Internal Medicine Commons^™

Massive Hemoptysis In The Setting Of Acute Mitral Regurgitation, Joseph Moran Do, George Prousi Md, Ross Biggs Do, Nirupama Kakumanu Md, Fccp

Department of Medicine

No abstract provided.

Cardio Metabolic Risk Factors For Atrial Fibrillation In Type 2 Diabetes Mellitus: Focus On Hypertension, Metabolic Syndrome And Obesity, Mihnea-Alexandru Gaman, Elena-Codruta Dobrica, Emilia G. Pascu, Matei-Alexandru Cozma, Mirela-Elena Epingeac, Amelia M. Gaman, Anca M. Pantea Stoian, Ovidiu G. Bratu, Camelia C. Diaconu

Journal of Mind and Medical Sciences

Objective. Atrial fibrillation (AF) in type 2 diabetes mellitus (T2DM) has been little explored so far. However, there are several cardio metabolic risk factors for AF in T2DM patients, such as arterial hypertension, obesity or the metabolic syndrome. Our objective was to evaluate cardio metabolic risk factors for AF in T2DM patients. Methods. We studied the medical records of T2DM patients hospitalized in the Internal Medicine department of an emergency referral hospital in Bucharest, Romania. The study was observational, retrospective and carried out between January-June 2018. Results. The study group included 221 T2DM patients (with a mean age of 68.65 …

Large Coronary Arteries Mean No Chance Of A Heart Attack, Right? An Acute Myocardial Infarction In The Setting Of Holding Anticoagulation For A Routine Colonoscopy, Nathan Brewster Do, Jennifer Nesfeder, Ryan Murphy Do, Brian J. Holahan, Syed Rafay Ali Sabzwari

Department of Medicine

Coronary artery ectasia (CAE) is an uncommon pathology, which is sometimes incidentally found on left heart catheterization (LHC). CAE is occasionally treated with systemic anticoagulation to prevent thrombosis or progression of the clot in the coronary arteries. We present a 63-year-old male with known CAE on warfarin who presented to the hospital with myocardial infarction after a routine colonoscopy for which anticoagulation was held. His myocardial infarction was attributed to a likely coronary thromboembolic event. This case highlights the need for consideration of bridging anticoagulation therapy before and after procedures in patients with CAE to prevent adverse coronary events.

Sudden Cardiac Death Associated With Malignant Mitral Valve Prolapse, Damon Mcenroe Md, Fnu Vikram Md, Kailyn Mann Do, Lohit Garg Md, Syed Rafay Ali Sabzwari, Nael Hawwa Md

Department of Medicine

No abstract provided.

A Rare Case Of Minocycline Induced Eosinophilic Myocarditis, Tarick Sheikh Md, Anam Malik Md, Paul Secheresiu Do, James R. Kimber Do, Hiwot Ayele Md, Lekha Racharla Do

Department of Medicine

No abstract provided.

Aortoduodenal Fistula Forms From Primary Aortic Stump Graft In A Two-Time Multi-Visceral Transplant Patient With Presentation Of Gastrointestinal Bleed And Bowel Perforation: A Case Report, Brielle Corrente

Graduate Student Research Symposium

Usually not diagnosed until open laparotomy, aortoduodenalfistulas (ADF) are one of the rarest complications of intestinal transplant surgery. With an incidence rate of only 0.04% at autopsy and only 250 documented cases since the early 1800’s, aortoduodenal fistulas are the most deadly complications of intestinal transplantation with a mortality rate of 100% without surgical intervention. A 39 year old, two-time multi-visceral transplant African American female patient suffered from a primary aortoduodenal fistula formation in a primary modified multi-visceral transplant aortic stump graft site. With emergency open laparotomy repair, revascularization of the secondary multi-visceral transplant was performed, saving the life of …

Atrial Myxoma Presenting With Palpitations: A Case Report, George Prousi Md, Joseph Moran Do, Ross Biggs Do

Department of Medicine

Abstract

Atrial myxomas are a rare phenomenon and although benign, primary neoplasms of the heart can be burdensome depending on their location. Clinical symptoms are caused through a variety of mechanisms including conduction disturbances, obstruction, and valvular interference. Size and symptom development are strongly correlated and can almost always be detected by the use of echocardiography, magnetic resonance imaging or computed tomography. This is a case of a 62-year-old female with no significant past medical history presented to our facility with complaints of palpitations and associated dizziness for three months.

