Cardiology Commons^™

Quality Review And Education As Method Of Improving Guideline Adherence For Medication Prescription And Outcomes Among Vascular Interventionalists Performing Non-Cardiac Vascular Surgeries, Alejandro Perez, Shih-Ting Chiu, A Manning, Brant W Ullery

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Background: Medical management of patients undergoing non-cardiac vascular procedures often sub-optimally follow evidence based guidelines. We hypothesized that feedback to practitioners in regards to outcomes and medications prescribed would improve care.

Methods: With conversion to new database in 2015 that allowed for more comprehensive tracking of vascular surgery outcomes, a decision was made to share these data with practitioners on regular basis as well as relay medications prescribed at discharge. Carotid and abdominal aortic surgeries were evaluated. The most frequent format for presentation of data was vascular morbidity and mortality conference. Medications included in presentations were antiplatelet and statin therapies. …

Frequency Of Intraoperative Hypotension After The Induction Of Anesthesia In Hypertensive Patients With Preoperative Angiotensin-Converting Enzyme Inhibitors, Fahad Salim, Fazal Hameed Khan, Muhammad Nasir, Rashid Ali, Ayesha Iqbal, Amir Raza

Department of Anaesthesia

Introduction: The renin-angiotensin-aldosterone system (RAAS) is an important target in the treatment of hypertension. Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to angiotensin II. ACE inhibitors not only treat hypertension but also decrease morbidity and mortality in heart failure patients and in patients with acute myocardial infarction. The discontinuation of ACE inhibitors before the surgery is still controversial. To assess the current magnitude of the problem in our population, we aimed to conduct this study, which evaluated the frequency of intraoperative hypotension after the induction of anesthesia in controlled hypertensive patients with preoperative ACE inhibitors.
Material and …

A Case Of Phlegmasia Cerulea Dolens., Davin Barnett, John Casey

Heart and Vascular Articles

Phlegmasia cerulea dolens (PCD) is a rare presenting condition that carries a high mortality and morbidity risk. It is a cannot miss diagnosis with potentially deadly sequelae, and we highlight the importance of a thorough physical examination and initiation of empiric treatment to help prevent such.

Secondary Prevention Of Cardiovascular Diseases In India: Findings From Registries And Large Cohorts, Hasan Rehman, Ankur Kalra, Ajar Kochar, Angad S. Uberoi, Deepak L. Bhatt, Zainab Samad, Salim S. Virani

Section of Cardiology

Several registries and quality improvement initiatives have focused on assessing and improving secondary prevention of CVD in India. While the Treatment and Outcomes of Acute Coronary Syndromes in India (CREATE), Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF), and Trivandrum Heart Failure (THF) registries are limited to collecting data, the Tamil Nadu-ST-Segment Elevation Myocardial Infarction (TN-STEMI) program was aimed at examining and improving access to revascularization after an ST-elevation myocardial infarction (STEMI). The Acute Coronary Syndromes: Quality Improvement in Kerala (ACS-QUIK) study recruited hospitals from the Kerala ACS registry to assess a quality improvement kit for patients with ACS while the Practice …

Flash Pulmonary Edema: A Case And Review Of Left Ventricular Non-Compaction Cardiomyopathy, Paula J. Watts, Oliver S. Garbo, Wendy Barrett, Michael Kopstein, Ryan Maybrook, Dmitriy Scherbak

HCA Healthcare Journal of Medicine

Left ventricular non-compaction cardiomyopathy is an uncommon type of cardiomyopathy caused by malformation of the myocardium during embryogenesis. This results in trabeculations within the ventricular wall that can affect the left and, less commonly, right ventricles. Presentation ranges from clinically asymptomatic to life-threatening arrhythmias. It is a rare and relatively unknown form of cardiomyopathy, though thought to be underdiagnosed. Prevalence is increasing due to improvements in imaging and awareness. Management is similar to that of other cardiomyopathies including angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, beta-blockers, diuretics, automatic implantable cardioverter defibrillator placement and cardiac transplantation. We present a case of a …

Cangrelor: Safe And Effective For Left Ventricular Assist Device Thrombosis, Roopa Rao, Eve Anderson, Mark Jones, Muhamed Safiia, Maya Guglin

The VAD Journal

Pump thrombosis is a devastating complication of left ventricular assist device implantation as it increases the risk of mortality and morbidity. Early and effective treatment is important to prevent the progression of the clot and to avoid the surgical need for pump exchange or heart transplant. The current strategies of intensifying anticoagulation therapy are not consistently effective and carry significant bleeding risks. Cangrelor is a new pharmacological agent that has been utilized as an antiplatelet agent in several cardiac procedures. In this case series, we describe the use of cangrelor for left ventricular assist device thrombosis in five patients. Cangrelor …

