Cardiology Commons^™

Initial Experience In Monitoring Qt Intervals Using A Six-Lead Contactless Mobile Electrocardiogram In An Inpatient Setting., Daniel Frisch, Eitan Frankel, Darius Farzad, Md, Sang H Woo, Alan Kubey

Division of Cardiology Faculty Papers

Mobile electrocardiograms (ECGs) (mECGs) using smartphone applications are an emerging technology. In the coronavirus disease 2019 (COVID-19) era, minimizing patient contact has gained increasing importance. Additionally, increased QT/corrected QT (QTc) monitoring has concurrently been required. The KardiaMobile 6L ECG device, cleared by the United States Food and Drug Administration (FDA) for recording ECGs, along with the KardiaStation tablet application is a platform (AliveCor, Mountain View, CA, USA) that addresses these two issues. A team of residents, fellows, hospitalists, and cardiologists identified inpatients in need of QT/QTc interval monitoring to pilot the adoption of a system composed of a KardiaMobile 6L …

Symptomatic Presentation Of Acute Myocardial Infarction In Heart Transplantation Patients, Shashank Jain, Dexter Jacob, Mahek Shah, David L. Fischman

Division of Cardiology Faculty Papers

Patients with acute myocardial infarction with a history of an orthotopic heart transplantation rarely present with classic anginal symptoms, secondary to cardiac denervation. We present 2 cases, the first of a patient with a ST-segment elevation myocardial infarction and the second who presented with a non-ST-segment elevation myocardial infarction. Both patients presented with typical symptoms and were treated with percutaneous coronary intervention.

Almond Protects The Liver In Coronary Artery Disease: A Randomized Controlled Clinical Trial, Humaira Jamshed, Jamshed Arslan, Fateh Ali Tipoo Sultan, Hasan Salman Siddiqi, Muhammad Qasim, Anwarul Hassan Gilani

Section of Cardiology

Objective: To compare the effect of Pakistani and American almonds on serum concentration of liver enzymes in coronary artery disease patients.
Methods: The randomised controlled trial was conducted at the Cardiology Clinics of Aga Khan University Hospital, Karachi, from February to July, 2012, and comprised patients who were randomised into intervention PA and AA groups and the control NI groups. Subjects in the intervention groups were provided Pakistani and American varieties of almonds 10g/day respectively with instructions to soak them overnight, remove the skin and eat them before breakfast for 12 weeks. The control group underwent no intervention. Serum concentrations …

Proximal Subclavian Artery Injury Managed Without Performing Median Sternotomy: A Case Report, Zia Ur Rehman

Department of Surgery Docs

No abstract provided.

Hypoglossal Nerve Paraganglioma Depicting As Glomus Tumor Of Neck, Zaid Ahmed Shamsi, Fareed Ahmed Shaikh, Muhammad Wasif, Mustafa Belal Hafeez Chaudhry, Nadeem Ahmed Siddiqui, Ziad Sophie

Department of Surgery Docs

Introduction: Paraganglioma are infrequent neuroendocrine tumors that are most commonly found in the carotid body, ganglia of the vagus, jugular and tympanic nerve. Very rarely they can involve other cranial nerves outside the cranial cavity, we present one such case of hypoglossal nerve paraganglioma in neck.
Case report: A 48 years old male presented with 1-month history of right sided stroke and aphasia. Ultrasonography of neck revealed a highly vascular mass on the right side of the neck. CT angiogram confirmed a highly vascular mass arising above the carotid bifurcation. With the working diagnosis of Glomus tumor, he underwent right …

Relative And Absolute Risk To Guide The Management Of Pulse Pressure, An Age-Related Cardiovascular Risk Factor, Jesus D. Melgarejo, Lutgarde Thijs, Dong-Mei Wei, Michael Bursztyn, Wen-Yi Yang, Yan Li, Kei Asayama, Tine W. Hansen, Masahiro Kikuya, Gladys E. Maestre, Benjamin Gavish

School of Medicine Publications

BACKGROUND Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan.

METHODS In 4663 young (18-49 years) and 7185 older adults (≥50 years), brachial PP was recorded over 24-hour. Total mortality and all major cardiovascular events combined (MACE) were co-primary endpoints. Cardiovascular death, coronary events and stroke were secondary endpoints.

