Cardiology Commons^™

Bronchial Carcinoid Presenting As Multiple Lung Abscesses, Zeeshan Waheed, Muhammad Irfan, Saulat Fatimi, Ruqaiya Shahid

Section of Pulmonary & Critical Care

Bronchial carcinoid tumours is a rare group of pulmonary malignant neoplasm that is derived from neuroendocrine system. Bronchial carcinoid usually present with hilar masses, atelactasis, bronchiectasis, or post-obstructive pneumonia. This case describes a very unusual presentation of bronchial carcinoid tumour with multiple lung abscesses involving the whole lung. This report is of an adult lady who presented with multiple lung abscesses involving her whole of the right lung. She was found to have an endo-bronchial lesion in her right main bronchus which eventually turned out to be carcinoid tumour. She responded to resection and antibiotic therapy.

Some Thoughts About The Historic Events That Led To The First Clinical Implantation Of A Total Artificial Heart, Denton A Cooley

The Texas Heart Institute Journal

No abstract provided.

Coronary Artery Diameter Related To Calcium Scores And Coronary Risk Factors As Measured With Multidetector Computed Tomography: A Substudy Of The Accuracy Trial, Yasmin S Hamirani, Khurram Nasir, Emil Avanes, Jigar Kadakia, Matthew J Budoff

The Texas Heart Institute Journal

Arterial remodeling, an early change of atherosclerosis, can cause dilated arterial diameter. We measured coronary artery diameter with use of noncontrast 64-slice multidetector computed tomography (MDCT), and studied its association with coronary artery calcium levels and traditional coronary risk factors.

We included 140 patients from the ACCURACY trial whose noncontrast MDCT images showed measurable coronary arteries. Using 3 measurements of left main coronary artery (LMCA) and right coronary artery (RCA) diameters within 3 mm of the ostium, we associated the results with traditional coronary risk factors and calcium scores.

The prevalence of LMCA and RCA calcium was 22% and 51%, …

Low Serum Triglyceride Levels As Predictors Of Cardiac Death In Heart Failure Patients, Guliz Kozdag, Gokhan Ertas, Ender Emre, Yasar Akay, Umut Celikyurt, Tayfun Sahin, Gozde Gorur, Kurtulus Karauzum, Irem Yilmaz, Dilek Ural, Mira Sarsekeyeva

The Texas Heart Institute Journal

Understanding the influence of sex differences on predictors of cardiac mortality rates in chronic heart failure might enable us to lengthen lifetimes and to improve lives. This study describes the influence of sex on cardiovascular mortality rates among chronic heart failure patients.

From January 2003 through December 2009, we evaluated 637 consecutive patients (409 men and 228 women) with chronic heart failure, who ranged in age from 18 through 94 years (mean age, 64 ± 13 yr) and ranged in New York Heart Association (NYHA) functional class from II through IV. The mean follow-up period was 38 ± 15 months, …

A Genome-Wide Methylation Study On Essential Hypertension In Young African American Males., Xiaoling Wang, Bonita Falkner, Haidong Zhu, Huidong Shi, Shaoyong Su, Xiaojing Xu, Ashok Kumar Sharma, Yanbin Dong, Frank Treiber, Bernard Gutin, Gregory Harshfield, Harold Snieder

Department of Medicine Faculty Papers

OBJECTIVE: There is emerging evidence from animal studies suggesting a key role for methylation in the pathogenesis of essential hypertension. However, to date, very few studies have investigated the role of methylation in the development of human hypertension, and none has taken a genome-wide approach. Based on the recent studies that highlight the involvement of inflammation in the development of hypertension, we hypothesize that changes in DNA methylation of leukocytes are involved in the pathogenesis of hypertension.

