Cardiology Commons^™

Unexpected Course Of Left Ventricular Thrombus After Covid-19 Infection In A Woman With Peripartum Cardiomyopathy, Kutluhan Eren Hazir, Ersin Çağrı Şi̇mşek, Gizem Çabuk, Cenk Sari

Journal of the Saudi Heart Association

Peripartum cardiomyopathy (PPCMP) is defined as heart failure that develops in the last trimester of pregnancy or in the first few months after delivery without an underlying cause. Altought it is seen rarely, it can lead to thromboembolic events and can be life-threatening. Similarly, COVID-19, which is a viral pneumonia agent, is known to cause thrombogenesis. In this case report, the unexpected course of left ventricular thrombus developing in a patient with peripartum cardiomyopathy accompanied by COVID-19 infection is presented.

Novel Cause Of Late Atrial Septal Defect Devices Embolization, Wejdan Ba-Atiyah, Hala Gabel, Ahmad Jamjoom, Jameel Al-Ata

Journal of the Saudi Heart Association

Transcatheter closure of septal defects using specialized devices is a common procedure that has a high success rate. Embolization of Atrial septal defect devices is a known complication seen at a rate of 0.5%. We report a case of late ASD device occluder embolization immediately after brain MRI with clinical consequences and intraoperative evidence of right atrial wall thermal injury. To our knowledge Atrial septal occluder (ASO) device embolization post magnetic resonance imaging (MRI) was not reported before, although theoretically possible and that's why six to eight weeks post device implantation MRI is prohibited even with current MRI compatible devices.

“I Have Dizziness, Do I Need A Pacemaker?”, Ravi Choxi, Arun Kundra

Transformative Medicine (T-Med)

No abstract provided.

Comparing The Safety And Efficacy Of A Rapid High-Sensitivity Cardiac Troponin I Protocol Between Hospital-Based And Free-Standing Emergency Departments, Arqam Husain, Joseph B. Miller, Satheesh Gunaga, Seth Krupp, Howard Klausner, Elizabeth Plemmons, Hashem Nasseredine, Jacob Tuttle, Bernard Cook, James K. Mccord

Medical Student Research Symposium

Study Objectives: Current high sensitivity cardiac troponin I (hs-cTnI) research has been conducted almost exclusively in hospital-based emergency department (HBED) settings and the translation of these protocols into free-standing emergency departments (FSED) has yet to be explored. This study compared the safety and efficacy of applying a rapid-rule out protocol using hs-cTnI for exclusion of acute myocardial infarction (AMI) in HBEDs and FSEDs.

Methods: This was a secondary analysis of a randomized trial of patients evaluated for possible AMI in 9 emergency departments (ED) from July 2020 through March 2021. The trial arms included a new 0/1-hour rapid protocol using …

High Output Heart Failure, A Lethal And Forgotten Cause Of Heart Failure, Neiberg A. Lima Md, Ian Detroyer Bs, Saman Razzaq Md, Oluwale Adegbala Md, Preeti Ramappa Md

Medical Student Research Symposium

Introduction

Cardiac output (CO) is usually low or normal in patients with heart failure. However, some patients have a high CO deemed high-output heart failure (HOHF). HOHF is not well characterized and continues to be under-recognized clinically. At the Detroit VA, we conducted a quality improvement project to define the characteristics of this unique patient population, identify predictors and increase awareness of this entity.

Methods

Patients with HOHF were compared to patients with heart failure with preserved ejection fraction (HFpEF) and normal CO. HOHF was defined as CO >8 L/minute on right heart catheterization performed between 2008-2021. Retrospective data regarding …

Culprit Lesion Morphology On Oct In Stemi Vs Nstemi – A Systematic Review Of 7526 Patients, Avinash Mani, Vineeta Ojha, Harikrishnan Sivadasanpillai, Bijulal Sasidharan, Sanjay Ganapathi, Ajit Kumar Valaparambil

Journal of the Saudi Heart Association

Background Patients with STEMI are postulated to have different culprit lesion morphology compared to NSTEMI. The use of OCT in ACS can help delineate lesion morphology. The aim of this systematic review was to analyze the available data on culprit plaque morphology in ACS patients.

Methods The available literature was systematically screened for studies on culprit lesion morphology in ACS patients. Data was extracted from the selected studies and analyzed for baseline characteristics as well as culprit lesion morphology on OCT. Lesion characteristics between STEMI and NSTEMI groups were compared.

Results A total of 32 studies were selected for the …

Ttr Amyloidosis: Current State Of Affairs And Promise For The Future, Yevgeniy Brailovsky, Indranee Rajapreyar, Rene Alvarez

Division of Cardiology Faculty Papers

No abstract provided.

