Medical Specialties Commons^™

Chronic Outpatient Sildenafil Therapy For Pulmonary Hypertension In A Child After Cardiac Surgery, Chad A. Knoderer, E. S. Ebenroth, J. W. Brown

Scholarship and Professional Work – COPHS

We report the case of a 14-month-old male with d-transposition of the great arteries, ventricular septal defect, and pulmonary hypertension successfully treated with long-term sildenafil following cardiac surgery. To our knowledge, this is the first published report of long-term sildenafil treatment in a child after corrective cardiac surgery.

Non-Traumatic Aortic Emergencies - Experience From A Tertiary Care Centre In, Nadeem Khan Ullah Khan, Junaid A. Razzak, Hasanat Sharif, Saqib Hamid Qazi

Department of Emergency Medicine

Objective: To review the incidence, clinical presentation and outcome of Non traumatic Aortic emergencies in a tertiary care hospital and its evaluation in the Emergency department (ED).
Methods: We conducted a retrospective review of cases presented to the ED at Aga Khan University Hospital during 15 year period (1988 - 2002) who had final diagnosis of Aortic Dissection or Ruptured Aortic Aneurysm. Patients without confirmatory investigations were excluded. We aimed at looking for the incidence, clinical presentation, evaluation in the ED and final outcome.
Results: Of the 12 cases, 7 had aortic dissection while the remaining 5 had ruptured aortic …

Cardiogenic Shock After Dipyridamole Administration For Myocardial Perfusion Imaging, Fahim H. Jafary, Nageeb Basir, Adnan Amin, Nasiruddin Ahmed

Section of Cardiology

No abstract provided.

Heart Rate Variability In Non-Apneic Snorers And Controls Before And After Continuous Positive Airway Pressure, Gregory J. Gates, Susan E. Mateika, Jason H. Mateika

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

We hypothesized that sympathetic nervous system activity (SNSA) is increased and parasympathetic nervous system activity (PNSA) is decreased during non-rapid eye movement (NREM) sleep in non-apneic, otherwise healthy, snoring individuals compared to control. Moreover, we hypothesized that these alterations in snoring individuals would be more evident during non-snoring than snoring when compared to control.

Methods

To test these hypotheses, heart rate variability was used to measure PNSA and SNSA in 11 normotensive non-apneic snorers and 12 control subjects before and 7-days after adapting to nasal continuous positive airway pressure (nCPAP).

Results

Our results showed that SNSA was increased …

Predicting Postoperative Cardio-Pulmonary Complications By A Test Of Stair Climbing, Nawal Salahuddin, Saulat H. Fatimi, Shehzad Huda, Mohammad Islam, Azam Shafquat

Section of Cardiothoracic Surgery

OBJECTIVE: To assess whether a test of stair climbing ability could be used to predict the risk of developing postoperative cardiopulmonary complications in patients undergoing general anesthesia.
DESIGN: Cohort study.
PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi. The duration of the study was from December 2003 to December 2004. PATIENTS AND METHODS: This study was carried out on consecutive, adult patients presenting for elective thoracic or abdominal surgery under general anesthesia. Pre-operatively, patients were asked to climb a standard staircase. Number of steps climbed was recorded. Those unable to climb stairs due to debilitating …

Survival Of Patients Treated With Intra-Aortic Balloon Counterpulsation At A Tertiary Care Center In Pakistan - Patient Characteristics And Predictors Of In-Hospital Mortality., Fahim H. Jafary, Sohail A. Khan, Haresh Kumar, Numaan F. Malik, K. Kazmi, Sajid Dhakam, Azam Shafquat, Aamir Hameed, Javed Tai, Najaf Nadeem

Department of Medicine

BACKGROUND: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC. This is the first report on a sizeable experience with IABC from Pakistan.