Introduction

Atrial myxomas are the most common benign primary neoplasm …

Percutaneous Transluminal Balloon Venoplasty: A Less Invasive Technique For Implantation Of Cardiac Leads In Patients With Limited Venous Access To The Heart, Waiel Abusnina, Zachary O. Curtis, Emilia C. Leigh, Eric Y. Auyoung, Dr. Mehiar El-Hamdani, Esam Baryun

Marshall Journal of Medicine

Since its inception, cardiac pacing has made a significant advancement in cardiology. As new therapies and devices emerge, the number of implantations is steadily increasing which requires up-to-date clinical guidelines for management. Although advanced, these mechanical devices often require maintenance and revisions to achieve optimal performance. One of the most common deteriorations is the lead failure.

In the case of lead failure requiring revision, new lead implant, or upgrading to a more advanced pacing system, venous stenosis resulting in partial or complete obstruction of the vessel can pose a real problem. This case series report introduces the technique of percutaneous …

Trial Sequential Analysis Comparing Bleeding And Major Adverse Cardiovascular Events In Patients With Atrial Fibrillation And Acute Coronary Syndrome On Dual Versus Triple Therapy, Muhamad B. Munir, Khansa Osman, Maryam Saleem, Kinjan Patel, Sudarshan Balla

Faculty & Staff Scholarship

Objective To assess efficacy and safety of dual therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) with or without percutaneous coronary intervention (PCI) and evaluate the quality of evidence with respect to said outcomes based on contemporary randomized trials (RCTs). The efficacy outcome taken was major adverse cardiovascular events (MACE) while safety outcome was major bleeding events. Introduction Appropriate anti-thrombotic therapy is still controversial in patients with AF and concomitant ACS or PCI. We conducted a conventional meta-analysis pooling data from major RCTs to assess the efficacy and safety of DT …

Clinical Outcomes Of Successful Revascularization Of Chronic Total Coronary Occlusions With Bioresorbable Vascular Scaffolds: A Systematic Review., Roman Marchenko, Salik Nazir, Shelina Malla, Anthony Donato

Reading Hospital Internal Medicine Residency

Revascularization of chronic total occlusions (CTO) with percutaneous coronary intervention is associated with favorable long-term clinical and echocardiographic outcomes. Whether bioresorbable vascular scaffolds (BVS) would be advantageous in the treatment of CTO is unknown as patients with these lesions were generally excluded from large BVS randomized trials. We performed a systematic review, which sought to summarize known data on mid- to long-term clinical outcomes for BVS in CTO. We searched MEDLINE, EMBASE, clinicaltrials.gov, and the Cochrane Library through April 2018 to look for studies on implantation of BVS in CTO. Outcomes of interest included myocardial infarction, cardiac death, all-cause mortality, …

Chemo-Coronaries: A Rare Form Of Coronary Vasospasm Following 5-Fu Infusion, George Prousi Md, Joseph Moran Do, Ross Biggs Do, John Mannisi Md

Department of Medicine

No abstract provided.

Takotsubo Cardiomyopathy Associated With Polycythemia Vera., Sijan Basnet, Priya Rajagopalan, Rashmi Dhital, Biswaraj Tharu

Reading Hospital Internal Medicine Residency

Takotsubo cardiomyopathy is characterized by transient apical ballooning with preserved basal ventricular function triggered by physical or emotional stressors. We present a case of a 75-year-old man referred to our facility for the management of acute myocardial infarction later diagnosed as takotsubo cardiomyopathy. We believe platelet-mediated adrenaline release from massive thrombocytosis might have been the precipitating factor for the pathogenesis of takotsubo cardiomyopathy.

