Cardiology Commons^™

The Link Between Heart Disease In Low Socioeconomic Communities In America, Khristopher Chea

Nursing | Senior Theses

As a future medical professional in the healthcare field, we continue to see patients admitted for cardiovascular issues. Cardiovascular diseases (CVDs) remain the leading cause of mortality among adults living in the U.S. despite advances in treatment throughout the past century. A number of risk factors such as hypertension, obesity, smoking, and physical inactivity contribute to the significant rise of cardiovascular disease. Research data suggests that there is correlation between cardiovascular disease, low socioeconomic status, and diet. According to the American Phycological Association socioeconomic status is measured by income, educational status, and occupation, and has been shown to be closely …

Long-Term Clinical Outcomes Of Percutaneous Coronary Intervention In Saphenous Vein Grafts In A Low To Middle-Income Country, Ghurfan Adnan, Intisar Ahmed, Javed Tai, Maria Ali Khan, Hammad Hasan

Section of Cardiology

Background: Revascularization of saphenous vein grafts (SVGs) is challenging and debated for the last few decades. The percutaneous revascularization of SVGs was reported to have poorer long-term outcomes than native coronary artery revascularization.
Purpose: We aim to study the peri-procedural complications and long-term outcomes of the percutaneous revascularization of SVGs in a low-middle-income country.
Methods: In this retrospective study, we included 110 patients who underwent percutaneous revascularization from January 2011 to March 2020 and followed them retrospectively for long-term outcomes and major adverse cardiovascular events.
Results: The mean age was 71 ±9, and 81% were male. The most common reason …

Managing May-Thurner Syndrome And Associated Complications Throughout Pregnancy And Postpartum, Jessica A. Young, Stephen Zweibach, Nicole L. Plenty, Tiffany Tonismae

OB-GYN

No abstract provided.

Availability And Affordability Of Medicines And Cardiovascular Outcomes In 21 High-Income, Middle-Income And Low-Income Countries, Clara Kayei Chow, Tu Ngoc Nguyen, Simone Marschner, Rafael Diaz, Omar Rahman, Alvaro Avezum, Scott A. Lear, Koon Teo, Karen E. Yeates, Khawar Kazmi

Section of Cardiology

Objectives: We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.
Methods: We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types …

Comparison Of Figure Of Eight And Traditional Simple Wire Closure Method To Prevent Dehiscence After Sternal Closure, Aleezay Asghar, Khawaja Muhammad Talha, Muneer Amanullah, Syed Shahabuddin

Medical College Documents

Objective: To investigate significant differences, if any, between figure of-eight method and simple wire closure technique in reducing the incidence of infectious and non-infectious sternal dehiscence in patients undergoing sternal closure.
Methods: The systematic review was conducted in the Cardiothoracic Surgery Department at Aga Khan University from 1st December 2015 to 13th December 2017. The review was registered with PROSPERO, the International Prospective Register of Systematic Reviews. Pubmed, Cochrane Library (Wiley) and Scopus databases were searched for articles published up to December 13, 2017. The search was limited to randomised control trials, clinical trials, retrospective cohort studies, journal analyses, systematic …

Ionomic Profiling Of Pericardial Fluid In Ischemic Heart Disease, Noman Khan, Satwat Hashmi, Amna Jabbar Siddiqui, Sabiha Farooq, Shahid Ahmed Sami, Nageeb Basir, Syedah Saira Bokhari, Hasanat Sharif, Sanaullah Junejo, Syed Ghulam Musharraf

Department of Biological & Biomedical Sciences

Metals are essential cofactors that play a crucial role in heart function at the cell and tissue level. Information regarding the role of metals in the pericardial fluid and its ionome in ischemic heart disease (IHD) is limited. We aimed to determine the association of elements in pericardial fluid and serum samples of IHD patients and their correlation with systolic and diastolic function. IHD patients have been studied with systolic and diastolic dysfunction categorized on the basis of echocardiographic parameters. We measured concentrations of sixteen elements in the pericardial fluid and serum of 46 patients obtained during open heart surgery …

Ruptured Mycotic Reverse Saphenous Vein Graft Aneurysm: A Late Complication Of Mediastinitis, Yasir Bilal Khan, Shiraz Hashmi, Saulat Hasnain Fatimi

