Medical Specialties Commons^™

Right Heart Transvalvular Embolus With High Risk Pulmonary Embolism In A Recently Hospitalized Patient: A Case Report Of A Therapeutic Challenge, G. K. Acharya, A. M. Adedayo, H. Prabhu, D. R. Brinster, P. Mir

Journal Articles

Thrombus-in-transit is not uncommon in pulmonary embolism but Right Heart Transvalvular Embolus (RHTVE) complicating this is rare. A 54-year-old obese male with recent hospitalization presented with severe dyspnea and collapse. Initial investigations revealed elevated d-dimer and troponin. CTA showed saddle pulmonary embolus and bedside echocardiogram revealed right ventricular (RV) pressure overload and dilatation (RV > 41 mm), McConnell's sign, and mobile echodensity attached to tricuspid valve. Patient was immediately resuscitated and promptly transferred for surgical embolectomy under cardiopulmonary bypass. A long segment of embolus traversing through the tricuspid valve and extensive bilateral pulmonary artery embolus were removed. IVC filter was placed …

Rate Control Of Atrial Arrhythmias Can Be Achieved By Selective Cardiac Neurostimulation, Mark Marchitto, Aditya C. Sharma, Jeffrey P. Moak, Dingchao He, Conor Hynes, Gregory Trachiotis, Andy Blichard, Erin Montague, Xiyan Li, Gene Bornzin, Charles I. Berul, Richard A. Jonas, Marco A. Mercader

GW Research Days 2015

Introduction: Atrial arrhythmias (AA) occur in up to 40% of patients recovering from open-heart surgery (OHS). Pharmacologic treatment has been the main strategy used for the control of post-operative AA, but is associated with hypotension, pro-arrhythmia and myocardial dysfunction. There is a need for a reversible, modulated solution to rate control. We demonstrated the efficacy of vagal stimulation at inferior right fat pad (FP) to slow the ventricular response (VR) of atrial fibrillation (AF) and junctional ectopic tachycardia (JET). We hypothesized that the VR response to AA could be improved by alterations in 1) the site of stimulation (anterior right …

Calreticulin Mutated Essential Thrombocythemia Presenting As Acute Coronary Syndrome, B. Nazha, G. Garcia, R. Kandov, M. Odaimi

Journal Articles

Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by a clonal expansion of megakaryocytes. ET can result in both arterial and venous thrombosis. Involvement of the coronary arteries has been reported. Patients who harbor a CALR mutation are half as likely to suffer a thrombotic event as compared to patients with a JAK2 mutation. We report a case of CALR-mutated ET whose initial disease manifestation was a non-ST segment elevation myocardial infarction.

Antiplatelet Therapy Duration Following Bare Metal Or Drug-Eluting Coronary Stents: The Dual Antiplatelet Therapy Randomized Clinical Trial, D. J. Kereiakes, R. W. Yeh, J. M. Massaro, P. Driscoll-Shempp, I. T. Meredith, J. Ormiston, J. F. Tanguay, S. Windecker, K. N. Garratt, L. Mauri, +9 Additional Authors

Journal Articles

IMPORTANCE: Despite antirestenotic efficacy of coronary drug-eluting stents (DES) compared with bare metal stents (BMS), the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Although dual antiplatelet therapy (DAPT) beyond 1 year provides ischemic event protection after DES, ischemic event risk is perceived to be less after BMS, and the appropriate duration of DAPT after BMS is unknown. OBJECTIVE: To compare (1) rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE; composite of death, myocardial infarction, or stroke) after 30 vs 12 months of thienopyridine in patients treated with BMS taking aspirin and (2) …

Sleep Deficiency And Deprivation Leading To Cardiovascular Disease, M. Kohansieh, A. N. Makaryus

Journal Articles

Sleep plays a vital role in an individual's mental, emotional, and physiological well-being. Not only does sleep deficiency lead to neurological and psychological disorders, but also the literature has explored the adverse effects of sleep deficiency on the cardiovascular system. Decreased quantity and quality of sleep have been linked to cardiovascular disease (CVD) risk factors, such as hypertension, obesity, diabetes, and dyslipidemia. We explore the literature correlating primary sleep deficiency and deprivation as a cause for cardiovascular disease and cite endothelial dysfunction as a common underlying mechanism.

