Cardiology Commons^™

Eisenmenger Syndrome As A Long Term Complication Of Tricuspid Atresia, Brady Howard, Md

Poster Presentations

No abstract provided.

Difficult Iv Access (Diva) Tool’S Impact On Assisting Rns In Determining When To Call The Vascular Access Team (Vat) Rn For Assistance, Diane Dimarco Davis, Bsn, Rn, Va-Bc

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

The Vascular Access Team: Joey Guinto, BSN, RN, VA-BC; Chynna Vu, RN; SabelaBarrios, RN, VA-BC; Summer Cortinas, BSN, RN, VA-BC; Jeremy Tan, BSN, RN; Lynda Fenton, RN, VA-BC; VinhLe, RN, VA-BC

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.

Axillary Transvalvular Microaxial Pump As Bridge To Transcatheter Aortic Valve Replacement In Cardiogenic Shock, Jacob Abraham, Lian Wang, V Kumar, Eric B Kirker, Kateri Spinelli

Articles, Abstracts, and Reports

No abstract provided.

Successful Pivot Of A Community Exercise Program To Virtual During The Covid-19 Pandemic, Letracia Rose, James G Beckerman

Articles, Abstracts, and Reports

No abstract provided.

Improving Primary Care Screening For Familial Hypercholesterolemia, Mary Nametka, Brenda Senger

2021 Providence Nurse Research Conference

Background: Familial Hypercholesterolemia (FH) is the most common genetic condition resulting in cardiovascular disease, a leading cause of death in the United States. FH is estimated to affect 1 in 250 individuals with elevated lipid levels present from birth. An estimated 90% of individuals with FH remain undiagnosed. '

Purpose: The purpose of this quality improvement project was to increase provider awareness and promote screening for FH among adults ages 20 years and older. '

Methods: This quality improvement project consisted of an online educational intervention for providers working at an outpatient clinic regarding FH. Outcomes included: 1) pre-intervention …

Evaluation Of A Coronary Artery Bypass Graft Care Steps Program, Sheri Havel, Karen Colorafi, Mirjeta Beqiri

2021 Providence Nurse Research Conference

Background: Across the U.S., 20% of cardiothoracic surgery patients who are discharged to home experience unplanned readmission within 30 days of discharge. Readmissions and postsurgical complications are associated with poor patient outcomes, increased mortality rates, and increased cost of healthcare. Evidence-based recommendations for reducing preventable readmission are limited, although there is some indication that high quality pre-operative and discharge education can reduce this burden. Providing appropriate patient education at time of discharge from acute care to home regarding medication adherence, prescheduled follow-up appointments, wound management and monitoring, and symptom management education is theorized to have a significant positive impact on …

Very Low Prevalence And Incidence Of Atrial Fibrillation Among Bolivian Forager-Farmers., Christopher J Rowan, Michael A Eskander, Edmond Seabright, Daniel Eid Rodriguez, Edhitt Cortez Linares, Raul Quispe Gutierrez, Juan Copajira Adrian, Daniel Cummings, Bret Beheim, Kirsten Tolstrup, Abinash Achrekar, Thomas Kraft, David E Michalik, Michael Miyamoto, Adel H Allam, L Samuel Wann, Jagat Narula, Benjamin C Trumble, Jonathan Stieglitz, Randall C Thompson, Gregory S Thomas, Hillard S Kaplan, Michael D Gurven

Articles, Abstracts, and Reports

Background: Atrial fibrillation is the most common arrhythmia in post-industrialized populations. Older age, hypertension, obesity, chronic inflammation, and diabetes are significant atrial fibrillation risk factors, suggesting that modern urban environments may promote atrial fibrillation.

Objective: Here we assess atrial fibrillation prevalence and incidence among tropical horticulturalists of the Bolivian Amazon with high levels of physical activity, a lean diet, and minimal coronary atherosclerosis, but also high infectious disease burden and associated inflammation.

Methods: Between 2005-2019, 1314 Tsimane aged 40-94 years (52% female) and 534 Moseten Amerindians aged 40-89 years (50% female) underwent resting 12-lead electrocardiograms to assess atrial fibrillation prevalence. …

Rapid, Successful Adoption Of Virtual Outpatient Cardiology Care During The Covid-19 Pandemic, Lesley Jones Larson, D Christensen, S Long, Lian Wang, Kateri Spinelli, Xiaoyan Huang

Articles, Abstracts, and Reports

No abstract provided.

Heparin-Induced Thrombocytopenia Presenting As Splenic Hemorrhage Following Cardiac Surgery: A Case Report., Joseph Ferry, Samuel J Youssef, Pierce Wu, Livia Hegerova

Articles, Abstracts, and Reports

BACKGROUND: Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5-10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5-10%.

