Medical Specialties Commons^™

Special Article: Physical Activity, Physical Fitness, And Cardiovascular Risk Factors In Childhood, Samuel S. Gidding

Department of Pediatrics Faculty Papers

In adults, physical activity and exercise training are associated with reduced cardiovascular morbidity and mortality, a reduced likelihood of developing adverse cardiovascular risk factors, and improved insulin sensitivity. In childhood, participation in appropriate physical activity may prevent the development of cardiovascular risk factors in the future and complement treatment of existing cardiovascular risk factors, including hypertension, dyslipidemia, and overweight. Exercise in children can also significantly improve insulin sensitivity independent of weight loss. These e fects are mediated in overweight children by increases in lean body mass relative to fat mass and associated improvements in inflammatory mediators, endothelial function, and the …

Osmotic Demyelination Syndrome: Case Report, Mzee Ngunga, R. Harania, K. Hameed, J. O. Jowi

Internal Medicine, East Africa

We present a 40 year old man who was admitted to the hospital with convulsions. His final diagnosis was osmotic demyelination syndrome (ODS).We discuss the diagnostic and management challenges and the possible complications of this rare diagnosis.

Reduced Atrial Tachyarrhythmia Susceptibility After Upgrade Of Conventional Implanted Pulse Generator To Cardiac Resynchronization Therapy In Patients With Heart Failure, Demetris Yannopoulos, Keith Lurie Md, Scott Sakaguchi, Simon Milstein Md

Articles

OBJECTIVES:

We sought to identify the impact of cardiac resynchronization therapy (CRT) on atrial tachyarrhythmia (AT) susceptibility in patients with left ventricular (LV) systolic dysfunction in whom worsening heart failure (HF) resulted in upgrade from conventional dual-chamber pulse generator to cardiac resynchronization therapy-defibrillator (CRT-D).

BACKGROUND:

Cardiac resynchronization therapy with a defibrillator improves survival rates and symptoms in patients with LV systolic dysfunction but little is known about its effects on AT incidence in the same patient population.

METHODS:

Twenty-eight consecutive HF patients who underwent device upgrade to CRT-D were included. Patients had > or =2 device interrogations in the 1 year …

Left Ventricular Noncompaction Mimicking Peripartum Cardiomyopathy., Chetan Patel, Girish S. Shirali, Naveen Pereira

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Survival After Bidirectional Cavopulmonary Anastomosis: Analysis Of Preoperative Risk Factors., Mark A. Scheurer, Elizabeth G Hill, Nagavardhan Vasuki, Scott Maurer, Eric M. Graham, Varsha Bandisode, Girish S. Shirali, Andrew M. Atz, Scott M. Bradley

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Prognostic factors for survival after bidirectional cavopulmonary anastomosis for functionally single ventricle are not well defined. We analyzed preoperative hemodynamic and echocardiographic data to determine risk factors for death or transplantation at least 1 year after bidirectional cavopulmonary anastomosis.

METHODS: Data for all patients who underwent bidirectional cavopulmonary anastomosis before 5 years of age at our institution from September 1995 through June 2005 were analyzed. Available preoperative echocardiograms and catheterizations were reviewed. Survivors were compared with those who died or underwent transplantation. Bivariable associations between demographic and clinical risk factors and survival status (alive without transplantation vs dead or …

Gender Differences In Acute Cardiac Care: Where It’S Not (Poster), Marna R. Greenberg Do, Mph, Facep, Valerie Rupp Rn, Bsn, Anne Marie Crown, Sharon R. Kimmel

Department of Emergency Medicine

No abstract provided.