Sleep Disorders, Obesity, Hypertension, And Cardiovascular Risk, S. I. Mcfarlane, O. Ogedegbe, A. N. Makaryus, C. Agyemang, G. Jean-Louis

Journal Articles

No abstract provided.

Inflammatory Bowel Disease As A Risk Factor For Premature Coronary Artery Disease, P. Ruisi, J. N. Makaryus, M. Ruisi, A. N. Makaryus

Journal Articles

BACKGROUND: Crohn's disease and ulcerative colitis are both systemic chronic diseases that alter bowel physiology. The central process in inflammatory bowel disease (IBD) and the associated manifestations are the result of B-cell production of IgG autoantibodies directed against self-antigens in various organ systems including coronary endothelium. Previous studies have demonstrated significant micro-vascular endothelial dysfunction in patients with IBD compared to patients not affected by the disease. We sought to analyze the relation, if any, between IBD and the development of premature coronary artery disease (CAD). METHODS: We queried our hospital database to find IBD patients admitted to the hospital from …

Echocardiographic Manifestation Of Esophagitis Mimicking A Posterior Mediastinal Mass, S. Swarup, S. Kantamneni, S. Kabir, R. Zeltser, A. N. Makaryus

Journal Articles

Incidental extracardiac findings (ECFs) are commonly noted on cardiac imaging. The majority of the ECFs are noticed on computed tomography (CT), cardiac magnetic resonance scanning, and myocardial perfusion imaging. Although transthoracic echocardiography (TTE) is a widely used cardiac modality, there is scarcity of data describing ECF on TTE. ECFs have the potential to alter patient management. We present a rare case of a cystic mass seen in the posterior mediastinum on TTE, which led to further evaluation and diagnosis of esophagitis with ulceration.

Temporary Mechanical Circulatory Support: A Review Of The Options, Indications, And Outcomes, N. A. Gilotra, G. R. Stevens

Journal Articles

Cardiogenic shock remains a challenging disease entity and is associated with significant morbidity and mortality. Temporary mechanical circulatory support (MCS) can be implemented in an acute setting to stabilize acutely ill patients with cardiomyopathy in a variety of clinical situations. Currently, several options exist for temporary MCS. We review the indications, contraindications, clinical applications, and evidences for a variety of temporary circulatory support options, including the intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), CentriMag blood pump, and percutaneous ventricular assist devices (pVADs), specifically the TandemHeart and Impella.

Planning And Guidance Of Cardiac Resynchronization Therapy-Lead Implantation By Evaluating Coronary Venous Anatomy Assessed With Multidetector Computed Tomography, J. N. Catanzaro, J. N. Makaryus, R. Jadonath, A. N. Makaryus

Journal Articles

OBJECTIVES: We sought to evaluate the utility of multidetector computed tomography (MDCT) in preoperative planning of cardiac resynchronization therapy (CRT) device implantation. BACKGROUND: Variation in coronary venous anatomy can affect optimal lead placement and may warrant preimplantation visualization prior to CRT lead placement. METHODS: Prospective randomized enrollment of 29 patients (17 males; mean age at implant 66.7 +/- 12.8 years) was undertaken. Patients were randomized to preimplantation MDCT (GE((R)) 64-detector Lightspeed, n = 16) or no MDCT. Implantation was planned based on three-dimensional coronary venous reconstruction as visualized in the CT group. Measurement of coronary sinus (CS) angulation, CS ostial …

Isolated Cardiac Amyloidosis: An Enigma Unravelled, Umair Khalid, Omar Awar, Gordana Verstovsek, Benjamin Cheong, Sarvari Venkata Yellapragada, Hani Jneid, Anita Deswal, Salim S. Virani

Office of the Provost

Amyloidosis is a rare, multisystem disease characterized by deposition of fibrils in extracellular tissue involving kidney, liver, heart, autonomic nervous system, and several other organs. This report discusses a 75-year-old male who presented with worsening dyspnea on exertion, orthopnea, and lower-extremity edema. On physical exam, he had elevated jugular venous pressure and lower-extremity edema. Electrocardiogram depicted low voltage in limb leads and a prolonged PR interval. Echocardiogram revealed left ventricular hypertrophy, severe biatrial dilatation, and restrictive filling physiology. Coronary angiography showed absence of significant epicardial coronary artery disease. On right heart catheterization, a "dip-and-plateau sign" was noted on right ventricular …

