Internal Medicine Commons^™

Endocarditis Prophylaxis In Vulnerable Valve; Antibiotic Stewardship Or Suboptimal Care?, Zachary Taylor, Andrea Roast, Michael Layoun

Providence Portland Medical Center Internal Medicine 2025

Introduction Infective endocarditis (IE) is a relatively uncommon disease with an annual incidence of 5 per 100,000 people in the U.S.. Dental procedures are an exceptionally rare cause of IE. Amidst a global emphasis on antibiotic stewardship, U.S. and European guidelines only recommend antibiotic prophylaxis for dental procedures in high-risk groups. Having a bicuspid aortic valve (BAV) confers an 11-fold risk of endocarditis compared to the general public, and yet, is not classified as high-risk per AHA/IDSA guidelines. We present a patient with BAV who developed IE following a noninvasive dental procedure and review whether patients with BAV are under-classified …

A Deadly Case Of Encephalopathy, Brenna Ostertag, Md, Gita D Gelfer, Andrea Roast

Providence Portland Medical Center Internal Medicine 2025

Introduction: Human prion disease are heterogenous groups of neurodegenerative disorders characterized by spongiform degeneration, astrogliosis, and neuronal loss in the central nervous system from misfolding and subsequent spread of the prion protein. This disease manifests rapidly and is often accompanied by visual and speech abnormalities, gait changes, and progressive encephalopathy. It is always fatal. Around 400 people are diagnosed with prion disease in the United States annually. Recent innovations in diagnostics using Real-Time Quaking Induced Conversion (RT-QuIC) has allowed for antemortem diagnosis of prion disease. Case Presentation: A 66-year-old male with a history of alcohol use disorder in remission and …

Indeterminate Benefit Of Long-Term Beta-Blocker Use After Acute Myocardial Infarction For Some Patients, Logan S. Thayer, Khush Hussain, Nicholas Apostolakis, Gretchen Swift, Arifbillah Sarowar, Mohammad Al-Hadidi, Scott Yaekle

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Yndigegn T, Lindahl B, Mars K, et. al., Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. April 7 2024;390:1372-1381. https://doi.org/10.1056/NEJMoa2401479

for a patient showing 55% left ventricular ejection fraction after myocardial infarction.

Acute Rheumatic Fever Presenting With Isolated Myocarditis And Right Coronary Artery Occlusion, Sumedh Iyengar, Md Mashiul Alam, Shaun Abid Md, Evgeny Shkolnik, Stuart Zarich

Posters

Acute Rheumatic Fever (ARF) and rheumatic heart disease continues to be a major health hazard in most developing countries.

Coronary artery obstruction has long been regarded as an uncommon complication of rheumatic heart disease and has rarely been reported in ARF.

Meta-Analysis On Sex Differences In Mortality And Neurodevelopment In Congenital Heart Defects, Alyssa K Crain, Zhia N Lim, Chloe J Sarfatis, Magela Arias, Travis Holder, Alvaro G Moreira, Antonio F Corno, Tina O Findley

Faculty, Staff and Student Publications

Given the increasing survival rates among congenital heart disease (CHD) patients and the growing emphasis on their quality of life, there is a need to comprehensively assess the impact of surgical interventions on neurodevelopmental outcomes. With increasing awareness in sex-related disparities in CHD, there is a need to explore potential differences in surgical mortality and neurodevelopmental outcomes between male and female patients. In this systematic review, we adhered to PRISMA guidelines and PROSPERO registration (#CRD42021225610). Articles published from 2015 to 2021 were searched using MeSH descriptors in three major databases (MEDLINE Ovid, Elsevier Embase, and Cochrane Library). Study selection criteria …

New Onset Atrial Fibrillation In Hospitalized Patients, Arafat Ali Farooqui, Syed Mohammad Mazhar Uddin, Sanjay Kumar Maheshwari, Kevin Clements, Rabiah Ashraf, Jay Keith, Neha Sharma, Haris Bilal, Naira Saleem, Vijay S. Shetty

Journal of Community Hospital Internal Medicine Perspectives

Objectives: To evaluate different factors precipitating new onset atrial fibrillation (AF) in hospitalized patients and their effect on in-patient mortality.