METHODS: Hospital charts of 95 patients (mean age 58.8 (+/- 10.4) years; 78.9% male) undergoing IABC between 2000-2002 …

A Study Of Pediatric Heart Transplant Patients In Relationship To Post Transplant Coronary Artery Disease, Mark Randall

Loma Linda University Electronic Theses, Dissertations & Projects

Post transplant coronary artery disease influences short and long-term survival of pediatric heart transplant recipients. Associated cardiovascular disease risk factors among non-heart transplant adult and pediatric heart populations for development of coronary artery disease have been documented. Little is known about these typical cardiovascular disease risk factors as well as other possible risk factors in the development of post transplant coronary artery disease. Objective: The purpose of this research was to examine children/adolescents (n=194), 5-18 years old, at least one-year post heart transplant. This study also investigated if there were physiological and psychological/behavioral differences between recipients with (n = 28) …

Infant Heart Transplant: Perioperative Indicators Of Neurocognitive Development, Joy Michelle Gardner

Loma Linda University Electronic Theses, Dissertations & Projects

Approximately five to eight births per 1000 in the United States are born with a congenital heart defect (Limperopoulos et al, 1999), the primary defect in 57% is hypoplastic left heart syndrome (Johnston, 1991). A fatal disease twenty years ago, survival has jumped from less than 5% to 91% of infants surviving their one-month birthday due to advances in palliative and transplant procedures (Razzouk et al, 1996). Unfortunately, the decrease in mortality has been unmatched by a decrease in morbidity, which continues to be a major risk factor when undergoing deep hypothermia (du Plessis, 2000). While neurodevelopmental and cognitive dysfunction …

Clarithromycin Induced Digoxin Toxicity: Case Report And Review, N Kiran, S Azam, S Dhakam

Section of Cardiology

No abstract provided.

Il-5 Links Adaptive And Natural Immunity In Reducing Atherosclerotic Disease, Alan Daugherty, Debra L. Rateri, Victoria L. King

Gill Heart & Vascular Institute Faculty Publications

Oxidized LDL induces changes in several facets of the immune system, although the relationships between these facets and their contributions to atherogenesis have yet to be fully elucidated. A report in this issue of the JCI provides a novel demonstration of the adaptive immune system influencing the production of natural antibodies. The results demonstrate that injection of malondialdehyde-modified LDL promotes a Th2 response that in turn increases the titers of the natural antibody T15/EO6, which recognizes the oxidized phospholipid POVPC. Atherosclerotic lesion size in LDL receptor–deficient mice is reduced as a consequence of the increase in natural antibody titers, and …

Diversion Of The Inferior Vena Cava Following Repair Of Atrial Septal Defect Causing Hypoxemia, Ellen A. Thompson, Silvestre Cansino, Dennis Moritz, Romaine Perdue Perdue

Internal Medicine

Atrial septal defects (ASDs) are a common congenital abnormality, and operative repair is a routine, safe procedure. Diversion of the inferior vena cava (IVC) into the left atrium is an unusual complication following ASD closure. We report a case that illustrates the problem created by this right-to-left shunt. A middle-aged woman underwent ASD repair. She developed hypoxemia postoperatively. A transthoracic echocardiogram confirmed a right-to-left shunt, found only with agitated saline injected into the femoral vein, not into the basilic vein. Surgical reexploration revealed a residual ASD diverting IVC flow into the left atrium, which was repaired with a pericardial patch. …

Risk Factors And Behaviours For Coronary Artery Disease (Cad) Among Ambulatory Pakistanis, S P. Iqbal, S Dodani, Riaz Qureshi

Department of Family Medicine

Objective: To determine the frequency and distribution of various risk factors and behaviours for coronary artery disease (CAD) among ambulatory Pakistanis.
Methods: It is a cross-sectional descriptive study carried out at the Aga Khan University Hospital, a teaching hospital in Karachi. All the subjects were adults (18-60 years) presenting at the general checkup clinic with no history or evidence of CAD by convenient sampling method. Demographic variables included risk factors and behaviors including diabetes, hypertension, dyslipidemia, family history of heart disease, obesity, smoking and sedentary lifestyle.
Results: Among 370 ambulatory Pakistanis, the proportions of major risk factors for CAD were: …

Tissue Kallikrein In Cardiac Remodeling And Renal Damage In Genetic And Salt-Induced Hypertension Rat Models, Grant Anderson Bledsoe

MUSC Theses and Dissertations

Abnormalities of the tissue kallikrein-kinin system have been identified in the pathogenesis of hypertension and cardiac and renal diseases. The purpose of this study was to investigate the effect of exogenous tissue kallikrein gene delivery on heart and kidney injury in pressure overload and volume overload hypertension using spontaneously hypertensive rats (SHR) and Dahl salt-sensitive (DSS) rats. In order to examine the role of kallikrein in cardiac protection, adenovirus encoding the human tissue kallikrein gene was injected intravenously into SHR. Expression of recombinant human tissue kallikrein was identified in rat serum by ELISA and heart and kidney tissue by RT-PCR/Southern …