Section of Cardiothoracic Surgery

Reverse saphenous vein graft aneurysm (RSVGA) is a rare complication that occurs after coronary bypass grafting surgery. Mycotic aneurysm of reverse saphenous vein graft is even more rare. We describe the case of a 76-year-old man who underwent coronary artery bypass grafting 10 years back and had mediastinitis four to five months after surgery. He presented with chest pain in July 2017 and was diagnosed as NSTEMI. Angiography showed left main coronary artery disease (90%) with aneurysm of reverse saphenous vein graft to right posterior descending artery(RPDA). Emergent percutaneous coronary intervention (PCI) of the left main artery was performed as …

Cardiac Magnetic Resonance Evaluation Of Cardiac Masses In Patients With Suspicion Of Cardiac Masses On Echo Or Computed Tomography, Fateh Ali Tipoo Sultan, Syed Waqar Ahmed

Section of Cardiology

Objectives: In recent years, cardiac magnetic resonance (CMR) imaging has emerged as an important tool in the identification and characterization of cardiac masses. No imaging data on cardiac masses are available from Pakistan. We aimed to review the clinical presentation, CMR findings, and outcome of patients referred for CMR due to suspicion of cardiac masses on echocardiogram or computed tomography (CT).
Material and methods: We reviewed all the patients referred for CMR at Aga Khan University Hospital, Karachi, from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Only those with the confirmed diagnosis …

Flash Pulmonary Edema: A Case And Review Of Left Ventricular Non-Compaction Cardiomyopathy, Paula J. Watts, Oliver S. Garbo, Wendy Barrett, Michael Kopstein, Ryan Maybrook, Dmitriy Scherbak

HCA Healthcare Journal of Medicine

Left ventricular non-compaction cardiomyopathy is an uncommon type of cardiomyopathy caused by malformation of the myocardium during embryogenesis. This results in trabeculations within the ventricular wall that can affect the left and, less commonly, right ventricles. Presentation ranges from clinically asymptomatic to life-threatening arrhythmias. It is a rare and relatively unknown form of cardiomyopathy, though thought to be underdiagnosed. Prevalence is increasing due to improvements in imaging and awareness. Management is similar to that of other cardiomyopathies including angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, beta-blockers, diuretics, automatic implantable cardioverter defibrillator placement and cardiac transplantation. We present a case of a …

Health Insurance Plan Design And Chronic Disease Management, Daniel E. Feldman

Electronic Theses and Dissertations

Each year, Americans spend more money on health care than any other industrialized nation, despite comparable mortality rates for people with risk factors for heart disease. The reasons for this lack of health care value in the US are numerous and complex – including market distortions like supplier-inflated pricing and regulatory structures that enable consumers to utilize ubiquitous, high-cost medical technologies that yield uncertain benefits. Health insurance, once thought to be an insignificant contributor to rising health spending, has changed considerably in the past few decades in ways that make it more accessible and more generous in coverage. Health insurance …

Incidental Discovery Of Anomalous Left Coronary Artery Arising From The Pulmonary Artery In A Coronavirus Disease-2019 Patient: A Blessing In Disguise, Masood Ghori, Rizwan Ahmed

Journal of the Saudi Heart Association

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a serious congenital malformation. Reports about asymptomatic, incidentally discovered ALCAPA in adults are scarce. We describe a patient with no known pre-existing cardiac condition admitted to our hospital with coronavirus disease 2019 (COVID-19) and was incidentally found to have ALCAPA. To the best of our knowledge, this is the first reported case of incidentally discovered ALCAPA in a COVID-19 patient and highlights the importance of appropriate investigation of the coronary status by Multidetector Cardiac Computed Tomographic Angiography (MDCCTA) in individuals with asymptomatic left ventricular dysfunction. The presentation …

Understanding Of Metals Dysregulation In Patients With Systolic And Diastolic Dysfunction In Ischemic Heart Disease, Noman Khan, Satwat Hashmi, Amna Jabbar Siddiqui, Sabiha Farooq, Shahid Ahmed Sami, Nageeb Basir, Syeda Saira Bokhari, Hasanat Sharif, Sanaullah Junejo, Hesham R. El-Seedi, Syed Ghulam Musharraf

