Cardiology Commons^™

Evidence Based Management Of High Ldl-C For Prevention Of Atherosclerotic Cardiovascular Disease In Adult Patients In Resident Run Clinic: A Qi Project, Astha Prasai, Sahej Manesh Singh Arora, Hafsa Jawaid, Aakriti Jain, Omofolarin Babayale, Nauman Naeem, Hina Ukrani, Nawid Latifi, Binita Neupane, Soon-Il Song, Gaurav Sharma

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death worldwide and in the United States, with significant healthcare and economic burden. Despite clear guideline recommendations, the implementation of ASCVD risk assessment and statin use for primary prevention remains suboptimal.

Methods:

A quality improvement project was conducted at a resident run clinic with an objective to improve ASCVD risk documentation and guideline-based lipid management. A total of 600 patients aged 40-75 years without a history of cardiovascular disease were randomly selected- 300 in the pre-intervention group and 300 in the post-intervention group. The intervention included didactic sessions and quick …

Late Bioprosthetic Valve Migration- A Rare Entity After Tavi, Sahej Arora, Ghazi Khan, Jeremiah Depta

Advances in Clinical Medical Research and Healthcare Delivery

We present a case of hemolytic anemia due to a rare complication of late bioprosthetic valve migration, who underwent successful treatment with valve in valve transcatheter aortic valve implantation. Our patient with symptomatic moderate aortic stenosis underwent the index procedure a year ago and treated for bacteremia 3 months ago, presented with hemolytic anemia and echocardiography revealing aortic paravalvular leak. The hemolysis was attributed to Bioprosthetic valve dysfunction after a negative hematological workup. The patient's aortography revealed ventricular migration of the valve, not seen on a cardiac CT scan performed before. This was followed by a successful valve in valve …

A Rare Case Of Lithium Toxicity Inducing Complete Heart Block And Nephrogenic Diabetes Insipidus, Rohail A. Baig, Gurtej Dhaliwal, Nimra Shafi, Omar Siddiqui, Michelle L. Malnoske

Advances in Clinical Medical Research and Healthcare Delivery

Lithium is a commonly utilized mood stabilizer for the treatment of bipolar disorder. Although it is efficacious, elevated levels may lead to neurologic, cardiac, nephrogenic, and gastrointestinal side effects. Management of severe lithium toxicity has been an evolving topic of debate in terms of its clinical management. We report a case of a 23-year-old female who presented to the emergency department with severe lithium toxicity, who needed intensive intervention and a critical level of care. This case provides an example of how utilizing standardized care algorithms may provide great benefit to clinicians managing lithium toxicity in emergencies and critical care …

Literally Heartburn: A Case Report Exploring Potential Preventive Measures Of Esophageal Injury After Radiofrequency Ablation For Atrial Fibrillation, Venkat Arutla, Chengu Niu, Prajjwol Bhatta, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Esophageal injury (EI) after radiofrequency ablation (RF) for atrial fibrillation (AF) is a feared complication due to its extreme variability in presentation and very high mortality rate. The incidence of EI after RF ablation also varies widely among the literature. The diagnosis and management of EI is a combination of swift clinical recognition, confirmatory computed tomography (CT) imaging, and prompt surgical repair. This case discusses a 56-year-old male with past medical history of AF who presented to the hospital with complaints of chest pain, shortness of breath and nausea after undergoing recent RF ablation for AF. Imaging revealed an esophageal …

‘Is The Patient Clear For Surgery?’ Takotsubo Cardiomyopathy Presenting As T-Wave Inversions In A Pre-Operative Ekg: A Case Report, Muhammad Hammad Sharif, Madeeha Khaleeque, Syed Faiz Abbas, Gaurav Sharma, Aditya Sanjeevi, Muhammad Hassan Jan, Atif Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Takotsubo cardiomyopathy (TC) can cause dynamic changes in the electrocardiogram (EKG) and troponin elevation which can be misinterpreted as an acute coronary event that can cause an unnecessary delay in the surgery and affect the outcomes of a non-cardiac surgery. We present a case of a patient with pre-operative T-wave inversions diagnosed with TC. A 90-year-old female presented with a femur fracture. Pre-operative EKG showed symmetric T-wave inversions in the inferior and pre-cordial leads. Delta troponin was unremarkable and she remained chest pain-free. Transthoracic echocardiogram (TTE) showed an ejection fraction of 60% with apical ballooning and basal hyperkinesis concerning for …

