Cardiology Commons^™

2020 American Heart Association Guidelines: Updates, Education, & Compliance In The Emergency Care Center And The Acute Care Setting, Laura Derr, Rn, Cen, Cn Iv

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Cardiovascular Fellow-In-Training Feedback On Virtual And Simulator-Based Learning Experience During Covid-19 Pandemic In A Low To Middle Income Country - A Cross-Sectional Study, Pirbhat Shams, Intisar Ahmed, Hunaina Shahab, Zehra Kadani, Aisal Khan, Marvi Shams, Yawer Saeed, Syedah Saira Bokhari, Aamir Hameed Khan

Section of Cardiology

Background: COVID-19 pandemic has introduced us to a greater need of virtual learning platforms and has resulted in less clinical exposure for fellows-in-training. Virtual and simulator-based learning is not widely available in LMIC. It is imperative to analyze feedback of CV fellow-in-training regarding this mode of learning before large scale implementation.
Methodology: This was an observational study conducted between July-August 2020. A multicentered survey was conducted. Survey questionnaire was disseminated to FIT (fellow-in-training) via Google Forms. The questionnaire contained a total of 24 questions about virtual and simulator-based learning during the pandemic.
Results: A total of 68 FIT responded to …

Comparative Trends In Ischemic Heart Disease Admissions, Presentation And Outcomes Due To The Covid-19 Pandemic: First Insights From A Tertiary Medical Center In Pakistan, Ali Aahil Noorali, Humza Thobani, Shiraz Hashmi, Sara Iqbal, Asma A H. Merchant, Mian Arsam Haroon, Sardar Shahmir Babar Chauhan, Saad Mallick, Nida Zahid, Yasir Khan, Osman Faheem, Saulat Fatimi

Department of Medicine

Introduction: COVID-19 has manifested a striking disarray in healthcare access and provision, particularly amongst patients presenting with life-threatening ischemic heart disease (IHD). The paucity of data from low-middle income countries has limited our understanding of the consequential burden in the developing world. We aim to compare volumes, presentations, management strategies, and outcomes of IHD amongst patients presenting in the same calendar months before and during the COVID-19 pandemic.
Methods: We conducted a retrospective cross-sectional analysis at the Aga Khan University Hospital, one of the premier tertiary care centres in Pakistan. Data were collected on all adult patients (>18 years) …

Business Cards As A Mechanism To Encourage Patient Feedback About Trainees, Marc Atzenhoefer, Jodie Ruffin, David Parewski, Nicole Deklotz, M. Fuad Jan, Ana Cristina Perez Moreno, Suhail Q. Allaqaband

Journal of Patient-Centered Research and Reviews

This project sought to evaluate if business card distribution improved the utility of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys by serving as a feedback mechanism for trainees. Between fall 2018 and spring 2019, patient encounters for 6 cardiovascular disease fellows were tracked over two 60-day periods. Six weeks were allowed for HCAHPS surveys to be returned. Business cards were subsequently deployed and encounters similarly tracked. During the control-group monitoring period, 721 patient encounters were logged and 80 (11.1%) surveys were returned. Qualitative feedback, in the form of free-response comments, was provided in 41 (51.3%) surveys. Business …

Development And Validation Of Machine Learning-Based Race-Specific Models To Predict 10-Year Risk Of Heart Failure: A Multicohort Analysis, Matthew W Segar, Byron C Jaeger, Kershaw V Patel, Vijay Nambi, Chiadi E Ndumele, Adolfo Correa, Javed Butler, Alvin Chandra, Colby Ayers, Shreya Rao, Alana A Lewis, Laura M Raffield, Carlos J Rodriguez, Erin D Michos, Christie M Ballantyne, Michael E Hall, Robert J Mentz, James A De Lemos, Ambarish Pandey

Faculty, Staff and Students Publications

BACKGROUND: Heart failure (HF) risk and the underlying risk factors vary by race. Traditional models for HF risk prediction treat race as a covariate in risk prediction and do not account for significant parameters such as cardiac biomarkers. Machine learning (ML) may offer advantages over traditional modeling techniques to develop race-specific HF risk prediction models and to elucidate important contributors of HF development across races.