RESULTS In young adults (median follow-up, 14.1 years; mean PP, 45.1 mmHg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1000 person-years. The adjusted hazard ratios expressed per 10-mmHg …

Methamphetamine Associated Cardiomyopathy In Pregnancy: The Distinctions And The Implications, Ashan Hatharasinghe, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction

Methamphetamine associated cardiomyopathy (MAC) and peripartum cardiomyopathy (PPCM) are both rare obstetric conditions. Literature regarding methamphetamine associated cardiomyopathy in the obstetric population is limited, and it can be difficult to make the distinction between the two given the similarities in clinical presentation. However similar, there are significant distinctions in the pathophysiology of these two that can help clinicians with the management process.

Clinical Findings and Outcomes

This case involves a 35-year-old Hispanic G6P5005 at 37 weeks gestation presenting with acute respiratory failure secondary to acute decompensated heart failure with reduced ejection fraction and superimposed preeclampsia leading to urgent cesarean …

Trichobezoer: An Unusual Presentation With Congestive Heart Failure, Madeeha Malik, Fatima Javed, Bassam Helou, Furrukh Malik

HCA Healthcare Journal of Medicine

Trichobezoars are impactions of hair that accumulate in the gastrointestinal track and are most often located in the stomach. They are often associated with psychiatric illnesses like trichotillomania and trichophagia, which usually occurs in young and adolescent females. Gastric trichobezoars (GT) are the most common variety of bezoar found in the stomach. The most common complications that arise alongside GT include gastric erosion, ulceration or perforation of the small intestine. Gastric outlet obstruction, obstructive jaundice, pancreatitis and death have been reported, though these complications are rare. We report a 40-year-old female who presented to the hospital with dyspnea on exertion …

Association Of Cardiovascular Health And Epigenetic Age Acceleration, Tess D. Pottinger, Sadiya S. Khan, Yinan Zheng, Wei Zhang, Hilary A. Tindle, Matthew Allison, Gretchen Wells, Aladdin H. Shadyab, Rami Nassir, Lisa Warsinger Martin, Joann E. Manson, Donald M. Lloyd-Jones, Philip Greenland, Andrea A. Baccarelli, Eric A. Whitsel, Lifang Hou

Nursing Faculty Publications

BACKGROUND: Cardiovascular health (CVH) has been defined by the American Heart Association (AHA) as the presence of the "Life's Simple 7" ideal lifestyle and clinical factors. CVH is known to predict longevity and freedom from cardiovascular disease, the leading cause of death for women in the United States. DNA methylation markers of aging have been aggregated into a composite epigenetic age score, which is associated with cardiovascular morbidity and mortality. However, it is unknown whether poor CVH is associated with acceleration of aging as measured by DNA methylation markers in epigenetic age.

METHODS AND RESULTS: We performed a cross-sectional analysis …

A High-Precision Machine Learning Algorithm To Classify Left And Right Outflow Tract Ventricular Tachycardia, Jianwei Zhang, Guohua Fu, Islam Abudayyeh, Magdi Yacoub, Anthony Chang, William Feaster, Louis Ehwerhemuepha, Hesham El-Askary, Xianfeng Du, Bin He, Mingjun Feng, Yibo Yu, Binhao Wang, Jing Liu, Hai Yao, Hulmin Chu, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

Introduction: Multiple algorithms based on 12-lead ECG measurements have been proposed to identify the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) locations from which ventricular tachycardia (VT) and frequent premature ventricular complex (PVC) originate. However, a clinical-grade machine learning algorithm that automatically analyzes characteristics of 12-lead ECGs and predicts RVOT or LVOT origins of VT and PVC is not currently available. The effective ablation sites of RVOT and LVOT, confirmed by a successful ablation procedure, provide evidence to create RVOT and LVOT labels for the machine learning model.

Methods: We randomly sampled training, validation, and testing …

Improved Walk Test Performance And Blood Pressure Responses In Men And Women Completing Cardiac Rehabilitation: Implications Regarding Exercise Trainability, Felipe Araya-Ramirez, Jose Moncada-Jimenez, Peter W. Grandjean, Barry A. Franklin

Articles

Purpose. To evaluate changes in walk test performance and blood pressure (BP) responses following a 12-week exercise-based outpatient cardiac rehabilitation (CR) program. Methods. Six-Minute Walk Test (6MWT) and resting systolic BP (SBP), diastolic BP (DBP), post-6MWT heart rate (HR), and post-6MWT BPs were measured before and after CR in 311 (237 men,74 women) patients. Using age as a covariate, 2 by 2 (Gender × Measurement) ANCOVAs were used to determine differences in 6MWT performance and hemodynamic variables. Results. After adjusting for age, men covered a greater 6MWT distance than women; pre-CR versus post-CR program values are as follows: men, 429.3 …