The Relationship Of Health Beliefs And Health Value In Cardiovascular Outcomes, Kimberley Schaub

All-Inclusive List of Electronic Theses and Dissertations

Despite extensive theoretical information regarding Schwarzer's Health Action Process Approach the utility of the model pas yet to be explored within a chronic illness population. Using Schwarzer's Health Action Process Approach (Schwarzer, 1992), the purpose of this study was to investigate cardiovascular outcomes based on health beliefs and health value. Participants were eighty-one adults ages 42-87 with cardiovascular disease recruited from a cardiac rehabilitation program in Central Indiana. Participants completed instruments that assessed (a) health beliefs, (b) health value and, (c), quality of life. Measurements of physiological outcome (resting heart rate, distance walked, and metabolic equivalent) were also obtained. A …

Ischemic Stroke Subtypes In Pakistan: The Aga Khan University Stroke Data Bank, N. A. Syed, B. A. Khealani, S. Ali, A. Hasan, H. Brohi, T. Mozaffar, N. Ahmed, A. Hameed, S. M. Baig, M. Wasay

Department of Medicine

Objective: Frequency of ischemic stroke subtypes is influenced by ethnic and geographic variables. Our objective was to identify various stroke subtypes and its determinants at a tertiary care hospital.

Methods: We prospectively collected data on ischemic stroke subtypes admitted to The Aga Khan University Hospital in Karachi.

Results: A total of 596 patients were enrolled in 22 months in the Aga Khan Universtiy Stroke Registry. These included 393 patients with Ischemic stroke, 126 patients with intracerebral hemorrhage, 50 patients with subarachnoid hemorrhage and others. The ischemic stroke group was classified according to the TOAST criteria and comprised of lacunar 168/393 …

Situs Ambiguous, Saba Sohail, Mukhtiar Ahmed Memon, Allah Rakhiyo

Department of Radiology

The case of a female child is described who presented with recurrent respiratory infections and "recurrent right subphrenic abscess." Detailed radiological work-up identified situs ambiguous abdominis with bronchiectasis, duodenal malrotation, umbilical hernia and spina bifida.

Risk Factors For Cardiovascular Disease In School Children--A Pilot Study., A. K. Khuwaja, Zafar Fatmi, W. B. Soomro, N. K. Khuwaja

Community Health Sciences

OBJECTIVE:

To assess the frequencies of risk factors for cardiovascular disease in school children. The information may help in designing interventions aimed at modifying unhealthy lifestyle in children, which may reduce the later incidence of cardiovascular disease in adults.

METHODS:

A cross-sectional study was conducted on 206 students (ages 14-18 years), enrolled in higher secondary school. Students were interviewed about their lifestyles, family history of cardiovascular disease and its risk factors. Moreover, they were assessed for height, weight and blood pressure.

RESULTS:

Twenty nine percent of the children were physically inactive, 31% were taking unhealthy diet daily, 21% were overweight …

Probucol Prevents Early Coronary Heart Disease And Death In The High-Density Lipoprotein Receptor Sr-Bi/Apolipoprotein E Double Knockout Mouse, Anne Braun, Songwen Zhang, Helena E. Miettinen, Shamsah Ebrahim, Teresa M. Holm, Eliza Vasile, Mark J. Post

Dartmouth Scholarship

Mice with homozygous null mutations in the high-density lipoprotein receptor SR-BI (scavenger receptor class B, type I) and apolipoprotein E genes fed a low-fat diet exhibit a constellation of pathologies shared with human atherosclerotic coronary heart disease (CHD): hypercholesterolemia, occlusive coronary atherosclerosis, myocardial infarctions, cardiac dysfunction (heart enlargement, reduced systolic function and ejection fraction, and ECG abnormalities), and premature death (mean age 6 weeks). They also exhibit a block in RBC maturation and abnormally high plasma unesterified-to-total cholesterol ratio (0.8) with associated abnormal lipoprotein morphology (lamellar/vesicular and stacked discoidal particles reminiscent of those in lecithin/cholesterol acyltransferase deficiency and cholestasis). Treatment …