Aortic Valvular Papillary Fibroelastoma Presenting As Transient Ischemic Attacks, Mahrukh Tariq, Zauraiz Anjum, Joel Shapiro

Advances in Clinical Medical Research and Healthcare Delivery

We present an aortic valve Papillary Fibroelastoma diagnosed on a transesophageal echo (TEE) in 2020 in a patient who had been presenting with recurrent CNS symptoms since 2013 without any known cause. She had clean imaging including transthoracic echo (TTE) and the Fibroelastoma was discovered only on a TEE in 2020. We hope to highlight the elusive nature of the lesion as an obscure cause of CNS symptomatology.

A Rare Case Of Systolic Heart Failure In A 32-Year-Old Man, Neha Narayanan, Paulina N. Goodermote, Mohammad Jawish

Advances in Clinical Medical Research and Healthcare Delivery

There is limited data about heart failure in individuals below 65 years of age, despite the increasing incidence and rapidly progressive nature of heart failure in this patient population. This case of a 32-year-old African American male highlights the importance of early diagnosis and rapid transfer to higher level care given the quick progression of his systolic heart failure. This case also aims to discuss the common etiologies behind heart failure in young adults, highlighting how crucial it is to consider this diagnosis in an individual with polysubstance use. We hope this case report sheds light on the rising incidence …

Multivalvular Native Valve E. Coli Endocarditis, Madison Baker, Jose Reyes, Natasha Singh, Samir Shah, Rohail A. Baig, Justin Nistico

Advances in Clinical Medical Research and Healthcare Delivery

E. coli is a rare cause of infective endocarditis. This report describes an 81-year-old-woman with a history of aortic stenosis and recurrent urinary tract infections who presented in sepsis secondary to E. coli urinary tract infection which was complicated by multivalvular infective endocarditis of the aortic and tricuspid native valves identified on transesophageal echocardiogram (TEE). The patient was managed medically with ceftriaxone, and resolution of both vegetations was seen on TEE without the need for cardiothoracic surgery. Literature review did not yield prior cases of multivalvular E. coli endocarditis.

Appropriate Application Of Cardiac Telemetry Monitoring: A Quality Improvement Initiative, Muhammad H. Sharif, Abdullah A. Orakzai, Nauman Naeem, Omofolarin Babayale, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Background: Telemetry is an important clinical tool but it can be overutilized and leads to a higher cost of patient care and negative patient experience. We conducted this study to assess the effectiveness of our educational intervention in reducing inappropriate use of telemetry and to determine if there is any difference between the two types of educational interventions.

Methods: We conducted a retrospective in-patient study that included all non-ICU patients admitted on a randomly selected mid-week day at our hospital. A 2-step educational intervention was used separated by a 5-week period. The first, a PowerPoint presentation regarding the updated 2017 …

Intractable Hiccups As The Presenting Symptom Of Relapsed Salmonella Bacteremia Complicated By Salmonella Endocarditis, Sahej Arora, Tripti Jain, Hafsa Jawaid, Nada Hafez, Binita Neupane

Advances in Clinical Medical Research and Healthcare Delivery

Salmonella infections are generally acute diarrheal illnesses that uncommonly spread to deeper or endovascular tissues, with key symptoms being nausea, vomiting, diarrhea, abdominal pain and fever. We present a case of a 76-year male who presented chiefly with recurrent intractable hiccups after finishing two weeks of oral ciprofloxacin for a previous episode of Salmonella bacteremia. He was ultimately found to have an aortic root vegetation on transesophageal echocardiogram and focal adenomyomatosis on gallbladder ultrasound. He underwent cholecystectomy, aortic valve replacement and six weeks of antibiotic therapy with resolution of his hiccups. Our case demonstrates an atypical symptom of intractable hiccups …