CASE PRESENTATION: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department on day nine following coronary artery bypass graft surgery with acute weakness, dizziness, and malaise. Her …

Circulating Exosomal Microrna Expression Patterns Distinguish Cardiac Sarcoidosis From Myocardial Ischemia., Elliott D Crouser, Mark W Julian, Sabahattin Bicer, Vikas Ghai, Taek-Kyun Kim, Lisa A Maier, May Gillespie, Nabeel Y Hamzeh, Kai Wang

Articles, Abstracts, and Reports

OBJECTIVE: Cardiac sarcoidosis is difficult to diagnose, often requiring expensive and inconvenient advanced imaging techniques. Circulating exosomes contain genetic material, such as microRNA (miRNA), that are derived from diseased tissues and may serve as potential disease-specific biomarkers. We thus sought to determine whether circulating exosome-derived miRNA expression patterns would distinguish cardiac sarcoidosis (CS) from acute myocardial infarction (AMI).

METHODS: Plasma and serum samples conforming to CS, AMI or disease-free controls were procured from the Biologic Specimen and Data Repository Information Coordinating Center repository and National Jewish Health. Next generation sequencing (NGS) was performed on exosome-derived total RNA (n = 10 …

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

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 …

Cardio-Renal-Metabolic Care Models: Toward Achieving Effective Interdisciplinary Care., Janani Rangaswami, Katherine Tuttle, Muthiah Vaduganathan

Articles, Abstracts, and Reports

No abstract provided.

Quality Review And Education As Method Of Improving Guideline Adherence For Medication Prescription And Outcomes Among Vascular Interventionalists Performing Non-Cardiac Vascular Surgeries, Alejandro Perez, Shih-Ting Chiu, A Manning, Brant W Ullery

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Background: Medical management of patients undergoing non-cardiac vascular procedures often sub-optimally follow evidence based guidelines. We hypothesized that feedback to practitioners in regards to outcomes and medications prescribed would improve care.

Methods: With conversion to new database in 2015 that allowed for more comprehensive tracking of vascular surgery outcomes, a decision was made to share these data with practitioners on regular basis as well as relay medications prescribed at discharge. Carotid and abdominal aortic surgeries were evaluated. The most frequent format for presentation of data was vascular morbidity and mortality conference. Medications included in presentations were antiplatelet and statin therapies. …

Lower Rates Of Heart Failure And All-Cause Hospitalizations During Pulmonary Artery Pressure-Guided Therapy For Ambulatory Heart Failure: One-Year Outcomes From The Cardiomems Post-Approval Study., David M Shavelle, Akshay S Desai, William T Abraham, Robert C Bourge, Nirav Raval, Lisa D Rathman, J Thomas Heywood, Rita A Jermyn, Jamie Pelzel, Orvar T Jonsson, Maria Rosa Costanzo, John D Henderson, Marie-Elena Brett, Philip B Adamson, Lynne W Stevenson, Cardiomems Post-Approval Study Investigators, Jacob Abraham (Cardiomems Post-Approval Study Investigator)

Articles, Abstracts, and Reports

BACKGROUND: Ambulatory hemodynamic monitoring with an implantable pulmonary artery (PA) sensor is approved for patients with New York Heart Association Class III heart failure (HF) and a prior HF hospitalization (HFH) within 12 months. The objective of this study was to assess the efficacy and safety of PA pressure-guided therapy in routine clinical practice with special focus on subgroups defined by sex, race, and ejection fraction.

METHODS: This multi-center, prospective, open-label, observational, single-arm trial of 1200 patients across 104 centers within the United States with New York Heart Association class III HF and a prior HFH within 12 months evaluated …

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 …

Progress In The Seasonal Variations Of Blood Lipids: A Mini-Review., Xiaochun Ma, Haichen Yan, Haizhou Zhang, Mansen Wang, Qunye Zhang, Xiaoming Zhou

Articles, Abstracts, and Reports

The seasonal variations of blood lipids have recently gained increasing interest in this field of lipid metabolism. Elucidating the seasonal patterns of blood lipids is particularly helpful for the prevention and treatment of cardiovascular and cerebrovascular diseases. However, the previous results remain controversial and the underlying mechanisms are still unclear. This mini-review is focused on summarizing the literature relevant to the seasonal variability of blood lipid parameters, as well as on discussing its significance in clinical diagnoses and management decisions.