A Review Of The Association Between Congestive Heart Failure And Cognitive Impairment., Michael B. Cohen, Paul J. Mather

Division of Cardiology Faculty Papers

Heart failure is a growing epidemic with an estimated 5 million Americans suffering from this condition. Several clinical trials have demonstrated a high correlation between congestive heart failure (CHF) and cognitive impairment. The severity of cognitive impairment correlates positively with the degree of CHF. The underlying mechanism for cognitive impairment remains unclear but appears to be related to cerebral hypoperfusion and impaired cerebral reactivity with selective impairment of verbal memory and attention domains. Furthermore, cognitive dysfunction represents one aspect of frailty, a novel concept that encompasses a range of clinical conditions that results in functional impairment in patients with heart …

Symptom Clusters In Acute Myocardial Infarction: A Secondary Data Analysis, Catherine J. Ryan, Holli A. Devon, Rob Horne, Kathleen B. King, Kerry A. Milner, Debra K. Moser, Jill R. Quinn, Anne Rosenfeld, Seon Young Hwang, Julie J. Zerwic

Nursing Faculty Publications

Background: Early recognition of acute myocardial infarction (AMI) symptoms and reduced time to treatment may reduce morbidity and mortality. People having AMI experience a constellation of symptoms, but the common constellations or clusters of symptoms have yet to be identified.
Objectives: To identify clusters of symptoms that represent AMI.
Methods: This was a secondary data analysis of nine descriptive, cross-sectional studies that included data from 1,073 people having AMI in the United States and England. Data were analyzed using latent class cluster analysis, an atheoretical method that uses only information contained in the data.
Results: Five distinct clusters of symptoms …

Beta Blocker Specificity: A Building Block Toward Personalized Medicine., Brent R Degeorge, Walter J Koch

Center for Translational Medicine Faculty Papers

Drugs known as beta blockers, which antagonize the beta-adrenergic receptor (beta-AR), are an important component of the treatment regimen for chronic heart failure (HF). However, a significant body of evidence indicates that genetic heterogeneity at the level of the beta(1)-AR may be a factor in explaining the variable responses of HF patients to beta blockade. In this issue of the JCI, Rochais et al. describe how a single amino acid change in beta(1)-AR alters its structural conformation and improves its functional response to carvedilol, a beta blocker currently used in the treatment of HF (see the related article beginning on …

Three Pregnancies With Mechanical Heart Valve And No Follow-Up In 10 Years, Raja Parvez Akhtar, Abdul Rehman Abid, Hasnain Zafar

Section of General Surgery

Anticoagulation and proper INR (International Normalized Ratio) monitoring is essential for patients having mechanical heart valves; it is vital in these patients in order to prevent lethal complications such as valve thrombosis and systemic embolism. In pregnancy, it becomes even more important as pregnancy itself is a hypercoagulable state. This report describes a female patient having undergone mitral valve replacement with a Starr Edward metallic prosthesis. She came back to the operating surgeon after 10 years of valve replacement with a history of three uneventful healthy deliveries and no follow-up and INR monitoring during this period.

The "Incidental" Episode Of Ventricular Fibrillation: A Case Report, Fahim H. Jafary

Section of Cardiology

Polymorphic ventricular tachycardia and ventricular fibrillation (VF) carry important prognostic implications, especially in the post myocardial infarction period. However, artifact on the electrocardiographic tracing can mimic VF particularly on routinely recorded rhythm strips in hospitals. Such misinterpretation can lead to expensive (and potentially risky) diagnostic and therapeutic steps. We report on such a case and highlight the need for careful inspection of the tracing.

Rare Relapsed Extrapulmonary Hydatid Disease, Saulat H. Fatimi, Mj Schuuring, S. Sheikh

Section of Cardiothoracic Surgery

Hydatid cysts are rarely seen at the extrapulmonary sites. We report relapsed hydatid cysts with abdominal origin in a 25 years old woman. Over 1000 Hydatid cysts were removed through right posterolateral thoracotomy without any complications. Only very few cases are reported in the literature.