National Heart Center/Saudi Heart Association 2023 Guidelines On The Management Of Hypertension, Waleed Alhabeeb, Adel Abdulkader Tash, Mostafa Alshamiri, Mohamed Arafat, Mohammed Ali Balghith, Ali Almasood, Abdulla Eltayeb, Hossam Elghetany, Taher Hassan, Owayed Alshemmari

Journal of the Saudi Heart Association

Background: Hypertension is a highly prevalent disease in Saudi Arabia with poor control rates. Updated guidelines are needed to guide the management of hypertension and improve treatment outcomes. Methodology: A panel of experts representing the National Heart Center (NHC) and the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to the local population, clinical practice and the healthcare system. The recommendations were reviewed to ensure scientific and medical accuracy. Recommendations: Hypertension was defined and a new classification was proposed as relevant to the Saudi population. Recommendations on diagnosis, clinical evaluation, cardiovascular assessment were detailed, along with guidance …

Better Survival In Morbidly Obese Patients With Atrial Fibrillation Treated With Non-Vitamin K-Dependent Oral Anticoagulants, Monirah A. Albabtain, Zaid Alanazi, Nawaf Al Mutairi, Yahya Al Hebaishi, Ola Alyafi, Haneen Alghasoon, Amr A. Arafat

Journal of the Saudi Heart Association

Background: The efficacy and safety of non-vitamin K-dependent anticoagulants (NOAC) are not well investigated in the obese population, and fixed dosing could lead to under-anticoagulation. Our objective was to evaluate the effect of obesity on anticoagulation outcomes and survival in non-valvular atrial fibrillation (AF) patients. Methods: We enrolled 755 patients who required anticoagulation for AF from 2015 to 2016. We grouped the patients into four groups. Group 1 (n= 297) included patients with BMI< 40 Kg/m2 treated with NOACs, Group 2 (n= 358) included patients on warfarin with BMI< 40 Kg/m2, Group 3 (n= 57) had patients on NOACs with BMI≥ 40 Kg/m2 and Group 4 (n= 43) included patients on warfarin and BMI≥ 40 Kg/m2. Study outcomes were the composite endpoint of stroke, bleeding, and survival. Results: Competing risk regression showed that stroke and bleeding were not affected by obesity or treatment (SHR: 1.09 (95% CI: 0.79- 1.51); P= 0.62). Older age was the predictor of stroke/bleeding (HR:1.03 (95% CI:1.01- 1.06); P= 0.02). Predictors of mortality were heart failure (HR:2.23 (95% CI:1.25- 3.97); P= 0.007), lower creatinine clearance (HR: 0.98 (95% CI:0.97- 0.98): P< 0.001), non-obese patients on warfarin (HR:3.51 (95%CI:1.6- 7.7): P=0.002) and obese patients on warfarin (HR: 6.7 (95% CI:2.51- 17.92); P< 0.001). Conclusion: NOACs could have a similar risk profile to warfarin in obese and non-obese patients with non-valvular AF but could have better survival. Larger randomized trials are recommended.

A Case Of Congenital Coronary Sinus Ostial Atresia With Persistent Left Superior Vena Cava, Laura Onderko, Thomas A. Miller, Sean Novak, Jeffrey Rosenblatt

Journal of Maine Medical Center

Introduction: The coronary sinus is responsible for venous drainage of the heart. Congenital anomalies of the coronary sinus are rare and typically associated with other anomalies, such as atrial septal defects or other congenital heart malformations.

Clinical Findings: We present a case of incidentally found atresia of the coronary sinus ostium with associated persistent left superior vena cava. This case involved a 52-year-old patient who initially presented with a supraventricular tachycardia and elevated troponin.

Clinical Course: The patient underwent cardiac workup with a coronary computed tomographic angiography scan. This scan showed no obstructive coronary artery disease, but did show congenital …

Risk Of Coronary Artery Disease In Patients With Gout On Treatment With Colchicine: A Systematic Review And Meta-Analysis, Muhammad U Siddiqui, Joey Junarta, Swaminathan Sathyanarayanan, Kirpal Kochar, Waqas Ullah, D L Fischman

Division of Cardiology Faculty Papers

Background: Colchicine has anti-inflammatory properties, but its utility in improving cardiovascular outcomes has been disputed. Here, we study the impact of colchicine on cardiovascular outcomes in patients with gout with and without coronary artery disease (CAD).

Methods: Medline, Web of Science and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Primary outcomes included myocardial infarction (MI), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Secondary outcomes included stroke and all-cause mortality.

Results: We included 4 observational studies comprising 10,026 patients with gout on treatment with colchicine. There was no significant difference in the …

Left Bundle Branch Area Pacing From A Femoral Approach In A Patient Without Superior Access, Bishnu Dhakal, Stuart Prenner, Edward Magargee, Danesh Modi, Colin Movsowitz, Robert Schaller

Division of Cardiology Faculty Papers

Limited venous access and lateral left ventricular scar are impediments to traditional cardiac resynchronization therapy. We present a case where placement of an implantable cardioverter-defibrillator from a femoral approach while using left bundle branch area pacing led to clinical improvement. (Level of Difficulty: Intermediate.)