Very Low Prevalence And Incidence Of Atrial Fibrillation Among Bolivian Forager-Farmers., Christopher J Rowan, Michael A Eskander, Edmond Seabright, Daniel Eid Rodriguez, Edhitt Cortez Linares, Raul Quispe Gutierrez, Juan Copajira Adrian, Daniel Cummings, Bret Beheim, Kirsten Tolstrup, Abinash Achrekar, Thomas Kraft, David E Michalik, Michael Miyamoto, Adel H Allam, L Samuel Wann, Jagat Narula, Benjamin C Trumble, Jonathan Stieglitz, Randall C Thompson, Gregory S Thomas, Hillard S Kaplan, Michael D Gurven

Articles, Abstracts, and Reports

Background: Atrial fibrillation is the most common arrhythmia in post-industrialized populations. Older age, hypertension, obesity, chronic inflammation, and diabetes are significant atrial fibrillation risk factors, suggesting that modern urban environments may promote atrial fibrillation.

Objective: Here we assess atrial fibrillation prevalence and incidence among tropical horticulturalists of the Bolivian Amazon with high levels of physical activity, a lean diet, and minimal coronary atherosclerosis, but also high infectious disease burden and associated inflammation.

Methods: Between 2005-2019, 1314 Tsimane aged 40-94 years (52% female) and 534 Moseten Amerindians aged 40-89 years (50% female) underwent resting 12-lead electrocardiograms to assess atrial fibrillation prevalence. …

Development And Validation Of A Prediction Model For Stroke, Cardiac, And Mortality Risk After Non-Cardiac Surgery., Sang H Woo, Gregary D. Marhefka, Scott W. Cowan, Md, Lily Ackermann, Md

Department of Medicine Faculty Papers

Background: Commonly used cardiovascular risk calculators do not provide risk estimation of stroke, a major postoperative complication with high morbidity and mortality. We developed and validated an accurate cardiovascular risk prediction tool for stroke, major cardiac complications (myocardial infarction or cardiac arrest), and mortality after non-cardiac surgery.

Methods and Results: This retrospective cohort study included 1 165 750 surgical patients over a 4-year period (2007-2010) from the American College of Surgeons National Surgical Quality Improvement Program Database. A predictive model was developed with the following preoperative conditions: age, history of coronary artery disease, history of stroke, emergency surgery, preoperative serum …

Long-Term Effects Of Very Low Dose Particle Radiation On Gene Expression In The Heart: Degenerative Disease Risks, Venkata Naga Srikanth Garikipati, Arsen Arakelyan, Eleanor A Blakely, Polly Y Chang, May M Truongcao, Maria Cimini, Vandana Malaredy, Anamika Bajpai, Sankar Addya, Malik Bisserier, Agnieszka Brojakowska, Abrisham Eskandari, Mary K Khlgatian, Lahouaria Hadri, Kenneth M Fish, Raj Kishore, David A Goukassian

Kimmel Cancer Center Faculty Papers

Compared to low doses of gamma irradiation (γ-IR), high-charge-and-energy (HZE) particle IR may have different biological response thresholds in cardiac tissue at lower doses, and these effects may be IR type and dose dependent. Three- to four-month-old female CB6F1/Hsd mice were exposed once to one of four different doses of the following types of radiation: γ-IR 137Cs (40-160 cGy, 0.662 MeV), 14Si-IR (4-32 cGy, 260 MeV/n), or 22Ti-IR (3-26 cGy, 1 GeV/n). At 16 months post-exposure, animals were sacrificed and hearts were harvested and archived as part of the NASA Space Radiation Tissue Sharing Forum. These heart tissue samples were …

Hypertension Guidelines And Coronary Artery Calcification Among South Asians: Results From Masala And Mesa, Jaideep Patel, Anurag Mehta, Mahmoud Al Rifai, Michael J. Blaha, Khurram Nasir, John W. Mcevoy, Ambarish Pandey, Alka M. Kanaya, Namratha R. Kandula, Salim S. Virani

