Cardiology Commons^™

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Incidental Coronary Artery Calcification: A Low-Hanging Fruit With Life-Prolonging Potential, Ryan Gardner, Md, Youssef Elfatatry, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

Incidental coronary artery calcium (CAC) seen on ungated computerized tomography (CT) scans obtained for various clinical reasons can serve as an excellent opportunity for screening of patients with previously undiagnosed coronary artery disease (CAD). Despite this, studies have shown that these findings are rarely reported in final impressions of radiology reports.

Project AIM:

To propose the use of a natural language processing (NLP) algorithm to identify incidental CAC noted in radiology reports and an electronic alert to notify primary care clinicians of such findings.

Cardiology Referrals For African-American Basketball Players Falls Below Expectation, Vacha Shah, Blaise O'Malley, Douglas Corsi, Avinash Saraiya, Margaret Doyle, I. Masood, Brian Osler, A. Hajduczok, David Shipon

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• Rates of sudden cardiac death due to hypertrophic cardiomyopathy are higher in male African American basketball players compared with White players (Maron, 2003)
• Male African American NCAA Division I basketball players have the highest incidence of sudden cardiac arrest and death between the ages of 11 and 29 (Peterson, 2020)
• Retrospective analysis of the HeartBytes Registry collected by Simon’s Heart Organization identified multiple risk factors, such as asthma and sickle cell anemia, higher in this population than in the general population
• Increased murmurs and EKG abnormalities such as ST-segment depressions and other nonspecific changes are present in …

Racial Disparities In Transcatheter And Surgical Aortic Valve Replacement, Maggie Doyle, Svenja Schneider, Md, Kashka Mallari, Md, Nicholas Ruggiero, Md, Rebecca Marcantuono, Crnp, Alec Vishnevsky, Md, Yevgeniy Brailovsky, Do

Health Equity and Quality Improvement (HEQI) Summit

Background

• Transcatheter and surgical aortic valve replacement (TAVR, SAVR) is disproportionately distributed across racial and ethnicity groups.^{1, 2}
• Nationally, 87-91% of individuals undergoing AVR are White, despite making up approximately 60% of the US population.^1-4
• Jefferson’s AVR demographic data is consistent with national trends.
• Further studies have found that zip codes associated with lower socioeconomic status (SES) have lower rates of TAVR.⁵
• Although this disparity is widely recognized, there lacks understanding of contributing factors and potential interventions.

Project Aim:

• Investigate additional demographic data of Thomas Jefferson University Hospital (TJUH) patients undergoing TAVR to isolate targets for future …

Importance Of The Assessment Of Left Ventricular Function Following A Diagnosis Of Left Bundle Branch Block, Samuel Dyer, Bs, Benjamin Mass, Bs, Alyson Owen, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Left bundle branch block (LBBB) is a diagnosis often encountered in clinical practice.
• It can be seen as a harbinger of decreased left ventricular function in the future. LBBB has been associated with new onset congestive heart failure (CHF) and death from cardiovascular diseases.¹

Problem Statement

• LBBB in and of itself is given inadequate follow-up and attention by clinicians. Project AIM: bring to light the delay in follow-up after diagnosis of LBBB.

Ventilation Method During Intensive Care Unit Transport After Cardiac Surgeries; When Should We Use A Ventilator?, Francis Anderson, Do, Kent Berg, Md, Marc Torjman, Phd, Yoshihisa Morita, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Manual ventilation with AMBU bag is utilized mostly for transporting post cardiac surgery patients to the intensive care unit, but some patients need mechanical ventilation due to concern for oxygenation, ventilation, and cardiac function.

Also, transport can be a critical moment because of limited hemodynamic information and suboptimal environment for therapeutic intervention.

Thus, risk stratification for appropriate ventilation is necessary for safe transport. •

Project AIM: We assessed biventricular function (with a hand-held echocardiography), arterial blood gas, and hemodynamics pre and post transport in manual and mechanical ventilation groups.

Myxedema Coma-Induced Heart Failure With Reduced Ejection Fraction: Unraveling The Complex Interplay, Mohammad Ali Mozaffari, Batool Shukr, Hafsa Hassan, Khurram Arshad, Antoine Egbe Bessong Tabot, Mariam Jamil, Rajiv John, Adam Hafeez

Conference Presentation Abstracts

Introduction Myxedema coma is a rare condition with a high mortality rate. It poses the risk of cardiovascular complications, typically affects elderly females, and is often triggered by an underlying infection or systemic illness in the setting of preexisting severe hypothyroidism. Patients may exhibit multiorgan dysfunction with altered mentation ranging from disorientation and lethargy to obtundation and coma. Other physical exam findings may include dry scaly skin, non-pitting edema, delayed reflexes, bradycardia, and hypothermia. Prompt diagnosis and early treatment are crucial to reducing mortality rates associated with this severe condition. Case description A 74-year-old female with no known past medical …

