Medical Specialties Commons^™

Endocarditis Prophylaxis In Vulnerable Valve; Antibiotic Stewardship Or Suboptimal Care?, Zachary Taylor, Andrea Roast, Michael Layoun

Providence Portland Medical Center Internal Medicine 2025

Introduction Infective endocarditis (IE) is a relatively uncommon disease with an annual incidence of 5 per 100,000 people in the U.S.. Dental procedures are an exceptionally rare cause of IE. Amidst a global emphasis on antibiotic stewardship, U.S. and European guidelines only recommend antibiotic prophylaxis for dental procedures in high-risk groups. Having a bicuspid aortic valve (BAV) confers an 11-fold risk of endocarditis compared to the general public, and yet, is not classified as high-risk per AHA/IDSA guidelines. We present a patient with BAV who developed IE following a noninvasive dental procedure and review whether patients with BAV are under-classified …

A Rare Case Of Anomalous Left Coronary Artery From Right Cusp In A Young Athlete, Brittany Hooper, Michael J. Nolan

2025 Student Academic Showcase

This case report evaluates a 15-year-old male diagnosed with Anomalous Left Coronary Artery from Right Cusp. This rare condition often goes unnoticed until a tragic event occurs. In March 2022, a teenage athlete was completing practice when he suddenly collapsed. Fortunately, a police officer was already in the parking lot when teammates and coaches flagged them down. Emergency medical services arrived, and the athlete was transported to a nearby hospital. Despite extensive medical interventions and spending 35 days in a coma, he unfortunately succumbed to the condition. This case report aims to raise awareness of Anomalous Left Coronary Artery from …

Is There A Role Of Adding Defibrillation To Cardiac Resynchronization Therapy For Primary Prevention In Patients With Heart Failure And Reduced Ejection Fraction?, Hong Yee Lim, Yew Chung Chan, Wee Lee Chin, Soot Keng Ma

Journal of the Hong Kong College of Cardiology

Heart failure with reduced ejection fraction (HFrEF) is a major global health concern, and the mortality rate remains high despite advances in medical and device therapies. Cardiac resynchronization therapy with a pacemaker (CRT-P) and implantable cardioverter-defibrillator (ICD) therapies have demonstrated efficacy in improving outcomes for patients with heart failure, but their roles in combination for primary prevention remain under ongoing investigation. This review explores the current literature on the role of adding defibrillation to CRT for primary prevention in HFrEF patients. We examine key studies, mechanisms of action, and clinical outcomes to evaluate the benefits, risks, and future directions of …

Future Perspective Of Pulse Field Ablation For Atrial Fibrillation, Ka-Ying Li, Ho-Ting Ngan, Chu-Pak Lau, Hung-Fat Tse

Journal of the Hong Kong College of Cardiology

Pulse field ablation (PFA) represents cutting edge technique in cardiac electrophysiology designed to treat arrhythmias. Unlike traditional catheter ablation methods that rely on thermal energy to create heart lesions, PFA employs pulsed electric fields to trigger irreversible electroporation, resulting in precise tissue ablation. This comprehensive review explores the mechanisms and clinical uses of PFA, emphasizing its potential benefits over conventional ablation techniques and exploring its limitations. It also examines clinical data on current PFA devices, which offer consistent procedural outcome and lower risk of thermal related complications. These developments have driven rapid advancements of modern PFA catheters, with future innovations …

Ensemble Learning With Explainable Ai For Improved Heart Disease Prediction Based On Multiple Datasets, Shahid Mohammad Ganie, Pijush Kanti Dutta Pramanik, Zhongming Zhao

Faculty, Staff and Student Publications

Heart disease is one of the leading causes of death worldwide. Predicting and detecting heart disease early is crucial, as it allows medical professionals to take appropriate and necessary actions at earlier stages. Healthcare professionals can diagnose cardiac conditions more accurately by applying machine learning technology. This study aimed to enhance heart disease prediction using stacking and voting ensemble methods. Fifteen base models were trained on two different heart disease datasets. After evaluating various combinations, six base models were pipelined to develop ensemble models employing a meta-model (stacking) and a majority vote (voting). The performance of the stacking and voting …

High-Pressure Excursion In Oxygenators During Adult Cardiopulmonary Bypass: A Scoping Review, Anne Nguyen

Student Works

Background: High-pressure excursions (HPE) in oxygenators during cardiopulmonary bypass (CPB) are rare but clinically significant events that can lead to compromised perfusion and adverse patient outcomes. HPE occurs due to fibrin and platelet deposition within the oxygenator, leading to increased transmembrane pressure and potential obstruction of blood flow. Despite its clinical importance, HPE remains an underrecognized issue with limited standardized guidelines for detection, prevention, and management.