Sir/Rsna/Cirse Joint Medical Simulation Task Force Strategic Plan: Executive Summary, Derek Gould, Aalpen Patel, Gary Becker, Buddy Conners, John Cardella, Steven Dawson, Craig Glaiberman, David Kessel, Mick Lee, Mark Scerbo

Psychology Faculty Publications

(First paragraph) The Executive Councils of the Society of Interventional Radiology (SIR), Radiological Society of North America (RSNA), and Cardiovascular and Interventional Radiological Society of Europe (CIRSE) have charged their Medical Simulation Task Forces and Work Groups to cooperate to achieve excellence and safety in interventional radiology patient care by jointly recommending and guiding implementation of a robust infrastructure and process to support Interventional Radiology (IR) simulation development, assessment, validation, application, and dissemination.

Is The Treatment And Transport Of Asystolic Cardiac Arrest Patients To Hospital By Ambulance Services Appropriate?, Andy Symons

Theses: Doctorates and Masters

The Paramedic's role requires them to attend many patients in cardiac arrest. The victim' s survival depends on a variety of issues, such as previous medical history, pathological cause of cardiac arrest, presenting cardiac arrest dysrhythmias, and the time elapsed before medical aid is administered. The purpose of this present study was to review current practice advocated by St John Ambulance Service WA for the treatment of the cardiac arrest dysrhythmia `asystole'. At present, certain victims of an asystolic arrest are treated and transported to hospital irrespective of time in arrest. As such, questions are raised as to the suitability …

Guidelines And Standards For Performance Of A Pediatric Echocardiogram: A Report From The Task Force Of The Pediatric Council Of The American Society Of Echocardiography., Wyman W. Lai, Tal Geva, Girish S. Shirali, Peter C. Frommelt, Richard A. Humes, Michael M. Brook, Ricardo H. Pignatelli, Jack Rychik, Pediatric Council Of The American Society Of Echocardiography

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

P5l Mutation In Ank Results In An Increase In Extracellular Inorganic Pyrophosphate During Proliferation And Nonmineralizing Hypertrophy In Stably Transduced Atdc5 Cells, Raihana Zaka, David Stokes, Arnold S. Dion, Anna Kusnierz, Fei Han, Charlene J. Williams

Center for Translational Medicine Faculty Papers

Ank is a multipass transmembrane protein that regulates the cellular transport of inorganic pyrophosphate. In the progressive ankylosis (ank) mouse, a premature termination mutation at glutamic acid 440 results in a phenotype characterized by inappropriate deposition of basic calcium phosphate crystals in skeletal tissues. Mutations in the amino terminus of ANKH, the human homolog of Ank, result in familial calcium pyrophosphate dihydrate deposition disease. It has been hypothesized that these mutations result in a gain-of-function with respect to the elaboration of extracellular inorganic pyrophosphate. To explore this issue in a mineralization-competent system, we stably transduced ATDC5 cells with wild-type Ank …

Incidence And Outcome Of Cardiopulmonary Resuscitation In Patients With Shunted Single Ventricle: Advantage Of Right Ventricle To Pulmonary Artery Shunt., Eric M. Graham, Geoffrey A. Forbus, Scott M. Bradley, Girish S. Shirali, Andrew M. Atz

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Knowledge Of Modifiable Risk Factors Of Heart Disease Among Patients With Acute Myocardial Infarction In Karachi, Pakistan: A Cross Sectional Study, Muhammad S. Khan, Fahim H. Jafary, Tazeen H. Jafar, Azhar M. Faruqui, Syed I. Rasool, Juanita Hatcher, Nish Chaturvedi

Community Health Sciences

Background: Knowledge is an important pre-requisite for implementing both primary as well as secondary preventive strategies for cardiovascular disease (CVD). There are no estimates of the level of knowledge of risk factor of heart disease in patients with CVD. We estimated the level of knowledge of modifiable risk factors and determined the factors associated with good level of knowledge among patients presenting with their first acute myocardial infarction (AMI) in a tertiary care hospital in Karachi, Pakistan.Methods: A hospital based cross-sectional study was conducted at the National Institute of Cardiovascular Disease, a major tertiary care hospital in Karachi Pakistan. Patients …