Rare Case Of Hemorrhagic Pericardial Effusion Due To Coxsackie B Pericarditis, Nolan Shoukri, Hazem Alakhras, Kateryna Strubchevska, Steven Timmis

Conference Presentation Abstracts

Introduction Acute pericarditis is caused by inflammation of the pericardial sac. Amongst the vast number of potential causes, viruses tend to trigger pericarditis most frequently. Some of the more common viral causes are coxsackie A/B, echovirus, adenovirus, CMV, HSV, and HIV.1-3 Pericarditis often presents with signs and symptoms such as a friction rub, pain relieved with sitting up and leaning forward. ST segment elevations and PR segment depressions are seen on EKG. Laboratory tests showed increased inflammatory markers and WBC count. Pericardial effusion is a common complication and can be visualized on echocardiogram. In some cases, the pericardial effusion can …

Instent Thrombosis 20 Years After Stent Placement, Hussein Gaith, Najeebullah Bangash

Conference Presentation Abstracts

Stent thrombosis is not very common but it is a serious complication of percutaneous coronary intervention (PCI). Here in, we present a case of 55 years old who presented with acute chest pain, was found to have non ST elevation myocardial infarction due to a thrombotic occlusion of prior drug eluting stent placed 20 years ago. A 55 years old male presented to the emergency department with one day history of mid-chest retrosternal pain that started while playing hockey, associated with nausea and diaphoresis. On initial evaluation, vital signs were stable, and patient was afebrile. Cardiac examination was normal with …

An Unexpected Finding During A Breast Excisional Biopsy: A Case Report, Emily Forester, Anjeanette Brown

Rowan-Virtua Research Day

Background: Pacemaker leads within the breast are rare. Although it is infrequent, there are some reports of implanted cardiac devices or wires migrating into breast tissue or through the chest wall. To the best of our knowledge, there are no current reports of pacemaker leads within the breast tissue of a patient with concurrent breast cancer. This case aims to detail the surgical management of this rare phenomenon.

Case Presentation: A pacemaker-dependent, female patient presented to the operating room for a left breast excisional biopsy. Intraoperatively, two epicardial leads were unexpectedly found within the center of the patient’s breast tissue. …

Clinical Outcomes For Va-Ecmo Patients Associated With Hyperlipidemia: An Analysis Of The National Inpatient Sample, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is considered the most advanced temporary life support which provides complete hemodynamic support in addition to gas exchange. There is limited data available on the impact of hyperlipidemia (HLD) on VA-ECMO patients. We sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these patients.

Methods: The NIS was searched for hospitalizations of adult VA-ECMO patients with and without a concomitant diagnosis of HLD for the years 2019 and 2020. The primary outcome was inpatient mortality.

Results:This study included 3,885 VA-ECMO patients, of which 1,082 (27.8%) patients had HLD. …

Outcomes Of Thoracic Endovascular Aortic Repair (Tevar) Procedure In Octogenarians, Nonagenarians And Centenarians: A Population-Based Study, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: Limited data exists for patients undergoing a thoracic endovascular aortic repair (TEVAR) procedure who are older than or equal to 80 years old (YO). This study sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these older patients.

Methods: The NIS was searched for hospitalizations of adults who underwent a TEVAR procedure in 2019 and 2020. The study compared those aged 80 YO and over to those younger than 80 YO. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), and total hospital charges (TOTHCG).

Results: This study included …

Sex Differences In Outcomes Among Patients Undergoing Thoracic Endovascular Aortic Repair (Tevar) Procedure: A Retrospective Cohort Study, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: There is limited data about sex differences in patients undergoing a thoracic endovascular aortic repair (TEVAR) procedure. This study sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes by gender.

Methods: The NIS was searched for hospitalizations of adult patients who underwent TEVAR in 2019 and 2020. For this cohort, female patients were identified, and pregnant patients were excluded. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), and total hospital charges (TOTHCG).

Results: This study included 696 patients who underwent TEVAR. 255 (36.6%) females were identified, of which, 7 …

Effects Of Exercise On The Cardiovascular Health Of Adolescents And Young Adults With Down Syndrome, Samarth Gupta

Rowan-Virtua Research Day

Introduction: It is known that the incidence of Down Syndrome has increased over time and that this condition is associated with congenital heart defects, lower cardiorespiratory capacity, and increased rates of obesity and type 2 diabetes. It has been shown that individuals who have congenital heart defects but not Down Syndrome have increased cardiorespiratory function after engaging in exercise. Unfortunately, the role of exercise in improving cardiovascular health outcomes among individuals with DS is not yet fully understood.

