Cardiology Commons^™

Venovenous Extracorporeal Membrane Oxygenation To Facilitate Removal Of Endobronchial Tumors, Bryan Miles, Lucian A Durham, Jonathan Kurman, Lyle D Joyce, David W Johnstone, David Joyce, Paul J Pearson

The Texas Heart Institute Journal

Short-term extracorporeal membrane oxygenation is a useful adjunct to thoracic procedures. We report the cases of 2 middle-aged men who were supported with venovenous extracorporeal membrane oxygenation to facilitate tumor debulking and recanalization of the carina and mainstem bronchi. Neither patient had major complications or adverse events. These cases suggest that short-term extracorporeal membrane oxygenation is safe in patients undergoing complex resection or debulking of endobronchial lesions.

A Review Of The Cardiac And Cardiovascular Effects Of Covid-19 In Adults And Children, Bibhuti B Das, S Kristen Sexon Tejtel, Shriprasad Deshpande, Lara S Shekerdemian

The Texas Heart Institute Journal

Symptomatic coronavirus disease 2019 (COVID-19) typically affects the respiratory system but can involve the cardiovascular system. Cardiac complications of COVID-19 can result directly from myocarditis or indirectly from numerous other mechanisms. Differentiating between primary and secondary cardiovascular involvement-our focus in this review-may help to identify the long-term effects of COVID-19 on the heart in adults and children.

Delayed Treatment Of Acute Myocardial Infarction With Ventricular Septal Rupture Due To Patient Fear During The Covid-19 Pandemic, Minar Chhetry, Reema Bhatt, Nathan H Tehrani, Dimitrios V Avgerinos, Charles A Mack, Samuel J Lang, Xuming Dai

The Texas Heart Institute Journal

During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case …

A Retrospective Study Of Admission Nt-Probnp Levels As A Predictor Of Readmission Rate, Length Of Stay And Mortality, Kunjan Udani, Dveet Patel, Andrew Mangano

HCA Healthcare Journal of Medicine

Introduction

Serum levels of pro-B-type natriuretic peptide (BNP) and N-terminal (NT) proBNP are measured at admission to assess the likelihood of acutely decompensated heart failure (ADHF). Elevated NT-proBNP levels on initial presentation are a reliable marker of ADHF. However, the prognostic significance of NT-proBNP levels measured on admission remains unknown. With a better understanding of how admitting NT-proBNP levels impacts readmission rates, length of stay and mortality, future prospective studies with specific interventions can be developed to reduce all-cause readmissions, shorten length of stay and reduce mortality.

Methods

In this retrospective study, we evaluated heart failure with reduced ejection fraction …

Cardiac Transplant Recipient With Covid-19 Induced Acute Hypoxic Respiratory Failure: A Case Report, Ariyon Schreiber, Kalaimani Elango, Kimberly Hong, Chowdhury Ahsan

School of Medicine Faculty Research

Background: Heart transplant recipients represent a particularly vulnerable patient population to the novel coronavirus disease 2019 (COVID-19) due to chronic immunosuppression and high rates of comorbidities. Currently, data are limited and evidence to guide management of heart transplant recipients with COVID-19 is sparse. In this case report, we provide a summary of the current literature as well as an in-depth analysis of our clinical decision-making. Case summary: A 67-year-old female who underwent cardiac transplantation 1 year prior was found to have acute hypoxic respiratory failure due to COVID-19. Her immunosuppressant medications were modulated with discontinuation of mycophenolate and titration of …

Off-Pump Heartmate Ii Exchange In A Patient With Severe Lower Extremity Peripheral Artery Disease: A Case Report, Mehmet H. Akay, Ismael A. Salas De Armas, Manish K. Patel, Rajko Radovancevic, Igor D. Gregoric

The VAD Journal

Thrombosis of left ventricular assist device (LVAD) pumps is a serious complication that often requires exchange of the device. A 66-year-old man with severe peripheral vascular disease presented with pump thrombosis of the HeartMate II (HMII) LVAD 1.5 years after implantation. The HMII was exchanged to another HMII through a subcostal incision and without the use of cardiopulmonary bypass. For safety, the patient was prepared for cardiopulmonary bypass by exposing the right subclavian artery and insertion of a 5 FR cannula in the left common femoral vein. The pump was exchanged through a subcostal incision made over the LVAD pump …

Arteriovenous Fistula Formation After Transradial Coronary Intervention, Khader Herzallah, Abdulmohsin Ahmadjee, Yehia Saleh, George S Abela

The Texas Heart Institute Journal

No abstract provided.