Cardiac-Specific Elevations In Thyroid Hormone Enhance Contractility And Prevent Pressure Overload-Induced Cardiac Dysfunction, Maria G. Trivieri, Gavin Y. Oudit, Rajan Sah, Benoit-Giles Kerfant, Hui Sun, Anthony O. Gramolini, Yan Pan, Alan D. Wickenden, Walburga Croteau

Dartmouth Scholarship

Thyroid hormone (TH) is critical for cardiac development and heart function. In heart disease, TH metabolism is abnormal, and many biochemical and functional alterations mirror hypothyroidism. Although TH therapy has been advocated for treating heart disease, a clear benefit of TH has yet to be established, possibly because of peripheral actions of TH. To assess the potential efficacy of TH in treating heart disease, type 2 deiodinase (D2), which converts the prohormone thyroxine to active triiodothyronine (T3), was expressed transiently in mouse hearts by using the tetracycline transactivator system. Increased cardiac D2 activity led to elevated cardiac T3 levels and …

The Effect Of An Acute Bout Of Aerobic Exercise On Arterial Stiffness And Wave Reflection In Patients With Coronary Artery Disease, Alyssa L. Borell, Cristin A. Davis

Inquiry Journal 2006

No abstract provided.

Visual-Spatial & Visual-Motor Function In Pediatric Heart Transplant Recipients, Stephanine Dianne Griffone

Loma Linda University Electronic Theses, Dissertations & Projects

Heart surgery is commonly used to repair congenital heart defects and to perform heart transplantation. The associated hypoxia before or during the surgery may cause damage in the parasaggital area of the cerebral cortex, with resulting difficulty during tasks requiring visual-spatial and visual-motor skills. This study compares the performance of children who received a heart transplant during infancy to that of nonclinical children with no medical complications on three visual-motor measures, three visual-spatial measures, and two computerized visual-spatial tasks - a Block Design Matching task and a Mental Rotation task. The children who received a heart transplant achieved significantly lower …

The Reckless Pursuit Of Dominion: A Situational Analysis Of The Nba And Diminishing Player Autonomy, Michael Mccann

Law Faculty Scholarship

This Article examines required genetic testing of NBA players from a situational vantage point, integrating socio-psychological, legal, and ethical analyses. The core argument may be expressed as follows: required genetic testing of NBA players appears consistent with a broader and largely deleterious agenda by the NBA to control players. Since implementation of the rookie wage scale in 1995 through the recent imposition of a paternalistic player dress code, the NBA has increasingly usurped player autonomy. The NBA's capacity to do so largely rests in its adroit manipulation of the situational influences that influence fans and media. For instance, because of …

Effect Of Changes In Contractility On The Index Of Myocardial Performance In The Dysfunctional Left Ventricle, Steven J. Lavine

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

The index of myocardial performance has prognostic power in patients with cardiomyopathy and following myocardial infarction. As the index of myocardial performance has been shown to be preload and afterload dependent, the effect of altering contractility on IMP and its components with left ventricular dysfunction has been incompletely delineated.

Methods

Chronic left ventricular dysfunction was induced in 10 canines using coronary microsphere embolization. Each dog was instrumented and imaged with 2D echo and Doppler. At the same atrially paced rate, contractility was increased with a dobutamine infusion and then following 4 weeks of oral digoxin.

Results

With chronic …

Incidence Of Post Myocardial Infarction Left Ventricular Thrombus Formation In The Era Of Primary Percutaneous Intervention And Glycoprotein Iib/Iiia Inhibitors. A Prospective Observational Study, Arshad Rehan, Manpreet Kanwar, Howard Rosman, Sujood Ahmed, Arshad Ali, Julius Gardin, Gerald Cohen

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Before the widespread use of primary percutaneous coronary intervention (PCI) and glycoprotein IIb/IIIa inhibitors (GP IIb/IIIa) left ventricular (LV) thrombus formation had been reported to complicate up to 20% of acute myocardial infarctions (AMI). The incidence of LV thrombus formation with these treatment modalities is not well known.