Methods: A comprehensive literature search was conducted across multiple databases and grey literature sources to identify studies reporting on HPE in CPB oxygenators. The selection process followed the PRISMA-ScR framework, with articles screened based …

5-Year Outcomes After Transcatheter Or Surgical Aortic Valve Replacement In Low-Risk Patients With Aortic Stenosis., John K Forrest, Steven J Yakubov, G Michael Deeb, Hemal Gada, Mubashir A Mumtaz, Basel Ramlawi, Tanvir Bajwa, John Crouch, William Merhi, Stephane Leung Wai Sang, Neal S Kleiman, George Petrossian, Newell B Robinson, Paul Sorajja, Ayman Iskander, Pierre Berthoumieu, Didier Tchétché, Christopher Feindel, Eric M Horlick, Shigeru Saito, Jae K Oh, Yoojin Jung, Michael J Reardon

Heart and Vascular Articles

BACKGROUND: The Evolut Low Risk trial demonstrated that transcatheter aortic valve replacement (TAVR) was noninferior to surgery for the primary endpoint of all-cause mortality or disabling stroke at 2 years. Outcomes at 5 years have not been reported.

OBJECTIVES: This study sought to evaluate 5-year clinical and hemodynamic outcomes with TAVR vs surgery in patients from the Evolut Low Risk trial.

METHODS: We randomly assigned low-risk patients with severe aortic stenosis to TAVR or surgery. The primary endpoint was a composite of all-cause mortality or disabling stroke. Secondary endpoints included clinical, echocardiographic, and quality-of-life outcomes through 5 years.

RESULTS: A …

The Benefits Of Leukocyte Depletion Filters For Blood Product Administration During Cardiopulmonary Bypass: A Scoping Review, Amber J. Helms

Student Works

Background: Cardiopulmonary bypass (CPB) is a critical component in cardiac surgery, enabling surgeons to perform complex procedures while maintaining systemic perfusion, oxygenation, and a bloodless field. Despite advancements in the CPB circuit design, prime solutions, and management strategies, complications such as inflammatory responses, coagulopathy, and organ dysfunction remain common. Therefore, identifying best practices that optimize perfusion parameters and improve patient outcomes is paramount.

Despite the best efforts, every patient has an inflammatory response to CPB, and it is not unusual to receive a blood product transfusion during CPB. A leukocyte depletion filter (LDF) is a device used in blood transfusions …

Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention In Patients With Non-St-Segment Elevation Myocardial Infarction In The United States: Results From Big Data Analysis, Chayakrit Krittanawong, Song Peng Ang, Neil Sagar Maitra, Zhen Wang, Mahboob Alam, Hani Jneid, Samin Sharma

Faculty, Staff and Students Publications

Non-ST-segment elevation myocardial infarction (NSTEMI) can be managed by ischemia guide strategies or early invasive strategies. Here, we present the findings of an updated contemporary analysis regarding the use of intracoronary imaging (ICI)-guided PCI versus angiography-guided PCI and in-hospital mortality in patients with NSTEMI in the United States using the NIS database from 2016 to 2021. ICI use increased by nearly threefold between 2016 and 2021, without a significant difference in in-hospital mortality, though interestingly, mortality rates compared with angiography guidance were similar and relatively low. In this study, the use of ICI was associated with lower adjusted odds of …

Simulation-Based Assessment Of Blood Pressure By Certified Athletic Trainers, Michael W. Verde, Lindsey E. Eberman, Dawn M. Emerson, Zoë J. Foster, Zachary K. Winkelmann

Internet Journal of Allied Health Sciences and Practice

Purpose: Blood pressure (BP) assessment is a key component of pre-participation examinations and can aid athletic trainers (ATs) in diagnosing hypertension. However, the current pedagogical technique, which involves practicing BP assessment on healthy individuals, may not adequately prepare healthcare providers to recognize Korotkoff sounds at abnormal pressures during clinical practice. Therefore, the purpose of this study was to examine AT's ability to and confidence in assessing and interpreting BP using a high-fidelity simulator.