Continuous-Flow Left Ventricular Assist Device Explantation After More Than 5 Years Of Circulatory Support And Ventricular Reconditioning, George V Letsou, Andrew C W Baldwin, Andrew B Civitello, William E Cohn, O H Frazier

The Texas Heart Institute Journal

Continuous-flow left ventricular assist devices have proved to be effective, durable, life-saving tools in patients with end-stage heart failure. However, because of the risks associated with mechanical circulatory support (including stroke, infection, gastrointestinal bleeding, and device malfunction), the optimal goal of device therapy is myocardial recovery and device removal. Ventricular reconditioning and pump explantation after continuous-flow support have been reported; however, little is known about variables that govern the pace and degree of myocardial response in patients who experience such recovery. We describe our long-term pump-weaning strategy for a 25-year-old man who had a continuous-flow device implanted and then needed …

Rv Lead Placement - A Forgotten Cause Of Right Heart Failure., Muhammad Arslan Cheema, Talal Almas, Waqas Ullah, Donald C. Haas

Abington Jefferson Health Papers

Introduction: Cardiac implantable electronic devices (CIEDs) have opened new doors, improving the quality, and increasing the duration of life by providing support of heart rate, atrioventricular and interventricular synchrony, thereby preventing sudden cardiac death. Nevertheless, these devices can pose some risks to the patients, including pacemaker-mediated cardiomyopathy and endocarditis.

Case presentation: We elucidate the case of a patient who had severe Tricuspid Regurgitation as a result of single chamber Implantable Cardioverter Defibrillator (ICD) placement which led to right heart failure (RHF). His chief complaints were generalized fatigability and difficulty climbing steps at home. He also had orthopnea but denies paroxysmal …

Association Between Morning Surge In Systolic Blood Pressure And Syntax Score I In Patients With Stable Coronary Artery Disease, Alaa Quisi, Gokhan Alici, Hazar Harbalioglu, Omer Genc, Ibrahim Halil Kurt, Murat Cayli

The Texas Heart Institute Journal

A high morning surge in systolic blood pressure poses a risk in people who have cardiovascular disease. We investigated the relationship between this phenomenon and the SYNTAX score I in patients who had stable coronary artery disease.

Our single-center study included 125 consecutive patients (109 men and 16 women; mean age, 54.3 ± 9 yr) in whom coronary angiography revealed stable coronary artery disease. We calculated each patient's sleep-trough morning surge in systolic blood pressure, then calculated the SYNTAX score I.

The morning surge was significantly higher in patients whose score was >22 (mean, 22.7 ± 13.2) than in those …

Flecainide-Induced Atrial Flutter With 1:1 Conduction Complicated By Ventricular Fibrillation After Electrical Cardioversion, Timothy Colangelo, Drew Johnson, Reginald Ho

The Texas Heart Institute Journal

Flecainide, a widely prescribed class IC agent used to treat atrial arrhythmias, can in rare cases cause 1:1 atrial flutter with rapid conduction. We describe the case of a 59-year-old man who was on a maintenance regimen of flecainide for refractory atrial fibrillation. When 1:1 atrial flutter with rapid conduction developed, emergency medical technicians attempted synchronized cardioversion, which caused ventricular fibrillation necessitating defibrillation. The patient ultimately underwent radiofrequency ablation and cryoablation to resolve his symptomatic atrial flutter. We discuss the atrial proarrhythmic effects of flecainide and how to mitigate complications in high-risk patients.

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 …

Longitudinal Analysis Of Myocardial Function Using Strain In Patients Receiving Cardiotoxic Chemotherapy, Anmol Goyal, Amulya Buddhavarapu, Kayla Simpson, Nataliya Kibiryeva, Wendy Hein, Joy M. Fulbright, Sanket Shah

Posters

Background:

Chemotherapy-related cardiotoxicity (CTRC) is associated with significant morbidity and mortality in long-term cancer survivors. Left ventricular [LV] Global longitudinal strain (GLS) is a sensitive parameter that can be used for earlier detection of contractile function changes in these patients. Recent literature suggested certain genotypes may influence CTRC. Our goal was to assess longitudinal myocardial function and identify any correlation between certain genetic variations and LV function regarding CTRC in our pediatric population.

