which problems are most significant during the immediate posthospitalization period. Thus, the purpose of this study was to identify high-priority problems experienced by individuals the first month after discharge from an acute care facility with a diagnosis of heart failure.

Methods: This descriptive, exploratory study was part of a 12-week randomized controlled pilot study that examined the efficacy of a coping partnership intervention (COPE-HF Partnership) between a trained research nurse …

Uncertainty And Competing Priorities In Shared Clinical Decision-Making, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews observes that a connecting thread among the articles published therein is an element of uncertainty among patients and clinicians. Competing priorities for the patient also may be present. Several approaches to overcoming these prevalent conflicts to delivery of better health care have been proposed, the most important of which may be clinicians embracing a will to practice shared decision-making.

Review Of The Safety And Efficacy Of Echocardiographically Guided Pericardiocentesis: A Retrospective Single-Center Analysis, 2009 – 2016, Robert Park, Md, Michael Valentino, Md, Phd, Rajiv Kabadi, Md, Matthew Decaro, Md, Gregary Marhefka, Md

Division of Cardiology Posters

Aims

• To investigate the safety and efficacy of EGP given the relatively limited data of this modality’s safety profile in American healthcare centers over the past decade
• To evaluate the characteristics of and risk factors of those needing EGP

Spontaneous Coronary Artery Dissection: A Case Series Of 9 Patients With Literature Review., Ali Raza Ghani, Md, Faisal Inayat, Nouman Safdar Ali, Reema Anjum, Michael Viray, Arsalan Talib Hashmi, Iqra Riaz, Bruce D. Klugherz, Hafeez Ul Hassan Virk

Abington Jefferson Health Papers

Spontaneous coronary artery dissection is an increasingly recognized nonatherosclerotic cause of acute coronary syndrome. Reports regarding the prognosis and natural history of this disease are limited. In addition to the diagnostic difficulty, this condition poses a significant therapeutic challenge due to the lack of specific management guidelines. We present here a case series of 9 patients with spontaneous coronary artery dissection. Additionally, this article reviews the incidence, clinical characteristics, risk factors, diagnostic modalities, therapeutic approaches, and patterns of recurrence in patients with spontaneous coronary artery dissection.

N-Terminal Pro-B-Type Natriuretic Peptide And Microsize Myocardial Infarction Risk In The Reasons For Geographic And Racial Differences In Stroke Study, Madeline R. Sterling, Raegan W. Durant, Joanna Bryan, Emily B. Levitan, Todd M. Brown, Yulia Khodneva, Stephen P. Glasser, Joshua S. Richman, George Howard, Mary Cushman, Monika M. Safford

Internal Medicine Faculty Publications

Background: N-terminal pro B-type peptide (NT-proBNP) has been associated with risk of myocardial infarction (MI), but less is known about the relationship between NT-proBNP and very small non ST-elevation MI, also known as microsize MI. These events are now routinely detectable with modern troponin assays and are emerging as a large proportion of all MI. Here, we sought to compare the association of NT-proBNP with risk of incident typical MI and microsize MI in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

Methods: The REGARDS Study is a national cohort of 30,239 US community-dwelling black and white …

Changing Characteristics Of The Surface P Wave With Aging, And Insights Into Inter-Atrial Conduction - A Study Of 2,156 Patients Over 9 Decades Of Life, Chamaka Kalutota, Bs, Gregory Troutman, Bs, Goutham Ravipati, Bs, Anna Carleen, Ba, Matthew Decaro, Md, Behzad B. Pavri, Md

Sigma Xi Student Research Day

Objective

To define changes in surface ECG P-wave morphology, vector, and duration with advancing age, and make inferences about IAC and risk of atrial fibrillation

Meditation As A Tool For Blood Pressure Management, Maggie Ray

Thinking Matters Symposium Archive

PURPOSE: Appraise existing evidence about meditation and blood pressure in persons with cardiac risk factors and offer evidence-based recommendations about the use of meditation in management of blood pressure