Pericardiocentesis Indications And Complications: A Retrospective Observational Study In A Tertiary Care Hospital In Karachi, Pakistan, Abdul Baqi, Intisar Ahmed

Section of Cardiology

Introduction: Pericardiocentesis is crucial for the diagnosis and management of diseases responsible for significant pericardial effusions. Pericardiocentesis was performed the first time by Riolanus for cardiac tamponade. He described the process of trephination of the sternum to remove the abnormally accumulated fluid from the pericardial space. However, with the advancement of expertise in echocardiography assisted procedures, echocardiography-guided diagnostic and therapeutic pericardiocentesis is now considered standard clinical practice in the treatment of pericardial effusions.
Objectives: We aim to study different causes of pericardial effusion and indications of pericardiocentesis as well as complications associated with it in our population.
Methods: This is …

Exploring The Influence Of Socio-Cultural Factors And Environmental Resources On The Health Related Quality Of Life Of Children And Adolescents After Congenital Heart Disease Surgery: Parental Perspectives From A Low Middle Income Country, Laila Ladak, Robyn Gallagher, Babar Hasan, Khadija Awais, Ahmed Abdullah, Janice Gullick

Department of Paediatrics and Child Health

Background: Health related quality of life (HRQOL) is an important indicator of long-term well-being, influenced by environmental factors such as family, culture, societal norms and available resources. This study aimed to explore parental perspectives on the influence of socio-cultural factors and environmental resources on the HRQOL of children and adolescents after congenital heart disease (CHD) surgery.
Methods: Using a descriptive, qualitative design, semi-structured interviews of children/adolescents who had CHD surgery in this low-middle income country (LMIC) were collected between July to December 2017. There were 20 families enrolled, which included 18 parent dyads (mother and father) and two single mothers, …

Effect Of Niacin Monotherapy On High Density Lipoprotein Composition And Function, Scott M. Gordon, Marcelo J. Amar, Kianoush Jeiran, Michael Stagliano, Emma Staller, Martin P. Playford, Nehal N. Mehta, Tomas Vaisar, Alan T. Remaley

Saha Cardiovascular Research Center Faculty Publications

BACKGROUND: Niacin has modest but overall favorable effects on plasma lipids by increasing high density lipoprotein cholesterol (HDL-C) and lowering triglycerides. Clinical trials, however, evaluating niacin therapy for prevention of cardiovascular outcomes have returned mixed results. Recent evidence suggests that the HDL proteome may be a better indicator of HDL's cardioprotective function than HDL-C. The objective of this study was to evaluate the effect of niacin monotherapy on HDL protein composition and function.

METHODS: A 20-week investigational study was performed with 11 participants receiving extended-release niacin (target dose = 2 g/day) for 16-weeks followed by a 4-week washout period. HDL …

Hydroxychloroquine And Azithromycin As A Treatment Of Covid- 19: Electrocardiogram Variability, Amal El Ouarradi, Salma Abdeladim, Sara Oualim, Llham Bensahi, Sara Hafid, Hamza Tazi, Mahassine Elharras, Rita Aniq Filali, Abdelhamid Nailhou, El Arbi Bouaiti, Abdelhamid Moustaghfir, Mohamed Sabry

Journal of the Saudi Heart Association

During the COVID 19 pandemic, the effectiveness of the combination of hydroxychloroquine and azithromycin is widely discussed. This treatment can cause many severe cardiac side effects that makes us discuss its utility.

The aim of this study is to describe the cardiovascular effect of hydroxychloroquine and azithromycin by analyzing surface ECG in patients with COVID 19.

Methods: This observational cohort study included Moroccan patients with COVID 19 diagnosis and were hospitalized in Cheikh Khalifa International University Hospital, Casablanca, Morocco between March 26 and April 20, 2020.Patients were treated with a combination of hydroxychloroquine and azithromycin over a period of at …

Incidental Discovery Of Anomalous Left Coronary Artery Arising From The Pulmonary Artery In A Coronavirus Disease-2019 Patient: A Blessing In Disguise, Masood Ghori, Rizwan Ahmed

Journal of the Saudi Heart Association

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a serious congenital malformation. Reports about asymptomatic, incidentally discovered ALCAPA in adults are scarce. We describe a patient with no known pre-existing cardiac condition admitted to our hospital with coronavirus disease 2019 (COVID-19) and was incidentally found to have ALCAPA. To the best of our knowledge, this is the first reported case of incidentally discovered ALCAPA in a COVID-19 patient and highlights the importance of appropriate investigation of the coronary status by Multidetector Cardiac Computed Tomographic Angiography (MDCCTA) in individuals with asymptomatic left ventricular dysfunction. The presentation …