Bevacizumab: A Rare Cause Of Nonischemic Cardiomyopathy., Oreoluwa Oladiran, Salik Nazir

Reading Hospital Internal Medicine Residency

Left ventricular dysfunction is a rare side effect of bevacizumab occurring in 2-4% of cases. We report the case of a 68-year-old woman who presented to the emergency department (ED) with sudden onset of shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea. She was tachypneic and in respiratory distress. Physical examination revealed jugular venous distention, diffuse expiratory wheeze, and bipedal edema. She had been started on bevacizumab for the treatment of hereditary hemorrhagic telangiectasia 1 month prior to presentation. Laboratory tests revealed BNP of 1697 pg/ml with slightly elevated troponin 0.05 ng/ml. Chest X-ray showed interstitial edema with cardiomegaly, and …

A Rare Case Of Spontaneous Cardiac Tamponade Induced By Concomitant Use Of Rivaroxaban And Amiodarone., Oreoluwa Oladiran, Jared Segal, Ifeanyi Nwosu, Salik Nazir

Reading Hospital Internal Medicine Residency

Rivaroxaban is a direct oral anticoagulant (DOAC) approved as an important alternative to warfarin in patients with nonvalvular atrial fibrillation. We report the case of an 87-year-old man with past medical history of nonvalvular atrial fibrillation on rivaroxaban and recently started amiodarone for pulseless ventricular tachycardia who presented to our hospital with intermittent chest pain and was diagnosed with spontaneous hemopericardium causing cardiac tamponade. The culprit drugs were discontinued, and the patient was treated with emergent pericardiocentesis. Both rivaroxaban and amiodarone are substrates for the CYP3A4 hepatic pathway, and concomitant use can result in increased plasma rivaroxaban levels causing an …

Aspirin In Primary Prevention Of Myocardial Infarction/Angina And Stroke In Hypertensive Patients, Aysha Almas, Muhammad Salman Ghazni, Shahrukh Hashman, Zain Mushtaq

Section of Internal Medicine

No abstract provided.

Get With The Rhythm – Telemetry Education In Internal Medicine Residency, Rashesh Shah, Md, Hanna Sofie Ellingsen, Md, Molly Halloran, Md, Reetu Mukherji, Md, Juergen Kloo, Md, Yair Lev, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aim

• Our aim was to design and implement cardiac monitoring education for medical residents in order to help residents feel more comfortable navigating and assessing telemetry.
• Our objective was to create and pilot a telemetry education video among Internal Medicine residents (from March to May 2018) resulting in a 75% increase in ability to demonstrate essential telemetry skills as determined by a pre and post video assessment.

The Disappearing Murmur: Systolic Anterior Motion Of The Mitral Valve Leaflet In A Non-Hypertrophic Cardiomyopathy Patient, Syed Rafay Ali Sabzwari, James R. Kimber, Hiwot Ayele, Nimra Khan, Tarick Sheikh, Ghulam Akbar Md, Bruce Feldman Do

Department of Medicine

Systolic anterior motion (SAM) of the mitral valve is a well-known phenomenon associated with left ventricular outflow tract obstruction and hemodynamic compromise. This finding may occur in patients with or without hypertrophic cardiomyopathy. In this report, a patient with no prior medical history presented to the hospital with left-sided chest pain and high-risk echocardiogram (ECG) findings. Left heart catheterization with coronary angiography was negative for coronary artery disease. His initial examination was significant for a systolic murmur due to the underlying SAM, as demonstrated by transthoracic echocardiogram. During his hospitalization, he developed acute heart failure syndrome as a result of …

Going Beyond The Final Impression With Radiologic Data In The Era Of Clerical Medicine: A Case Report Of Coronary Artery Disease Found Incidentally On Computed Tomography, Andrea M. Lauffer

Marshall Journal of Medicine

Introduction:

Given the challenges in modern healthcare, physicians find themselves devoting a great deal of mental and emotional energy into executing the appropriate care for patients as well as performing their daily clerical duties. Many clinicians have resorted to innovative ways to minimize their tasks which often leads to narrowing the focus of a patient’s overall care and the birth of medical errors described in the Swiss cheese effect model.

