Cardiology Commons^™

A Heart Full Of Nails: Complex Management Of Multiple Nail Gun Cardiac Injuries, Shaun Abid Md, Stuart Zarich

Posters

A 54-year-old male presented after a suicide attempt, suffering severe cardiac and extracardiac injuries from firing a nail gun into both temples (Figure 1A) and his chest. Imaging showed six 5cm nails embedded in his heart: two in the left ventricle, two in the right ventricle, one traversing the ascending aorta into the left atrium, and one entering the right ventricle from the left parasternal chest wall (Figure 1B, C, D). These injuries resulted in hemorrhagic pericardial effusion with tamponade, acute aortic regurgitation, mitral valve/pulmonary artery perforations, and a ventricular septal defect.

When The Farm Turns Fatal: A Rare Infection Causing Heart Block, Shaun Abid Md, Anton Stolear, Sumedh Iyengar, Yussif Issaka Md, Vanessa Agberien Md, Stuart Zarich

Posters

Brucellosis, a zoonotic bacterial infection caused by Brucella species, is typically acquired through contact with infected livestock or consumption of unpasteurized dairy products. It can manifest with various systemic symptoms but is rarely associated with cardiac complications, particularly conduction disturbances such as heart block. When brucellosis does affect the heart, it may result in endocarditis, myocarditis, or, more infrequently, conduction abnormalities. This report describes an unusual case of brucellosis-induced complete heart block in an elderly woman who recently returned from a farm in Colombia, a region where brucellosis is endemic.

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.

Predictors Of Incidence Of Candida Endocarditis In Patients With Candidemia: Insights From The National Inpatient Sample (2016-2020, Didien Meyahnwi Md, Tawanda Zinyandu, Ashraf Ahmed, Isaac Opoku Md

Posters

This study identifies critical predictors of CE incidence in patients with candidemia, including IV drug use, male gender, and the presence of prosthetic devices. These findings highlight the importance of targeted surveillance and management strategies in vulnerable populations.

A Rising Threat: Epidemiologic Trends In Incidence, Mortality, And Cost Of Candida Endocarditis In The United States, Didien Meyahnwi Md, Ashraf Ahmed, Tawanda Zinyandu, Isaac Opoku Md

Posters

Candida Endocarditis (CE) is a rare yet critical form of infective endocarditis (IE), accounting for approximately 1% of all IE cases. In light of the evolving epidemiology of candidemia, this study aims to elucidate any associated shifts in the epidemiology of CE within the United States.

Dual Circulatory Support With Ecmo And Mcs Devices Is Associated With Shorter Hospital Stay Without Compromising Heart Transplant Survival, Tawanda Zinyandu, Abhinav Aggarwal, Ashraf Ahmed, Isaac Opoku Md, Didien Meyahnwi Md, Yussuf Isaka Md, Stuart Zarich, Carlos Davila

Posters

• ECMO is commonly used as a bridge to heart transplantation in critically ill patients.
• Additional MCS devices (e.g., Impella, IABP) may be used alongside ECMO to enhance cardiac output.
• The effect of dual circulatory support vs. ECMO alone on post-transplant survival is unclear especially after 2018, when the heart allocation system was revised to reduce waitlist times for MCS patients.

Importance Of Recognizing Hypertrophic Cardiomyopathy In The Preoperative Clinic., Anne Mcrae Botti, Edward Bope, Charles Botti, Marc Brower, Akira Wada, Meredith Arensman

Heart and Vascular Articles

BACKGROUND: Hypertrophic cardiomyopathy is a relatively common inherited disorder that may be asymptomatic. It is a common cause of sudden cardiac death and can lead to catastrophic cardiovascular collapse in the operating room if previously undiagnosed. This case report discusses the implications of unsuspected hypertrophic cardiomyopathy for anesthesia management.