Department of Biological & Biomedical Sciences

Ischemic heart disease (IHD) is the leading cause of death and chronic disability in the world. IHD affects both the systolic and diastolic function of the heart which progressively leads to heart failure; a structural and functional impairment of filling or ejection of blood from the heart. In this study, the progression of systolic and diastolic dysfunction characterized according to their echocardiographic parameters including left ventricular ejection fraction (EF), grades of diastolic dysfunction and ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e'), were correlated with differential regulation of various metals in patients sera samples (n …

Efficacy And Safety Of Bempedoic Acid For Prevention Of Cardiovascular Events And Diabetes: A Systematic Review And Meta-Analysis., Xing Wang, Yu Zhang, Huiwen Tan, Peng Wang, Xi Zha, Weelic Chong, Liangxue Zhou, Fang Fang

Department of Medicine Faculty Papers

BACKGROUND: Bempedoic acid is an oral, once-daily, first-in-class drug being developed for the treatment of hyperlipidemia. However, evidence of bempedoic acid use for the prevention of cardiovascular events and diabetes is lacking. Thus, we aim to evaluate the benefit and safety of bempedoic acid use for the prevention of cardiovascular events and diabetes.

METHODS: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials with no language restriction from inception until March 3, 2020. Pairs of reviewers independently identified randomized controlled trials comparing the use of bempedoic acid with placebo or no treatment for primary prevention of cardiovascular …

Evaluation Of Aspirin And Statin Therapy Use And Adherence In Patients With Premature Atherosclerotic Cardiovascular Disease, Dhruv Mahtta, David J. Ramsey, Mahmoud Al Rifai, Khurram Nasir, Zainab Samad, David Aguilar, Hani Jneid, Christie M. Ballantyne, Laura A. Petersen, Salim S. Virani

Section of Cardiology

Importance: Studies on the use of and adherence to secondary prevention therapies in patients with premature and extremely premature atherosclerotic cardiovascular disease (ASCVD) are lacking.
Objective: To evaluate and compare aspirin use, any statin use, high-intensity statin use, and statin adherence among patients with premature or extremely premature ASCVD compared with patients with nonpremature ASCVD.
Design, setting, and participants: This multicenter cross-sectional study used the clinical and administrative data sets of the US Department of Veterans Affairs (VA) to identify adult patients with at least 1 primary care visit in the VA health care system between October 1, 2014, and …

Direct True Lumen Versus Conventional Cannulation For Acute Type-A Aortic Dissection, Asra Wahid, Syed Shahabuddin, Muhammad Muneer Amanullah, Shiraz Hashmi, Shahid Ahmed Sami

Medical College Documents

Acute type-A aortic dissection is a surgical emergency and has a high rate of short-term mortality. Aortic dissection is highly under-reported in Pakistan. With the technological developments in its management, arterial cannulation technique of direct true lumen cannulation has emerged with improved outcomes. We aimed to compare the mortality and morbidity outcomes between direct true lumen and conventional cannulation techniques for arterial access in patients with acute type- A aortic dissection under a single-centre retrospective review from 2007 to 2017. Mean age of the participants was 43.3±11.6 vs 45±12.4 years with males being dominant in both groups. Frequency of overall …

Characterizing Recurrence Following Hybrid Ablation In Patients With Persistent Atrial Fibrillation, David C. Kress, Lynn Erickson, Tadele W. Mengesha, David Krum, Jasbir Sra

Journal of Patient-Centered Research and Reviews

Purpose: It is It is widely accepted that atrial fibrillation (AF) accounts for half of arrhythmia recurrences following endocardial catheter ablation of AF. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study is aimed at characterizing recurrence following hybrid ablation for patients with persistent AF.

Methods: Patients with persistent AF (N = 108) received both endocardial and epicardial ablation of the posterior left atrial wall using catheter ablation and a small midline surgical approach (hybrid). Presence of …

Wet Labs: A Useful Tool In Training Surgical Residents In A Third World Country, Hina Inam, Narmeen Asif, Abdul Ahad Sohail, Saulat Fatimi

Section of Cardiothoracic Surgery

•Wet labs are a useful, cost-effective and safe tool in teaching of Cardiothoracic Surgery residents.•In a third world country where advance real life simulators are not available.•It improves resident's tissue handling and surgical skills.•Allows faculty members to give continuous feedback to their residents.