Methods: We recruited ATs through conferences, in-services, and postprofessional athletic training programs. In total, 100 ATs from various job settings (age=31±11 years; men=37, women=63, clinical experience=8±10 years; …

Impact Of Shift Length On Burnout And Job Or Life Satisfaction Among Allied Healthcare Professionals, Tareq F. Alotaibi, Abdulmohsen Altayyar, Muteb Al Muflih, Nawaf Alqahtani, Naif Alhawiti, Badi A. Alotaibi, Sami Al Ossaimi, Hassan Y. Aljohani, Mobarak Alqahtani, Taha Ismaeil, Mohammed Al Qahtani, Saleh Al Garni

Internet Journal of Allied Health Sciences and Practice

Abstract: Background/Objectives: Healthcare professionals are critical to community well-being, but the 12-versus 8-hour shifts on their stress and burnout are unclear. This study examines the effects of work patterns on the quality of life, job satisfaction, and burnout among allied healthcare professionals. Method: a validated questionnaire was used. A descriptive analysis, independent samples t-test and Mann–Whitney U test were used, and the significance level was p < 0.05. Results: Among the 340 participants, the mean age was 28 years, and most were women (63.5%), single (58%), and worked 8-hour shifts (54.4%). Most (78%) of the participants reported their job satisfaction …

Effects Of Vacuum-Assisted Venous Drainage In Cardiopulmonary Bypass: A Scoping Review, Brandon Williamson

Student Works

Introduction: The use of Vacuum-assisted Venous Drainage (VAVD) in cardiopulmonary bypass is a standard in many perfusion practices. This scoping review targets the need for all positive and negative effects to be accounted for when using VAVD. A well thought out scoping review is the basis for additional research like a systematic review to be assembled. The goal of this scoping review is to encompass this topic to the best of its ability and supply relevant data in this field.

Methods: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping …

Plasma Proteomic Biomarkers Of Physical Frailty In Heart Failure: A Propensity Score Matched Discovery-Based Pilot Study, Quin Denfeld, Noelle Pavlovic, Christopher Lee, Jon Jacobs, Mary Roberts Davis, Samantha Powell, Marina Gritsenko, Susan Joseph, Beth Habecker

Division of Cardiology Faculty Papers

BACKGROUND: Physical frailty is highly prevalent in heart failure (HF), but we lack an understanding of the underlying pathophysiology. Proteomic evaluation of plasma samples may elucidate potential mechanisms and biomarkers of physical frailty in HF.

OBJECTIVES: We aimed to identify plasma proteomic biomarkers that are differentially expressed between physically frail and non-physically frail adults with HF.

METHODS: This was a secondary analysis of a subset of data and plasma samples from a study of frailty among patients with New York Heart Association (NYHA) Functional Classification I-IV HF. Physical frailty was measured using the Frailty Phenotype Criteria. Propensity score matching was …

Indeterminate Benefit Of Long-Term Beta-Blocker Use After Acute Myocardial Infarction For Some Patients, Logan S. Thayer, Khush Hussain, Nicholas Apostolakis, Gretchen Swift, Arifbillah Sarowar, Mohammad Al-Hadidi, Scott Yaekle

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Yndigegn T, Lindahl B, Mars K, et. al., Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. April 7 2024;390:1372-1381. https://doi.org/10.1056/NEJMoa2401479

for a patient showing 55% left ventricular ejection fraction after myocardial infarction.