CASE PRESENTATION: A veteran aged 55 years presented to the preadmission testing clinic prior to undergoing outpatient surveillance colonoscopy under anesthesia. His initial medical history was unremarkable. On physical examination, a murmur with benign characteristics was detected. However, further evaluation with echocardiography, revealed severe hypertrophic obstructive cardiomyopathy. The patient was ultimately …

Factors Associated With Shock At Presentation In Kawasaki Disease Versus Multisystem Inflammatory Syndrome In Children Associated With Covid-19., Supriya S. Jain, Ashraf S. Harahsheh, Simon Lee, Geetha Raghuveer, Nagib Dahdah, Michael Khoury, Michael A. Portman, Melissa Wehrmann, Arash A. Sabati, Marianna Fabi, Deepika Thacker, Nilanjana Misra, Mark D. Hicar, Nadine F. Choueiter, Matthew D. Elias, Audrey Dionne, William B. Orr, Jacqueline R. Szmuszkovicz, Seda Selamet Tierney, Luis Martin Garrido-Garcia, Frederic Dallaire, Balasubramanian Sundaram, Deepa Prasad, Tyler H. Harris, Elizabeth Braunlin, Elisa Fernandez Cooke, Cedric Manlhiot, Pedrom Farid, Brian W. Mccrindle, International Kawasaki Disease Registry

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: While clinical overlap between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) has been evident, information regarding those presenting with shock has been limited. We sought to determine associations with shock within and between diagnosis groups.

METHODS: The International KD Registry enrolled contemporaneous patients with either KD or MIS-C from 39 sites in 7 countries from January 1, 2020, to January 1, 2023. Demographics, clinical features and presentation, management, laboratory values, and outcomes were compared between the diagnosis and shock groups.

RESULTS: Shock at presentation was noted for 19 of 672 KD patients (2.8%) and 653 of …

Practices In Single Ventricle Repairs: Insights From Computational Fluid Dynamics On Cavopulmonary Connections – A Scoping Review, Olivia K. Osuch

Student Works

Abstract: Single-ventricle congenital heart defects require complex surgical strategies, with computation fluid dynamics (CFD) playing a growing role in optimizing cavopulmonary connections. This scoping review examines CFD-derived insights into power loss, hepatic flow distribution (HFD), and wall shear stress (WSS) across different Fontan geometries.

Methods: A search of available peer-reviewed literature (1995-2024) identified studies using CFD models to analyze hemodynamic performance in second and third-stage single-ventricle repairs. Studies were categorized based on surgical stage, anatomical variations, modeling assumptions, and key outcomes such as power loss, HFD, and WSS.

Results: Of 30 included studies, 28 analyzed power loss, 24 evaluated HFD, …

Left Ventricular And Aortic Pressures Measured With Fluid-Filled And Solid-State Pressure Catheters: Similarities And Differences, Priscilla Machado, Ira Cohen, Brian Osler, Maureen E. Mcdonald, Cara Esposito, Marguerite Davis, David Fischman, Michael P. Savage, Praveen Mehrotra, Flemming Forsberg, Jaydev K. Dave

Division of Cardiology Faculty Papers

Objective: To compare left ventricular (LV) and aortic (AO) pressures obtained using fluid-filled and high-fidelity solid-state pressure catheters in subjects undergoing left heart catheterization.

Materials and Methods: Twenty subjects scheduled for a left heart catheterization were enrolled and 18 subjects completed this IRB-approved study. LV and AO pressures were obtained using fluid-filled pressure catheter (standard-of-care) and high-fidelity solid-state pressure catheter synchronously. Pressure tracings were analyzed to measure LV systolic (LVSP), LV minimum-diastolic (LVMDP), LV end-diastolic (LVEDP), AO systolic (AOSP), and AO diastolic (AODP) pressures. Isovolumic contraction and relaxation rates (peak ± dp/dt) were derived from the pressure waveforms. Repeated measures …

The Future Direction Of Post-Transcatheter Aortic Valve Replacement Reinterventions: Insights From The Transcatheter Valve Therapy Registry, Edward Percy, Joseph E. Bavaria

Division of Cardiology Faculty Papers

No abstract provided.

"The Role Of Venous Excess Ultrasound Score In Optimizing Acute Heart Failure Diagnosis And Prognosis, Saoussen Antit, Sarra Romdhane, Imen Mtiri, Lilia Zakhama

Journal of the Saudi Heart Association

Acute heart failure (AHF) is a critical condition with significant morbidity and mortality, necessitating timely and accurate diagnosis for effective management.