Bidirectional Cavopulmonary Shunt For Cyanotic Heart Disease: Surgical Experience From A Developing Country, G. Khan, S. S. Ali, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Objective: The importance of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic con-genital heart disease is widely recognized. This study was conducted to highlight our surgical experience withthis procedure in a developing country.
Methods: A retrospective study was conducted using medical records at the Aga Khan University Hospital,Karachi, Pakistan. Clinical findings at presentation, anatomical defects seen on transthoracic echocardiography,pre-operative McGoon index, cardiopulmonary bypass time, use of cardioplegia,post-procedure oxygen satura-tions and complications were evaluated.
Results: A total of 8 patients underwent bidirectional cavopulmonary anastomosis. There were 6 males (75%)and 2 females (25%). Ages and weights atoperation averaged 5.7 ± 3.7 …

Is Dynamic Atrial Overdrive Pacing Anti-Arrhythmic Or Proarrhythmic: A Case Report, Ngai-Yin Chan, Miu-Fong Kwok, Chi-Chung Choy

Journal of the Hong Kong College of Cardiology

No abstract provided.

Respiratory Arrest In A Child After Flushing Of Pancuronium From The Dead Space Of Intravenous Cannula, Robyna Irshad Khan, Fazal Hameed Khan, Hamid Iqil Naqvi

Department of Anaesthesia

It is common practice for patients admitted to Intensive Care Units to have indwelling intravenous cannulae. Sometimes these cannulae are used only for the administration of drugs and are closed otherwise. Residual drugs in the deadspace of these intravenous cannulae as well as connected stoppers or 3-way stopcocks can later be flushed unknowingly. We would like to report a case in which inadvertent flushing of residual pancuronium caused complete muscle paralysis and respiratory arrest in a young child.

Drug Eluting Stent: A Major Advance In Fighting Coronary Artery Restenosis, Yuk-Kong Lau

Journal of the Hong Kong College of Cardiology

Since the first use of coronary angioplasty in 1977, there have been major growth and development in percutaneous coronary intervention (PCI). Due to the advances in techniques, experiences, devices, and newer potent antiplatelet and antithrombotic medications, PCI is increasingly performed in highly complex and high risk patients with a reasonably low complication rate. Coupled with reduced discomfort, shorter hospital stay and recovery time, it has far outnumbered the volume of coronary artery bypass surgery. Currently, 1.7 million PCI procedures are performed annually worldwide with increases by 15-20% per year the last decade.

Role Of Signal-Averaged Ecg In Predicting Results Of Flecainide Provocation Test Used In Family Screening For Brugada Syndrome, Ngai-Shing Mok, Chi-Chung Choy, Ngai-Yin Chan, Amy Ho

Journal of the Hong Kong College of Cardiology

Brugada syndrome (BS) is an inherited arrhythmogenic disease with an autosomal dominant mode of inheritance. Flecainide provocation test (FPT) has been shown to be highly sensitive and specific in unmasking the Brugada ECG pattern in affected subjects. We sought to test if late potential (LP) in signal averaged electrocardiogram (SAECG) is helpful in predicting the results of FPT used in family screening for BS. The study included 17 asymptomatic Chinese subjects from 8 families (M:F 10:7, mean age 24.8±11.4 years) who have undergone family screening for BS. All screened subjects had a normal 12-lead ECG at baseline. None had structural …

The Post-Madit Ii Era: Icd For All Post-Infarct Patients With Moderate To Severe Left Ventricular Dysfunction?, Kathy Lai-Fun Lee, Chu-Pak Lau

Journal of the Hong Kong College of Cardiology

Device therapy has become the preferred treatment for patients who have survived sudden cardiac death. Throughout the last decade, large-scale randomized clinical trials have provided consistent evidence on the clinical efficacy of device therapy. ICD is proven to be superior to anti-arrhythmic drugs in patients with structural heart diseases who suffer from haemodynamically significant ventricular arrhythmias. The role of ICD in primary prevention of sudden death in selected patients with coronary artery disease and left ventricular dysfunction is also widely established after the Multicenter Automatic Defibrillator Implant Trial (MADIT) and the Multicenter Unsustained Tachycardia Trial (MUSTT).