Comparison Of Patent Foramen Ovale Closure Vs Medical Therapy For The Prevention Of Recurrent Cryptogenic Stroke: A Systematic Review, Omar Hamodata, Saif , Almuzainy, Rand Yahya, Salam Koniali

Journal of the Saudi Heart Association

Objectives: The optimal management approach for patients with cryptogenic stroke and patent foramen ovale (PFO) remains uncertain. Whether medical therapy—using antiplatelet agents or anticoagulants—or transcatheter device closure offers superior protection against stroke recurrence has been a topic of considerable debate. This systematic review aims to assess and compare the effectiveness of these two treatment strategies, incorporating recent studies to provide updated insights on the most effective approach to preventing recurrent cryptogenic stroke. Methodology: We systematically searched PubMed, Scopus, and Ovid database through December 2024. Eligible studies were randomized controlled clinical trials (RCTs) comparing PFO closure versus medical therapy among patients …

Efficacy And Safety Of Concomitant Surgical Ablation During Mitral Valve Replacement: A Systematic Review, Omar Hamodat, Saif Almuzainy, Rand Yahya, Razan Alzaatreh, Samiullah Haroon, Salam Koniali

Journal of the Saudi Heart Association

Objectives: Atrial fibrillation (AF) is a common comorbidity in patients undergoing mitral valve surgery (MVS), significantly increasing the risk of thromboembolism, heart failure, and mortality. Surgical ablation has recently been given a Class IA recommendation for concomitant MVS, reinforcing its role in restoring sinus rhythm and improving outcomes in this population. However, concerns about procedural complexity, extended operative time, and postoperative risks have limited its widespread adoption. This systematic review aims to synthesize evidence from recent randomized controlled trials to evaluate the safety and efficacy of surgical ablation for AF in patients undergoing MVS, addressing critical gaps in current clinical …

The Impact Of Perfusion Techniques On Inflammatory Response During Cardiopulmonary Bypass; A Scoping Review, Rodolfo Alfaro

Student Works

Background: Cardiopulmonary bypass (CPB) is an essential part of cardiac surgery, but it leads to SIRS (systemic inflammatory response syndrome) which in turn increases postoperative complications. There are many proposed approaches to reduce inflammation, but there is no clear best practice on the approach to use. This scoping review aims to explore the literature and classify the studies that investigate the effects of various CPB perfusion techniques on inflammatory responses to determine the possible best practices and the gaps that exist in the literature.

Methods: The present scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews …

Addressing Frailty In Heart Failure: Essential Tools & Strategies For Occupational Therapists, Malachy Clancy, Phd, Otr/L, Bcpr

Department of Occupational Therapy Posters and Presentations

Learning Objectives

• Understand and describe the concept of frailty and its impact on occupational performance for patients with heart failure (HF).
• Identify comprehensive assessments that encompass physical, cognitive, and psychosocial domains to provide a holistic assessment of frailty.

Potential Benefits And Drawbacks Of Washing Stored Red Blood Cells Prior To Transfusion: A Scoping Review, Mary Mccullough

Student Works

Background: There is growing interest in washing banked blood with an intraoperative autotransfusion device (IAT) prior to transfusing to patients. The main purpose of this practice is to reduce the effects caused by storage lesion, both to the blood and the patient, and diminish the cost and of washing by using an IAT as opposed to washing in the blood bank.

Objective: The objective of this scoping review is to summarize the existing data on the use of IATs for washing stored banked blood and evaluate the potential advantages and disadvantages associated with transfusing the washed blood.

Method: This scoping …

Working Conditions Of Perfusionists In North America: A Scoping Review, James Strong

Student Works

Perfusionists face significant challenges, including long hours, high workloads, burnout, and workplace risks like sleep deprivation and discrimination, which impact both their well-being and patient outcomes. Despite these concerns, no comprehensive review has mapped workforce trends, and the lack of widespread American Society of Extracorporeal Technology (AmSECT) guideline implementation worsens the situation. This scoping review highlights these issues, emphasizing the need for standardized assessments, better enforcement of guidelines, and proactive strategies to improve perfusionist well-being and patient safety. This scoping review aims to describe the working conditions of North American Certified Clinical Perfusionists (CCPs).