A Rare Case Of Constrictive Pericarditis As Initial Manifestation Of Paediatric Anaplastic Large Cell Lymphoma Requiring Urgent Pericardiectomy, Sara Iqbal, Abdul Ahad Sohail, Narmeen Asif, Muhammad Rahil Khan, Sabeehuddin Siddique, Saulat Fatimi

Section of Cardiothoracic Surgery

Constrictive pericarditis (CP) is a rare end stage inflammatory disorder affecting both parietal and visceral pericardium leading to a right heart failure. Malignancy is the least common cause of CP. Anaplastic large cell lymphoma (ALCL) accounts for 10-15% of all Non-Hodgkin lymphomas in children. Very few case reports have reported ALCL that is involving the heart and only two have been published involving pericardium but all were managed medically. We present an interesting case of an 11 year old child who presented with an effusive CP that required urgent Pericardiectomy for managing right heart failure. His histopathology was positive for …

Major Septal Defects: Comparative Study Of Down Syndrome And Non-Down Syndrome Infants, Before And After Surgery, Saleha Aziz, Maaha Ayub, Laiba Masood, Muneer Amanullah, Rukhsana Hameed, Shiraz Hashmi, Waris Ahmad

Medical College Documents

Objective: To compare pre-operative, intra-operative, and post-operative parameters in Down syndrome (DS) and non-DS patients with atrioventricular septal defects (AVSD) and inlet ventricular septal defects (VSD) in a tertiary care hospital in Pakistan.
Methods: We conducted a retrospective study at Aga Khan University, Pakistan. All complete atrioventricular septal defect (CAVSD), partial atrioventricular septal defect (PAVSD), and VSD with inlet extension surgical cases from January 2007 to January 2019 were included. Patients with congenital heart diseases other than those listed above were excluded.
Results: In 61 cases, 18 had DS. Median age, mean body surface area (BSA), and height were lower …

Kounis Syndrome, Charles Doerner, Mark Sawh, Tamer A. Amer, Konstantinos Marmagkiolis

West Florida Division Virtual Research Day 2020

Kounis syndrome, also known as allergic vasospastic angina, is a type of acute coronary syndrome caused by an allergic reaction or immune response to a substance.[1] It is essentially an “allergic angina” which is believed to be caused by mast cell activation and release of cytokines and histamine causing spasm of the artery leading to acute coronary syndrome and acute myocardial infarction. Stress cardiomyopathy (Takotsubo syndrome), which predominantly affects post-menopausal women, may also occur in anaphylaxis where transient ventricular dysfunction associated with regional ventricular wall abnormalities extending beyond the regions of coronary blood supply ensues.[2] The suspected prevalence of Kounis …

Bedside Point Of Care Ultrasound Diagnosing Bilateral Valve Involvement In Infective Endocarditis, Corey Cole, Alfredo Tirado, Jonathan Schwadron

West Florida Division Virtual Research Day 2020

Endocarditis is a well known complication of intravenous drug abuse which classically affects the tricuspid valve. It is usually diagnosed by formal echocardiogram and positive blood cultures. Vegetations involving both the mitral and tricuspid valves are rare, occurring in less than 5% of all cases of infective endocarditis. 1 Here we report a case of a patient with vegetations on both valves which was discovered by point of care ultrasound.

End The Glow!, Roli Kushwaha, Anthony Furiato, Justin Mcnamee

West Florida Division Virtual Research Day 2020

Aortic dissection (AD) is part of a group of acute aortic syndromes consisting of intramural aortic hematoma, penetrating aortic ulcer, and aortic rupture. On its own, the incidence is ~3 to 8 cases per 100,000 per year, and up to 25% of cases are missed. The in-hospital mortality when treated is 27%, and with a 2% increase in mortality/hour. Imaging modalities like CT angiography, TEE, and MRA have made improved diagnosis of the disease, but are costly, potentially harmful, time consuming, and require patient stability when in use (1). The key question we have as emergency department providers is if …

Nanoparticle-Mediated Drug Delivery For The Treatment Of Cardiovascular Diseases, Rajasekharreddy Pala, Vt Anju, Madhu Dyavaiah, Siddhardha Busi, Surya M. Nauli