Accurate Modelling And Positioning Of A Magnetically-Controlled Catheter Tip, Vi T. H. Le

Theses: Doctorates and Masters

This thesis represents the initial phase of a proposed operator and patient friendly method designed to semi-automate the positioning and directing of an intravascular catheter in the human heart using a variable electromagnetically induced field to control a catheter tip equipped with three tiny fixed magnets oriented in XYZ planes. Here we demonstrate a comprehensive mathematical model which accurately calculates the magnetic field generated by the electromagnet system, and the magnetic torques and forces exerted on a three-magnet tip catheter. From this we have developed an iterative predictive computer algorithm to show the displacement and deflection of the catheter tip. …

Ablation Of Myocardial Tissue With Nanosecond Pulsed Electric Fields, Fei Xie, Frency Varghese, Andrei G. Pakhomov, Iurii Semenov, Shu Xiao, Jonathan Philpott, Christian Zemlin

Bioelectrics Publications

Background

Ablation of cardiac tissue is an essential tool for the treatment of arrhythmias, particularly of atrial fibrillation, atrial flutter, and ventricular tachycardia. Current ablation technologies suffer from substantial recurrence rates, thermal side effects, and long procedure times. We demonstrate that ablation with nanosecond pulsed electric fields (nsPEFs) can potentially overcome these limitations.

Methods

We used optical mapping to monitor electrical activity in Langendorff-perfused New Zealand rabbit hearts (n = 12). We repeatedly inserted two shock electrodes, spaced 2–4 mm apart, into the ventricles (through the entire wall) and applied nanosecond pulsed electric fields (nsPEF) (5–20 kV/cm, 350 ns duration, …

Outcomes Of Sepsis Patients Using Noninvasive Cardiac Output Monitoring To Guide Fluid Resuscitation, Rosemary Lee, Rosie Sanchez, Laura Berni, Joyce Nealey, Maria Ojeda

All Publications

No abstract provided.

The Association Between Environmental Cadmium Exposure And All-Cause Mortality And Cardiovascular Disease In A Cohort Of Elderly Western Australian Women, Kane Deering

Theses : Honours

Introduction: Recent research suggests an association between environmental cadmium exposure and increased risk of, and death from, cardiovascular disease, the number one cause of mortality in Australia and worldwide. However, the research to date is neither comprehensive nor have there been any studies conducted on an Australian population. This study identified whether increasing concentrations of urinary cadmium in elderly West Australian women was associated with an increased odds of incidence of, and deaths from CVD, as well as all-cause mortality.

Method: Cadmium excretion was measured in urine samples collected at baseline (1998) from 1359 women from Perth who …

A Qualitative Study Of How Children Experience And Live With Long Qt Syndrome, Patrick Mcelwaine

PCOM Psychology Dissertations

Long QT syndrome (LQTS) is an inherited and potentially fatal disorder affecting approximately 1 in 2,000 people. Children often experience anxiety and a sense of loss of control as they try to manage the medical, social, and psychological stress that accompanies being diagnosed with LQTS. The present study utilized a qualitative research design to examine how children experience and live with long QT syndrome. Semistructured interviews were conducted with eight children between the ages of 7 to 12 who were diagnosed with LQTS. This period in a child’s life is very important for developing social skills and self-esteem as peers …

Coffee: A Selected Overview Of Beneficial Or Harmful Effects On The Cardiovascular System?, Thomas F. Whayne Jr.

Internal Medicine Faculty Publications

With a history that began in 800 A.D., coffee is the most popular drink known and as a result, the issues regarding its physiologic effects deserve attention. Maintaining alertness is a well-known benefit and in addition, the cardiovascular (CV) effects of the active compounds, which include polyphenols and caffeine, must be considered. Genetics are relevant and where slow caffeine metabolism is inherent, the risk of nonfatal myocardial (MI) has been shown to be increased. Overall risk for coronary heart disease (CHD) is not supported and unless there is excessive intake, congestive heart failure (CHF) is not adversely affected; in moderation, …

Promoting Comfort During Ct-Coronary Angiogram, Margo Archer, Dawn Arevalo, Kelly Vazquez

All Publications

No abstract provided.

