Cardiology Commons^™

Prevent Vascular Access Complications By Adopting A Vascular Access Assessment Improvement Process In The Adultdialysis Unit, Ana Lopez Franco

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

No abstract provided.

Patient Outcomes: Stemi Diagnosis In The Emergency Care Center (Ecc) Resulting In Subsequent Pci Procedures, Laura Derr

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

No abstract provided.

Chronic High Salt Diets Contribute To Neurogenic Hypertension By Increasing B1r Expressionand B1r-Mediated Ace2 Internalization And Degradation, Jagnoor Benipal, Navya Lakkapa, Anna Nuzzo, Mona Elgazzaz, Eric Lazartigues

Medical Student Research Poster Symposium

The Centers for Disease Control and Prevention estimates that hypertension affects nearly 50% of Americans1 . Previous studies have shown that chronically elevated dietary salt intake contributes to developing neurogenic hypertension2 . Additionally, increased expression of the bradykinin B1 receptor (B1R) in neurons in the hypothalamic paraventricular nucleus (PVN) is seen in neurogenic hypertension which leads to neuroinflammation and oxidative stress3 . Angiotensin-converting enzyme 2 (ACE2) is a key enzyme in the renin-angiotensin system (RAS) pathway that mitigates the vasoconstrictive effects of Angiotensin (Ang) II by cleaving it to Ang-(1-7)4 . We previously observed that the binding of Ang-II to …

Barriers That Contribute To Disparities Seen In The Prenatal Diagnosis Of Congenital Heart Disease In Patients With Government-Funded Health Insurance, Olivia Crapanzano, Lauren Haddad, Kathleen Crapanzano

Medical Student Research Poster Symposium

BACKGROUND: Multiple national studies have established an inverse relationship between surgical center volume and surgical outcomes in pediatric cardiac surgery. The aim of the initial study was to determine whether surgical outcomes for a private, outpatient pediatric cardiology practice that was not associated with a surgical center, differed based on the surgical center volume to which the patient was referred. While we did not find significant differences in clinical outcomes related to surgical center volume, race or insurance status during the initial study, important disparities to care were identified. Children with private insurance were more likely to be diagnosed prenatally …

Validating Contrast-Enhanced Infarct Characterization Of A Novel Manganese-Based Positive Contrast Agent In A Porcine Model Of Myocardial Ischemia Reperfusion, Benjamin Bonner, Salva Yurista, Jaume Coll-Front, Shi Chen, Robert Eder, Anna Foster, Khoi Nguyen, Peter Caravan, Eric Gale, Christopher Nguyen

Medical Student Research Poster Symposium

Background: Late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) is an effective and reproducible method for characterizing myocardial infarction (MI). However, gadolinium-based contrast agents are contraindicated in patients with acute and chronic renal insufficiency. This is particularly problematic in the setting of CMR where the coincidence of heart and renal disease is approximately 3 0%. There is therefore a clinical need for alternative forms of MRI contrast agents that are acceptable in the setting of renal insufficiency. Methods: We consider two positive MR contrast agents: gadoteric acid (DOTA), a clinically employed gadolinium-based agent; and RVP-001, a structurally similar manganese-based compound. …

An Ebp Approach To Managing Post Cardiac Arrest Interdisciplinary Care, Mary Kay Bader, Teresa Wavra, Tauseef Qureshi, Jon Cline, Marne Andersen

2022 Southern California Nursing Research Conference

The Joint Commission (TJC) published new performance standards on Post Cardiac Arrest (PCA) care that went into effect on Jan 1, 2022. The new standards encourage hospitals to review and synthesize current scientific literature on Post Cardiac Arrest Syndrome (PCAS) and analyze current hospital practice. Following a review of the evidence, hospitals are guided to create a multidisciplinary protocol and education that facilitates training of personnel, implementation of the evidence into clinical practice, data collection, and case review processes. The intent of the standard is to bring hospital based clinical practice in line with the established standards to improve patient …

Podium Presentation: Using An Existing Clinical Practice Guideline To Develop And Implement An Adult Ecmo Program During A Global Pandemic, Brandy Pitts, Midge Vaughan, Jamie Roney

2022 Providence Nurse Research Conference

No abstract provided.

Stroke In Hfref Without Atrial Fibrillation And Concurrent Protein S Deficiency: What Is The Best Treatment?, Rohan Umrani, Trinava Roy, Bhavana Kadiyala, Yvette Wang

Rowan-Virtua Research Day

Hypercoagulable disorders are often the culprit for repeated strokes in young patients, with or without other comorbidities

Medications typically used for stroke prophylaxis:

• Warfarin
• Aspirin
• Direct Oral Anticoagulants (DOACs)

Warfarin is the preferred method of anticoagulation for stroke prophylaxis in patients with hypercoagulable disorders

A deficiency of protein S increases the risk of pro coagulation due to a relative deficiency of anticoagulants.