Murder Mystery Solved! Unmasking Multi-Generational Familial Death As A Result Of Brugada Syndrome, Ryan Tam, Sandres Aodish, Jeremiah Tom, Mohammad Jawish

Advances in Clinical Medical Research and Healthcare Delivery

Brugada syndrome is an inherited condition that has an increased risk of developing ventricular arrhythmias and sudden cardiac death. This condition can be diagnosed by using the Shanghai Scoring System. Here, we present a patient with an incidental finding of Type 1 Brugada pattern on electrocardiogram amidst atypical neurological findings on presentation to the emergency department and a history of cardiac-related familial deaths of uncertain etiology.

Acute Mitral Regurgitation Presenting As Unilateral Pulmonary Edema, Jacob Seth Psomiadis, Austin Kim Md, Whitnee Otto Md, Kavitha Vemuri Md

Advances in Clinical Medical Research and Healthcare Delivery

Acute mitral regurgitation caused by papillary muscle rupture is a rare and life-threatening complication of myocardial infarction. This devastating complication can present as unilateral cardiogenic pulmonary edema which can be easily mistaken for other cardiopulmonary pathology, resulting in delay of care. Proper evaluation and diagnosis is key for obtaining timely surgical evaluation. Here we present a case of an 87-year-old male with a past medical history of coronary artery disease status post percutaneous intervention with one stent, cerebrovascular accident status post left carotid stenting, and Alzheimer’s dementia that presented to the emergency department with a chief complaint of exertional dyspnea …

Covid-19-Associated Myocarditis: Screening For Early Diagnosis, Yousuf Khan, Salmman Ahmed, Samuel John Wlasowicz, Ronald G. Lott Iii, Xavier C. Zonna

Advances in Clinical Medical Research and Healthcare Delivery

The SARS-CoV-2 virus (causing COVID-19), has infected about 770 million people, and caused the death of about 6.9 million people worldwide in the span of three years (John Hopkins Resource Center). Common symptoms of a patient infected with the virus include shortness of breath, fever, chills, fatigue, loss of taste or smell, and muscle aches. However, recent studies have also shown a prevalence of patients presenting with cardiac inflammation (endocarditis, myocarditis or pericarditis) as a potential comorbidity, both during the infectious stage as well as after the infection has subsided. A pattern of specific clinical markers may be indicative of …

Defying The Vicious Cycle: An Intriguing Case Of Brash Syndrome, Ahmed Shehadah, Himal Kharel, Pulkit Gandhi

Advances in Clinical Medical Research and Healthcare Delivery

BRASH Syndrome is a rare and life-threatening condition marked by the combination of bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia. This case report presents a 79-year-old female with acute kidney injury, hyperkalemia, and severe bradycardia without typical EKG changes associated with hyperkalemia. The aim of this article is to provide a comprehensive overview of BRASH syndrome, including its clinical manifestations, underlying pathophysiology, diagnostic approaches, and management strategies. The patient's presentation, laboratory findings, and response to treatment support the diagnosis of BRASH syndrome. The syndrome's pathogenesis involves a vicious cycle of bradycardia, renal failure, AV nodal blockade, and …

The Prevalence And Impact Of Obesity On The Outcomes Of Patients Undergoing Transcatheter Mitral Valve Repair Using Mitraclip - A National Inpatient Sample Analysis 2016 To 2020., Garba Rimamskep Shamaki, Favour Markson, Osarenren Idemudia, Andrew Murphy, Tamunoinemi Bob-Manuel, Akanimo Antia, David Corteville

Advances in Clinical Medical Research and Healthcare Delivery

Background: Low Body Mass Index (BMI) is associated with poor outcomes in patients who undergo various cardiac interventions. Studies on patients with elevated BMI have produced mixed results. Our study aims to evaluate the impact of obesity on the in-hospital outcomes of patients undergoing transcatheter mitral valve repair using MitraClip in the United States.