Measuring Adherence To Evidence-Based Practice Guidelines For The Management Of Hypertension In Women, Cristina M. Jorgensen

DNP Projects

Approximately 1 in 3 adults In the United States (U. S.) with approximately half being women have hypertension, a significant risk factor for cardiovascular disease (CVD) and stroke (Nwankwo, Yoon, Burt, & Gu, 2013). Nearly 70% of people who had a first heart attack, 80% of those who had a first stroke, and 75% of those who had congestive heart failure (CHF) have hypertension (Mozaffarian et al., 2013). Hypertension was the underlying or contributing cause of more than 375,000 deaths in 2011. Despite multiple publications of national hypertension guidelines, only 50% of adults with hypertension have their blood pressure under …

Renal And Hematological Effects Of Clcf-1, A B-Cell-Stimulating Cytokine Of The Il-6 Family., Virginia J. Savin, Mukut Sharma, Jianping Zhou, David Gennochi, Timothy Fields, Ram Sharma, Ellen T. Mccarthy, Tarak Srivastava, Jos Domen, Aurélie Tormo, Jean-François Gauchat

Manuscripts, Articles, Book Chapters and Other Papers

CLCF-1 is a cytokine known for B-cell stimulation and for neurotrophic properties. We have identified CLCF-1 as a potential injurious factor in the human renal disease focal segmental glomerulosclerosis (FSGS). We investigated its effects on renal cells and renal function in in vitro and in vivo studies. Methods include measurement of the effect of CLCF-1 on phosphorylation of target molecules of the JAK/STAT pathway, on cytoskeleton and cell morphology in cultured podocytes, on albumin permeability of isolated rat glomeruli, and on tissue phosphorylation and urine albumin after acute or chronic CLCF-1 injection. In addition, cell sorting was performed to determine …

Vitamin C: A Potential Regulator Of Inflammatory Response, Bassem M. Mohammed

Theses and Dissertations

Introduction: Neutrophils (PMNs) and Macrophages are the first responders recruited consecutively to the site of injury/inflammation. PMNs’ response/fate as well as macrophage reprogramming ultimately determine the course of resolution of inflammation. Physiologic wound healing has a significant inflammatory component. An exaggerated inflammation however is self-defeating leading to delayed healing. Parenteral vitamin C (VitC) attenuated inflammation in murine sepsis models and in patients with sepsis. However information about the mechanisms by which VitC regulates these events is limited.

Methods: Humanized mice lacking VitC synthesis capability (Gulo^-/-) were used. VitC sufficient and deficient mice were challenged with sterile inflammation, or …

Association Between Ideal Cardiovascular Health Metrics And Depression In Chinese Population : A Cross-Sectional Study, Zhikun Li, Xin Yang, Anxin Wan, Jing Qui, Wei Wang, Qiaofeng Song, Xizhu Wang

Research outputs 2014 to 2021

The study aimed to examine the association between ideal cardiovascular health (CVH) metrics and depression. We conducted a population-based, cross-sectional study of 6,851 participants aged 20 years or older (3,525 men and 3,326 women) living in Tangshan City, China. Information on the seven CVH metrics (including smoking, body mass index, dietary intake, physical activity, blood pressure, total cholesterol and fasting blood glucose) was collected via questionnaires, physical examination and laboratory test. Depression status was assessed using the Epidemiologic Studies Depression Scale (CES-D) and a score of 16 or above was considered depression. The relationship between CVH metrics and depression was …

Reduced Cardiovascular Capacity And Resting Metabolic Rate In Men With Prostate Cancer Undergoing Androgen Deprivation: A Comprehensive Cross-Sectional Investigation, Bradley Wall, Daniel A. Galvao, Naeem Fatehee, Dennis Taaffe, Nigel Spry, David Joseph, Robert Newton

Research outputs 2014 to 2021

Objectives. To investigate if androgen deprivation therapy exposure is associated with additional risk factors for cardiovascular disease and metabolic treatment-related toxicities. Methods. One hundred and seven men (42-89 years) with prostate cancer undergoing androgen deprivation therapy completed a maximal graded objective exercise test to determine maximal oxygen uptake, assessments for resting metabolic rate, body composition, blood pressure and arterial stiffness, and blood biomarker analysis. A cross-sectional analysis was undertaken to investigate the potential impact of therapy exposure with participants stratified into two groups according to duration of androgen deprivation therapy (≥3 months). Results. Maximal oxygen uptake (26.1 ± 6.0 mL/kg/min …

Left Ventricular Assist Device As Destination Therapy, Maya Guglin, Leslie W. Miller

The VAD Journal

Mechanical circulatory support is the most rapidly evolving strategy in heart failure management. The growing number of patients who need better results than medical therapy can offer, the limited pool of donors for cardiac transplantation, and several technological breakthroughs have all made the option of implanting a left ventricular assist device (LVAD) as destination therapy more important.