Pediatric And Congenital Cardiac Services: An Innovative And Empowering Approach To Global Training And Equitable Care, Wyman W. Lai, Dominique Vervoort, David Bradley, Antonio G. Cabrera, Casey Culbertson, Alejandro Floh, Saurabh K. Gupta, Babar S. Hasan, Adrian Holloway, Jeffrey P. Jacobs, Kathy J. Jenkins, R. K. Kumar, L.A. Larrazabal, Colin J. Mcmahon, Daniel J. Penny, Alistair Phillips, Emilio Quezada, Craig A. Sable, Shubhika Srivastava, Sandra L. Staveski, Patcharapong Suntharos, David F. Teitel, Betsy Tirado, Brian C. Tran, Bistra Zheleva, Liesl Zuhkle, Anthony C. Chang

Division of Cardiology Faculty Papers

Congenital heart disease is a leading cause of preventable death in children, with a disproportionate impact on low- and middle-income countries. Despite progress in treating congenital heart disease globally, significant challenges remain in accessing specialized cardiovascular care, particularly cardiac surgery, in low- and middle-income countries. This review examines current models of assistance and proposes a novel global training program to address these inequities. Key challenges identified include building program infrastructure, training health care providers, ensuring financial sustainability, and promoting local engagement. The proposed program, structured under a new international organization, will leverage emerging technologies to deliver accessible and rigorously assessed …

Association Of Age, Sex And Education With Access To The Intravenous Thrombolysis For Acute Ischemic Stroke, Yoona Ko, Beom Joon Kim, Youngran Kim, Jong-Moo Park, Kyusik Kang, Jae Guk Kim, Jae-Kwan Cha, Tai Hwan Park, Kyungbok Lee, Jun Lee, Keun-Sik Hong, Byung-Chul Lee, Kyung-Ho Yu, Dong-Eog Kim, Joon-Tae Kim, Jay Chol Choi, Jee Hyun Kwon, Wook-Joo Kim, Kyu Sun Yum, Sung-Il Sohn, Hyungjong Park, Sang-Hwa Lee, Kwang-Yeol Park, Chi Kyung Kim, Sung Hyuk Heo, Moon-Ku Han, Anjail Z Sharrief, Sunil A Sheth, Hee-Joon Bae

Faculty, Staff and Student Publications

Background: Barriers to treatment with intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) in South Korea remain incompletely characterized. We analyze a nationwide prospective cohort to determine patient-level features associated with delayed presentation and non-treatment of potential IVT-eligible patients.

Methods: We identified consecutive patients with AIS from 01/2011 to 08/2023 from a multicenter and prospective acute stroke registry in Korea. Patients were defined as IVT candidates if they presented within 4.5 hours from the last known well, had no lab evidence of coagulopathy, and had National Institute of Health Stroke Scale (NIHSS) ≥ 4. Multivariable generalized linear mixed …

Pro: The Use Of Sugammadex Does Not Preclude The Need For Objective Neuromuscular Monitoring., J Ross Renew, Dustin D. Linn

Parkview Pharmacy Department

Based on strong evidence, optimal management of neuromuscular block should incorporate objective (or quantitative) neuromuscular monitoring with appropriately dosed antagonists such as sugammadex. Sugammadex has the unique ability to antagonize aminosteroidal-induced neuromuscular block at any level; however, neostigmine is a reasonable alternative at minimal levels. Blind or excessive administration of sugammadex does not eliminate the risk of patients having postoperative residual neuromuscular block. Significant variability exists in how patients respond both to neuromuscular blocking agents and their antagonists.

Canary In The Carpal Tunnel: A Pilot Study Of The Value Of The Screening For Amyloidosis In Carpal Tunnel Syndrome, Trevor Ruesch, Nevil Khurana, Logan Hansen Md, Katiya Barkho, Julia Malewicz, Charles Day Md

Medical Student Research Symposium

Introduction/Purpose:

Transthyretin amyloidosis occurs in two forms, hereditary transthyretin amyloidosis (hATTR), and wild-type ATTR (wtATTR)². Amyloidosis can result in restrictive cardiomyopathy presenting as heart failure with preserved ejection fraction (HFpEF)⁴. A growing body of evidence demonstrates that amyloidosis may be underdiagnosed and can be caught earlier in the disease course⁵. The proteins causing amyloidosis can also deposit into various tissues including the carpal tunnel leading to carpal tunnel syndrome ².