Complications Of Cardiopulmonary Bypass From An Anesthesia Perspective: A Clinical Review, Alex Roberts, Elizabeth C. Duncan, Paul Hargrave, David Redding Kingery, Josh Barnes, Derek L. Horstemeyer, Russell F. Stahl

HCA Healthcare Journal of Medicine

Cardiopulmonary bypass (CPB) is frequently used for open heart surgery and other procedures that utilize temporary substitution or support of heart and lung function. While it is widely accepted as the predominant method to carry out these procedures, it is not without possible complications. CPB can be seen as the ultimate “team sport” as it includes and is dependent on contributions from multiple professionals including anesthesiologists, cardiothoracic surgeons, and perfusion technicians. In this clinical review paper, we examine possible complications of CPB, primarily from the perspective of the anesthesiologist, and how to troubleshoot them if they arise, which often requires …

Case Of Bilateral Atrial Myxomas In Carney Syndrome, Anwar Abdullatif Alhulaibi, Abdulrahman Mashatel Alruwaili, Zahra Mohammed Albahar, Wiam Tagelsir Abdelsalam, Mohamed Abdelaziz Elasheri, Abdullah Saad Alotaibi

Journal of the Saudi Heart Association

Carney complex is rare neoplastic disorder. Intracardiac myxoma presenting the most common non-cutaneous lesions in this complex. We are reporting a 31-year-old Saudi female known case of Carney complex presented with asymptomatic biatrial myxoma that was identified on routine transthoracic echocardiogram, and was successfully excised. However, these patients need a careful surveillance in order to detect any new masses and prevent their complications.

Preserving The Patients’ Lifeline: Reducing Complications By Adopting A Vascular Access Assessment Improvement Process, Ana Lopez Franco

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Prevention Of Doxorubicin-Induced Cardiotoxicity By A Coumestan Analogue, Psoralidin, Mujtaba H. Shah, Myia Aiges, Kota V. Ramana

Annual Research Symposium

Natural phenolic compound Psoralidin limits cardiotoxicity associated with Doxorubicin

Severe Left Ventricular Dysfunction Earlier After Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Predictors And In-Hospital Outcome– A Middle Eastern Tertiary Center Experience, Sheeren Khaled, Ghada Shalaby

Journal of the Saudi Heart Association

Improving or maintaining heart function following percutaneous coronary intervention (PPCI) is not identified in all patients. Our aim in the current study is to investigate the prevalence, factors associated with early left ventricular (LV) dysfunction following successful revascularization of myocardial infarction patients

Methods: A single-center retrospective study included 2863 myocardial infarction patients who were admitted to our center and treated with successful PPCI

Results: Out of 2863 consecutive patients who underwent PPCI from May 2018 to August 2021, 1021 (36%) developed server LV dysfunction. They showed a higher history rate of ischemic heart disease and previous revascularization before AMI (P=0.05 …

Management Of Patients With Refractory Cardiogenic Shock And Cardiointestinal Syndrome With Impella 5.5 As Bridge To Decision: Case Series, Ismael A. Salas De Armas, Bindu Akkanti, Amanda Bergeron, Anju Bhardwaj, Kha Dinh, Ali Shirafkan, Jayeshkumar A. Patel, Manish K. Patel, Carlos R. Manrique Neira, Igor D. Gregoric, Biswajit Kar, Mehmet H. Akay

Journal of Shock and Hemodynamics

Patients with advanced heart failure require multi-system management as a majority succumb to end-organ dysfunction, including gastrointestinal sequelae. Temporizing measures, such as early mechanical circulatory support, can assist in the recovery of patients with acute cardiogenic shock. The temporary support can improve patient characteristics to enable future definitive heart failure therapies such as durable left ventricular assist devices and orthotopic heart transplantation. We present two cases of cardiogenic shock that were successfully bridged with an Impella 5.5 (Abiomed). The management enabled the patients to recover from reversible cardiointestinal syndrome and undergo successful definitive therapies.

Revascularization In Cardiogenic Shock: Residual Syntax Score And Chronic Total Occlusions, Venugopal Menon

Journal of Shock and Hemodynamics

The residual syntax score (rSS) is strongly associated with outcomes in patients with stable coronary artery disease. In patients with acute myocardial infarction-associated cardiogenic shock (AMI-CS), the correlation or association of the rSS, mortality risk, and revascularization strategy has not yet been elucidated and needs more investigation. The SHOCK trial demonstrated that patients with left main and severe triple-vessel disease, who underwent coronary artery bypass grafts, had improved outcomes and higher 1-year survival rates than those with initial medical stabilization. However, it is unclear which is the superior technique for achieving complete revascularization. In contrast to the SHOCK trial’s results, …

Covid-19 Induced Right Ventricular Failure And Right Ventricular Assist Device Support, Marvin Slepian M.D.

Journal of Shock and Hemodynamics

COVID-19, while primarily recognized for its pulmonary and systemic manifestations, afflicts the cardiovascular system through various abnormalities. Notably, right ventricular (RV) involvement leading to dysfunction and failure is a manifestation seen in up to 20% of severe COVID patients. RV severity correlates with overall COVID severity, serving as a prognostic marker. Data review reveals that RV failure was largely underdiagnosed, particularly early on in the pandemic. The therapy approach for RV failure in patients with COVID should focus on supporting overall RV perfusion pressure, maintaining sinus rhythm, optimizing RV loading conditions and contractility, and addressing anticoagulation and thrombus-related conditions. Beyond …