Cardiology Commons^™

Management Of Refractory Ventricular Fibrillation With Double Sequential Defibrillation, Kaitlyn A. Brown

Capstone Showcase

Patients experiencing cardiac arrest are treated according to ACLS protocols, however current protocols lack recommendations for the treatment of refractory Ventricular Fibrillation which persists after more than 3 cycles of CPR and defibrillation. One potential intervention for these cases that is being researched is the use of simultaneous or sequential activation of two defibrillators. This literature review analyzed the results of several studies to determine if double sequential defibrillation (DSD) is a viable treatment to achieve return of spontaneous circulation (ROSC) and improved patient survival. The results of the studies were mixed with some showing positive outcomes, and others showing …

Transcutaneous Energy Transmission: Can We Do It Now?, Yuriy Pya

The VAD Journal

The percutaneous driveline used in contemporary LVADs presents a continuous risk of infection for the duration of support. Minimizing infection in durable mechanical circulatory support systems requires total implantation of all components and energy transfer by means other than percutaneous drivelines. A novel coplanar energy transfer (CET) system, similar to the original transcutaneous energy transfer (TET) design, is unique by incorporating two large rings with coil-within-the-coil topology to ensure strong resonance power. The CET system consists of an internal integrated controller, a battery coupled with an internal thoracic coil ring, and the LVAD pump. External equipment includes a power transmission …

When Myocardial Infarction Is Choosing Young Victims, Cristina Nedelcu, Mihaela Ionescu, Paris Ionescu, Vitalie Morosanu, Gabriel Smarandache, Dumitru Cristinel Badiu, Florentina Gherghiceanu, Vlad Denis Constantin, Emanuele Maria Merlo, Daniel Niţă

Journal of Mind and Medical Sciences

We present the case of a 31-year-old patient, without cardiovascular risk factors, without significant pathological or family history of cardiovascular disease, who was diagnosed with severe coronary artery disease, left main bifurcation localization, which required surgical coronary revascularization. The angiographic and intraoperative aspect excluded the most common causes of non-atherosclerotic causes of coronary lesions. Vasculitis was another possible etiology but was also excluded based on the normal clinical examination, negative inflammation markers, lack of diffuse vascular impairment, TPHA and negative VDRL. Prolonged mental stress can lead to accelerated progression of atherosclerosis by inducing endothelial dysfunction, our patient describing a “burnout …

Diagnosis And Management Of Pericardial Effusion, Maria Manea, Ovidiu Gabriel Bratu, Nicolae Bacalbasa, Camelia Cristina Diaconu

Journal of Mind and Medical Sciences

Pericardial effusion is a common pathology in clinical practice. The etiology of pericardial effusion is diverse, from infectious diseases, malignancies, autoimmune diseases, chronic renal failure, to drug-related or after an invasive cardiac intervention. Clinical presentation of pericardial effusion is variable, depending on the volume of the fluid and the rate of accumulation. Clinical manifestations are dramatic if the pericardial fluid accumulates rapidly. Classical symptoms in pericardial effusion include pleuritic chest pain associated with dyspnea. In case of cardiac tamponade, orthopnea, jugular venous distension, pulsus paradoxus, hypotension, and shock appear. Transthoracic echocardiography is the gold standard investigation for the diagnosis of …

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

Research Days

No abstract provided.

What Did We Learn About Vads In 2019?, Maya Guglin

The VAD Journal

This is our 6th annual literature review on mechanical circulatory support (MCS) devices.

Our previous reports for 2014, 2015, 2016, 2017, 2018 were published as open access articles and were well received by the readers. In this paper, we summarize the most interesting and important, from our standpoint, publications from 2019. As we have done for the past two years, a section on extracorporeal membrane oxygenation (ECMO) is included and primarily addresses new developments in veno-arterial ECMO use.

Implementation Of Liberate Protocol With Focus On Delirium In An Acute Care Community Hospital’S Medical And Cardiovascular Intensive Care Units, Jasmine M. Hossler, Emily A. Sedio, Karen L. Kier

Pharmacy Faculty Scholarship

No abstract provided.