Office of the Provost

Untreated hypertension may contribute to increased atherosclerotic cardiovascular disease (ASCVD) risk in South Asians (SA). We assessed HTN prevalence among untreated adults free of baseline ASCVD from the MASALA & MESA studies. The proportion of participants who received discordant recommendations regarding antihypertensive pharmacotherapy use by the 2017-ACC/AHA and JNC7 Guidelines across CAC score categories in each race/ethnic group was calculated. Compared with untreated MESA participants (n = 3896), untreated SA (n = 445) were younger (55±8 versus 59±10 years), had higher DBP (73±10 versus 70±10 mmHg), total cholesterol (199±34 versus 196±34 mg/dL), statin use (16% versus 9%) and …

5Th Generation Vs 4Th Generation Troponin T In Predicting Major Adverse Cardiovascular Events And All-Cause Mortality In Patients Hospitalized For Non-Cardiac Indications: A Cohort Study, Vedant Gupta, Marc Paranzino, Talal Alnabelsi, Karam Ayoub, Joshua Eason, Andin Mullis, John R. Kotter, Andrew Parks, Levi May, Sethabhisha Nerusu, Chen Dai, Daniel Cleland, Steve W. Leung, Vincent L. Sorrell

Gill Heart & Vascular Institute Faculty Publications

OBJECTIVE: The frequency and implications of an elevated cardiac troponin (4^th or 5^th generation TnT) in patients outside of the emergency department or presenting with non-cardiac conditions is unclear.

METHODS: Consecutive patients aged 18 years or older admitted for a primary non-cardiac condition who had the 4^th generation TnT drawn had the 5^th generation TnT run on the residual blood sample. Primary and secondary outcomes were all-cause mortality (ACM) and major adverse cardiovascular events (MACE) respectively at 1 year.

RESULTS: 918 patients were included (mean age 59.8 years, 55% male) in the cohort. 69% had elevated …

Successful Pregnancy With Centrifugal Flow Left Ventricular Assist Device: A Case Report And Review Of The Literature, Seyed Hamed Hosseini Dehkordi, Matthew R. Lippmann, Travis Abicht, Andrew J. Sauer, Nicholas A. Haglund, Marc R. Parrish, Jared Staab, Bhanu Gupta

The VAD Journal

Successful deliveries from patients supported by axial flow left ventricular devices have been previously reported. We present the first case of a successful pregnancy and birth in a patient with a centrifugal-flow left ventricular assist device. A 24-year-old female with methamphetamine-induced cardiomyopathy and end-stage congestive heart failure supported by a HeartWare™ ventricular assist device (Medtronic) presented two years after device implantation with an unplanned pregnancy at 11-weeks of gestation. Following a multidisciplinary evaluation by experts in advanced heart failure, maternal fetal medicine, cardiothoracic surgery, anesthesia, ethics, psychiatry, and palliative care, an advanced plan of care was established. An elective induction …

Cardiac Stress Testing, Michael Bozzi, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline and Learning Objectives

-- Questions to be answered:
• What is a stress test?
• Who should I send for a stress test?
• Which kind of stress test should I order?
• How do I interpret these results?

-- 4 Cases

Length Of Hospital Stay Following Temporary Pacing Post-Transcatheter Valve Replacement, Sean Mccarthy, Marvin Eng M.D.

Medical Student Research Symposium

Transcatheter valve replacement (TVR) provides a minimally invasive method of valve replacement. During TVR, conduction abnormalities can develop, but only some will require permanent pacing, and use of temporary pacing provides immediate support until a decision of temporary pacing is made. Henry Ford Health System has two methods of pacing lead placement: balloon tipped leads and screw-in leads. Currently, the impact of different types of temporary pacing leads on recovery time is still unknown. This project investigated the differences in the length of hospital and ICU stay between patients who received the balloon tipped and screw-in leads. Data was collected …

Cardiac Arrest Clinical Outcomes In Patients Presenting With Opioid Overdose, Andrew Toron, Morgan Hutchinson, Md, David Gaieski

Phase 1

Introduction: Understanding opioids and their potential to cause cardiac arrests is integral in learning how to lower mortality rates in patients who overdose on them. Few studies have specifically examined the association of out-of-hospital cardiac arrests with opioid overdoses. We hypothesized that cardiac arrests caused by opioid overdoses will result in longer hospital stays and a higher mortality rate than other cardiac arrests.

Methods: This study is a secondary analysis of data from the Cardiac Arrest Registry to Enhance Survival. Data regarding 35 patients who presented to Jefferson and Methodist hospitals with out-of-hospital cardiac arrests due to opioid overdose …