METHODS: We performed a retrospective analysis of 4 large, community cohort studies (ARIC [Atherosclerosis Risk in Communities], DHS [Dallas Heart Study], JHS [Jackson Heart Study], and MESA [Multi-Ethnic Study of Atherosclerosis]) with adjudicated HF events. …

Dexrazoxane Decreases The Cardiotoxic Effects Of Doxorubicin In Osteosarcoma Patients Without Increasing Mortality From Secondary Malignant Neoplasms, Thomas S. Przybycien

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Schwartz CL, Wexler LH, Krailo MD, et al. Intensified chemotherapy with dexrazoxane cardioprotection in newly diagnosed nonmetastatic osteosarcoma: A report from the Children’s Oncology Group. Pediatr Blood Cancer. 2016;63(1):54-615. https://doi.org/10.1002/pbc.25753

for a patient with osteosarcoma and concerns about the risk of secondary malignant neoplasms that attend use of dexarazoxane.

Treatment Anxiety Education For Pediatric Cardiac Neurodevelopmental Patients, An Evidence Based Project, Mary Nagel

Doctor of Nursing Practice Final Manuscripts

Abstract

Background

Congenital heart disease (CHD) is the most common birth defect and affects almost 1% of all live births. Treatment anxiety is common among children with CHD who undergo multiple procedures early in their lifetime. Dramatically increased life spans for this cardiac population has led to a shift from focusing on survival to their long-term health outcomes.

Methods:

Administration of the Peds QL Cardiac Module 3.0 assesses health related quality of life (HRQOL) during annual visits to a Cardiac Neurodevelopmental (ND) Clinic by evaluating the level of Treatment Anxiety a patient experiences during healthcare appointments. The questionnaire scores are …

Providing High Reliability Care For Picu Patients With Pulmonary Hypertension: A Quality Improvement Project, Anjali Subbaswamy, Nicholas Tan, Iric Guthrie, Kelsey Fath, Cole Linzmeyer, Elizabeth Yakes Jimenez

Quality Improvement/Patient Safety Symposium

Providing High Reliability Care for PICU Patients with Pulmonary Hypertension: A Quality Improvement Project

Anjali Subbaswamy, MD; Nicholas Tan, DO; Iric Guthrie, MD; Kelsey Fath, MD; Cole Linzmeyer, DO; Elizabeth Yakes Jimenez, PhD, RDN, LD

Purpose: Pediatric patients with pulmonary hypertension (PHTN) are a high acuity, low frequency population, and are often admitted to the pediatric intensive care unit (PICU). To mitigate the risk of precipitating a potentially life-threatening pulmonary hypertensive crisis, health care staff need to take specific precautions. This quality improvement (QI) project aims to increase the number of inpatient PHTN patients for whom PHTN precautions are applied …

Pediatric Pulmonary Artery Aneurysms Causing Pulmonary Hemorrhage: A Case Of Transcatheter Intervention While On Va Ecmo Support, Igor Areinamo

Research Days

Background: The incidence of pulmonary artery aneurysm (PAA) in children remains unknown. There are few reports of a transcutaneous interventional approach to address this type of pathology. Management of PAAs while on VA ECMO has not been described in pediatrics.

Objectives/Goal:

Methods/Design:

Case: 9-year-old previously healthy male presented with MRSA associated ARDS and sepsis requiring urgent VA ECMO cannulation. Chest CT done on ECMO day 22 showed development of right sided PAAs. Patient had an episode of significant pulmonary hemorrhage. Angiogram demonstrated two fusiform right PAAs, one of which had ruptured and was bleeding into the lung parenchyma. Patient had …

Online Echocardiography Modules For Pediatric Cardiology Fellows, Sarah Studyvin, Doaa Aly, Tyler Johnson, Laura Kuzava, Alison Samrany, Nitin Madan, Sanket Shah

Research Days

Background: Adequate echocardiographic (echo) education is integral to successful cardiology training. Online education is proven to be effective in other specialties, but pediatric echo training data are lacking.

Objectives/Goal: Our aim was to design and assess the role of a novel online module-based curriculum to enhance pediatric cardiology fellows’ echo education.

Methods/Design: Four interactive modules, focused on principles and interpretation of a normal echo, were delivered to fellows. Content included high quality 2D and 3D echo clips as well as interactive quizzes and could be accessed from a phone, tablet, or computer. All fellows completed pre- and post-tests, validated by …

Constrictive Pericarditis After Repair Of A Ruptured Sinus Of Valsalva, Sarah Studyvin, Laura Kuzava

Research Days

Background: Constrictive pericarditis is an uncommon complication of cardiac surgery. We report a patient who developed constrictive pericarditis after ruptured sinus of Valsalva (RSOV) repair.