Patients with protein S deficiency tend to have recurrent venous thromboses and pulmonary emboli

The Cloak Of Invisibility: Subclinical Infective Endocarditis Resulting In Chordae Tendineae Rupture In Mitral Valve Prolapse, Jason Naftulin, Trinava Roy, Anjeli Patel, Steven Silver

Rowan-Virtua Research Day

While Chordae tendineae rupture(CTR) is often caused due to mitral valve prolapse, rheumatic heart disease or infective endocarditis, CTR secondary to a combination of the factors is not often seen. We present a unique case of CTR due to subclinical infective endocarditis(IE) with underlying mitral valve prolapse(MVP).

Myopericarditis In A Patient With Recent Covid-19 Mrna Vaccine, Zamran Masih, Wayne Tamaska, Nicholas Tomasello

Rowan-Virtua Research Day

Myopericarditis after Covid-19 mRNA vaccination is not well described. However, there have been several cases described throughout the pandemic suggesting some correlation between Covid-19 vaccination and myopericarditis. We describe such a case where a patient developed myopericarditis after receiving Johnson & Johnson vaccine.

Digoxin Toxicity And Acute Renal Failure In A 75 Year-Old Female, Daniel Zaayenga, Andrew Caravello, Nicholas Tomasello

Rowan-Virtua Research Day

Digoxin toxicity can present with varying manifestations. While pathognomonic symptoms such as xanthopsia (object appearing yellow) are a board favorite it is not a required finding and is in fact not seen with most patients. Rather digoxin toxicity presents with more non-specific symptoms such as GI distress (anorexia, N/V) neurological distress (lethargy, fatigue, delirium, confusion, disorientation, weakness. EKG findings are varied and include premature ventricular contractions, bradycardia, atrial tachyarrhythmias with AV block, ventricular bigeminy, junctional rhythms, various degrees of AV nodal blockade, ventricular tachycardia, and ventricular fibrillation. Although rarely seen, digoxin is one of the only causes of bidirectional ventricular …

Effect Of Calcium Chloride And Isoflurane On Force Frequency Relationship In Canines, Harrison Patrizio, Lawrence Mulligan

Rowan-Virtua Research Day

Proper calcium cycling is critical for a optimally functioning heart.

Improper calcium cycling in humans can contribute to heart failure.

Human calcium cycling is difficult to study due to the risks of damaging the patient’s cardiac tissue.

Risk of further damaging cardiac tissue is substantially increased in a heart failure patient.

Past studies focus on studying the effects of changing calcium cycling in lab rats.

Current research shows limited alternative methods in studying relationships between calcium cycling and FFR in larger mammals.

This project analyzes data to determine the response of the canine force frequency relationship to calcium chloride and …

Case Report And Review: Spontaneous Coronary Artery Dissection (Scad), Michael Morris, Wayne Tamaska, James Espinosa, Alan Lucerna, Trent Malcolm

Rowan-Virtua Research Day

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome or sudden death. SCAD has a high incidence in a younger, female population with an association with peripartum or postpartum status. Connective tissue disorders and vasculitides are also associated with SCAD. The purpose of this poster will be to examine the presentation and risk factors associated with SCAD and to discuss optimal treatment strategies.

Case Report: The Heart Breaking Tale Of Takotsubo In The Ed, Richard Baluyot, James Espinosa, Alan Lucerna, Sergey Medlenov, Joseph Pagano, Bhumi Shah

Rowan-Virtua Research Day

Chest pain is one of the most common chief complaints that emergency room physicians deal with on a daily basis. Here we present a rare cause of chest pain on a patient diagnosed with takotsubo cardiomyopathy. This is a condition that has been on the rise since its initial discovery and therefore clinicians should consider this on their differential when assessing patients with chest pain, especially postmenopausal women.

Effect Of Osteopathic Manipulative Treatment In Patients With Postural Orthostatic Tachycardia Syndrome (Pots): A Literature Review, Sidharth Sahni, Harrison Jordan, Binoy Desai, Danielle Cooley, Alexander King

Rowan-Virtua Research Day

Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by autonomic dysregulation resulting in diminished blood flow and excessive tachycardia.

POTS has been scarcely studied in the clinical setting. A review of literature generated only four articles, only one of which met the established criteria.

A follow up study to evaluate the effect of OMT on the quality of life for patients with POTS is planned. The hypothesis is that osteopathic manipulation plays a role in the management of POTS, as patients should experience improvement in their symptoms and their overall quality of life.

Safety, Timing And Outcomes Of Early Postoperative Cardiac Catheterization Following Congenital Heart Surgery, Karoline Krzywda

Research Days

Watch recording of live presentation

Background: Early postoperative ( < 6weeks) cardiac catheterization (EPOCC) has been considered high risk and often delayed. Recently, the safety of EPOCC has been demonstrated. The optimal timing of catheterization and its outcomes in struggling postoperative patients remains uncertain.

Objective: To describe EPOCC in our center and its impact on length of stay (LOS), number of mechanical ventilation days, number of ECMO days, and catheter-based interventions.