Abstract 219: Use Of Machine Learning Models To Identify Atherosclerotic Cardiovascular Disease Patients At Very High Risk For Future Events In A Multi-State Health Care System, Hsin-Fang Li, Amir Ali, Kateri Spinelli, A Sajja, Ss Virani, Ss Martin, Tyler J Gluckman

Articles, Abstracts, and Reports

Background: In the 2018 AHA/ACC Blood Cholesterol Guideline, it is recommended that ASCVD patients be classified as very high-risk (VHR) vs not-VHR (NVHR) to guide treatment decisions. This has important implications for ezetimibe and PCSK9 inhibitor eligibility. We aimed to develop a tool that could assist in more easily identifying VHR patients based on machine learning (ML) techniques. This approach offers a powerful, assumption-free alternative to conventional methods, such as logistic regression, to identify potential interactions among risk factors while incorporating the hierarchy of interaction among variables.

Method: We used EHR-derived ICD-10 codes to identify patients within our health system …

Adoption Of A Strategy Of Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Is Associated With Fewer Neurologic Events In A Large Volume Center, Ec Korngold, Eb Kirker, Robert W. Hodson, Ruyun Jin, Kateri Spinelli, Shih-Ting Chiu, S Verburg, V Kumar, Bm Jones

Articles, Abstracts, and Reports

No abstract provided.

Patient And Physician Predictors Of Ffr/Ifr Utilization In Acs And Sihd, Payal Kohli, Peiqi Wang, Andrew Wang, Lucy Liu, Ali Weinstein, Jeptha P. Curtis, John A. Spertus, Jonathan P. Piccini, Marty Makary, Tyler J Gluckman

Articles, Abstracts, and Reports

Background

Despite guidelines supporting FFR/iFR to guide PCI, these modalities remain underutilized. We sought to characterize factors associated with FFR/iFR use in patients undergoing index PCI for an acute coronary syndrome (ACS) or stable ischemic heart disease (SIHD).

Methods

ICD-9/10 codes were used to identify patients undergoing PCI and receiving FFR/iFR for an ACS (n=1,042,896) or SIHD (n=255,213) in a Medicare claims database from Jan. 1, 2013-June 30, 2018. Patients with functional/anatomical testing were excluded (5d prior in ACS; 60d prior in SIHD). Individuals with FFR/iFR performed 1-60 days prior to PCI were also excluded to limit analysis to non-staged …

Clinical Characteristics Of Patients Classified As Very High Risk And Not Very High Risk Based On The 2018 Aha/Acc Multi-Society Cholesterol Guideline, Aparna Sajja, Amir Ali, Hsin-Fang Li, Kateri Spinelli, Salim S. Virani, Seth Shay Martin, Tyler J Gluckman

Articles, Abstracts, and Reports

Background

The 2018 AHA/ACC Cholesterol Guideline recommendation to classify ASCVD patients as very high-risk (VHR) vs not-VHR (NVHR) has important implications for ezetimibe and PCSK9 inhibitor eligibility. We aimed to define the clinical characteristics of these two groups within a large multi-state healthcare system in the Western U.S.

Methods

We performed a retrospective cohort analysis of patients defined as having ASCVD in 2018 using EHR ICD-10 codes. VHR was defined by ≥2 major ASCVD events (ACS ≤12 months, history of MI >12 months, ischemic stroke, or symptomatic PAD) or 1 major ASCVD event and ≥2 high-risk conditions (age ≥65, DM, …

Comparison Of Echocardiographic Outcomes Following Transcatheter Aortic Valve Replacement With Edwards S3 23 Mm Versus Medtronic Evolut 26 Mm Valves, Michael Ring, Ruyun Jin, Rollie Parrish, Brydan Curtis, Matthew Forrester, Branden Reynolds, Sameer Gafoor

Articles, Abstracts, and Reports

Background

Patients with small aortic valve annulus (SAVA) undergoing TAVR are prone to higher post TAVR trans-valve gradients. In many such patients, the choice of TAVR valve commonly involves choosing between the Edwards S3 23 mm (ES23) versus the Medtronic Evolut 26 mm (ME26). The supraannular design of the Evolut has been touted as providing superior hemodynamics in SAVA. We sought to compare performance of these two valves in SAVA, particularly in regard to occurrence of elevated trans-valve gradients.

Methods

We queried the Providence St Joseph Health STS/ACC TVT Registry database for patients undergoing TAVR for SAVA with either the …

Covid-19 Clinical Guidance For The Cardiovascular Care Team, Thomas M. Maddox, Eric C. Stecker, Biykem Bozkurt, Nathalie Demichelis, John U. Doherty, Andrew Freeman, Tyler J Gluckman, Dipti Itchhaporia, Andrew P. Miller, Andrea L. Price, Lonny Reisman, Prem Soman, Mohammad Madjid, Scott D. Solomon, Orly Vardeny

Articles, Abstracts, and Reports

COVID-19 is a quickly evolving public health emergency. The guidance provided in this document is based on the best available published information and expert evaluation. This document is intended to supplement, not supersede, relevant guidance from the Centers for Disease Control and Prevention, state and local health authorities, and your institution’s infectious disease containment, mitigation, and response plan.