METHOD & RESULTS: We conducted a genome-wide methylation analysis on 8 hypertensive cases and 8 normotensive age-matched controls aged 14-23 years and performed …

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 …

The Impairment Of Macrophage-To-Feces Reverse Cholesterol Transport During Inflammation Does Not Depend On Serum Amyloid A, Maria C. De Beer, Joanne M. Wroblewski, Victoria P. Noffsinger, Ailing Ji, Jason M. Meyer, Deneys R. Van Der Westhuyzen, Frederick C. De Beer, Nancy R. Webb

Saha Cardiovascular Research Center Faculty Publications

Studies suggest that inflammation impairs reverse cholesterol transport (RCT). We investigated whether serum amyloid A (SAA) contributes to this impairment using an established macrophage-to-feces RCT model. Wild-type (WT) mice and mice deficient in SAA1.1 and SAA2.1 (SAAKO) were injected intraperitoneally with ³H-cholesterol-labeled J774 macrophages 4 hr after administration of LPS or buffered saline. ³H-cholesterol in plasma 4 hr after macrophage injection was significantly reduced in both WT and SAAKO mice injected with LPS, but this was not associated with a reduced capacity of serum from LPS-injected mice to promote macrophage cholesterol efflux in vitro. Hepatic accumulation of ^{3 …}

Tracheal Reconstruction For Comlex Acute Tracheal Stenosis, Saulat H. Fatimi, M.Qasim Raza, Alina Ghani, Nilay Shah, Awais Ashfaq

Section of Cardiothoracic Surgery

Tracheal stenosis refers to a reduction in the size of the tracheal lumen and can be due to a myriad of reasons, but the most common remains trauma. In iatrogenic situations, internal trauma is the most likely culprit, resulting from prolonged intubation. Our case reviews a patient who developed severe tracheal stenosis (90% reduction in lumen size) within a month of a threeday- long intubation, and presented to the emergency room with dyspnea, orthopnea, and stridor. Tracheal reconstruction with resection of the stenosed segment and end-to-end anastomosis was done. The patient returned a month later with re-stenosis, and underwent tracheal …

Lipid Targets In Clinical Practice: Successes, Failures And Lessons To Be Learned, M Dunne, Oscar Mac Ananey, V Maher

Articles

Abstract

INTRODUCTION:

Optimal risk factor control is integral to managing patients with proven coronary heart disease (CHD+) and for those at risk of coronary heart disease (CHD-). The primary aim of the study was to assess the success rate of reaching lipid risk factor targets in a multiple risk factor clinic.

METHODS:

A retrospective audit was conducted in 488 patients (CHD+, n = 112; CHD-, n = 376) who attended the Cardiovascular Risk Factor Clinic at Tallaght Hospital, Dublin in 2009 and 2010.

RESULTS:

Risk factor targets achieved in CHD+ and CHD- patients were LDLc (54/62 %), HDLc (67/67 %), …

Role Of Complementary And Alternative Medicine In Cardiovascular Diseases, Waris Qidwai, Peng Nam Yeoh, Victor Inem, Kashmira Nanji, Tabinda Ashfaq

Department of Family Medicine

No abstract provided.

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 …

Psychiatric Nursing Care For Patients With Cardiac Disease, Gail Stern Msn, Donna Petruccelli Msn, Crnp, Np-C, Jeanne Manavizadeh Bsn, Rn, Pccn

Patient Care Services / Nursing

No abstract provided.

Relation Between Optimism And Lipids In Midlife, Julia K. Boehm, David R. Williams, Eric B. Rimm, Carol Ryff, Laura D. Kubzansky

Psychology Faculty Articles and Research

This research examined optimism’s relationship with total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, and triglycerides. The hypothesis that optimism is associated with a healthier lipid profile was tested. Participants were 990 mostly white men and women from the Midlife in the United States study who were on average 55.1 years old. Optimism was assessed by self-report with the Life Orientation Test. A fasting blood sample was used to assess serum lipid levels. Linear and logistic regression models examined the cross-sectional association between optimism and lipids accounting for covariates such as demographic characteristics (e.g., education) and …

Infective Endocarditis Epidemiology Over Five Decades: A Systematic Review., Leandro Slipczuk, J Nicolas Codolosa, Carlos D Davila, Abel Romero-Corral, Jeong Yun, Gregg S. Pressman, Vincent M. Figueredo

Division of Cardiology Faculty Papers

AIMS: To Assess changes in infective endocarditis (IE) epidemiology over the last 5 decades.

METHODS AND RESULTS: We searched the published literature using PubMed, MEDLINE, and EMBASE from inception until December 2011.