Results: Exercise has been found to improve several health outcomes among individuals with Down Syndrome. For example, moderate to vigorous treadmill exercises …

Brash Syndrome: A Deadly Pentad Of Symptoms, Peter Killian, Adam Kandil

Rowan-Virtua Research Day

Here we present the case of a male in his 70’s who presented with diarrhea and a syncopal episode and was ultimately diagnosed with BRASH syndrome. The acronym BRASH is a novel way to describe the constellation of symptoms that result in unfortunate synergistic affects that can result in profound bradycardia. In the setting of hyperkalemia and concurrent use of atrioventricular nodal blockers, there is potential for a worsening bradycardia and inevitable cardiovascular collapse if not identified.

Case Report: Wellens Syndrome In 28-Year-Old With Pleuritic Chest Pain, Tucker A. Ledo

Rowan-Virtua Research Day

We report a case of a 28-year-old male with months of diffuse, pleuritic, intermittent, non-exertional chest pain. He had an elevated troponin and ECG showing Wellens’ syndrome and was found to have 80% LAD coronary artery occlusion and 100% apical occlusion. Identification and proper management of Wellens’ syndrome relies on being familiar with its ECG patterns. Other information such as age, cardiac risk factors, chest pain with exertion and at rest, and elevated troponin, are all helpful supplemental information, but as demonstrated in the following case report, presentations may vary or even cause as distractors to the diagnosis.

Clinical Outcomes For Cardiac Ablation In Octogenarians, Nonagenarians, And Centenarians: A Retrospective Cohort Study, Tony Elias, Mena Elmalh, Kyrillos Girgis, Michael Valderrama, Rafail Beshai

Rowan-Virtua Research Day

Background

Cardiac ablation is a therapeutic intervention aimed at correcting abnormal heart rhythms by disrupting electrical pathways in the heart, using techniques such as radiofrequency or cryoablation. Despite its effectiveness, there is a scarcity of data regarding the outcomes of cardiac ablation specifically among elderly patients. Previous studies have highlighted the complexities and challenges associated with managing cardiac arrhythmias in the elderly population, emphasizing the need for further investigation into treatment outcomes in this demographic.1,2 Therefore, this study aimed to investigate in-hospital outcomes among elderly patients who underwent cardiac ablation using data from the National Inpatient Sample (NIS) Database.

Methods …

Sex Differences In Outcomes Among Patients Who Underwent Cardiac Ablation: A Retrospective Cohort Study, Tony Elias, Mena Elmalh, Kyrillos Girgis, Taha Syed, Rafail Beshai

Rowan-Virtua Research Day

Background Cardiac ablation, encompassing radiofrequency and cryoablation modalities, is a therapeutic intervention targeting abnormal heart rhythms by disrupting electrical pathways within the heart. Despite its widespread use, research focusing on sex-specific outcomes among patients undergoing cardiac ablation remains limited. Understanding potential sex differences in treatment response and outcomes is crucial for optimizing patient care and outcomes.1,2 Therefore, this retrospective cohort study aimed to analyze the national inpatient sample database to assess in-hospital outcomes among patients undergoing cardiac ablation, specifically focusing on sex disparities.

Methods Data from the National Inpatient Sample (NIS) Database for the years 2019 and 2020 were utilized …

National Inpatient Sample Analysis: Examining Clinical Outcomes In Cardiac Ablation Patients With Hyperlipidemia, Tony Elias, Mena Elmalh, Kyrillos Girgis, Taha Syed, Rafail Beshai

Rowan-Virtua Research Day

Background Cardiac ablation, utilizing radiofrequency or cryoablation, is a therapeutic approach for correcting abnormal heart rhythms by disrupting specific electrical pathways within the heart. Despite the growing utilization of cardiac ablation, limited research exists on the impact of hyperlipidemia, a prevalent cardiovascular risk factor, on outcomes in patients undergoing this procedure. Previous studies underscore the importance of understanding how comorbid conditions, such as hyperlipidemia, influence the efficacy and safety of cardiac ablation.1,2 Consequently, this study aimed to leverage the national inpatient sample database to investigate in-hospital outcomes among cardiac ablation patients with hyperlipidemia.

Methods Data from the National Inpatient Sample …

Use Of Point-Of-Care Ultrasound In The Diagnosis Of Postpartum Cardiomyopathy, Muhammad Noman, Frank A. Wheeler, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Postpartum cardiomyopathy (PPCM), also known as peripartum cardiomyopathy is a rare form of heart failure (HF) that occurs in the late stages of pregnancy or in the early postpartum period. For it to be classified as PPCM, it must occur in the absence of another identifiable cause for HF and have left ventricular (LV) systolic dysfunction with an LV ejection fraction (LVEF) less than 45%. Here we present the case of a 46-year-old female G3P2 presented 5 days postpartum cesarean section delivery in acute respiratory distress where point of care ultrasound was used for assessment of the lungs to visualize …