Pharmacy Faculty Articles and Research

Cardiovascular diseases (CVDs) are one of the foremost causes of high morbidity and mortality globally. Preventive, diagnostic, and treatment measures available for CVDs are not very useful, which demands promising alternative methods. Nanoscience and nanotechnology open a new window in the area of CVDs with an opportunity to achieve effective treatment, better prognosis, and less adverse effects on non-target tissues. The application of nanoparticles and nanocarriers in the area of cardiology has gathered much attention due to the properties such as passive and active targeting to the cardiac tissues, improved target specificity, and sensitivity. It has reported that more than …

Isolated Polymorphic Ventricular Tachycardia: An Unusual Presentation Of Acute Myocarditis, Natalie S. Shwaish

Research Days

No abstract provided.

Heart Rate Recovery Following Exercise Testing In Pediatric Patients With Acyanotic Repaired Congenital Heart Disease, Natalie S. Shwaish

Research Days

No abstract provided.

The Evolving Management Of Aortic Valve Disease: Trends In The Utilization And Cost Of Savr, Tavr, And Medical Therapy, Andrew Goldsweig

Theses & Dissertations

Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding usage and cost of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease. From the Nationwide Readmissions Database, we determined utilization and cost trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted 2012-2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. From 2012 through 2016, there was a 48.1% increase in the number of patients hospitalized for aortic valve disease annually. Overall, 19.9%, 6.7%, …

Evaluating The Effects Of Detergent Concentration On The Reendothelialization And Ultrastructure Of Porcine Internal Thoracic Artery Scaffolds, Jesse Bruce Kooistra

Graduate Theses

Cardiovascular disease exerts a consistent force of morbidity and mortality on the global population. This pressure has created a demand for reliable replacement vascular tissues. Current solutions include synthetic grafts and biological transplant options that are associated with a multitude of complications. Therefore, the continued innovation of vascular tissue replacement solutions is warranted. Decellularized vascular tissues have been previously utilized as scaffolds upon which recellularized tissue engineered vascular solutions are constructed. However the interplay between decellularization agent concentration and effective recellularization has not been well documented. Herein we investigate this relationship through a detail oriented research model that both qualifies …

Evolving De Winter Presentation Of Acute Myocardial Infarction, Caroline Shepherd, Anthony Furiato

West Florida Division Virtual Research Day 2020

de Winter ECG pattern first detailed in 2008 in a case series Diagnostic criteria

• Tall, prominent, symmetric T waves in the precordial leads
• Upsloping ST segment depression >1mm at the J-point in the precordial leads
• Absence of ST elevation in the precordial leads
• ST segment elevation (0.5mm-1mm) in aVR

Strongly correlated with acute LAD occlusion

Progressive Collateral Stenosis Leading To Symptomatic Chronic Total Occlusion, Farhan Shah, Andrew Maiolo

Capital Division Virtual Research Day 2020

Chronic total occlusion is defined as the complete obstruction of a coronary artery, with TIMI 0 or TIMI 1 flow, and an occlusion duration of greater than 3 months. We present a case of symptomatic chronic total occlusion in a functional 79 year old female with no past history of coronary artery disease, previously asymptomatic due to robust collateral circulation.

Dietary Fat And Sugar Differentially Affect Β-Adrenergic Stimulation Of Cardiac Erk And Akt Pathways In C57bl/6 Male Mice Subjected To High-Calorie Feeding, Sadia Ashraf, Gizem Yilmaz, Xu Chen, Romain Harmancey

Journal Articles

BACKGROUND: High dietary fat and sugar promote cardiac hypertrophy independently from an increase in blood pressure. The respective contribution that each macronutrient exerts on cardiac growth signaling pathways remains unclear.

OBJECTIVE: The goal of this study was to investigate the mechanisms by which high amounts of dietary fat and sugar affect cardiac growth regulatory pathways.

METHODS: Male C57BL/6 mice (9 wk old; n = 20/group) were fed a standard rodent diet (STD; kcal% protein-fat-carbohydrate, 29-17-54), a high-fat diet (HFD; 20-60-20), a high-fat and high-sugar Western diet (WD; 20-45-35), a high-sugar diet with mixed carbohydrates (HCD; 20-10-70), or a high-sucrose diet …