In this review, we outline the indications and decision making process of considering a patient for a destination therapy LVAD, as well as outcomes, complications, and issues related to management of patients on currently approved devices. The future direction of the field will …

The Bubbling Aorta, Hesham R. Omar, Maya Guglin

The VAD Journal

We are presenting the image of the bubbles in the descending aorta in a patient on VA ECMO.

The Utilization Of Independent Lung Ventilation Via High Frequency Percussive Ventilation (Hfpv) During Extracorporeal Membrane Oxygenation (Ecmo), Kenneth Miller Med, Msrt, Rrt-Accs, Nps, Ae-C, Faarc, Rita Pechulis Md, Fccp, James K. Wu, Chad Traub Rrt-Accs, Dorothea T. Watson Do

Patient Care Services / Nursing

No abstract provided.

Senile Cardiac Amyloidosis: An Undervalued Cause Of Heart Failure., Toni Anne Alvarez De Venecia, Scott Blumhof, Daniel Ukpong, Marvin Lu, Claudia Nieves, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Despite recurrent hospitalizations for heart failure exacerbations, the underlying cause can be missed. Senile amyloidosis is a disease prevalent in the elderly African American population. Senile amyloidosis is underdiagnosed as a cause of heart failure because of its occurrence with more common comorbidities, such as long-standing systemic hypertension. It is important to maintain a high index of suspicion for senile amyloidosis in patients such as this case, who presented with multiple exacerbations of heart failure combined with characteristic electrocardiographic and echocardiographic findings.

Better Physician-Patient Communication; An Important Milestone In Control Of Hypertension, A Multicenter Study From Karachi, Pakistan., Aysha Almas Almas, Faridah Bhamani, Aamir Hameed

Department of Medicine

Control of hypertension is an important cornerstone in prevention of cardiovascular morbidity and mortality. This study was designed to compare physician encounter score in patients with controlled and uncontrolled hypertension. It was conducted at three tertiary care hospitals in Karachi. Patients were categorized into controlled and uncontrolled hypertension based on their initial blood pressure readings on presentation. Primary outcome variable was control of hypertension and physician encounter score (a composite score of 12 item question) was the main candidate variable. Higher scores reflected favorable encounter with physician. Mean age of participants was 57.7 ± 12 years; 224 (50.1%) were men. …

Takotsubo Cardiomyopathy: Ten Year Experience At A Tertiary Care Hospital In Pakistan., Abid Laghari, Aamir Hameed, K. Kazmi

Department of Medicine

Objective: There is very little literature regarding Takotsubo Cardiomyopathy (TTC) from the Asian Countries other than Japan and Korea. We conducted this study to determine the demographics, clinical presentations, complications and recovery of left ventricular (LV) systolic function in TTC patients of Pakistani origin.

Methods: A ten years retrospective case series study of TTC was conducted at the Aga Khan University Hospital. Patients were followed for up to six months after presentation, with special emphasis on the recovery of LV function.

Conclusion: TTC is classically triggered by an acute illness or by extreme stress and a triggering incident may not …

Development Of A Heart Rate Variability Measurement System Using Embedded Electronics, Naresh Kumar Velmurugan

Graduate Theses and Dissertations

Recent advances in embedded electronics have a remarkable influence on the health care system. One of the most important applications is to monitor the health care of the patients at anytime and anyplace. In the last two decades, many researchers have focused mainly on heart rate variability (HRV) measurements. Patient's heart rate variability should be continuously monitored to help them in case of emergency. Under these circumstances, patients are required to have a HRV measuring kit for a constant observation.

The proposed project focuses on the development of a heart rate variability measurement system with the use of embedded electronics. …