Design: Retrospective cross-sectional study

Setting: Urban tertiary care center in New York City

Measurements:

Primary outcomes:

• Determine different factors precipitating new onset atrial fibrillation in hospitalized patients and their effect on in-patient mortality

Secondary outcomes:

• Determine the duration of hospital stay after admission precipitating new onset atrial fibrillation and its effect on mortality
• Evaluate different factors in COVID-19 patients with new onset atrial fibrillation

Results: Out of 464 patients; 62.3% were males and 37.72% were females. Evaluation of patients before …

Intracavitary Left Ventricular Thrombus In A Patient With Severe Ischemic Cardiomyopathy And Nstemi: A Case Report And Management Approach, Ivan Mogollon, Luis Salcedo, Francisco Arias, Aura Calderon, Catherine Matos, Ismael Cantu

Research Symposium

Background: Intracavitary thrombi are a known complication of ischemic cardiomyopathy, often arising in the setting of severely reduced left ventricular ejection fraction. These thrombi can predispose patients to thromboembolic events and exacerbate cardiovascular compromise. Diagnostic challenges arise when intracavitary masses are identified in conjunction with other critical pathologies, such as acute coronary syndromes or peripheral artery disease. This report highlights the case of a 74-year-old male with multiple cardiovascular comorbidities who presented with near syncope, non-ST elevation myocardial infarction, and an incidental finding of an intracavitary left ventricular thrombus.

Case Presentation: A 74-year-old male with a history of coronary artery …

Acute Heart Failure Secondary To Coxsackie Dilated Cardiomyopathy In An Immunocompetent Adult: A Case Report From A Social Disparities Perspective, Barbara Malaga-Espinoza, Donnel Dockery-Joseph, Jessica Daza, Oscar Lopez, Andres Suarez Parraga

Research Symposium

Introduction: Cardiomyopathies (CM) are defined as myocardial disorders in the absence of coronary artery disease, hypertension, valvular or congenital heart conditions. Dilated CM is characterized by dilation and impaired contraction of one or both ventricles. The prevalence of this condition is underestimated because of variable disease expression and challenging diagnosis. We present the case of an undocumented and immunocompetent patient who debuted with acute heart failure after being exposed to significant environmental stressors.

Case Presentation: A 44-year-old Hispanic gentleman with a history of untreated hypertension presented to the ED with severely persistent left-sided chest pain at rest associated with frontoparietal …

Case Series On Prosthetic Valve Thromboses Treated With Intravenous Thrombolysis At A Tertiary Teaching Hospital In Nairobi – Kenya, John Odhiambo, Salim Abdallah, Mzee Ngunga

Internal Medicine, East Africa

Valvular heart disease is a significant global health issue, particularly in developing countries where Rheumatic Heart Disease (RHD) is the leading cause. Valve replacement surgeries have increased, with mechanical prostheses favored for their durability. However, thromboembolism remains a critical complication post-surgery, with prosthetic valve thrombosis rates of 0.03% for bioprosthetic valves and between 0.5% to 8% for mechanical valves in the aortic and mitral position. This report details two cases of heart failure following valve replacement due to rheumatic heart disease. The first case involves a 42-year-old female who developed prosthetic valve thrombosis after discontinuing warfarin for menorrhagia postmechanical mitral …

Efficacy And Safety Of Mechanical Transvenous Lead Extraction: Median Follow-Up Analysis And Development Of An Experimental Model For Predicting Survival Post-Extraction, Shima Nasri, Sahar Samimi, Masoud Eslami, Khashayar Hematpour, Morteza Eslami, Hirad Yarmohammadi, Reza Mollazadeh, Mehrzad Rahmanian

Faculty, Staff and Student Publications

Background: Cardiac implantable electronic device (CIED) implantation is on the rise, accompanied by an increase in its inevitable complications such as different types of CIED infections that require further therapy and potential device extraction. Ensuring efficacy and safety remains paramount in transvenous lead extraction (TLE), given the complex nature of the procedure. The purpose of this study is to assess the outcomes of relatively low-cost mechanical TLE, including mid-term clinical follow-up, and to develop a predictive model for post-TLE survival. This study included all consecutive patients admitted for TLE at two tertiary medical centers between 2016 and 2021. Baseline characteristics, …

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.