Prasugrel Inappropriate Use In Patients Post-Percutaneous Coronary Intervention (Pci). A Single Center Study, Ahmed Amro, Kanaan Mansoor, Mohammad Amro, Amal Sobeih, Obadah Aqtash, Hisham Hirzallah, Alaa Gabi, Madhulika Urella, Waseem Ahmed, Sandra Shenouda, Dr. Rameez Sayyed, Md

Marshall Journal of Medicine

Prasugrel is a thienopyridine that was approved by the US Food and Drug Administration (FDA) in combination with aspirin for the reduction of thrombotic events as well as stent thrombosis in patients with ACS who undergo PCI. This retrospective study aims to assess the frequency of inappropriate use of prasugrel and to emphasize that prasugrel still needs more attention as inappropriate use may result in significant morbidity.

Massive Hemoptysis In The Setting Of Acute Mitral Regurgitation, Joseph Moran Do, George Prousi Md, Ross Biggs Do, Nirupama Kakumanu Md, Fccp

Department of Medicine

No abstract provided.

Incidence And Predictor Variables Of Pressure Injuries In Patients Undergoing Ventricular Assist Device And Total Artificial Heart Surgeries: An Eight-Year Retrospective Review, Christopher T. Brindle

Theses and Dissertations

BACKGROUND

Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored.

OBJECTIVES

To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Role Of Echocardiography In The Intensive Care Unit: Overview Of The Most Common Clinical Scenarios, Luca Longobardo, Concetta Zito, Scipione Carerj, Giuseppe Caracciolo, Bijoy K. Khandheria

Journal of Patient-Centered Research and Reviews

The intensive care unit (ICU) is among the more important settings in which echocardiography plays a pivotal role. The ease of use, speed of execution, and completeness of information on heart anatomy and function that echocardiography is able to provide makes this tool the perfect diagnostic technique in patients for whom exhaustive information must be quickly obtained by physicians who sometimes lack specific skills in cardiovascular imaging. However, the clinical entities encountered by ICU clinicians are often difficult to distinguish and patient symptoms may not be obvious. This brief review describes three common clinical scenarios that benefit from echocardiography in …

Exploring The “Weekend Effect” On The Care Of Patients With Left Ventricular Assist Devices, Gbolahan O. Ogunbayo, Le Dung Ha, Naoki Misumida, Ayman Elbadawi, Qamar Ahmad, Remi Okwechime, Deborah Akanya, Andrew Kolodziej, Claude S. Elayi, Maya E. Guglin

The VAD Journal

Many studies have described differences in in-hospital outcomes and length of stay between patients treated for major cardiac conditions on weekdays versus weekends.¹ Our study aimed to explore the “weekend effect” on in-hospital care among patients with left ventricular assist devices.

Using data from the National Inpatient Sample (NIS) database, with a weighted estimate of more than 35 million admissions per year.² We identified patients 18 years or older with an ICD code signifying presence of a LVAD. Characteristics, comorbidities and clinical outcomes were compared between patients admitted on a weekend versus patients admitted on a weekday. The …

A Rare Case Of Diffuse Alveolar Hemorrhage Secondary To Dabigatran Successfully Treated With Extracorporeal Membrane Oxygenation, C. Hutchinson, F. M. West, H. Hirose

Department of Medicine Posters

Introduction

Dabigatran, a direct thrombin inhibitor, is used for stroke risk reduction in non-valvular atrial fibrillation and for treatment and prevention of venous thromboembolism. Minor side effects include indigestion and stomach pain. Major life threatening bleeding occurs in up to 2% of patients and is largely attributed to gastrointestinal hemorrhage. Here, we describe a case of a dabigatran related diffuse alveolar hemorrhage (DAH) treated successfully with extracorporeal membrane oxygenation.

Experimental Intravascular Hemolysis Induces Hemodynamic And Pathological Pulmonary Hypertension: Association With Accelerated Purine Metabolism, Victor P. Bilan, Frank Schneider, Enrico M. Novelli, Eric E. Kelley, Sruti Shiva, Mark T. Gladwin, Edwin K. Jackson, Stevan P. Tofovic

Faculty & Staff Scholarship

Pulmonary hypertension (PH) is emerging as a serious complication associated with hemolytic disorders, and plexiform lesions (PXL) have been reported in patients with sickle cell disease (SCD). We hypothesized that repetitive hemolysis per se induces PH and angioproliferative vasculopathy and evaluated a new mechanism for hemolysis-associated PH (HA-PH) that involves the release of adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP) from erythrocytes. In healthy rats, repetitive admin- istration of hemolyzed autologous blood (HAB) for 10 days produced reversible pulmonary parenchymal injury and vascular remodeling and PH. Moreover, the combination of a single dose of Sugen-5416 (SU, 200mg/kg) and 10-day …