Methods: This is a retrospective cohort study of patients who underwent cardiac surgery between 01/01/2010 and 12/31/2019 and EPOCC within 30 days after surgery. Cohorts were early EPOCC (≤72 hr) vs late EPOCC ( >72 hr). Data on timing, indication, and complications of EPOCC; days of mechanical ventilation and ECMO; and CICU/total hospital LOS were collected. Data was analyzed using chi-square and Student’s t-test, …

Ekg Technology: It Is Time For A Change!, Megan Carroll

Research Days

Watch recording of live presentation

Background: Technology for obtaining pediatric EKGs has not changed in over 70 years. Current guidelines recommend a 12-lead EKG, which takes approximately 7 minutes to complete. Newer adult technology utilizes between 1-6 leads for EKG analysis. There has not been a study in pediatrics to assess the minimum number of leads required to attain diagnostic accuracy.

Objectives/Goal: To determine the appropriate number of leads needed to read pediatric EKGs safely and accurately.

Methods/Design: This is a single center systematic review that included randomly selected EKGs from our hospital database (2017-2020) read by two independent pediatric …

Neonatal Hypoxia Due To Pulmonary Artery Thrombus, Bianca Cherestal

Research Days

Background: Pulmonary artery thrombus is rare and should be considered in neonates with refractory hypoxia.

Case: Preterm female neonate had persistent hypoxia after birth despite intubation, high-frequency oscillatory ventilation (FiO2 100%), and inhaled nitric oxide. Delivery was via c-section at 33 weeks 4 days for new onset hydrops and poor biophysical profile. Echocardiogram revealed echo brightness in the lumen of the left pulmonary artery (LPA) with no color flow (figure 1a), concerning for occlusive thrombus. Chest CT angiogram confirmed the diagnosis (figure 1b, c). Hematology was consulted and recommended systemic thrombolysis (tissue plasminogen activator, tPA) with concomitant anticoagulation (Bivalirudin). Imaging …

A Project Proposal: The Effects Of Standard Protocols During Cpr On Hospital-Acquired Infections Of Post-Open-Heart Surgery Patients In The Cvicu, Jessica Monahan

Symposium of Student Scholars

Abstract

A Project Proposal: The Effects of Standard Protocols during CPR on Hospital-Acquired Infections of Post-Open-Heart Surgery Patients in the CVICU

Background: Hospital-acquired infections (HAIs) are one of the most common complications post-cardiac surgeries and are associated with longer hospitalizations, elevated use of healthcare resources, and increased morbidity and mortality. The effects of HAIs after cardio-pulmonary resuscitation (CPR) in recent post-open-heart surgery patients remains largely unexplored. Therefore, the purpose of this project was to determine, in the CVICU does implementing standard protocols during CPR on recent post-open-heart surgery patients reduce HAIs?

Literature Review: HAIs during CPR can be acquired through …

Breaks In Longitudinal Elastic Fibers Of Human Femoropopliteal Arteries, Elham Zamani

UNO Student Research and Creative Activity Fair

Breaks in Longitudinal Elastic Fibers of Human Femoropopliteal Arteries

Elham Zamani1, Majid Jadidi1

1 Department of Biomechanics, University of Nebraska Omaha, Omaha, NE

Introduction: Elastin is a major protein in the body with half-life >50 years. It is thought that elastic fibers are formed before the postnatal period. In the femoropopliteal artery (FPA), the main artery in the leg, longitudinal elastic fibers are present in External Elastic Lamina (EEL). Our team has studied more than 1000 cadaveric human FPA and has noticed that there are big breaks in their longitudinal elastic fibers in some subjects. Our goal in this work …

A Case Of Protein Losing Enteropathy After Fontan Operation, Gina Kim

Capstone Showcase

Protein Losing Enteropathy (PLE) is a condition in which an excessive amount of proteins are lost through the gastrointestinal tract leading to hypoproteinemia and manifesting as edema, ascites, and diarrhea. While in most cases PLE is a treatable disorder with good outcomes, the morbidity and mortality of the disorder is significantly elevated in patients with a history of Fontan surgery–an operation used to palliate patients born with a single ventricle by rerouting venous blood return directly to pulmonary circulation. After failure of first-line therapeutics of diuretics and steroids, this case study explores the successful treatment of a 5-year-old patient with …

Percutaneous Coronary Intervention Using Second Generation Drug-Eluting Stents Vs Coronary Artery Bypass Graft In Left Main Coronary Artery And Multivessel Coronary Artery Disease, Eric Kim

Capstone Showcase

Many of the studies that are used in reference to the clinical decision making between PCI vs CABG use BMS or first-generation DES as a comparison. With the advancement of stent technology, second-generation DES have emerged with improved efficacy and overall outcome rates compared to BMS and first-generation DES. Some of the newer studies such as EXCEL1-2 , demonstrated noninferiority of second-generation DES to CABG but there are limited studies that support this conclusion. Currently, the studies remain divided in the impact of newer-generation PCIs, and 10-year follow up studies may be required to further validate noninferiority before it can …