Percutaneous Revascularisation In Diabetic Patients With Coronary Artery Disease, Wai-Hong Chen, Chu-Pak Lau

Journal of the Hong Kong College of Cardiology

Diabetic patients with coronary artery disease are associated with an unfavourable long-term outcome. Surgical revascularisation on top of medical therapy has been shown to confer survival benefit in patients with mutivessel and left main disease. With the emergence of the percutaneous approach of revascularisation, several clinical trials have been conducted to compare these two modalities of treatment. Consistent results were demonstrated in the diabetic subgroup that coronary artery bypass grafting is superior to balloon angioplasty in preventing late adverse cardiac event. With the advancement of percutaneous technique using coronary stenting as the predominant mode of catheter based revascularisation, the latest …

Update - May 2002, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- The Compleat Physician
-- Informed Consent Documentation for Total Artificial Hearth Technology
-- Ralph J. and Carolyn Thompson Endowment established in 2001

Typical Symptoms Are Predictive Of Acute Coronary Syndromes In Women, Kerry A. Milner, Marjorie Funk, Amy L. Arnold, Viola Vaccarino

Nursing Faculty Publications

Background: Previous research suggests that the presentation of acute coronary syndromes (ACS) may differ in women and men. No study has prospectively evaluated the role of a comprehensive set of typical and atypical symptoms and whether different symptoms on presentation predict ACS diagnosis in women and men. Methods and Results: We directly observed 246 women and 276 men seen in the emergency department with symptoms suggestive of ACS and documented their symptoms verbatim. ACS was eventually diagnosed in 89 (36%) women and 124 (45%) men on the basis of standard electrocardiogram and cardiac enzyme criteria. Presence of typical symptoms (chest …

The Long-Term Clinical Prognosis In Patients With Anterior Wall And Non-Anterior Wall Acute Myocardial Infarction Referred To Primary Percutaneous Transluminal Coronary Angioplasty, Mingzhong Zhao, Dayi Hu, Tianchang Li, Sanqing Jia

Journal of the Hong Kong College of Cardiology

Objective: To investigate the long-term clinical prognosis in patients with anterior wall acute myocardial infarction (AW-AMI) and non AW-AMI (NAW-AMI) referred to primary percutaneous transluminal coronary angioplasty (P-PTCA). Methods: 287 patients with AMI who underwent P-PTCA were divided into AW-AMI group (142 cases) and NAW AMI group (145 cases) according to different sites of AMI. The baseline characteristics and coronary artery lesions of patients were analysed. The primary end points were in-hospital mortality and the major cardiovascular events (MACE) during a mean 17.3±9.8 months follow-up including the occurrences of non-fatal myocardial infarction, non-fatal congestive heart failure, revascularization of target vessels …

Appropriate Use Of Clopidogrel, Cyrus R Kumana, Bernard Man-Yung Cheung, Ij Lauder

Journal of the Hong Kong College of Cardiology

Clopidogrel (Plavix®) is an orally administered pro-drug, whose pharmacology and therapeutic role has been extensively reviewed in recent publications.1-5 In essence, it results in selective and irreversible antagonism of ADP-induced platelet aggregation. Such aggregation normally results in the surface expression of platelet glycoprotein (GP) IIb/IIIa receptors, which facilitate fibrinogen binding as well as consequential further platelet aggregation – the final common pathway of vascular occlusion. Specific cytochrome P450 enzymes are thought to generate the responsible active metabolite (believed to persist transiently). However, dosage adjustment is not recommended in hepatic impairment (unless severe) and drug-drug interactions and co-administration with meals are …

Spatio-Temporal Variation In Activation Intervals During Ventricular Fibrillation, Sachin Anil Moghe

University of Kentucky Doctoral Dissertations

Spatio-temporal variation in activation rates during ventricular fibrillation (VF)provides insight into mechanisms of sustained re-entry during VF. This study had three objectives related to spatio-temporal dynamics in activation rates during VF.

The first objective was to quantify spatio-temporal variability in activation rates,that is, in dominant frequencies, computed from epicardial electrograms recorded during VF in swine. Results showed that temporally and spatially, dominant frequencies variedas much as 20% of the mean dominant frequency, and the mean dominant frequencies increased during first 30 sec of VF. These results suggest that activation rates are nonstationary during VF.

The second objective of the study …