Cardiology Commons^™

Interventional Approach To Intermediate-High-Risk Pe: Catheter-Directed Mechanical Thrombectomy, Shreya Agarwal, Kirill Ruban, Ishan Kirti, Karina Ruban, Fadi Saab, Sujata Kambhatla, Pranay Gupta

Conference Presentation Abstracts

Acute pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. The clinical outcomes are largely determined by thrombus burden and its hemodynamic impact on the right ventricle (RV). Over the past decade, catheter-directed mechanical thrombectomy has emerged as a promising alternative for systemic thrombolysis for PE management, particularly in patients at high risk for major bleeding. This approach provides rapid mechanical debulking of thrombus without exposure to thrombolytics and has been associated with significant improvements in RV function and pulmonary artery pressures. We present a case of extensive bilateral PE successfully treated with mechanical thrombectomy, highlighting the …

Right Ventricular Involvement In Stress Cardiomyopathy: A Case Of Biventricular Takotsubo With Cardiogenic Shock, Ahmad Muhammad, Yazan Alkehef, Theodore Schreiber

Conference Presentation Abstracts

Introduction Takotsubo cardiomyopathy (TC) is characterized by transient left ventricular (LV) dysfunction following a stressor in the absence of obstructive coronary artery disease. We present a case of a less common variant with right ventricular involvement. Hospital course A 45-year-old woman with sickle cell disease and asthma presented with nausea, vomiting, abdominal pain, and fevers, one week after the death of her father. Examination revealed an irregular tachycardia. Labs demonstrated leukocytosis, elevated lactate, and markedly increased troponin. Chest imaging showed bilateral basilar opacities. ECG demonstrated atrial flutter with rapid ventricular response. She developed progressive respiratory failure requiring intubation. Repeat ECG …

Spontaneous Coronary Artery Dissection In Postpartum: A Hidden Cause Of Maternal Myocardial Infarction, Riya Chhabra, Brian Renard

Conference Presentation Abstracts

Spontaneous coronary artery dissection (SCAD) is a tear in the coronary artery lining which decreases blood flow to the heart. SCAD is the leading cause of myocardial infarction in young to middle aged women, especially during and after pregnancy. While SCAD is often managed conservatively, patients are prone to complications like cardiomyopathy. This case underscores the importance of considering SCAD as a differential for postpartum women with chest pain. Furthermore, this case highlights the diagnosis and management of an atypical stress-induced cardiomyopathy with global hypokinesis following postpartum SCAD. A 37-year-old female postpartum for five weeks presented to our hospital with …

Leveraging State Of The Art Simulation-Based Education To Enhance Medical Student Interest In Internal Medicine And Cardiology, Mohamed Abdalaziz, Nicholas Mitchell, Ryan Madder

Conference Presentation Abstracts

Abstract Background: Early clinical exposure plays a critical role in shaping medical student interest, and therefore choice in medical specialty. Traditional curricula offer limited opportunities for hands-on engagement with cardiovascular decision-making and procedures. Simulation-based education may address this gap by providing immersive, low-risk learning experiences. Methods: An internal medicine resident and Cardiology fellow led, faculty-supported simulation curriculum was developed for third- and fourth-year medical students using a state-of-the-art simulation laboratory. Two 75-minute sessions were conducted over a two-month period, with a total of 27 students participating. The first session included a focused electrocardiography didactic emphasizing ST-elevation myocardial infarction (STEMI) recognition, …

Severe Transvalvular And Paravalvular Aortic Regurgitation As Late Tavr Failure Successfully Treated With Percutaneous Therapy, Ashley Armstrong, Luca Halalau, Ivan Hanson

Conference Presentation Abstracts

BACKGROUND - Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis. With improving long-term survival, late prosthetic valve–related complications are increasingly recognized. CASE SUMMARY - We report a 74-year-old man who presented eight years after TAVR with progressive dyspnea, orthopnea, and bilateral lower extremity edema, identified to be acute decompensated heart failure with a new diastolic murmur. Transthoracic echocardiography demonstrated severe aortic regurgitation. Subsequent transesophageal echocardiography identified concomitant severe paravalvular and severe transvalvular regurgitation of the bioprosthetic valve. Invasive hemodynamic assessment revealed acute volume overload with markedly elevated filling pressures, secondary pulmonary hypertension, and right ventricular …

Acute Myocardial Injury And Vasospastic Stunning Following A Grand Mal Seizure, Aaron Goyal, Kirill Ruban, Ishan Kirti, Karina Ruban, Fadi Saab, Pranay Gupta, Sujata Kambhatla