Methods:

50 subjects ≥10 years of age who have survived >2 years after completion of cancer treatment were enrolled out of which 29 subjects agreed for genetic …

Transient Tricuspid Valvulitis: Another Brief Casualty Of Covid-19 In Children, Amulya Buddhavarapu, Girish S. Shirali, Stephen Kaine, Doaa Aly

Posters

Clinical Presentation:

We discuss 3 patients, 8-10 years old, with significant tricuspid valve dysfunction during initial days of admission for multi-system inflammatory syndrome in children (MIS-C) associated with coronavirus 2019 (COVID-19) infection.

All 3 patients had COVID antibodies and presented in uncompensated shock needing aggressive fluid resuscitation and vasoactive support. Elevated acute inflammatory markers, acute kidney injury (2/3 patients), troponin leak and repolarization abnormality on ECG were present on admission and resolved by discharge. All were treated with intravenous immunoglobulin (IVIG) infusion, high-dose steroids and prophylactic low molecular weight heparin. They were discharged home on aspirin and steroid taper.

All …

Challenges In Echocardiographic Diagnosis Of Corrected Malposition Of Great Arteries: The Segmental Approach Coming Handy, Amulya Buddhavarapu, Anmol Goyal, Sanket Shah, Nitin Madan, Hayley S. Hancock, Maria Kiaffas

Posters

Clinical Presentation

Two cases of {S,D,L} anatomically corrected malposition of great arteries (ACMGA) are presented with differences in conal anatomy. Case 1: A fetal echocardiogram (echo) performed at 28 weeks gestation due to multiple anomalies revealed atrial situs solitus, D-loop ventricles, a large conoventricular septal defect (VSD) and an overriding, anterior and leftward aorta. The diagnosis of double outlet right ventricle (DORV) vs ACGMA was entertained. Postnatal echo revealed {S,D,L} segmental anatomy with ventriculoarterial concordance consistent with ACGMA and a muscular VSD. Case 2: A 3-week-old boy presented to clinic for a murmur evaluation with no associated cardiac symptoms. Transthoracic …

Development Of Stress-Induced Cardiomyopathy After Cytoreductive Surgery And Hyperthermic Intraperitoneal Chemotherapy, Saad Ahmed Naved, Sadiq Shoukat Parpia, Huma Shoukat Ali

Medical College Documents

Pseudomyxoma Peritonei, a massive mucinous peritoneal collection due to a rare epithelial neoplasm, can be effectively treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). A 43-year-old female, previously treated for mucinous ovarian carcinoma with CRS-HIPEC, and total abdominal hysterectomy and bilateral salpingo-oophorectomy, presented with new-onset abdominal distension and early satiety. She was diagnosed with Pseudomyxoma Peritonei. After 48 hours of treatment with CRS-HIPEC, she presented haemodynamically unstable with acute chest pain. Electrocardiogram showed broad complex tachycardia with ST depression in leads V3-6. Severe systolic dysfunction with Ejection Fraction (EF) of 20% along with severe pulmonary hypertension, visualized on Echocardiography. …

Speckle-Tracking Echocardiography For Detecting Subclinical Left Ventricular Dysfunction In Patients With Familial Hypercholesterolemia, Rongjuan Li, Jinjie Xie, Bo Jiang, Zhonghua Sun, Lvya Wang, Zhaoting Leng, Yueli Wang, Ya Yang

The Texas Heart Institute Journal

Myocardial ischemia and left ventricular dysfunction have been documented in young adults with familial hypercholesterolemia. We investigated whether speckle-tracking echocardiography can be used to detect subclinically impaired global and regional myocardial function in patients with this lipid disorder. This single-center study included 47 patients with familial hypercholesterolemia and 37 healthy control subjects who underwent transthoracic Doppler echocardiography and speckle-tracking echocardiography from January 2003 through December 2016. Conventional echocardiographic and strain parameters in the 2 groups were analyzed and compared. Left ventricular dimensions were significantly larger at end-diastole (P=0.02) and end-systole (P=0.013), left ventricular walls were significantly thicker (P