The Venous Excess Ultrasound (VExUS) score has emerged as a non-invasive diagnostic tool, aimed at evaluating venous congestion through ultrasound. This scoring system integrates assessments of the inferior vena cava, hepatic veins, portal veins, and renal venous flow to quantify congestion severity. By providing a real-time assessment of venous pressure, the VExUS score has shown potential in optimizing early diagnosis of AHF and predicting outcomes and overall prognosis.

Recent studies suggest that incorporating the VExUS score into clinical practice …

Predictors Of Outcomes In Pediatric Pulmonary Arterial Hypertension, Aditya Doni Pradana

Journal of the Saudi Heart Association

There is no abstract for this article type.

Rare Damaging Ccr2 Variants Are Associated With Lower Lifetime Cardiovascular Risk, Marios K Georgakis, Rainer Malik, Omar El Bounkari, Natalie R Hasbani, Jiang Li, Jennifer E Huffman, Gabrielle Shakt, Reinier W P Tack, Tamara N Kimball, Yaw Asare, Alanna C Morrison, Noah L Tsao, Renae Judy, Braxton D Mitchell, Huichun Xu, May E Montasser, Ron Do, Eimear E Kenny, Ruth J F Loos, James G Terry, John Jeffrey Carr, Joshua C Bis, Bruce M Psaty, W T Longstreth, Kendra A Young, Sharon M Lutz, Michael H Cho, Jai Broome, Alyna T Khan, Fei Fei Wang, Nancy Heard-Costa, Sudha Seshadri, Ramachandran S Vasan, Nicholette D Palmer, Barry I Freedman, Donald W Bowden, Lisa R Yanek, Brian G Kral, Lewis C Becker, Patricia A Peyser, Lawrence F Bielak, Farah Ammous, April P Carson, Michael E Hall, Laura M Raffield, Stephen S Rich, Wendy S Post, Russel P Tracy, Kent D Taylor, Xiuqing Guo, Michael C Mahaney, Joanne E Curran, John Blangero, Shoa L Clarke, Jeffrey W Haessler, Yao Hu, Themistocles L Assimes, Charles Kooperberg, Jürgen Bernhagen, Christopher D Anderson, Scott M Damrauer, Ramin Zand, Jerome I Rotter, Paul S De Vries, Martin Dichgans

Faculty, Staff and Student Publications

BACKGROUND: Previous work has shown a role of CCL2, a key chemokine governing monocyte trafficking, in atherosclerosis. However, it remains unknown whether targeting CCR2, the cognate receptor of CCL2, provides protection against human atherosclerotic cardiovascular disease.

METHODS: Computationally predicted damaging or loss-of-function (REVEL > 0.5) variants within CCR2 were detected in whole-exome-sequencing data from 454,775 UK Biobank participants and tested for association with cardiovascular endpoints in gene-burden tests. Given the key role of CCR2 in monocyte mobilization, variants associated with lower monocyte count were prioritized for experimental validation. The response to CCL2 of human cells transfected with these variants was tested …

A Saudi Heart Association Position Statement On The Use Of Doacs In Patients With Arterial And Venous Thrombosis, Waleed Alhabeeb, Adel Tash, Ahmed Aljedai, Ayman Morsy, Feras Khaliel, Iman Alhazmi, Mohammed Alsheef, Mohammed Arafah, Owayed Alshammeri, Saeed Alahmari

Journal of the Saudi Heart Association

Background: Direct oral anticoagulants (DOACs) have emerged as non-inferior and effective alternatives to traditional anticoagulants in managing thromboembolic risks associated with various cardiovascular conditions. This position statement by the Saudi Heart Association (SHA) aims to provide guidance on the use of DOACs in the context of cardiovascular disease, particularly patients with arterial and venous thrombosis.

Methods: A multidisciplinary panel of experts reviewed current evidence and international guidelines on DOACs, considering the local healthcare context in Saudi Arabia. The statement addresses the initiation, maintenance, interruption, and re-initiation of DOAC therapy across different patient populations.