Conference Presentation Abstracts

Acute non-ischemic myocardial injury results from myocardial oxygen supply-demand mismatch in the absence of critical coronary stenosis or atherothrombotic plaque rupture, and may be precipitated by acute physiologic stress, including sustained sympathetic overactivity. Troponin elevation may occur in 6.7-10.9% of post-seizure cases, with higher incidence among the elderly and individuals with cardiovascular risk factors. We present the case of a 55-year-old woman with long-standing epilepsy, dyslipidemia, multiple sclerosis treated with ocrelizumab, and significant cardiovascular risk factors (20 pack-year smoking history, occasional alcohol use, family history of early myocardial infarction) who presented to the emergency room after a witnessed generalized tonic-clonic …

Novel Applications Of Coronary Cta In Patients With Intermediate Risk Of Cad, Ashley Armstrong, Luai Madanat, Robert D. Safian

Conference Presentation Abstracts

Background: ACC/AHA guidelines provide class 1 and 2A recommendations respectively for coronary CTA and FFRCT in patients with chest pain and intermediate risk of CAD. We present a case in which novel applications of CTA excluded obstructive CAD, identified the correct diagnosis, and allowed optimization of medical therapy. Case: In a 72-year-old male with stable angina and HEART score 6, stress ECG was positive for angina and frequent PVCs (Fig 1A). Coronary CTA (Fig 1B) and FFRCCT (Fig 1C) showed non-obstructive CAD and intramyocardial bridging/severe systolic compression in the mid-LAD (Fig 1D). AI plaque analysis demonstrated a mixed plaque burden …

A Storm Within: Anti-Nmda Receptor Encephalitis Mimicking Anxiety In A Young Woman, Izma Khaliq, Omar Sami Abdelhai, Angela Ishaq, Emmanuel Meram, Anointing Onuoha, Ahmed Jabri, William Dillon

Conference Presentation Abstracts

Case Description: A 21-year-old female with a history of asthma presented to the emergency department (ED) with restlessness, anxiety, and loss of appetite shortly after returning from a trip to France, where she and her boyfriend ended their relationship. Her initial evaluation, including unremarkable laboratory results, led to the attribution of her symptoms to anxiety from life stressors. She was treated with supportive measures in the ED and prescribed Xanax by her primary care physician at follow-up. Six days later, the patient returned to the ED with hallucinations and panic attacks. Again, laboratory results were unremarkable, and she was diagnosed …

Double Trouble: A Case Of Persistent Left-Sided Superior Vena Cava, Lark Steafo, Kateryna Strubchevska, Olena Strubchevska, Marko Kozyk, Shazil Mahmood, Steven Timmis

Conference Presentation Abstracts

A persistent left-sided superior vena cava (PLSVC) is a rare vascular anomaly where the left superior cardinal vein fails to regress during embryogenesis, resulting in an additional venous structure that drains into the right atrium, often via the coronary sinus. It is usually asymptomatic but may be discovered incidentally during imaging or procedures, but its presence can have implications for central venous access and pacemaker placement. Our case features an 82-year-old male with a past medical history of coronary artery disease, remote esophageal cancer, hypertension, hyperlipidemia, and tobacco use disorder, referred to the emergency department from his primary care doctor’s …

Profound Endocarditis Resulting In Recurrent Fatigue, Shawn Matharu, Majid Qazi

Conference Presentation Abstracts

A 46 year-old female with past medical history of congenital aortic stenosis status post bovine bioprosthetic valve replacement and an ascending aortic aneurysm repair 13 years prior to presentation presented with fatigue and generalized weakness. The patient also had a history of non-obstructive coronary artery disease, hypertension, and HFpEF. She recently was diagnosed with infectious mononucleosis 3 weeks prior. In the 1 month prior to her index presentation she had two prior admissions for respiratory symptoms. On physical exam, the patient had a 4/6 holosystolic murmur. Her laboratory markers revealed a profound leukocytosis, mild anemia, a mild troponinemia, hypokalemia, and …

Case Report - Complex Management Of Tricuspid And Pulmonic Valve Endocarditis In An Intravenous Drug User: A Case Report And Review Of Challenges And Outcomes, Luxhman Gunaseelan, Michael Kattula, Sam Alsabti, Ahmad El-Gammal, Khurram Arshad, James Richard Spears

Conference Presentation Abstracts

Background: Right-sided infective endocarditis (RSIE), commonly associated with intravenous drug use (IVDU), primarily affects the tricuspid valve (TV). With sustained bacteremia, the pulmonic valve may also become involved. Staphylococcus aureus remains the leading cause of tricuspid valve infective endocarditis (TVIE), diagnosed using Duke’s criteria, which integrate clinical findings, blood culture results, and echocardiographic evidence. The management of TVIE poses unique challenges, particularly in patients with IVDU, who often face barriers to surgical intervention despite severe complications like tricuspid regurgitation (TR), which normally carries a poor prognosis if left untreated. Case Presentation: We describe the case of a 39-year-old female with …