Correlation Between Strain And Weight Status In Infants With A Univentricular Hear, Amulya Buddhavarapu, Mathew Warren, Lori Erickson, Christopher Mathis, Whitney Haas, Daniel Forsha

Posters

Background

Infants with univentricular physiology are at risk of poor weight gain and reduced ventricular function, both of which have been independently associated with worse outcomes. Since nutritional status has been correlated to ventricular function in other populations, we evaluated the relationship between nutritional status and ventricular function including speckle-tracking strain during this period.

Methods

Thirty term infants (median age 55 days, 13 females) with univentricular physiology prior to stage II palliation were included with data obtained at the time of their initial hospital discharge. Ventricular function was quantified using 2D global longitudinal strain (GLS) and strain rate, analyzed from …

Active Implantable Cardioverter-Defibrillators In Continuous-Flow Left Ventricular Assist Device Recipients, Kuldeep Shah, Rahul Chaudhary, Mohit K. Turagam, Mahek Shah, Brijesh Patel, Gregg Lanier, Dhanunjaya Lakkireddy, Jalaj Garg

Division of Cardiology Faculty Papers

Introduction

Implantable cardioverter-defibrillator (ICD) in patients with heart failure with reduced ejection fraction reduces mortality secondary to malignant arrhythmias. Whether end-stage heart failure (HF) with continuous-flow left ventricular assist device (cf-LVAD) derive similar benefits remains controversial.

Methods

We performed a systematic literature review and meta-analysis of all published studies that examined the association between active ICDs and survival in advanced HF patients with cfLVAD. We searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting the association between ICD and all-cause mortality in advanced HF patients with cfLVAD. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data.

Results …

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 …

Dexrazoxane Decreases The Cardiotoxic Effects Of Doxorubicin In Osteosarcoma Patients Without Increasing Mortality From Secondary Malignant Neoplasms, Thomas S. Przybycien

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Schwartz CL, Wexler LH, Krailo MD, et al. Intensified chemotherapy with dexrazoxane cardioprotection in newly diagnosed nonmetastatic osteosarcoma: A report from the Children’s Oncology Group. Pediatr Blood Cancer. 2016;63(1):54-615. https://doi.org/10.1002/pbc.25753

for a patient with osteosarcoma and concerns about the risk of secondary malignant neoplasms that attend use of dexarazoxane.

Outpatient Mineralocorticoid Receptor Antagonist Prescription Rate For Heart Failure, Svenja Schneider, Md, Sairamya Bodempudi, Md, Joshua Bernard, Md, Ryan D'Angelo, Pharmd, Eitan Frankel, Md, Sara Collins, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement:

Improve MRA prescription rate in the outpatient cardiology clinic by 25%

Mind The Gap: A Call For Attention At The Telemetry Station, N. Haroian, Md, T. Zivan, D. Frisch, A. Greenspon, Y. Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

"Gaps" in telemetry recordings are a risk factor for patient identification errors and have led to near misses and adverse events in our hospital.

Goal: Completely eliminate wrongful telemetry data display by the end of the academic year.

Treatment Anxiety Education For Pediatric Cardiac Neurodevelopmental Patients, An Evidence Based Project, Mary Nagel

Doctor of Nursing Practice Final Manuscripts

Abstract

Background

Congenital heart disease (CHD) is the most common birth defect and affects almost 1% of all live births. Treatment anxiety is common among children with CHD who undergo multiple procedures early in their lifetime. Dramatically increased life spans for this cardiac population has led to a shift from focusing on survival to their long-term health outcomes.