Cardiovascular Disease In Adults With Osteogenesis Imperfecta: Clinical Characteristics, Care Recommendations, And Research Priorities Identified Using A Modified Delphi Technique, Lars Folkestad, Siddharth K Prakash, Sandesh C S Nagamani, Niels Holmark Andersen, Erin Carter, Jannie Dahl Hald, Riley J Johnson, Bente Langdahl, Eleanor M Perfetto, Cathleen Raggio, Stuart H Ralston, Robert A Sandhaus, Oliver Semler, Laura Tosi, Eric Orwoll

Faculty, Staff and Student Publications

Osteogenesis imperfecta (OI) is a multisystem disorder most often caused by pathogenic variants in genes that encode type I collagen. Type I collagen is abundant not only in bone but also in multiple tissues including skin, tendons, cornea, blood vessels, and heart. Thus, OI can be expected to affect cardiovascular system, and there are numerous reports of cardiovascular disease (CVD) in people with OI. However, there is no consensus on how CVD in OI should be assessed or managed. To fill this gap, a multidisciplinary group was convened to develop clinical guidance. The work included a systematic review of the …

Proteus Mirabilis: An Unlikely Device-Related Infection, Mark A. Colantonio, Michelle Hartzell D.O, Brooke Shannon D.O.

Journal of Community Hospital Internal Medicine Perspectives

Implantable cardiac devices, including cardiac pacemakers, are not without risk for infection, carrying a mortality and morbidity of around 5-15%. Gram positive organisms are most common in 91% of cases, whereas gram negative organisms are less common, found in 2% of cases secondary to gram negative organisms other than Pseudomonas aeruginosa. Here, we present a rare case of the gram-negative organism Proteus mirabilis leading to a pacemaker site infection.

Sle And Aps Synergy: Aortic Dissection, Neil Maithel, Ali Asghar, Rabia Mahfooz, Ibrahim Musa, Hasnan Ijaz, Thomas Alexander

Gulf Coast Division GME Research Day 2025

No abstract provided.

Micra-Scopic Hero: Rare Unroofed Cornoary Sinus Complicating Pacemaker Placement, Suhas Tatapudi, E Castillo, Jeby Kalathoor, Zuhair Ali, Hytham Rashid, R Cargioli

Gulf Coast Division GME Research Day 2025

No abstract provided.

Not Your Typical Chest Pain: Anomalous Rca, Suhas Tatapudi, Nomair Ashraf, E Castillo, Jeby Kalathoor, Hytham Rashid, Ibrahim Yazji, M Daniel

Gulf Coast Division GME Research Day 2025

No abstract provided.

Unbreak My Heart: Improving The Cardiac Rehabilitation Referral Rate, Akash Patel, Samer Khalil, Iman Squires, Abed Naser, Eric Vargas, Manuel Carrazana, Olga Karasik

North Florida Division GME Research Day 2025

No abstract provided.

Post-Operative Afib After Cabg: A Retrospective Analysis, Leonardo A. Almaguer Gongora, Myrna E. Reinhardt, Manuel Jimenez, Luis E. Remedios Carbonell, Daniel Padron, Priya Mohan, Juliette Camejo, Bernardo Reyes

East Florida Division GME Research Day 2025

No abstract provided.

Recurrent Syncope In A Young Adult With Postural Orthostatictachycardia Syndrome (Pots): A Diagnostic And Therapeutic Challenge, Syed Raza, Shuchita Jhaveri, Neethu George, Julian Nguyen

Gulf Coast Division GME Research Day 2025

No abstract provided.

Not Your Average Syncope: A Case Of Bifascicular Block, Shuchita Jhaveri, Maria Amigo, Zahoor Khan, Marloe Prince

Gulf Coast Division GME Research Day 2025

No abstract provided.

Thyroid Storm And High Output Heart Failure, A Perfect Storm, Gunjan Mundhra, Haris Ahmed, Rebecca Schuyler, Karina Bidani, Justin Gisel

South Atlantic Division GME Research Day 2025

No abstract provided.