DATA FROM: Einstein Medical Center, Philadelphia, PA were also included. Criteria for inclusion in this systematic review included studies with reported IE microbiology, IE definition, description of population studied, and time frame. Two authors independently extracted data and assessed manuscript quality. One hundred sixty studies (27,083 patients) met inclusion criteria. Among hospital-based studies (n=142; 23,606 patients) staphylococcal IE percentage increased over time, with coagulase-negative staphylococcus (CNS) increasing over …

Periodontal Disease Is An Independent Predictor Of Intracardiac Calcification., Gregg S Pressman, Atif Qasim, Nitin Verma, Masami Miyamae, Kumiko Arishiro, Yasuhiro Notohara, Vitalie Crudu, Vincent M. Figueredo

Division of Cardiology Faculty Papers

BACKGROUND: Periodontitis is the most common chronic inflammatory condition worldwide and is associated with incident coronary disease.

HYPOTHESIS: We hypothesized that periodontal disease would also be associated with cardiac calcification, a condition which shares many risk factors with atherosclerosis and is considered a marker of subclinical atherosclerosis.

METHODS: Cross-sectional study at two sites (USA and Japan) involving subjects with both clinical echocardiograms and detailed dental examinations. Semiquantitative scoring systems were used to assess severity of periodontal disease and echocardiographic calcification.

RESULTS: Fifty-six of 73 subjects (77%) had cardiac calcifications, and 51% had moderate to severe periodontal disease (score > 2). In …

Preventing Sudden Cardiac Death In Athletes: In Search Of Evidence-Based, Cost-Effective Screening, Paolo Angelini, Mladen I Vidovich, Christine E Lawless, Macarthur A Elayda, J Alberto Lopez, Dwayne Wolf, James T Willerson

The Texas Heart Institute Journal

Sudden cardiac death in athletes is a recurrent phenomenon at sporting events and during training. Recent studies have associated sudden cardiac death with such cardiovascular conditions as coronary artery anomalies, cardiomyopathies, and electrocardiographic abnormalities, most of which are screenable with modern imaging techniques. We recently inaugurated the Center for Coronary Artery Anomalies at the Texas Heart Institute, which is dedicated to preventing sudden cardiac death in the young and investigating coronary artery anomalies. There, we are conducting 2 cross-sectional studies intended to firmly establish and quantify, in a large group of individuals from a general population, risk factors for sudden …

Preoperative Statin Therapy In Cardiac Surgery Is More Effective In Patients Who Display Preoperative Activation Of The Inflammatory System, José Martínez-Comendador, José Rubio Alvarez, Juan Sierra, Elvis Teijeira, Belén Adrio

The Texas Heart Institute Journal

We sought to determine whether preoperative statin treatment is more effective in reducing, after cardiac surgery with cardiopulmonary bypass, systemic inflammatory response and myocardial damage markers in patients who have elevated preoperative interleukin-6 levels than in patients who have normal preoperative interleukin-6 levels.

The study involved a prospective cohort of 164 patients who underwent coronary and valvular surgery with cardiopulmonary bypass. There were 2 study groups: group A (n = 60), patients with elevated preoperative interleukin-6 levels; and group B (n = 104), patients with normal preoperative interleukin-6 levels. Each group was subdivided according to whether patients were (group 1) …

Preventing Deep Wound Infection After Coronary Artery Bypass Grafting: A Review, Charles S Bryan, William M Yarbrough

The Texas Heart Institute Journal

The consequences of deep wound infections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined. Intraoperative risk factors include …

Predicting Early Death After Cardiovascular Surgery By Using The Texas Heart Institute Risk Scoring Technique (Thirst), Saurabh Sanon, Vei-Vei Lee, Macarthur A Elayda, Sreedevi Gondi, James J Livesay, George J Reul, James M Wilson

The Texas Heart Institute Journal

Preoperative risk-prediction models are an important tool in contemporary surgical practice. We developed a risk-scoring technique for predicting in-hospital death for cardiovascular surgery patients. From our institutional database, we obtained data on 21,120 patients admitted from 1995 through 2007. The outcome of interest was early death (in-hospital or within 30 days of surgery). To identify mortality predictors, multivariate logistic regression was performed on data from 14,030 patients from 1995 through 2002 and risk scores were computed to stratify patients (low-, medium-, and high-risk). A recalibrated model was then created from the original risk scores and validated on data from 7,090 …

Can The Bicuspid Aortic Valve Be Spared? The Con Position, With Caveats And Nuances, Joseph E Bavaria, Caroline M Komlo, Tyler Rhode, Prashanth Vallabhajosyula

The Texas Heart Institute Journal

No abstract provided.