Decreasing Cardiac Arrests In The Pediatric Intensive Care Unit, Jeremy Affolter, Kathlyn Baharaeen, Mari Hanson, Lisa Laddish, Amy Bohm, Lindsey Bradbury, Megan Mcghee, Anne Leroy, Hannah Cunningham, Michelle Waddell, Tiffany Mullen, Kimberly Lucas, William Douglas, Angel Pope, Marita Thompson, Paul N. Bauer, Erica Molitor-Kirsch, Tara Benton, Laura Miller-Smith

Posters

No abstract provided.

Caught In The Act - Migration Of A Large Right Atrial Thrombus To Pulmonary Artery During Transthoracic Echocardiography - A Case Report, Bilal Hussain, Fateh Ali Tipoo Sultan, Talha Shahzad, Sumaira Punjani

Section of Cardiology

In cases of pulmonary embolism, the visualization of a free-floating right heart thrombus on conventional transthoracic echocardiography is extremely rare. Even rarer is an echocardiographic recording of migration of a free-floating clot from the right heart into the pulmonary vasculature leading to pulmonary embolism. We present a unique case of an elderly man who presented with dyspnoea, in whom a routine 2-D bed side transthoracic echo recorded the live transit of a free floating thrombus from the right heart into the pulmonary artery resulting in pulmonary embolism. The patient remained haemodynamically stable and was managed with anticoagulation. Our case objectively …

Emergency Department Repair Of Blunt Right Atrial Rupture Utilizing Cardiopulmonary Bypass, Samuel P. Carmichael, Michael C. Bounds, Alexis E. Shafii, Phillip K. Chang

Internal Medicine Faculty Publications

Blunt cardiac injury (BCI) with free wall rupture carries a high risk of pre-hospital death. Cardiopulmonary bypass (CPB) has been utilized as a bridge to repair of cardiac lesions in select patients. We present an interesting case of emergency department repair of right atrial rupture with cardiopulmonary bypass.

Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Maine Medical Center

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.

In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …

Venoarterial Extracorporeal Membrane Oxygenation For Cardiogenic Shock: A Retrospective Analysis Based On The Etiology Of Shock, Andrew Burchett, Thomas Tribble, Richard Charnigo, Susan Smyth, Maya Guglin

The VAD Journal

Abstract:

Background: We performed a retrospective analysis to evaluate the efficacy of VA-ECMO support in cardiogenic shock based on various etiologies.

Methods: We retrospectively analyzed 99 patients supported with VA-ECMO from January 1, 2012 to January 1, 2015. Outcomes included survival to discontinuation of VA-ECMO support and survival to hospital discharge. The etiologies of cardiogenic shock included cardiac arrest (CPR), acute myocardial infarction (AMI), decompensated congestive heart failure (CHF), pulmonary embolism (PE), right ventricular failure (RVF) not secondary to an acute pulmonary embolism, and post-cardiotomy syndrome (PCS). The PCS group was used as a reference group; odds ratios were estimated …

Pre-Implementation Of A Fontan Post-Operative Clinical Pathway: Summary Of 2016 Pdsa Cycles, Sarah M. Lagergren, Bryan Beaven, Suma Goudar, Megan Jensen

Posters

Background/Introduction: Post-operative hospitalization for the Fontan procedure tends to have an extended hospital length of stay (LOS). From 2013-2014, the average LOS at Children’s Mercy for the Fontan procedure is 14 days, whereas the U.S. national reported average is 11 days. Post-operative management of this patient population is often caregiver dependent. It has been theorized that developing a more standardized post-operative management regimen tailored specifically toward the unique physiology of Fontan patients may be able to improve outcomes and decrease LOS.

Methods: A review of literature was performed and revealed three pediatric institutions have published their post-operative Fontan care guidelines. …

Obstacles To Introducing A Post-Operative Feeding Protocol In The Single Ventricle Population, Lisa Laddish, Laura Miller-Smith, Jennifer Flint

Posters

Objective:

To decrease the morbidity associated with feeding complications by implementing a post-operative feeding protocol for infants with single ventricle physiology

A Quality Improvement Project For The Evaluation And Management Of Possible Necrotizing Enterocolitis In Single Ventricle Patients, Laura Miller-Smith, Jennifer Flint, Lisa Laddish

Posters

Background:

Infants with single ventricle (SV) physiology are at high risk for interstage complications, including necrotizing enterocolitis (NEC). The underlying pathophysiology and age at presentation differs from NEC literature described in premature infants, making NEC in SV patients challenging to diagnose and treat. We perceive significant variability in the approach to possible NEC in SV patients at our institution.