A Rare Case Of Right Sided May-Thurner Syndrome Diagnosis And Treatment, Sania Moonnumackel, Akhil Gade, Anand Karthik, Machaiah Madhrira

North Texas Research Forum 2025

Introduction: May-Thurner Syndrome (MTS) is a phenomenon commonly described as acquired stenosis of the left common iliac vein secondary to compression by the right common iliac artery. Right sided MTS is a rare syndrome that can happen due to a left sided inferior vena cava (IVC) and abdominal aorta with a high bifurcation which results in the right common iliac vein being compressed by the left internal iliac artery. It is a rare presentation of this condition which can commonly be missed and management guidelines are less defined compared to classic MTS. Case Report: A 63-year- old female with past …

Pacing-Induced Cardiomyopathy After Leadless Pacemaker Placement, Kathleen Mattingly, Ann Opondo, Abdullah Elnaji, Heena Patel, Jonathan Grube, Heather Reed, Justin Reed

North Florida Division GME Research Day 2025

No abstract provided.

Bradycardia In A Renal Transplant Patient Receiving Rabbit Antithymocyte Globulin, John Mathew, Victor Delprincipe, Seline Haci, Karthik Anand, Rangina Farhad

North Texas Research Forum 2025

Rabbit antithymocyte globulin (rATG) is widely used for induction and treatment of acute T-cell mediated rejection in renal transplant patients. Bradycardia is reported as a rare side effect of this medication (citation). With the increasing number of transplanted kidneys in today's world, there is greater need to understand the adverse effects of these drugs in transplant recipients.. Here we report a case of symptomatic bradycardia in a renal transplant patient receiving rATG for acute T-cell mediated rejection.

Unintentional Lead Dislodgement In Twiddler’S Syndrome, Howard Tan, Ashok Chaudhary, Nishant Nerella, Suman Pasupuleti

West Florida Division GME Research Day 2025

No abstract provided.

Development Of Intra-Hospital Ceftriaxone Resistance Of Serratia Marcescens Endocarditis, Mahyar Doraji, Michael Denney, Adeel Malik, Praveen Chekka, Nishant K. Nerella

West Florida Division GME Research Day 2025

No abstract provided.

Beyond Avnrt: A Case Of Coexisting Adenosine-Sensitive Focal Atrial Tachycardia, Kareem Elgendi, Brandon Quintana, Christopher Wilson, Marsall Marcus

West Florida Division GME Research Day 2025

No abstract provided.

Right Radial Artery Occlusion Post-Impella Removal: A Case Of First Radial Stenting Following Axillary Impella Placement, Sacha Saba, Joshini Simon, Mohamed Tashani, Jeffery Steinhoff, Jesse Klein

West Florida Division GME Research Day 2025

No abstract provided.

Iatrogenic Femoral Arteriovenous Fistula After Leadless Pacemaker Implantation Treated With Balloon-Expandable Stent: A Report Of Three Cases, Cheuk Yin Lai, Timothy Ho Him, Mark Tk Tam, Guang-Ming Tan, Bryan P Yan

Journal of the Hong Kong College of Cardiology

Endovascular covered stenting is a minimally invasive option for treating iatrogenic femoral access site complications, including arteriovenous femoral fistula (AVF). Reports on AVF repair mainly concern small bore devices, but large bore devices such as leadless pacemakers post unique challenges. We present 3 cases of iatrogenic femoral AVF after large-bore, 27Fr access sheath insertion for leadless pacemaker implantation. Both underwent endovascular balloon-expandable covered stenting, with resolution of AVF and durable long-term results. As patients referred for leadless pacemaker implantations are often frail with co-morbidities, endovascular stenting is an appealing alternative to open surgical repair for AVF.

Severe Mitral Bioprothesis Stenosis, A Clinical Dilemma Solved By The Sapien 3 Valve, Haris Ahmed, Natalia C. Badillo-Velez, Awad Hammad, Andrea Deneen, Youssef Al Saghir

South Atlantic Division GME Research Day 2025

No abstract provided.