Methods

92 consecutive patients with ST-elevation AMI treated with PCI and GP IIb/IIIa inhibitors underwent 2-D echocardiograms, with and without echo contrast agent, within 24–72 hours.

Results

Only 4/92 (4.3%) had an LV thrombus, representing a significantly lower incidence than that reported in the pre-PCI era. Use of contrast agents …

Minimally Symptomatic Severe Hypercalcaemia In A Patient With Parathyroid Carcinoma., Aisha Sheikh, Najmul Islam

Department of Medicine

The case of a 38 years old man with generalized pains fatigue, anorexia, constipation, polyuria serum calcium level of 20.6mg/dl in paired renal function parathyroid hormone is presented. Sestamibi scan showed a functioning left inferior parathyroid tumor, which was successfully removed. Before surgery he was managed with rehydration, diuretics and pamidronate infusion. Five months post surgery the serum calcium levels are normal and renal function has improved.

5 Year Survival Of A Patient With Malignant Thymoma With Superior Vena Caval Syndrome, Saulat H. Fatimi, Sadaf Sheikh, Saba Mansoor

Section of Cardiothoracic Surgery

No abstract provided.

Tracheal Inujry Due To Blunt Chest Trauma: A Rare Surgical Emergency, Usman Ahmad, Muhammad A Javed, Saulat H. Fatimi, Fahad Shuja

Section of Cardiothoracic Surgery

Tracheal injury is a rare complication of blunt chest trauma. The patients usually present with signs of respiratory distress. Primary repair is the treatment of choice in case of large defects, while small tears can be managed conservatively. Immediate operation is recommended to improve deteriorating pulmonary function. The decrease in mortality and long-term morbidity depends on early diagnosis. We report a case of tracheal injury due to non-penetrating thoracic trauma which was successfully managed with surgery.

Cardiac Transplant Following Failed Fontan Or Glenn Procedures., Naveen L. Pereira, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Clinical And Echocardiographic Characteristics Of Patients With Significant Pericardial Effusion Requiring Pericardiocentesis, Ata Ur Rehman Quraishi, Arif Anis Khan, Khawar Abbas Kazmi, Syed Muhammad Najaf, M Najib Basir, Azam Shafquat, Fahim Jafary, Sajid Dhakan

Section of Cardiology

Objective: Clinical and echocardiographic features of significant pericardial effusion (PE) have been reported from the west. Currently there is lack of published data from this part of the world, we reviewed all consecutive cases of significant PE requiring echocardiographic assisted pericardiocentesis to analyze the clinical and echocardiographic features of these patients.Methods: Forty four consecutive patients who underwent echocardiography assisted pericardiocentesis at the Aga Khan University Hospital (AKUH) between January 1988 and May 2001" re included in this review.Results: Most common presenting symptoms were dyspnea (89%) and fever (36%). Elevated JVP and pulsus paradoxus were documented in 59% and 41% of …

Effects Of Aging On Pressure-Induced Mapk Activation In The Rat Aorta, Kevin M. Rice

Theses, Dissertations and Capstones

With age, the cardiovascular system experiences substantial alterations in cellular morphology and function. The factors regulating these changes are unknown; however, the mitogen activated protein kinase (MAPK) pathways have emerged as critical components for mediating numerous cellular responses including control of cell growth, differentiation and adaptation. Here we compare the expression, basal activation and the ability of increased pressure to activate the MAPK pathways in adult (6 month old), aged (30 month old) and very aged (36 month old) Fischer 344 x Brown Norway F1 Hybrid rats. Histochemical analysis demonstrated an age-related increase in tunica media thickness of approximately 11% …