Coronary Subclavian Steal Syndrome: A Rare But Deadly Complication In Post-Cabg Patients, Hazem Alakhras, Parvathy Sankar, James Goldstein

Conference Presentation Abstracts

Coronary Subclavian Steal Syndrome (CSSS) is a rare but serious complication of coronary artery bypass grafting (CABG). It occurs when the left anterior descending (LAD) coronary artery is bypassed from the left subclavian artery (LSA) using the left internal mammary artery (LIMA). The syndrome arises due to stenosis of the LSA, leading to reduced blood flow through the LIMA. This triggers retrograde flow from the LIMA to the distal LSA, resulting in myocardial ischemia despite patent grafts. Clinical presentation can vary from asymptomatic cases to severe manifestations such as new-onset heart failure or acute coronary syndrome (ACS). A 79-year-old female …

Pr Novel Hematoma Prevention Device, Nolan Shoukri, Steven Pearl, Nishaki Mehta

Posters

• Hematomas are a common complication in cardiac internal electronic device (CIED) placement procedures, they occur in up to 20-25% of CIED implants.

• Previous RCT tested a novel hematoma compression device (PR) and showed good tolerability, decreased hematoma formation from 15% to 6%, and wound improvement.

• Based on feedback collected from the nurses, physicians, allied health professionals during the randomized control trial, iteration of the PR was done (Gen 2 PR).

• This study evaluated 1) bench testing of the Gen 2 PR device and 2) healthy volunteer testing of Gen 2 PR device.

Suture Management Practices In Central Venous Catheters: A Survey Among Healthcare Professionals, Matthew Prevost, Nishaki Mehta

Posters

• Traditional suture methods (Fig. 1) for securing central venous catheters (CVCs) lack standardization, are nonadjustable postsecurement, and require dexterity → increasing risk of catheter micropistoning and central line-associated bloodstream infections (CLABSIs).

• This study examines medical practitioners' experiences and challenges with suturing CVCs

• Our hypothesis predicts that variations in responses and differences in practitioner training may influence experiences and complication rates.

Clinical Characteristics And Outcomes In Patients With Coronary Artery Aneurysms (Caa) Presenting With Acute Coronary Syndrome (Acs) Or Cardiomyopathy, Advaitha Misra, Mathangi Keshavan, Ersida Zerdelija, Zain Abidi, Alexandra Corrado, James Benke, Hassan Dalloul, Anton Salwan

Posters

Coronary artery aneurysms and ectasia are rare conditions with an incidence estimated at < 1% [1]. It is defined as either a focal or diffuse dilation of a coronary segment of at least one and a half times the adjacent normal segment [2,3].The most common etiology is atherosclerosis, although a variety of other culprits are implicated in its pathogenesis, such as vasculitidies and connective tissue disorders [3,4,5]. Its management is largely driven by the etiology of the coronary artery segment dilation and the presentation of disease at the time of diagnosis. Management strategies employ a judicious combination of medical therapy, percutaneous and surgical interventions. The presence of coronary artery aneurysm or ectasia has been associated with poor long-term outcomes [6,7,8]. Complications from coronary artery aneurysm influence management, largely guided by clinician judgment and limited published data. Given the paucity of evidence in the management of these conditions, we present a case series of three patients with coronary artery aneurysm or ectasia with varying presentations and their corresponding management. We aim to contribute to the growing body of evidence for the management of this elusive cardiac condition.

Instent Thrombosis 20 Years After Stent Placement, Hussein Gaith, Najeebullah Bangash

Conference Presentation Abstracts

Stent thrombosis is not very common but it is a serious complication of percutaneous coronary intervention (PCI). Here in, we present a case of 55 years old who presented with acute chest pain, was found to have non ST elevation myocardial infarction due to a thrombotic occlusion of prior drug eluting stent placed 20 years ago. A 55 years old male presented to the emergency department with one day history of mid-chest retrosternal pain that started while playing hockey, associated with nausea and diaphoresis. On initial evaluation, vital signs were stable, and patient was afebrile. Cardiac examination was normal with …

Rare Case Of Hemorrhagic Pericardial Effusion Due To Coxsackie B Pericarditis, Nolan Shoukri, Hazem Alakhras, Kateryna Strubchevska, Steven Timmis

