Cardiology Commons^™

Pcsk-9 Inhibitors Treatment: The Cardiovascular Disparity, Julia Lees, Seana-Pierre Williams, Tahir Razzaq, Michael B. Roberts

The Journal of Integrated Primary Care

Introduction: According to the Center for Disease Control and Prevention (CDC) and American Heart Association (AHA), cardiovascular disease is the leading cause of death in the United States. This phenomenon disproportionally affects the African American population, who have a 31% higher mortality rate than non-Hispanic Caucasian individuals. A retrospective review of PCSK-9 medication use, specifically in a patient population that had minimal representation in the large, landmark clinical trials, can lead to better understanding about the therapeutic potential in cardiovascular disease reduction and patient outcomes attributed to medication use. Education regarding this novel drug class, medication access and patient support, …

The Daily Activity Of Patients With Heart Failure During Covid-19 Pandemic., Christine Sykalo, Ugochukwu Egolum, Hua Ling

PCOM Scholarly Works

BACKGROUND: Sedentary behavior is thought to contribute to worsening heart failure syndromes. Here, we examined whether the shelter-in-place order during the coronavirus disease 2019 (COVID-19) pandemic changed daily activity duration, which was monitored by an implantable cardiac device-based multisensor index and alert algorithm called HeartLogic.

METHODS: We performed a retrospective review of the HeartLogic data from patients with heart failure managed at our clinic and compared the individual daily activity duration 90 days prior to vs. after implementation of the shelter-in-place order. The activity data were prepared by Boston Scientific. Demographic data were extracted from our electronic medical record.

RESULTS: …

Paradoxical Embolism Entrapped In A Patent Foramen Ovale, Mohammad Malik, Macy Rowan, Lucas Seibolt, Barney Beaver

Research Day

Background: According to the Centers for Disease Control (CDC), venous thromboembolisms affect 900,000 people and cause up to 100,000 deaths yearly. A less common subset of these cases includes those of which the emboli, though originating in venous vasculature, are able to pass through intracardiac defects, including a patent foramen ovale (PFO). PFOs are relatively common in the general population, with an incidence of approximately 20-30%. Though oftentimes asymptomatic, PFOs may present an opportunity for an embolism to bypass the lungs and utilize a more direct route to the systemic circulation, otherwise known as paradoxical embolism. One feared complication of …

A Unique Case Of Atrial Fibrillation Secondary To Squamous Cell Lung Carcinoma, Mohammad J. Malik, Emily K. Wilson, Vijay Bandhakavi

Research Day

Atrial fibrillation (AF) is widely considered to be the most prevalent cardiac arrhythmia with an incidence of roughly 1-2% in the United States alone. The incidence of AF has been known to increase with advancing age and thus presents a significant burden on healthcare systems across the globe. AF arises as a result of several mechanisms including structural changes that occur to the heart overtime. Here we present a case in which a 63-year-old male with no past medical history except heavy tobacco use presented to the emergency department complaining of shortness of breath. He also endorsed having palpitations and …

Atypical Presentation Of Obstructive Coronary Artery Disease In A Diabetic Female, Alexis Rodriguez, Zhi Kuat, Humaira Bibi, Lawrence Ukpong

Research Day

According to the World Health Organization (WHO), cardiovascular diseases (CVDs) account for 17.9 million deaths yearly and are the leading cause of mortality in the United States. CVDs are heart and blood vessel disorders, including coronary artery disease (CAD), coronary heart disease (CHD), cerebrovascular disease, cardiomyopathy, and more. In 2018, diabetic adults accounted for 1.87 million hospitalizations for major cardiovascular diseases. Diabetes Mellitus (DM) is a global epidemic affecting about 422 million people worldwide. The Centers for Disease Control and Prevention (CDC) has reported more than 37 million people in the United States are diagnosed with DM, and 1 in …

Dual Myristic Acid And Trans-Activator Of Transcription Conjugation Of Pkc Beta Ii Peptide Inhibitor Augments Cellular Delivery To Counteract Myocardial Ischemia/Reperfusion Injury, James Ramsarran, Logan Clair, Taurai Augustin, Zinya Talukder, Emily Andrews, Tameka Dean, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

INTRODUCTION: Dual conjugation of PKC Beta II peptide inhibitor (PKCβII-) with myristic acid (myr) and trans-activator of transcription (Tat) (Myr-Tat-CC-SLNPEWNET [myr-Tat-PKCβII-]) has been shown to enhance intracellular delivery and attenuate myocardial ischemia/reperfusion (I/R) injury in an ex-vivo rat model. Previously, myr-Tat-PKCβII- demonstrated significant cardioprotective effects from 100nM to the 1pM concentration.