Aims:

To identify variability & standardize the approach to management of NEC

To create a management algorithm for diagnosing and treating NEC

Methods:

After review of current practice and review of medical literature, an algorithm to guide medical decision making specific …

Epidemiology And Outcomes Of Out-Of-Hospital Cardiac Arrest In A Developing Country-A Multicenter Cohort Study., Minaz Mawani, Muhammad Masood Kadir, Iqbal Azam Syed, Amber Mehmood, Bryan Mcnally, Kent Stevens,, R. Nuruddin, Mohammad Ishaq, J. Razzak

Section of Cardiology

Background

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death and disability worldwide. Overall survival after an OHCA has been reported to be poor and limited studies have been conducted in developing countries. We aimed to investigate the rates of survival from OHCA and explore components of the chain of survival in a developing country.

Methods

We conducted a multicenter prospective cohort study in the emergency departments (ED) of five major public and private sector hospitals of Karachi, Pakistan from January 2013 to April 2013. Twenty-four hour data collection was performed by trained data collectors, using a …

Old Dog, New Tricks - Usefulness Of The Ecg In Monitoring Acute Rejection Post Cardiac Transplantation, Paul Anaya, Samy-Claude Elayi

The VAD Journal

Electrocardiographic abnormalities have been described in the setting of acute rejection following orthotopic cardiac transplantation. The following is a brief commentary related to an interesting case report by Goldraich et al. which was recently published in the VAD Journal.

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

Theses and Dissertations

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

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

Coronary Artery Dissection After Blunt Chest Trauma., Fahad Shamsi,, Javed Tai, Syedah Saira Bukhari

Department of Medicine

Blunt thoracic trauma may result in cardiac injuries ranging from simple arrhythmias to fatal cardiac rupture. Coronary artery dissection culminating in acute myocardial infarction (AMI) is rare after blunt chest trauma. Here we report a case of a 37-year-old man who had an AMI secondary to coronary dissection resulting from blunt chest trauma after involvement in a physical fight.

Hypertensive Crisis, Burden, Management, And Outcome At A Tertiary Care Center In Karachi, Aysha Almas, Ayaz Ghouse, Ahmed Raza Iftikhar, Munawar Khursheed

Department of Emergency Medicine

Objectives:. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi.

Methods: This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included.

Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) …

2014 Massachusetts Family Impact Seminar: A Lot On Our Plate; Chronic Health Threats In Massachusetts, Ira S. Ockene M.D., Christina D. Economos Ph.D, Barbara Goldoftas Ph.D, Denise A. Hines Ph.D., Caitlin Alcorn, Jacqueline A. Daigneault, Jordan R. Daley, Maura A. Flanagan, Carsten-Hendrik Rasche, Heather Rios, Julia Tran, Liam Kelly Fleming

Mosakowski Institute for Public Enterprise

A Lot on Our Plate: Chronic Health Threats in Massachusetts is the fifth Massachusetts Family Impact Seminar, and is designed to emphasize a family perspective in policymaking on issues related to childhood obesity, cardiovascular disease, and type 2 diabetes. In general, Family Impact Seminars analyze the consequences an issue, policy, or program may have for families.

Bronchial Carcinoid Presenting As Multiple Lung Abscesses., Zeeshan Waheed, Muhammad Irfan, Saulat H. Fatimi, Ruqaiya Shahid

Department of Medicine

Bronchial carcinoid tumours is a rare group of pulmonary malignant neoplasm that is derived from neuroendocrine system. Bronchialcarcinoid usually present with hilar masses, atelactasis, bronchiectasis, or post-obstructive pneumonia. This case describes a very unusual presentation of bronchial carcinoid tumour with multiple lung abscesses involving the whole lung. This report is of an adult lady who presented with multiple lung abscesses involving her whole of the right lung. She was found to have an endo-bronchial lesion in her right main bronchus which eventually turned out to be carcinoid tumour. She responded to resection and antibiotic therapy.