Development And Validation Of A Electrocardiographic Diagnostic Score Of Heart Failure Among Patients With Hypertension Attending A Tertiary Hospital In Ibadan, Nigeria: The Risk-Hhf Case-Control Study, Ayodipupo Sikiru Oguntade

Journal of the Saudi Heart Association

Objectives: Hypertension is the leading cause of heart failure (HF) in sub-Saharan Africa. Electrocardiography (ECG) is a cheap and easily available stratification tool for the diagnosis and prognostication of individuals with hypertension. The aim of this study was to develop an ECG-based HF diagnostic score among patients with hypertension attending a specialist cardiology clinic.

Methods:One hundred and one (101) case-control age- and sex-matched pairs were recruited. The study population were adults with a clinical diagnosis of hypertensive HF (cases) and hypertension without HF (controls). Participants underwent clinical assessment and ECG. Associations between ECG variables and HF risk were …

Discrete Left Ventricle Outflow Tract Obstruction In Children: Incidence And Predictors Of Recurrence. A Multi-Center Study, Gadah M. Alqurashi, Rema S. Almohanna, Kamal Mk Ayoub, Arwa A. Alkhuraiji, Najla A. Almasoud, Amjad R. Alsubaie, Alaa M. Althubaiti, Abdullah A. Al Sehly

Journal of the Saudi Heart Association

Objectives: The purpose of this study is to measure the incidence of recurrence of discrete subaortic stenosis (DSS) after primary resection in two major cardiac centers in Saudi Arabia and to identify risk factors associated with recurrence.

Methods: Data on 234 patients who were diagnosed with DSS and underwent surgical resection between 1999 and 2018 were retrospectively reviewed. Patient demographics as well as echocardiographic, surgical, and pathological data were compared between patients with recurrence and non-recurrence.

Results: The overall recurrence incidence after primary resection was 44.87% (N=105). Most patients were male (59%). The median age at the …

Associations Between High-Density Lipoprotein Particles And Ischemic Events By Vascular Domain, Sex, And Ethnicity: A Pooled Cohort Analysis, Kavisha Singh, Alvin Chandra, Thomas Sperry, Parag H. Joshi, Amit Khera, Salim S. Virani, Christie M. Ballantyne, James D. Otvos, Robin P F. Dullaart, Eke G. Gruppen

Office of the Provost

Background: High-density lipoprotein (HDL) cholesterol concentration (HDL-C) is an established atheroprotective marker, in particular for coronary artery disease; however, HDL particle concentration (HDL-P) may better predict risk. The associations of HDL-C and HDL-P with ischemic stroke and myocardial infarction (MI) among women and Blacks have not been well studied. We hypothesized that HDL-P would consistently be associated with MI and stroke among women and Blacks compared with HDL-C.
Methods: We analyzed individual-level participant data in a pooled cohort of 4 large population studies without baseline atherosclerotic cardiovascular disease: DHS (Dallas Heart Study; n=2535), ARIC (Atherosclerosis Risk in Communities; n=1595), MESA …

Interstage Home Monitoring For Infants With Single Ventricle Heart Disease: Education And Management: A Scientific Statement From The American Heart Association., Nancy A. Rudd, Nancy S. Ghanayem, Garick D. Hill, Linda M. Lambert, Kathleen A. Mussatto, Jo Ann Nieves, Sarah Robinson, Girish S. Shirali, Michelle M. Steltzer, Karen Uzark, Nancy A. Pike, American Heart Association Council On Cardiovascular And Stroke Nursing; Council On Lifelong Congenital Heart Disease And Heart Health In The Young; Council On Arteriosclerosis, Thrombosis And Vascular Biology; Council On Clinical Cardiology; And Council On Lifestyle And Cardiometabolic Health

Manuscripts, Articles, Book Chapters and Other Papers

This scientific statement summarizes the current state of knowledge related to interstage home monitoring for infants with shunt-dependent single ventricle heart disease. Historically, the interstage period has been defined as the time of discharge from the initial palliative procedure to the time of second stage palliation. High mortality rates during the interstage period led to the implementation of in-home surveillance strategies to detect physiologic changes that may precede hemodynamic decompensation in interstage infants with single ventricle heart disease. Adoption of interstage home monitoring practices has been associated with significantly improved morbidity and mortality. This statement will review in-hospital readiness for …