OBJECTIVES: The lowest concentration at which myr-Tat-PKCβII- is still cardioprotective has yet to be determined; this study investigates the 100fM concentration.

METHODS: Isolated rat hearts from anesthetized male SD rats (275g to 300g) underwent global I(30-min)/R(50-min). Cardiac function was recorded via a pressure transducer. Treatments were infused during the …

Assessment Of The Impact Of Race And Proxies Of Socioeconomic Status On The Prevalence And Health Outcome Of Peripartum Cardiomyopathy (Ppcm) Using The “All Of Us” Databank, Nicole Blatt, Brian J. Balin Phd, Ahmad B. Cader, C. Scott Little, Eleonora Savio-Galimberti

Research Day

Background: Peripartum Cardiomyopathy (PPCM) is a form of cardiomyopathy occurring during the last month of pregnancy or within months after giving birth in women with previously normal hearts. PPCM is an idiopathic systolic dysfunction that causes a reduced left ventricle ejection fraction. The estimated incidence of PPCM worldwide is 1 diagnosis out of 2,000 live births, and the causes of PPCM remain unknown. A retrospective cohort study conducted at the University of Pennsylvania Health System by Getz et al. showed that black race and socioeconomic proxies (like neighborhood disadvantage index (NDI)) were independently associated with sustained cardiac dysfunction (Getz et …

Cardioprotective Effects Of Naltrindole In Rat Myocardial Ischemia/Reperfusion Injury Are Concentration-Dependent, Logan Clair, Tanoh Boakye, James Ramsarran, Zinya Talukder, Nikola Maricic, Ukoha Kalu, Juliet Melnik, Tameka Dean, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

Myocardial infarction remains a major cause of mortality and morbidity globally and infarct size is a major determinant of prognosis. Early and successful restoration of myocardial reperfusion is effective to reduce final infarct size and improve clinical outcomes. However, reperfusion induces further damage to the myocardium, hence the need for adjunctive therapy. Cardioprotective therapies to limit myocardial hypercontracture that occurs during prolonged ischemia and is associated with ischemia-reperfusion (I/R) injury are an important clinical goal. Previously, naltrindole (NTI, 5µM), when given prior to ischemia, exerted cardioprotective effects in ex-vivo, rat myocardial I/R, in part, by attenuating ischemic hypercontracture that occurred …

Pretreatment With Naltrindole Generates Dose Dependent Effects On Reduction Of Infarct Size During Myocardial Ischemia Reperfusion In An In-Vivo Model, Annam Humayun, Sunit Singh, Arianna Gray, Devani Johnson, Tameka Dean, Qian Chen, Robert J. Barsotti, Lindon H. Young, Wangde Dai, Robert Kloner

Research Day

Over one million individuals experience a myocardial infarction (MI) every year. Currently, no therapeutic is available to salvage necrotic cardiac tissue following an MI. The use of a prophylactic agent to reduce infarct size in patients at high risk for an MI would attenuate the development of heart failure. Interventional cardiologists state that a 25% reduction in infarct size is clinically meaningful to reduce heart failure. Previously, a 5 min pretreatment with high dose (HD) naltrindole (NTI) (7.5 mg/kg x 5 min = 37.5 mg/kg, n=3) resulted in a robust 74% (15±6%) reduction in infarct size compared to control in …

The Effects Of Mitoquinone Pretreatment On Doxorubicin-Induced Acute Cardiac Dysfunction, Kimberly Dawes, Juliet Melnik, Meagan Lyons, Jonathan Amora, Lindon H. Young, Robert J. Barsotti, Qian Chen

Research Day

Introduction:

Doxorubicin (DOX) is a widely used anti-cancer drug notorious for its irreversible cardiac toxicity. Currently, Dexrazoxane is the only FDA-approved treatment for this toxicity. However, Dexrazoxane still bears some serious adverse events, and developing new strategies to mitigate DOX-induced heart damage is critical. Our lab has shown that pretreatment of the H9c2 myoblast cells with mitoquinone (MitoQ), a mitochondrial-targeted antioxidant, and significantly improved cells’ resiliency to DOX. This study aimed to determine if MitoQ pretreatment can preserve cardiac function against DOX-induced damage in isolated rat hearts.