Case Description:

A 66 year old male established care with a new primary care physician. Previous radiologic data revealed a pulmonary nodule that did not have appropriate follow up imaging. …

Triple Valve Infective Endocarditis - A Late Diagnosis, Edme R. Mustafa, Sineta C. Firulescu, Cristina D. Parvanescu, Beatrice A. Chisalau, Georgica C. Tartea, Ion C. Efrem, Andreea L. Barbulescu, Stefan C. Dinescu, Paulina L. Ciurea, Lucretiu Radu, Ananu F. Vreju

Journal of Mind and Medical Sciences

Behcet's disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established.

We present the case of a patient with Behcet disease in which transthoracic echocardiography showed mobile masses on the aortic, tricuspid, and mitral valves, leading to multivalvular infective endocarditis diagnosis, possibly in the context of valvular inflammation.

The case presented in this article confirms observation of other studies, namely that ultrasonography plays an important role in the diagnosis and …

Delayed Sternal Closure Does Not Reduce Complications Associated With Coagulopathy And Right Ventricular Failure After Left Ventricular Assist Device Implantation, Roh Yanagida, Navin Rajagopalan, Daniel L. Davenport, Thomas A. Tribble, Mark A. Bradley, Charles W. Hoopes

Internal Medicine Faculty Publications

Delayed sternal closure (DSC) is occasionally adopted after implantation of left ventricular assist device (LVAD). Recent studies suggest that DSC be used for high risk group of patients with coagulopathy, hemodynamic instability or right ventricular failure. However, whether DSC is efficacious for bleeding complication or right ventricular failure is not known. This study is single center analysis of 52 patients, who underwent LVAD implantation. Of those 52 patients, 40 consecutive patients underwent DSC routinely. The sternum was left open with vacuum assist device after implantation of LVAD. Perioperative outcome of the patients who underwent routine DSC were compared with 12 …

Infection Of A Ventricular Septal Defect Patch With Acremonium Species, Nosheen Nasir, Kauser Jabeen, Joveria Farooqi, Binish Arif Sultan, Afia Zafar, Aamir Hameed Khan, Muneer Amanullah, Farheen Ali

Section of Internal Medicine

A ventricular septal defect (VSD) patch infection with Acremonium species isolated from vegetation and blood culture is described. Antifungal treatment was discontinued after 3 months and patient developed relapse. Surgery with prolonged oral voriconazole was instituted with recovery. We emphasize importance of surgery and prolonged therapy to treat such infections.

Deciphering A Case Of Pulmonary Hypertension In A Young Female: Partial Anomalous Pulmonary Venous Drainage The Culprit, Hiten R. Patel, Suchit Bhutani, Fayez Shamoon, Hartaj Virk

Abington Jefferson Health Papers

Partial anomalous pulmonary venous drainage (PAPVD) is a rare congenital cardiac defect and is associated with sinus venosus atrial septal defect. While most cases are asymptomatic, a patient can present with pulmonary hypertension (PHTN) and it can be difficult to diagnose. Here, we discuss the case of a young female with PHTN who was found to have two right-sided PAPVD. Through this case, authors try to emphasize the importance of meticulous and thorough investigation when evaluating PHTN, which allows for correct diagnosis and a timely intervention before PHTN becomes irreversible.