Methods: A 23-year-old male presented with exertional dyspnea one year after RSOV repair. TTE showed a small, circumferential effusion with thickened pericardium, ventricular septal bounce, left atrial enlargement, diastolic hepatic flow reversal, and trivial mitral regurgitation without stenosis. He underwent cardiac catheterization, which revealed elevated filling pressures (RVEDP 16 mmHg, LVEDP 18 mmHg), RVEDP/RVSP ratio < 0.5, and a low cardiac index (1.65 L/min/m2). Cardiac MRI confirmed pericardial thickening with paradoxic septal motion, dilated pulmonary veins and retrograde flow in the SVC.

Results: Pericardiectomy of thickened and adherent pericardium was performed. The central venous pressure decreased from 23 to 7 mmHg and …

Online Echocardiography Modules For Pediatric Cardiology Fellows, Sarah Studyvin, Doaa Aly, Laura Kuzava, Tyler Johnson, Alison Samrany, Nitin Madan, Sanket Shah

Posters

Background: Adequate echocardiographic (echo) education is integral to successful cardiology training. Online education is proven to be effective in other specialties, but pediatric echo training data are lacking. Our aim was to design and assess the role of a novel online module-based curriculum to enhance pediatric cardiology fellows’ echo education.

Methods: Four interactive modules, focused on principles and interpretation of a normal echo, were delivered to fellows. Content included high quality 2D and 3D echo clips (Fig 1A) as well as interactive quizzes (Fig 1B) and could be accessed from a phone, tablet, or computer. All fellows completed pre- and …

The Role Of Implantable Cardioverter Defibrillators For The Prevention Of Ventricular Arrhythmia In Left Ventricular Assist Device Recipients, Nikhil Reddy, Cristina Ortiz, Toshimasa Okabe, Muhammad Afzal, Mohamed H. Derbala, Asvin Ganapathi, Sakima Smith

Medical Student Research Symposium Abstracts and Posters

Advanced heart failure represents a significant strain on our health care system and is associated with increased morbidity and mortality. New device therapies, including left ventricular assist device (LVAD) implantation, have transformed management as both a destination therapy and as a bridge to transplantation. Although LVADs have improved patient outcomes, arrhythmias represent a significant and costly complication of this therapy. In recent years, implantable cardioverter-defibrillators (ICDs) have been developed to reduce the incidence of lethal arrhythmia. However, a gap in the literature exists for both guidelines in prevention of early ventricular arrhythmia (VA) in LVAD recipients and the effectiveness of …

Methamphetamine Associated Cardiomyopathy And Fatal Thrombus Formation, Kaitlynne Pak, Sanuri Gunawardena, Ericson Torralba, Juan Linares, Damian Valencia, Nathaniel Dittoe

Medical Student Research Symposium Abstracts and Posters

Stimulant abuse is a rapidly growing epidemic both in the United States, and around the world. Reports show that nearly 4.7 million Americans have tried methamphetamines at least once. It is known that methamphetamines and related compounds significantly increase cardiovascular morbidity and mortality. Substance-related chronic inflammation and tissue fibrosis can cause irreversible cardiac structural changes, leading to conditions like methamphetamine-associated dilated cardiomyopathy (MACM). Left ventricular dilation results in hemodynamic flow disturbances, which promote turbulent blood flow and stagnation. Furthermore, the sympathomimetic effects of methamphetamines also disrupt pathways in coagulation homeostasis, providing further incitement of thrombus formation. This unstable catecholamine driven …

A Rocking Catastrophe: An Unusual Case Of Late Onset Prosthetic Valve Endocarditis Leading To Prosthetic Valve Dehiscence, Tuan Pham, Md, Shanana Baig-Lewis, Md, Mph

Articles, Abstracts, and Reports

2021-2022 PGY3

Utilizing A Patient’S Health Portal To Deliver Education In Cardiac Rehabilitation, Bari L. Diubaldo M.Ed, Ccrp, Tara Encarnacion Ms, Acsm-Cep

Posters

No abstract provided.

Paradigm Shift In The Surgical Training: The Era Of Innovation, Simulation And Beyond, Syed Shahabuddin, Shiraz Hashmi, Yasir Khan, Shahid Ahmed Sami

Section of Cardiothoracic Surgery

This is an era of transformation of surgical education and training. Modern methods of training are being introduced at a rapid pace and are being adopted in surgical practice not only to improve the outcomes and patient satisfaction, but also to provide an opportunity to develop a new well-structured training curriculum by integrating both traditional and modern approaches to teach and learn surgical skills. Various surgical simulators are in use as training aids and are constantly undergoing further refinement and development. To achieve a smooth transition in surgical training to modern methods, a structured programme has to be developed and …

Surgical Education And Training During The Covid-19 Pandemic: Strategies And Solutions For Pakistan, Edward Anthony Joseph, Russell S. Martins, Javeria Tariq, Namrah Aziz, Hina Inam, Mahim Malik