Results: DOACs are effective alternatives to traditional …

Characterization Of Novel Arrhythmogenic Patterns Arising Secondary To Heterogeneous Expression And Activation Of Nav1.8, Zhong-He Zhang, Hector Barajas-Martinez, Hong-Yi Duan, Guo-Hua Fan, Hong Jiang, Charles Antzelevitch, Hao Xia, Dan Hu

Department of Medicine Faculty Papers

Background: Previous studies suggested that SCN10A/Nav1.8 may influence cardiac electrophysiology and the susceptibility to cardiac arrhythmias. Notably, the expression of SCN10A is not uniform, showing variable expression in each cardiac chamber. The present study aims to explore the functional significance of Nav1.8 expression among different cell types present in the ventricular myocardium.

Methods: The effect of the specific Nav1.8 blocker, A-803467, on action potential was recorded from epicardial, mid-myocardial (M cells) and Purkinje tissue slices isolated from the canine left ventricle using standard microelectrode techniques and on late sodium current from Purkinje cells using patch-clamp techniques.

Results: A-803467 treatment …

Two-Dimensional Speckle Tracking Of The Ascending Aorta: A Novel Approach To Evaluate Arterial Stiffness In Pediatric Patients With Repaired Conotruncal Anomalies Using Echocardiography., Anmol Goyal, Anitha Parthiban, David A. White, Daniel Forsha, Doaa Aly

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Children with repaired conotruncal abnormalities (CTA) are at risk of progressive aortic dilation and deteriorating aortic elasticity even after surgical correction. Strain imaging, using a 2-dimensional speckle tracking echocardiography (2D-STE), has been used for arterial stiffness assessment, but pediatric data are still lacking. We investigated the feasibility, reproducibility, and clinical value of 2D-STE derived ascending aorta (AAo) stiffness in children with repaired CTA.

METHODS: 22 pediatric patients with repaired CTA were included along with 25 age- and sex- matched healthy controls (mean age 10.2 ± 4.5 years). Conventional 2D echocardiographic and 2D-STE assessment of AAo mechanics was performed. M-mode …

Perceptions Of Cardiac Surgeons Regarding The Integration Of Artificial Intelligence In Cardiac Surgery, Nada Alguizzani, Fareed Khouqeer, Rasha Alorini, Imtenan Oberi

Journal of the Saudi Heart Association

Background: After the surge of artificial intelligence in late 2022, researchers started exploring the idea of using artificial intelligence in the medical field. Considering the endless possibilities of artificial intelligence, there is still some hesitation toward its use in the medical field. This study aims to explore the attitudes of cardiac surgeons toward involving artificial intelligence in diagnosing cardiac conditions and planning cardiac operations.

Methodology: This study surveyed cardiac surgeons on AI integration in their field using a cross-sectional design and purposive sampling. Data were collected via a structured questionnaire and analyzed in IBM SPSS 29.0.

Results: Our study included …

Using Ehr Reminders To Control Hypertension, Umme Kulsoom Ghous, Logan Mcculley, Danielle C. Hall, Linda Katherine Lambert, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

Hypertension is a significant risk factor for cardiovascular and kidney diseases but is often under-diagnosed and poorly managed. Electronic Health Records (EHR) can help by providing automated reminders to recheck elevated blood pressure (BP) readings, ensuring accurate measurements, and guiding clinical interventions. This study aims to determine if EHR-based reminders improve BP control in adult patients aged 21 and older, focusing on hypertension diagnosis accuracy and timely management.

Methods

After a literature review, the study took place in a primary care clinic and only included patients with an existing diagnosis of hypertension. Thirty patients were included in the study. …

Appropriate International Normalized Ratio Follow-Up Interval In Patients With Atrial Fibrillation Taking Warfarin, Komsing Methavigul, Jirayu Sutasanasuang

Chulalongkorn Medical Journal

Background: The international normalized ratio (INR) is recommended to be followed up every four-week intervals in patients with atrial fibrillation (AF) taking warfarin. However, data about the appropriate INR follow-up interval are lacking in those patients.

Objective: We aimed to investigate the appropriate INR follow-up intervals in AF patients receiving warfarin between 6-week and 12-week intervals of follow-up appointments.

Methods: We retrospectively enrolled patients with AF taking warfarin at the Central Chest Institute of Thailand between January 2017 to May 2023. The primary outcome was time in therapeutic range (TTR) in each group of follow-up interval and secondary outcome …