The Impact Of Schizophrenia On Copd Readmission Rate Among Hospitalized South Carolinians, Emilienne Y. Watonsi

DNP Research Projects

Due to elevated readmission costs, the Affordable Care Act established the Hospital Readmission Reduction Program in 2012 to curb the 30-day readmission rates. COPD and schizophrenia are two very expensive diseases, COPD national medical costs is projected to be $49.0 billion in 2020; the cost of schizophrenia was 155.7 billion in 2013. The main objective of this study was to determine if schizophrenia is a significant predictor of 30-day readmission following hospitalization for acute exacerbation of COPD after adjusting for age, gender, anxiety, smoking status, T2DM, chronic ischemic heart disease, and GERD. Methods: A retrospective cohort design was used to …

Does Ecg And Arrhythmia Simulation Training In Adjunct To Didactics Improve Medical Students’ Clinical Skills Compared To Didactics Alone?, Reed Krause, Amy C. Hayton Md

Loma Linda University Student Journal

Medical Schools continue to face the challenge of bridging the gap between classroom education and its application in the clinical environment. Several studies have shown utility of incorporating simulation training into a variety of healthcare related topics. We hypothesize that incorporating ECG and arrhythmia simulation training in adjunction to ECG and arrhythmia didactics; it would improve Year-3 medical students’ preparedness for managing arrhythmias in the clinical setting.

National Trends In Admission And In-Hospital Mortality Of Patients With Heart Failure In The United States (2001–2014), Emmanuel Akintoye, Alexandros Briasoulis, Alexander Egbe, Shannon M. Dunlay, Sudhir Kushwaha, Diane Levine, Luis Afonso, Dariush Mozaffarian, Jarrett Weinberger

Internal Medicine Faculty Publications

Background-—To investigate heart failure (HF) hospitalization trends in the United States and change in trends after publication of management guidelines.

Methods and Results-—Using data from the National Inpatient Sample and the US Census Bureau, annual national estimates in HF admissions and in-hospital mortality were estimated for years 2001 to 2014, during which an estimated 57.4 million HF-associated admissions occurred. Rates (95% confidence intervals) of admissions and in-hospital mortality among primary HF hospitalizations declined by an average annual rate of 3% (2.5%–3.5%) and 3.5% (2.9%–4.0%), respectively. Compared with 2001 to 2005, the average annual rate of decline in primary HF admissions …

Sick Sinus Syndrome And Chronic Chagas Cardiomyopathy., Sagar Vadhar Do, Benjamin Sanchez Md

Department of Medicine

No abstract provided.

Patient Fall Prevention, R9 West Cardiovascular, Cathy Palleschi, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

PATIENT FALL PREVENTION STRATEGIES IN AN ACUTE HOSPITAL

Every year in the United States, hundreds of thousands of patients fall resulting in injury. Injured patients often require prolonged hospital stays and a resultant increase in medical costs.

The purpose of this study was to identify the current state of fall prevention strategies on a hospital inpatient acute care cardiac unit. Through a root cause analysis, some deficiencies were identified and a process improvement plan was implemented.

Several positive outcomes were attained as a result of the countermeasures initiated. Patient falls per month and total waste in dollars saw a decline …

Diagnostic Effectiveness Of High-Sensitivity Troponins, Sean R. Bodin, Jacqueline Ramirez

Physician Assistant Capstones, 2016 to 2019

Background: Acute myocardial infarctions (AMI) are a leading cause of death in the United States. The key to increasing survivability is early recognition to expedite the proper treatment modalities. In conjunction with the clinical presentation and electrocardiograms, the use of cardiac biomarkers is exponentially important in not only recognizing a cardiac event but also determining the extent of injury. Advancement in laboratory technology has led to the development of high-sensitive troponin (hs-troponin) assays which can detect smaller cardiac troponin serum levels compared to conventional troponin assays. This implies that the use of hs-troponin assays is more effective in the …

An Over-The-Counter Treatment For Diarrhea Leading To Euphoria And Fatal Arrhythmia., Angela Magdaleno, Michael Sumner Do, Travis Magdaleno Md, Justin L. Guthier Do, Apurva Vyas Md

Department of Medicine

No abstract provided.

Proceedings Of 2016 Aurora Scientific Day

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 42nd annual Aurora Scientific Day research symposium, held May 25, 2016, in Milwaukee, Wisconsin. Aurora Scientific Day provides a forum for original research conducted by faculty, fellows, residents, students and other allied health professionals affiliated with Aurora Health Care, a not-for-profit health system comprised of integrated hospitals and clinics across eastern Wisconsin and northeastern Illinois.