Medical College Documents

The coronovirus disease-2019 pandemic has severely impacted surgical education and training in Pakistan and worldwide, causing problems, such as risk of infection, limited hands-on training, examination delays, and trainee redeployment to non-surgical specialties. The current review was planned to describe innovative strategies adopted by surgical training programmes worldwide in order to suggest comprehensive recommendations at the level of the College of Physicians and Surgeons Pakistan and individual institutions to counter the challenges presented by the pandemic in Pakistan. The innovative use of technology, including open-access online educational portals, virtual educational activities and simulation-based learning, can help reform education delivery during …

Inferior St-Elevation Myocardial Infarction Presenting When Urgent Primary Percutaneous Coronary Intervention Is Unavailable: Should We Adhere To Current Guidelines?, Yochai Birnbaum, Glenn N Levine, John French, Juan Carlos Kaski, Dan Atar, Mahboob Alam, David Hasdai, Hani Jneid, Barry F Uretsky

Faculty, Staff and Students Publications

The pivotal studies that led to the recommendations for emergent reperfusion therapy for ST-elevation myocardial infarction (STEMI) were conducted for the most part over 25 years ago. At that time, contemporary standard treatments including aspirin, statin, and even anticoagulation were not commonly used. The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines and the 2017 European Society of Cardiology guidelines give a class I recommendation (with the level of evidence A) for primary percutaneous coronary intervention (pPCI) in patients with STEMI and ischemic symptoms of less than 12 h. However, if the patient presents to a hospital …

The Effect Of Mock Code Blue Simulations And Dedicated Advanced Cardiac Life Support Didactics On Resident Perceived Competency., Dallis Q Ngo, Christina Vu, Thien Nguyen, Patricia Sotolongo, Manika Talati, Nikki Zahabi, Katrina Platt

Articles, Abstracts, and Reports

In-hospital cardiac or pulmonary arrest is associated with high mortality. In the USA, approximately 200,000 of these events occur and are associated with overall survival rates of 18%-20%. Despite advances in resuscitative methods, the probability of intact survival also remains unfavorable. Though many factors play a role, we believe a large portion of a patient's survival is dependent on the competency of the leader of the code blue or resuscitative team's efforts. Newly minted physicians who enter medical training in their respective residencies are equipped with a wide range of clinical competency in regards to hands-on experience and aptitude with …

Rates Of Ondansetron Administration Prior To Spinal Anesthesia: Evaluating The Practice Of Prophylactic Attenuation Of Spinal-Induced Hypotension And Bradycardia, Clare Santana, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Hypotension and bradycardia are common complications of spinal anesthesia. Intraoperative hypotension and bradycardia may lead to complications that require additional treatment and increase cost. The literature identifies intervention strategies to attenuate spinalinduced hypotension (SIH) and bradycardia.1 Prophylactic administration of ondansetron, a serotonin 5-hydroxytryptamine receptor antagonist, prior to spinal anesthesia is associated with reduced SIH and bradycardia.1,2,3,4,6 The objective of this scholarly project was to report the practice of ondansetron prophylaxis for SIH and bradycardia and the rate of rescue interventions in patients who received ondansetron prior to spinal anesthesia.

Methods Retrospective, multi-center observational evidence-based practice project conducted at Providence …

Multi-Community Cardiopulmonary Resuscitation Education By Medical Students, Kenton L Anderson, Kian Niknam, Larry Laufman, Stefanie S Sebok-Syer, Sara Andrabi

Faculty, Staff and Students Publications

Introduction One purpose of the hands-only cardiopulmonary resuscitation (HOCPR) program is to simplify CPR instruction to encourage more bystanders to take action during cardiac arrest. Although the program has been successfully implemented in traditional classroom settings, the utility of large-scale training events has not been well-explored. We hypothesized that CPR knowledge and comfort levels would increase through a large-scale, multi-community HOCPR training event. We also explored what effect this training event had on perceived barriers to bystander-performed CPR. Methods A convenience sample participated in HOCPR training on a single day across 10 Texas cities. A sub-sample completed training questionnaires, including …

Post-Operative Atrial Fibrillation And Anticoagulation, J. Vojnika, Md, P. Varano, Md, S. Melnick, Do, Matthew Metzinger, Mba, Cphq, K. Patel, Rn, Msn, Mba, Cphq

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Overall aim: Improve recognition of need for anticoagulation in post-operative atrial fibrillation.