Methods: The National Inpatient Sample (NIS) database (2016-2020) was analyzed to identify patients who underwent transcatheter mitral valve repair using MitraClip. Patients less than 18 years, with protein-energy malnutrition and rapid weight loss, were excluded. Our final study population was classified into Obese (BMI ≥ 30 …

Kounis Syndrome – Anaphylaxis-Induced Acute Coronary Syndrome, Austin T. Thacker Do, Brachman Herzig Oms, Brendan Robinson Do, Ahad Anjum Do

Advances in Clinical Medical Research and Healthcare Delivery

Kounis syndrome is an underdiagnosed condition in which anaphylaxis triggers vasospastic acute coronary syndrome, either with or without underlying coronary artery disease. The prevalence of this syndrome among hospitalized patients for allergic/hypersensitivity/anaphylactic reactions in the United States is 1.1%, with a 7% rate of all-cause inpatient mortality. This article presents an anaphylaxis-induced acute coronary syndrome case in a patient with underlying coronary artery disease. The pathophysiological mechanism of anaphylactic-induced acute coronary syndrome involves the inflammatory mediators of type I hypersensitivity reactions.

Minoca - A Rarity Of It's Own And The Importance Of Cardiac Mri, Abdullah A. Orakzai, Deeptanshu Jain Md, Muhammad Osama, Syeda Sarah Raza, Soon-Il Song

Advances in Clinical Medical Research and Healthcare Delivery

Myocardial infarction with non-obstructive coronary arteries (MINOCA) disease is a diagnostic dilemma with clinical evidence of acute myocardial infarction (AMI) with normal coronary arteries. MINOCA is a complex issue; the management of the patients needs to be focused on identifying the core problem. Cardiac magnetic resonance (CMR) imaging is a non-invasive diagnostic tool that can play an important role in enabling clinicians to build a differential diagnosis in patients with MINOCA and also identify other non-ischemic aetiologies of myocardial injury. We present a challenging case of a patient with MINOCA with MI in small proximal septal artery distribution revealed on …

Bi-Atrial Thrombus Via Patent Foramen Ovale With Medical Noncompliance: A Case Report, Reid Mccullough, Ayesha Cheema, Owesh Contractor, Krystal Tomsky-Jackson

Advances in Clinical Medical Research and Healthcare Delivery

Numerous diagnoses in the hospital setting require anticoagulation. With different etiologies, certain specific assessments may not have a treatment plan that is studied extensively in evidence-based medical texts. In these uncommon situations, management may not have clear medical guidelines for successful treatment. We present a case of bi-atrial thrombus via PFO with concurrent pulmonary embolism, extensive clot burden history, and the plan to move forward with Angiovac. In patients with this specific history and pathology, modern procedures like Angiovac should be considered and discussed.

Pseudo-Wellens Syndrome: A Rare Entity Associated With Cocaine Use, Mohamed Salah Mohamed, Syed Hamza Waheed, Amir Mahmoud, Anas Hashem, Bipul Baibhav, Abdullah M. Firoze Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Wellens syndrome usually indicates critical left anterior descending artery (LAD) occlusion. Pseudo-Wellens syndrome consists of criteria of Wellens syndrome in the absence of critical LAD occlusion. We report a case of Pseudo-Wellens syndrome related to cocaine use. A 52-year-old male with a medical history of hypertension and diabetes, presented with acute retrosternal chest pain of 3 days duration. Physical examination was unremarkable. EKG on presentation showed deep T-wave inversions in leads V2 to V5. Highly sensitive troponin was elevated. The patient admitted to using cocaine daily for the past two months. Due to concerns for Wellens syndrome, the patient had …