Conference Presentation Abstracts

Introduction Acute pericarditis is caused by inflammation of the pericardial sac. Amongst the vast number of potential causes, viruses tend to trigger pericarditis most frequently. Some of the more common viral causes are coxsackie A/B, echovirus, adenovirus, CMV, HSV, and HIV.1-3 Pericarditis often presents with signs and symptoms such as a friction rub, pain relieved with sitting up and leaning forward. ST segment elevations and PR segment depressions are seen on EKG. Laboratory tests showed increased inflammatory markers and WBC count. Pericardial effusion is a common complication and can be visualized on echocardiogram. In some cases, the pericardial effusion can …

Myxedema Coma-Induced Heart Failure With Reduced Ejection Fraction: Unraveling The Complex Interplay, Mohammad Ali Mozaffari, Batool Shukr, Hafsa Hassan, Khurram Arshad, Antoine Egbe Bessong Tabot, Mariam Jamil, Rajiv John, Adam Hafeez

Conference Presentation Abstracts

Introduction Myxedema coma is a rare condition with a high mortality rate. It poses the risk of cardiovascular complications, typically affects elderly females, and is often triggered by an underlying infection or systemic illness in the setting of preexisting severe hypothyroidism. Patients may exhibit multiorgan dysfunction with altered mentation ranging from disorientation and lethargy to obtundation and coma. Other physical exam findings may include dry scaly skin, non-pitting edema, delayed reflexes, bradycardia, and hypothermia. Prompt diagnosis and early treatment are crucial to reducing mortality rates associated with this severe condition. Case description A 74-year-old female with no known past medical …

The Impact Of Patch Placement Using Fluoroscopy Guidance On Outcome Of Electrical Cardioversion Of Atrial Fibrillation, Joshua France, Luai Madanat, Nolan Shoukri, Daniel Walsh, Ilana Kutinsky, Sujana Gundlapalli, Abhay Bilolikar, Anil Kumar Anil, Brian Williamson, Elvis Cami, Michael Gallagher, Richard Bloomingdale, David E. Haines, Nishaki Mehta

Posters

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and is Conclusions increasing in prevalence, especially as the population ages.1 Proper management of AF is imperative to prevent long-term complications including hemodynamic impairment and thromboembolic events which result in significant morbidity, mortality, and health care cost.2 Electrical cardioversion (EC) is frequently used to restore sinus rhythm in patients with AF.3, 4 However, it can be unsuccessful in up to 10-12% of patients.5 Despite the increased utilization of EC for the treatment of AF, guidelines provide little procedural guidance on methods to maximize EC success rates. Current European and American …

Defining High-Risk Percutaneous Coronary Intervention: Characteristics Of Patients Undergoing Contemporary Percutaneous Coronary Intervention With Axial-Flow Mechanical Support, Aditya S. Bharadwaj, Alexander G. Truesdell, Alejandro Lemor, Julia B. Thompson, Arsalan Abu-Much, Yiran Zhang, Simon R. Dixon

Conference Presentation Abstracts

No abstract provided.

Performance Of Existing Risk Models In Impella-Supported High-Risk Percutaneous Coronary Interventions: The Protect Iii Cvad Study, Tayyab Shah, Alejandro Lemor, Julia B. Thompson, Majd B. Prothy, Mamas Mamas, Tim Kinnaird, Simon R. Dixon

Conference Presentation Abstracts

No abstract provided.

Changes In Electrocardiographic And Cardiac Implantable Electronic Device Parameters Following Transcatheter Aortic Valve Replacement, Elizabeth Seeley, Luai Madanat, Nishaki Mehta

Posters

Transcatheter aortic valve replacement (TAVR) is known to cause conduction abnormalities leading to the need for permanent pacemaker implantation. However, the impact of TAVR-related conduction abnormalities on cardiac implantable electronic device (CIED) parameters in patients with preexisting devices is not known. We sought to investigate and describe changes in EKG and CIED parameters following TAVR in patients with preexisting CIEDs.

A Retrospective Review Of Catheter-Directed Therapy For Patients With Intermediate Risk Pulmonary Embolisms, Austin Lehew, Michael Tucciarone

Posters

Each year, hundreds of patients present to the William Beaumont hospital system with intermediate risk pulmonary embolisms (IRPE) with common symptoms of chest pain, shortness of breath, and hypoxia. Conventional treatments include anticoagulants alone, or a more aggressive approach with systemic thrombolytics which come with a higher risk of major bleeding and death. However, in the last few years, catheter-directed therapies (CDT) have been developed to mechanically remove clots in a minimally invasive fashion. The goal of this study is to determine the safety and efficacy of novel CDT at Beaumont Troy and Royal Oak.