Relevance Of Molecular Mimicry In The Mediation Of Infectious Myocarditis, Chandirasegaran Massilamany, Sally A. Huber, Madeleine W. Cunningham, Jay Reddy

Jay Reddy Publications

Heart disease, the leading cause of death in humans, is estimated to affect one in four American adults in some form. One predominant cause of heart failure in young adults is myocarditis, which can lead to the development of dilated cardiomyopathy, a major indication for heart transplantation. Environmental microbes, including viruses, bacteria, and fungi that are otherwise innocuous, have the potential to induce inflammatory heart disease. As the list is growing, it is critical to determine the mechanisms by which microbes can trigger heart autoimmunity and, importantly, to identify their target antigens. This is especially true as microbes showing structural …

Interrupted Aortic Arch In The Adult, Amit Nanavati Md, Matthew W. Martinez, Nainesh Patel Md

Department of Medicine

No abstract provided.

St-Segment Elevation (Stemi) Real Time Data Feedback –A Process Of Care Initiative, Orlando E. Rivera Rn, Nainesh Patel Md, Bruce Feldman Do, Mercedes Rios-Scott Bs, David M. Richardson Md, J Patrick Kleaveland Md, David A. Cox Md, Ronald S. Freudenberger Md

Department of Medicine

No abstract provided.

Rapid Door To Balloon Time In The Treatment Of Acute St-Elevation Myocardial Infarction Is Associated With Reduced Length Of Hospital Stay, Amit Nanavati Md, David A. Cox Md, J Patrick Kleaveland Md, Orlando E. Rivera Rn, Nainesh Patel Md

Department of Medicine

No abstract provided.

Visualization And Management Of A Distally Embolized Stent After St-Elevation Myocardial Infarction, Amit Nanavati Md, Nainesh C. Patel Md

Department of Medicine

No abstract provided.

Endovascular Management Of Aortoiliac Occlusive Disease, Nitin Verma Md, Amit Nanavati Md, Bryan W. Kluck Do

Department of Medicine

No abstract provided.

The Diagnosis Of Exclusion: An Ongoing Uncertainty, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Two Cases Of Bezold-Jarisch Reflex Induced By Intra-Arterial Nitroglycerin In Critical Left Main Coronary Artery Stenosis, Sachin P Shah, Sergio Waxman

The Texas Heart Institute Journal

The Bezold-Jarisch reflex, a well-described phenomenon, occurs upon the stimulation of intracardiac mechanoreceptors and is mediated by vagal afferent nerve fibers. Several factors can sensitize the cardiovascular system to develop this reflex, including acute myocardial ischemia, natriuretic peptides, and, rarely, nitroglycerin administration in the setting of acute myocardial infarction. The development of the Bezold-Jarisch reflex in the presence of severe coronary artery stenosis, specifically left main coronary artery stenosis, has not been described. We report 2 cases of patients who underwent elective coronary angiography and were given intra-arterial nitroglycerin during radial sheath insertion to reduce radial artery spasm. In both …

Perventricular Device Closure Of Residual Muscular Ventricular Septal Defects After Repair Of Complex Congenital Heart Defects In Pediatric Patients, Da Zhu, Kaiyu Tao, Qi An, Shuhua Luo, Changping Gan, Ke Lin

The Texas Heart Institute Journal

Residual muscular ventricular septal defects are surgical challenges, especially after the repair of complex congenital heart defects. We investigated perventricular device closure as a salvage technique in pediatric patients who had postoperative residual muscular ventricular septal defects.

From February 2009 through June 2011, 14 pediatric patients at our hospital had residual muscular ventricular septal defects after undergoing surgical repair of complex congenital heart defects. Ten patients met our criteria for perventricular device closure of the residual defects: significant left-to-right shunting (Qp/Qs >1.5) or substantial hemodynamic instability (a defect ≥2 mm in size). The patients' mean age was 20.4 ± 13.5 …