Objectives:

The effects of DOX and MitoQ on cardiac function were evaluated in …

Long-Term Use Of Beta-Blocker Medication In Pediatric Long Qt Syndrome Patients: Neuropsychological Profiles, Kara J. Rudisill

PCOM Psychology Dissertations

Long QT syndrome (LQTS) is a heart rhythm disorder characterized by a disruption of the heart’s electrical activity that may cause accelerated and uncontrolled heartbeats referred to as ventricular fibrillation. LQTS is primarily treated with beta-blocker medications, which reduce the risk of experiencing an arrhythmia through regulating the heart rate. However, the potential neuropsychological side-effects associated with the use of beta-blocker medication may impact the executive functioning skills, mental health, and behavior of the affected pediatric population at home. As a result, a child’s academic performance and emotional regulation etiology may be misunderstood by his or her parents, caregivers, and …

Does Stem Cell Injection Improve Quality Of Life In Patients With Cardiopathy Patients?, Shoua Shue Casillas

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not stem cell injections improve the quality of life in patients with cardiopathy.

STUDY DESIGN: Review of three randomized controlled trial (RCT) articles. All articles were published between 2012 – 2017 and were all printed in the English language.

DATA SOURCES: All three RCT articles were found through PubMed.

OUTCOMES MEASURED: One of the outcomes measured in each of the articles were improvement in quality of life in patients with cardiopathy. Among the three review articles, quality of life was measured using either the Kansas City Cardiomyopathy …

Do Pcsk9 Monoclonal Antibodies Plus Soc Prevent Major Adverse Cardiovascular Events In Adults With Hypercholesterolemia Compared To Placebo Plus Soc?, Amy Doyle

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not PCSK9 monoclonal antibodies plus SOC prevent major adverse cardiovascular events in adults with hypercholesterolemia compared to placebo plus SOC.

Study Design: This review is using one double-blinded randomized controlled trial (RCT) and two open-label RCTs investigating alirocumab and evolocumab, published in 2014 and 2015.

Data sources: Articles were found on PubMed, and were published in peer-reviewed journals in English.

Outcome Measured: The outcome measured was major adverse cardiac events (MACE), which included death, MI, hospitalization for unstable angina, revascularization, or cerebrovascular event. …

Is Pharmacologic Therapy For Blood Pressure Control Effective At Reducing Symptoms And Improving Quality Of Life In Patients With Postural Orthostatic Tachycardia Syndrome (Pots)?, Christopher S. Sokalski

PCOM Physician Assistant Studies Student Scholarship

Objective The objective of this selective EBM review is to determine whether or not pharmacologic therapy for blood pressure control effective at reducing symptoms and improving quality of life in patients with postural orthostatic tachycardia syndrome (POTS).

Study Design Systematic review of two single blind crossover randomized control trials published in 2009 and 2012 and one retrospective case control study published in 2009.

Data Sources Three studies were obtained using PubMed. Outcomes Measured Self reported symptoms of POTS and the Vanderbilt POTS symptom scoring system as well as quality of life in patients.

Results Raj et al. (2009), Coffin et …

A Qualitative Study Of How Children Experience And Live With Long Qt Syndrome, Patrick Mcelwaine

PCOM Psychology Dissertations

Long QT syndrome (LQTS) is an inherited and potentially fatal disorder affecting approximately 1 in 2,000 people. Children often experience anxiety and a sense of loss of control as they try to manage the medical, social, and psychological stress that accompanies being diagnosed with LQTS. The present study utilized a qualitative research design to examine how children experience and live with long QT syndrome. Semistructured interviews were conducted with eight children between the ages of 7 to 12 who were diagnosed with LQTS. This period in a child’s life is very important for developing social skills and self-esteem as peers …

Mitoquinone (Mitoq) Exerts Antioxidant Effects Independent Of Mitochondrial Targeted Effects In Phorbol-12-Myristate-13-Acetate (Pma) Or N-Formyl-L-Methiony-L-Leucyl-L-Phenylalanine (Fmlp) Stimulated Polymorphonuclear Leukocyte (Pmn) Superoxide (So) Release, Matthew Lepera, D. Pesikan, J. Voeun, Kerry-Anne Perkins, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