• Increase recognition that thromboembolic risk in post-op atrial fibrillation is similar to that of non-valvular atrial fibrillation
• Increase the rate of appropriate anticoagulation initiation in patients with post-op atrial fibrillation

Identifying Women With Coronary Artery Disease Using Non-Cardiac Ct Imaging, Rachel Redfield, Md, Rani Rajaram, Md, Kathryn Anderson, Ba, Sarah Kamel, Md, Matthew Metzinger, Mba, Lydia Liao, Md, Katherine Sherif, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims

• Identify the percentage of female patients with prior CT scans done for noncardiac reasons who should have the diagnosis of CAD.
• Collaborate with primary care, cardiology and breast imaging to determine how best to integrate this incidental finding into clinical practice.
• Determine current barriers that may prevent providers from taking action on patients with new CAD.

Detection Of Coronary Artery Disease On Ct Chest Imaging, K. Mirzozoda, Md, Mba, J. Vojnika, Md, R. Mohammed, Md, H. Landon, Md, C. Murphy, Y. Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Overall aim: Improve diagnosis and management of CAD based on CT chest imaging.

• Improve diagnosis of silent CAD based on CT chest imaging: more patients who have findings of CAC on CT chest imaging will be diagnosed with CAD.
• Increase the number of appropriate statin prescriptions based on CAD findings on CT chest imaging.

A Novel 3d Model To Learn Coronary Angiography, N. Haroian, S. Chandragiri, M. Ho, M. Fields, D. Fischman, M. Savage, N. Ruggiero, A. Vishnevsky

Health Equity and Quality Improvement (HEQI) Summit

The limitations of 2D imaging creates challenges for cardiology fellows learning the basics of coronary angiography.

Using a 3D model to simulate a coronary angiogram outside the cath lab could shorten the learning cure and improve understanding of this essential procedure.

Time To Defibrillation After Onset Of Ventricular Fibrillation And Ventricular Tachycardia Cardiac Arrest At Thomas Jefferson University Hospital And Jefferson Hospital For Neurosciences., Sairamya Bodempudi, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Improve average time to defibrillation after VFib/pVTach cardiac arrest to < 2 minutes within an 8 month interval at TJUH and JHN.
• Improve the percent of VFib/pVTach cardiac arrests that are defibrillated within the recommended 2 minute interval by 30% at TJUH/JHN within an 8 month interval

Sglt2 Inhibitors In Patients With Diabetes And Cardiovascular Disease, Cristina Calogero, Md, Jillian Cooper, Md, Mathew Francis, Md, Joseph Grogg, Md, Shuwen Lin, Md, Patrick Prior, Md, Bo Hyung Yoon, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition: Multiple studies (e.g. EMPA-REG, CANVAS) demonstrate that SGLT2 Inhibitors (Inh) improve cardiac outcomes in patients with Type II Diabetes (DM2) with comorbid Cardiovascular Disease (CVD) including Heart Failure and Coronary Artery Disease. SGLT2 Inhibitors are considered standard of care for patients with DM2 and CVD. Based on literature published in European Journal of Preventative Cardiology and JACC HF, our prediction is that physicians at Thomas Jefferson University Hospital Ambulatory Practices (TJUH) under-utilize SGLT2 Inh for patients with co-morbid CVD and DM2.

Aims for Improvement: Within the Jefferson Healthcare System, we sought to determine: Future Interventions

1. The percentage of …

Use Of Epic Emr For Early Identification And Management Of Patients At Risk Of Cardiac Implantable Electronic Device (Cied) Infection, Priya Rajagopalan, Md, Yair Lev, Md, Arnold J. Greenspon, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Aim of our project was early identification of 100% of patients with a CIED IMPLANT presenting with bacteremia
• Process involves use of EPIC EMR to automatically identify patients with positive blood cultures
• Traditionally, cardiologists are alerted by the care team using the CONSULT system for management of these patients
• EPIC EMR as an adjunct to the CONSULT system

Improving Evaluation And Follow-Up Of Patients Diagnosed With Left Bundle Branch Block, Naman Upadhyay, Md, Alvin George, Md, John Schanz, Ms, Behzad Pavri, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Left bundle branch block (LBBB) is a pathologic finding on electrocardiogram (ECG).

• Most commonly present in patients with antecedent hypertension, cardiac enlargement, coronary artery disease or a combination of these
• Class 1B recommendation: Those with findings of LBBB on ECG should undergo transthoracic echocardiography for evaluation of underlying heart disease
• LBBB is prevalent (33%) in patients with heart failure
• Cardiac resynchronization therapy can improve left ventricular mechanical function in patients with LBBB (QRS >150 msec)

This study aims to understand how effectively we are evaluating and following up these patients at Thomas Jefferson University Hospital.