Methods:

Administration of the Peds QL Cardiac Module 3.0 assesses health related quality of life (HRQOL) during annual visits to a Cardiac Neurodevelopmental (ND) Clinic by evaluating the level of Treatment Anxiety a patient experiences during healthcare appointments. The questionnaire scores are …

Identifying Opportunities For Implementing Home Blood Pressure Monitoring In Newly Diagnosed Or Worsening Hypertension At A Family Health Clinic, Catherine Liikala

Doctor of Nursing Practice Final Manuscripts

Abstract

The literature is clear that the diagnosis, treatment, and plan of care for hypertension in adults should rely, at least in part, on ambulatory blood pressure. Using in-office blood pressures alone risks inaccurate measurements and can result in inappropriate treatments. Many clinics, however, do not adhere to this recommendation and will fall back on clinic readings which puts the patient at risk of mismanaged hypertension and polypharmacy. This project was formulated to identify the extent to which hypertensive patients were diagnosed and managed without the use of home blood pressure monitoring in a small local community clinic. This …

Providing High Reliability Care For Picu Patients With Pulmonary Hypertension: A Quality Improvement Project, Anjali Subbaswamy, Nicholas Tan, Iric Guthrie, Kelsey Fath, Cole Linzmeyer, Elizabeth Yakes Jimenez

Quality Improvement/Patient Safety Symposium

Providing High Reliability Care for PICU Patients with Pulmonary Hypertension: A Quality Improvement Project

Anjali Subbaswamy, MD; Nicholas Tan, DO; Iric Guthrie, MD; Kelsey Fath, MD; Cole Linzmeyer, DO; Elizabeth Yakes Jimenez, PhD, RDN, LD

Purpose: Pediatric patients with pulmonary hypertension (PHTN) are a high acuity, low frequency population, and are often admitted to the pediatric intensive care unit (PICU). To mitigate the risk of precipitating a potentially life-threatening pulmonary hypertensive crisis, health care staff need to take specific precautions. This quality improvement (QI) project aims to increase the number of inpatient PHTN patients for whom PHTN precautions are applied …

Biomarkers Of Thrombo-Inflammatory Responses In Pulmonary Embolism Patients With Pre-Existing Versus New-Onset Atrial Fibrillation., Dimpi Patel, Amir Darki, Debra Hoppensteadt, Iman Darwish, Mushabbar Syed, Yevgeniy Brailovsky, Jawed Fareed

Division of Cardiology Faculty Papers

Pulmonary embolism (PE) patients have an increased prevalence and incidence of atrial fibrillation (AF). Because comorbid AF increases risk of morbidity and mortality, we sought to investigate the role of thrombo-inflammatory biomarkers in risk stratifying patients who experience an acute PE episode. Study participants were enrolled from a Pulmonary Embolism Response Team (PERT) registry between March 2016 and March 2019 at Loyola University Medical Center and Gottlieb Memorial Hospital. This cohort was divided into 3 groups: PE patients with a prior diagnosis of AF (n = 8), PE patients with a subsequent diagnosis of AF (n = 11), and PE …

Calculation Of The Correct Angle Of Bifurcation Predicts The Atherosclerotic Lesion Severity More Accurately, Mehmet Ozgeyik, Onur Kaypakli, Mufide Okay Ozgeyik

Journal of the Saudi Heart Association

No abstract provided.

Rota Burr-Induced Aortic Cusp Laceration Necessitating Valve Replacement, Vinayak Vadgaonkar, Nooraldaem Yousif, Husam A. Noor, Sadananda Shivappa

Journal of the Saudi Heart Association

No abstract provided.

Differences In Nt-Probnp Response And Prognosis In Men And Women With Heart Failure With Reduced Ejection Fraction., Melissa A Daubert, Eric Yow, Huiman X Barnhart, Ileana L Piña, Tariq Ahmad, Eric Leifer, Lawton Cooper, Patrice Desvigne-Nickens, Mona Fiuzat, Kirkwood Adams, Justin Ezekowitz, David J Whellan, James L Januzzi, Christopher M O'Connor, G Michael Felker

Division of Cardiology Faculty Papers

Background NT-proBNP (N-terminal pro-B-type natriuretic peptide) is a prognostic biomarker in heart failure (HF) with reduced ejection fraction. However, it is unclear whether there is a sex difference in NT-proBNP response and whether the therapeutic goal of NT-proBNP ≤1000 pg/mL has equivalent prognostic value in men and women with HF with reduced ejection fraction. Methods and Results In a secondary analysis of the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment) trial we analyzed trends in NT-proBNP and goal attainment by sex. Differences in clinical characteristics, HF treatment, and time to all-cause death or HF hospitalization were compared. Landmark …