Understanding Of Metals Dysregulation In Patients With Systolic And Diastolic Dysfunction In Ischemic Heart Disease, Noman Khan, Satwat Hashmi, Amna Jabbar Siddiqui, Sabiha Farooq, Shahid Ahmed Sami, Nageeb Basir, Syeda Saira Bokhari, Hasanat Sharif, Sanaullah Junejo, Hesham R. El-Seedi, Syed Ghulam Musharraf

Department of Biological & Biomedical Sciences

Ischemic heart disease (IHD) is the leading cause of death and chronic disability in the world. IHD affects both the systolic and diastolic function of the heart which progressively leads to heart failure; a structural and functional impairment of filling or ejection of blood from the heart. In this study, the progression of systolic and diastolic dysfunction characterized according to their echocardiographic parameters including left ventricular ejection fraction (EF), grades of diastolic dysfunction and ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e'), were correlated with differential regulation of various metals in patients sera samples (n …

Effect Of Covid-19 Pandemic On The Cardiac Outpatients’ Perception Of Seeking Medical Advice, Sondos Samargandy, Turki A. Al Garni, Abdulrahman Almoghairi, Mohammed Alahmari, Bandar Alshehri, Mohammed Mosaad, Jamal Ahmed, Hussein Alamri, Shaza Samargandy

Journal of the Saudi Heart Association

Background:

During this unprecedented time of COVID-19 pandemic, it was noticed a decline in cardiovascular cases presentation to the Emergency rooms in many countries, raising many speculations about the reasons and its ramifications?

Objectives:

1-Identify the reasons during this pandemic that refrain patients from seeking medical care and its impact on stress level and medication adherence.

2- emphasize the new role of virtual medicine.

Methods:

A quantitative descriptive cross-section survey study of 388 patients. It has been done in the cardiac outpatient department and conducted virtually through telemedicine.

Results:

Despite this pandemic and its consensuses, the majority of cardiac outpatients …

Efficacy And Safety Of Bempedoic Acid For Prevention Of Cardiovascular Events And Diabetes: A Systematic Review And Meta-Analysis., Xing Wang, Yu Zhang, Huiwen Tan, Peng Wang, Xi Zha, Weelic Chong, Liangxue Zhou, Fang Fang

Department of Medicine Faculty Papers

BACKGROUND: Bempedoic acid is an oral, once-daily, first-in-class drug being developed for the treatment of hyperlipidemia. However, evidence of bempedoic acid use for the prevention of cardiovascular events and diabetes is lacking. Thus, we aim to evaluate the benefit and safety of bempedoic acid use for the prevention of cardiovascular events and diabetes.

METHODS: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials with no language restriction from inception until March 3, 2020. Pairs of reviewers independently identified randomized controlled trials comparing the use of bempedoic acid with placebo or no treatment for primary prevention of cardiovascular …

Detection Of Left Ventricular Thrombi On Cardiac Magnetic Resonance Viability Studies, Donya Ahmed Alhassan, Khawaja Bilal Waheed, Muhammad Nasim Sharif, Muhammad Zia Ulhassan, Fazal Ghaffar, Khaled Saleh Saleem, Emad Fouad Mahmoud Said, Bayan Mohammed Altalaq, Zechariah Jebakumar Arulanantham, Ahmad Omar Qarmash

Journal of the Saudi Heart Association

Objective: To highlight detection of left ventricular thrombi on cardiac magnetic resonance (CMR) viability studies.

Method: This retrospective observational study was conducted in the Radiology Department at our Hospital in Dhahran, from April 2015-2019. All recently re-perfused (post-percutaneous coronary intervention/ PCI) patients with ST-segment elevation myocardial infarctions (STEMI), having low ejection fractions (

Results: Of the 125 patients, most were men (71.2%) with a mean age of 56.78 years. Eleven patients had left ventricular thrombi (8.8%), and most of these were anterior wall infarctions with low ejection fractions (

Conclusion: Left ventricular thrombi can be detected on cardiac viability studies …

Optimal Time Repair Of Ventricular Septal Rupture Post Myocardial Infarction, Ibrahim Shafiei, Fatemeh Jannati, Mansour Jannati

Journal of the Saudi Heart Association

Ventricular septal rupture (VSR) is an uncommon complication of myocardial infarction (MI). The mortality rate of VSR is high. The management of VSR is including the stabilization of the hemodynamic status and surgical closure of the rupture. In spite of the agreement of experts on the necessity of surgical repair, the timing of VSR repair management remains unclear. In this review article, we evaluate the optimal time repair of VSR. To collect the data, Pubmed, EMBASE, and Cochrane Central Registry databases were searched for potentially suitable studies. Search terms were including “Ventricular Septal Rupture”, “Myocardial Infarction”, “Timing”, and “MI”. According …