Changes In Electrocardiographic And Cardiac Implantable Electronic Device Parameters Following Transcatheter Aortic Valve Replacement, Elizabeth Seeley, Luai Madanat, Nishaki Mehta

Posters

Transcatheter aortic valve replacement (TAVR) is known to cause conduction abnormalities leading to the need for permanent pacemaker implantation. However, the impact of TAVR-related conduction abnormalities on cardiac implantable electronic device (CIED) parameters in patients with preexisting devices is not known. We sought to investigate and describe changes in EKG and CIED parameters following TAVR in patients with preexisting CIEDs.

Pillow Cpr: Using A Low Resource Method To Teach Hands-Only Cpr To Hispanic Adolescents In A Community Setting, Benjamin Goldstein, Ekaterina Clark, Alan Silverman, Virginia Uhley

Posters

Hands-only Cardiopulmonary resuscitation (CPR) training for adolescents in community settings is often limited by training device availability. This pilot study’s objective was to investigate the feasibility, participant knowledge gains, and attitude changes through hands-only CPR training using a pillow for skill development.

Recurrent Myopericarditis Following Mrna-1273 Sars-Cov-2 Vaccination In A Patient With Previous Sars-Cov-2 Myopericarditis, Lauren Reinhold, Simon R. Dixon, Carl B. Lauter

Conference Presentation Abstracts

Introduction: Coronavirus disease (COVID-19) caused by SARS-CoV-2 infection has been associated with myocarditis. The novel mRNA vaccines, BNT162b2 and mRNA-1273, that encode the SARS-CoV-2 spike glycoprotein have shown to be a safe combatant to the pandemic. Myocarditis has become a rare, newly recognized complication of the SARS-CoV-2 mRNA vaccinations. The mechanism remains unknown, but multiple have been proposed. Case description: A 24-year-old healthy Caucasian female presented to the hospital with acute chest pain. The patient received her first dose of mRNA-1273 SARS-CoV-2 vaccine two days prior to onset of symptoms. She reported sharp mid-sternal chest pain worse with inspiration and …

Cardiorespiratory, Hemodynamic, And Perceived Exertion Responses To Seated Chair Exercise, Ryan Khemraj, Cristian Solano, Neesirg Patel, Roger Sacks

Posters

INTRODUCTION
The increasing prevalence of cardiovascular disease (CVD) and its sequelae in the United States population has led to escalating health care expenditures. To favorably modify cardiovascular outcomes, exercise physiologists have developed varied exercise programs that are associated with mortality reduction, symptom relief, improved exercise tolerance, favorable risk factor modification and improved psychosocial well-being. For patients with significant disability and deconditioning, chair-based exercise may provide an alternative method of achieving the relative cardioprotective benefits of traditional exercise.

Transcatheter Aortic Valve Replacement: Volume Impact On Length Of Stay And Readmissions, Alexander M. Balinksi, Patrick Karabon, Girish Pathangey, Amr E. Abbas

Posters

INTRODUCTION
TAVR is an alternative to surgery in patients with severe aortic stenosis. Procedural volume impacts mortality but little is known of its effect on length of stay (LOS) and readmissions. We sought to examine the impact of transcatheter aortic valve replacement (TAVR) procedural volume on trends in LOS and hospital readmission rates from 2012 to 2016.

Late Outcomes For Patients With Acute Chest Pain And Positive Fractional Flow Reserve By Computed Tomography, Zach Rollins, Jason Schott, Robert Safian

Posters

INTRODUCTION
Testing with fractional flow reserve derived from computed tomography (FFRCT) can be used to stratify otherwise indeterminate grade stenoses on cardiac computed tomography angiography (CCTA). Long-term clinical outcomes using FFRCT have been reported in stable heart disease but not for acute chest pain (ACP). This study analyzes clinical outcomes in patients with ACP who underwent FFRCT, including the risk of mortality, myocardial infarction (MI), invasive coronary angiography (ICA), and revascularization.

Does Aspirin Reduce Risk For Future Cardiovascular Events In Women With Diabetes?, Olivia Hillier, Amna Zeb, Pamela Marcovitz

Posters

INTRODUCTION
The use of low dose aspirin (LDA) in primary prevention of cardiovascular events (CVE) is no longer recommended due to lack of benefit in prevention of primary outcome and increased bleeding risks. It’s postulated that LDA could still be of benefit in those with very high vascular risk including diabetes mellitus (DM) as it confers a higher risk for future CVE in women as compared to men. We conducted a meta-analysis to determine if use of low dose ASA is beneficial to lower CVE in women with multiple risk factors.