MitoQ is a mitochondrial-targeted coenzyme Q antioxidant analog that dose-dependently restored cardiac function and reduced infarct size in isolated perfused rat hearts subjected to ischemia reperfusion (I/R). Moreover, mitoQ also dose-dependently attenuated PMA stimulated PMN superoxide (SO) release at the same concentration (10uM) as the cardioprotective dose. NADPH oxidase is the principle source of PMN SO release. We speculate that mitoQ may exert antioxidant effects independent of the mitochondria. Therefore, we hypothesized that inhibition of mitoQ on PMN-SO release will be similar as other coenzyme Q analogs: coenzyme Q1 and decylubiquinone without affecting cell viability. SO release was measured spectrophotometrically …

Gp91ds-Tat, A Selective Nadph Oxidase Peptide Inhibitor, Increases Blood Nitric Oxide (No) Bioavailability In Bind Limb Ischemia And Reperfusion (I/R), Sydney Walker, Tyler Galbreath, Qian Chen, Robert J. Barsotti, H. Patel, William Chau, Lindon H. Young

Research Day

I/R injury induces cell death and organ dysfunction in part due to a burst of reactive oxygen species that occurs upon the reintroduction of oxygen into the ischemic area, leading to endothelial dysfunction: decreased blood NO and increased hydrogen peroxide (H2O2 ) levels. We’ve previously shown in isolated rat hearts subjected to I/R injury, gp91ds-tat attenuated cardiac contractile dysfunction and reduced infarct size compared to controls presumably by the inhibition of NADPH oxidase induced superoxide release. Superoxide can quench NO via the formation of peroxynitrite and also be converted to H2O2 in blood. We attempted to confirm this hypothesis using …

Cyclic Nucleotide-Dependent Phosphorylation Regulates Bk-Ca Channel Activity In Human Coronary Artery Smooth Muscle Cells, Raeonda Williams

PCOM Biomedical Studies Student Scholarship

Cardiovascular diseases (CVD) can induce dysfunction in organ systems by attenuating normal blood flow. Gonadal steroids are vasoactive hormones, but their role in contributing to cardiovascular function remains controversial. We have demonstrated that gonadal steroids can relax coronary arteries by opening the large-conductance, calcium- and voltage-activated potassium (BKca) channel in smooth muscle cells by increasing cyclic nucleotide levels; however, the signaling pathways involved remain to be elucidated. The purpose of this study was to identify how phosphorylation (via cAMP- and cGMP-dependent protein kinases) I dephosphorylation (via phosphoprotein phosphatase 2A, PP2A) regulates BKca channel activity in human coronary artery smooth muscle …

Molecular Mechanisms Related To Endotoxemia In Primary Human Cardiomyocytes In Culture, Atijah J. Collins

PCOM Biomedical Studies Student Scholarship

Cardiovascular disease (CVD) is the leading cause of death in the United States and has been for the past 80 years. Development of novel therapeutic agents to address the large number of CVD deaths requires an in depth understanding of the structural and functional properties of human cardiomyocytes. Over the last few years we have been developing an in vitro paradigm to assess molecular cardiodynamics in Primary Human Cardiomyocyte in culture (PHCC). We tested the hypothesis whether endotoxemia would exhibit a marked decrease in contractile proteins and cause apoptosis in PHCC. In the current series of experiments, we induced endotoxemia …

Is Electrical Muscle Stimulation Effective In The Progression Of Oral Feeding, For Patients With Dysphagia, Caused By A Stroke?, Kristen Iaconelli

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not electrical muscle stimulation is effective in the progression of oral feeding, for patients with dysphagia, caused by a stroke.

STUDY DESIGN: Review of 3 randomized controlled trials, published between 2008-2009.

DATA SOURCES: All 3 randomized controlled trials were found using the Cochrane database.

OUTCOMES MEASURED: All 3 studies measured subjective swallowing function pre- and post-treatment, however, each trial differed in the way they measured this. Permsirivanich et al used a functional oral intake scale (FOIS), or a 7-point scale reflecting the patient’s report of …

Is Dabigatran Superior To Warfarin In Treating Patients With Atrial Fibrillation?, Kelly Higgins

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Dabigatran is superior to Warfarin in patients with atrial fibrillation.

STUDY DESIGN: Review of three English language primary studies published in 2007, 2009, and 2010.

DATA SOURCES: Three randomized control trials found using Cochrane Database.

OUTCOME(S) MEASURED: Outcomes measured were presence or absence of stroke or systolic embolism and intracranial hemorrhage. The absence of these events preserved neurologic function in patients with atrial fibrillation.

RESULTS: In both VKA-naïve and VKA-experienced patients, Dabigatran 150 mg was superior to Warfarin in both the prevention of stroke …