Hydroxychloroquine Induced Cardiomyopathy, Mohamed Salah Mohamed, Katrina Wojciechowski, Scott Feitell, Muhammad Osama, Anas Hashem, Jayesh Patel, Amir Mahmoud, Ali Abdelhay, Prakash Upreti, Soidjon Khodjaev

Advances in Clinical Medical Research and Healthcare Delivery

Hydroxychloroquine (HCQ) is one of the immunomodulatory medications used in treatment of autoimmune diseases. Rarely, HCQ can cause serious complications, such as cardiotoxicity. We present a rare case of HCQ-induced cardiomyopathy. 60-year-old female patient with a medical history of SLE on chronic HCQ therapy for 28 years, preexisting non-ischemic cardiomyopathy and heart failure with reduced ejection fraction for 7 years, and complete heart block status post pacemaker insertion presented with acute chest pain and severe weight loss. Patient underwent coronary angiogram that showed normal coronaries and right-sided heart catheterization that showed acute heart failure. Echocardiogram showed LVEF of 30% with …

Case Study: Abnormal Presentation Of Infective Endocarditis With Streptococcus Canis And Chiari Network, Shahbaz Afzal, Ryan Russell, Alexander Chekhov

Advances in Clinical Medical Research and Healthcare Delivery

Here we present a rare case of infective endocarditis (IE) with Streptococcus canis and Chiari network in an 85 year old female living with multiple dogs and open skin of lower extremity predisposing her to bacteremia. Underlying abnormalities of the cardiac chambers such as Chiari network predisposes to a higher incidence of bacterial seeding and causing IE. A Chiari network is usually asymptomatic and of no clinical significance but can worsen prognosis in IE. IE carries a significant morbidity and mortality burden and when diagnosed early can be a lifesaving diagnosis. Due to the wide range of complications, early diagnosis …

Spontaneous Coronary Artery Dissection In A Young Male: A Case Report, Irene Tchuente M.D.

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Cardiovascular disease remains the number one cause of death worldwide. In recent years, there has been an increased focus on Coronary Artery Dissection due to the increasing number of young individuals without any cardiovascular risk factors presenting with chest pain. Many of these patients would also have elevated troponins and sometimes electrocardiogram changes suggestive of myocardial infarction. Many reported cases have been in women and only a handful of cases have been reported in men. Although some potential risk factors have been identified, more data is needed to support these hypotheses. Coronary Artery Dissection (CAD) mimics Acute Coronary Syndrome …

The Role Of Coronary Artery Disease In Demand Mediated Myocardial Infarction: A Retrospective Study From A Community Hospital, Amr Salama, Nikhil Mehta, Abdullah Abdullah, Ruth Kouides, Jeremiah Depta, Ryan Hoefen, Richard Alweis

Advances in Clinical Medical Research and Healthcare Delivery

Type 2 Myocardial Infarction (T2MI) is an increasingly recognized clinical entity due to the availability of highly sensitive troponin assays for patients admitted due to common medical diagnoses. However, there is little epidemiological data on the significance and long-term prognosis of T2MI, which occurs secondary to an increase in myocardial oxygen demand and/or a decrease in myocardial blood flow. Arrhythmia, hypoxia, and sepsis are the major etiologies for T2MI. Therefore, sepsis was the identified area of interest for the study giving how common it is in a community hospital. We studied the cardiac workup of patients with elevated troponin in …

The Reel Deal: The Stacked Benefits Of A Reel Mower, John K. Hix, Simone Bailey

Advances in Clinical Medical Research and Healthcare Delivery

"Mow-lawning" is a colloquial term referred to actively cutting grass using a reel mower, typically at a faster than normal pace in order to maximize exercise benefit and minimize time, with the emphasis on the physical action of mowing and only secondarily on the resulting lawn care. While mow-lawning remains relatively uncommon in the United States, adoption of this practice by those healthy enough to engage in the level of exercise required can deliver a number of benefits that improve environmental, safety, and personal goals simultaneously. The stacking of so many benefits in one practice deserves more attention and promotion.