Biomass Fuel Use And Cardiac Function In Nepali Women., Jasleen Tiwana, Catherine Benziger, Laura Hooper, Karl Pope, Vijay Alurkar, Ramchandra Kafle, Tula R Sijali, John R Balmes, Joel D Kaufman, Michael N Bates

Articles, Abstracts, and Reports

Background: Exposure to household air pollution (HAP) from cooking with biomass fuel affects billions of people. We hypothesized that HAP from woodsmoke, compared to other household fuels, was associated with adverse cardiovascular outcomes, of which there have been few studies.

Methods: A cross-sectional study was completed in 299 females aged 40-70 years in Kaski District, Nepal, during 2017-18. All participants underwent a standard 12-lead ECG, ankle and brachial systolic blood pressure measurement, and 2D color and Doppler echocardiography. Current stove type was confirmed by inspection. Blood pressure, height, and weight were measured using a standardized protocol. Hypertension was defined as …

Implementation Of A Cardiogenic Shock Protocol And Data Review Process Is Associated With Improved In-Hospital Survival, Adrienne Jones, Renee Swanson, Kateri Spinelli, Joshua Remick, Daniel Westerdahl, Jill M Gelow, David Hotchkin, Jason Wells, Tim Lewis, Robert Kim, Jeff Robinson, Roxanna Barr, Sarah Ramelli, Jacob Abraham

Articles, Abstracts, and Reports

Background: Despite increasing use of mechanical circulatory support devices (MCS), cardiogenic shock (CS) mortality is persistently high, with worsening outcomes in later stages of CS. Delays in diagnosis and practice variation may contribute to in-hospital mortality.

Methods: In June 2018, we devised and implemented a CS protocol at two hospitals from one health system in Portland, OR. The CS protocol was designed to promote early CS recognition, rapid notification of a multi-disciplinary specialty team lead by a heart failure cardiologist, invasive hemodynamic evaluation, and institution of MCS as appropriate. CS was defined by widely accepted clinical and hemodynamic criteria. Patient …

Ridges And Pouches: A Case Series Of Anomalous Atrial Septal Fusion., David Zisa, Francesco F Faletra, Benjamin S Wessler, Neil J Halin, Pranitha Reddy, Ayan R Patel, Natesa G Pandian

Articles, Abstracts, and Reports

No abstract provided.

A Case Of Blunt Trauma-Induced St-Elevation Myocardial Infarction Sustained During A Prison Brawl., Zachary T Clark, Natalie Thiel, John Perry, Michael R Minckler

Articles, Abstracts, and Reports

Myocardial infarction (MI) is a serious and time-sensitive condition. MIs are typically seen in patients with coronary artery disease (CAD) and are caused by the rupture of an atherosclerotic plaque due to factors contributing to plaque instability. However, this case illustrates that plaque rupture can also be caused by blunt trauma to the chest. Considering MI as a possible result of chest trauma may decrease time from presentation to diagnosis and treatment and, therefore, improve outcomes in similar cases, particularly when patients presents unusually or with very few risk factors for MI.

Persistent Reduction In The Age Adjusted Mortality Rate From Aortic Valve Surgery In The United State With Elimination Of Gender Gap In Recent Years., Mohammad Reza Movahed, Sara Etemad, Mehrnoosh Hashemzadeh, Mehrtash Hashemzadeh

Articles, Abstracts, and Reports

BACKGROUND: Advancement in the surgical techniques should translate into better outcome. The goal of this study was to evaluate mortality trends from aortic valve surgery in the United State using large inpatient database.

METHOD: The Nationwide Inpatient Sample (NIS) database was used to calculate the age-adjusted mortality rate from aortic valve surgery from 1988 to 2011 in the United State using ICD-9 coding for aortic valve surgery.

RESULTS: We found that age adjusted mortality rate from aortic valve surgery gradually decreased from 1988 until end of study in 2011 to the lowest level with elimination of gender gap that was …

Investigating The Effects Of Brainstem Neuronal Adaptation On Cardiovascular Homeostasis., James H Park, Jonathan Gorky, Babatunde Ogunnaike, Rajanikanth Vadigepalli, James S Schwaber

Articles, Abstracts, and Reports

Central coordination of cardiovascular function is accomplished, in part, by the baroreceptor reflex, a multi-input multi-output physiological control system that regulates the activity of the parasympathetic and sympathetic nervous systems via interactions among multiple brainstem nuclei. Recent single-cell analyses within the brain revealed that individual neurons within and across brain nuclei exhibit distinct transcriptional states contributing to neuronal function. Such transcriptional heterogeneity complicates the task of understanding how neurons within and across brain nuclei organize and function to process multiple inputs and coordinate cardiovascular functions within the larger context of the baroreceptor reflex. However, prior analysis of brainstem neurons revealed …