In this pilot study, we propose that early detection of amyloid via a biopsy of the transverse carpal ligament or tenosynovium in the …

The Role Of Non-Statin Lipid Lowering Therapies To Reduce Ascvd Events In Primary Prevention, Chukwuemezie Mamanu, Dean Karalis

Division of Cardiology Faculty Papers

PURPOSE OF REVIEW: Atherosclerotic cardiovascular disease (ASCVD) remains a leading global health challenge, with low-density lipoprotein (LDL) cholesterol a pivotal risk factor. While statins are cornerstone therapy for lowering LDL cholesterol, many high-risk primary prevention patients are unable to tolerate statin therapy and do not achieve their guideline directed LDL cholesterol goal. For these patients, non-statin therapies offer complementary and alternative approaches to LDL cholesterol reduction.

RECENT FINDINGS: Recent advancements in non-statin therapies have expanded the options available to clinicians to lower LDL cholesterol in high-risk primary prevention patients. Yet these medications are often under-utilized in clinical practice. Observational studies, …

Prevalence And Trends Of Polypharmacy Among U.S. Adults On Statin, 1999–2018, Mohamed A. Badheeb, Riyadh Saif Md, Ibrahim Hassan Md, Mostafa Elbanna Md, Shady Abohashem Md

Posters

Polypharmacy is increasing among cardiovascular patients, but national data on trends in statin users are limited. This study evaluated polypharmacy prevalence and trends among U.S. adults on statins, focusing on differences by age, gender, race/ethnicity, education, poverty, insurance, and statin adherence.

The Second Ever Reported Case Of Acute Bacterial Native Valve Endocarditis Caused By Streptococcus Thoraltensis, Shaun Abid Md, Anton Stolear, Maxim Dulgher, Stuart Zarich

Posters

Streptococcus thoraltensis is a gram-positive coccus first described by Devriese et al. in 1997, who isolated it from the vaginal fluids and intestines of pigs [1]. This species has subsequently been isolated from rabbit feces [2], the human oral cavity [3], placenta [4], and in only five reported cases, the human blood [5]. To our knowledge, only one other case of native valve bacterial endocarditis due to this bacterium has ever been reported [5], as well as a single case of prosthetic valve bacterial endocarditis [6]. Intravenous drug use (IVDU) is a strong risk factor for infective endocarditis. The organisms …

A Heart Full Of Nails: Complex Management Of Multiple Nail Gun Cardiac Injuries, Shaun Abid Md, Stuart Zarich

Posters

A 54-year-old male presented after a suicide attempt, suffering severe cardiac and extracardiac injuries from firing a nail gun into both temples (Figure 1A) and his chest. Imaging showed six 5cm nails embedded in his heart: two in the left ventricle, two in the right ventricle, one traversing the ascending aorta into the left atrium, and one entering the right ventricle from the left parasternal chest wall (Figure 1B, C, D). These injuries resulted in hemorrhagic pericardial effusion with tamponade, acute aortic regurgitation, mitral valve/pulmonary artery perforations, and a ventricular septal defect.

When The Farm Turns Fatal: A Rare Infection Causing Heart Block, Shaun Abid Md, Anton Stolear, Sumedh Iyengar, Yussif Issaka Md, Vanessa Agberien Md, Stuart Zarich

Posters

Brucellosis, a zoonotic bacterial infection caused by Brucella species, is typically acquired through contact with infected livestock or consumption of unpasteurized dairy products. It can manifest with various systemic symptoms but is rarely associated with cardiac complications, particularly conduction disturbances such as heart block. When brucellosis does affect the heart, it may result in endocarditis, myocarditis, or, more infrequently, conduction abnormalities. This report describes an unusual case of brucellosis-induced complete heart block in an elderly woman who recently returned from a farm in Colombia, a region where brucellosis is endemic.

Acute Rheumatic Fever Presenting With Isolated Myocarditis And Right Coronary Artery Occlusion, Sumedh Iyengar, Md Mashiul Alam, Shaun Abid Md, Evgeny Shkolnik, Stuart Zarich

Posters

Acute Rheumatic Fever (ARF) and rheumatic heart disease continues to be a major health hazard in most developing countries.

Coronary artery obstruction has long been regarded as an uncommon complication of rheumatic heart disease and has rarely been reported in ARF.