SciFed journal of cardiology最新文献

{"title":"New Onset Right Bundle Branch Block In Acute Coronary Syndrome and High-Grade Stenosis: A Case Series.","authors":"Shakil Shaikh,&nbsp;Mohammed Al-Sadawi,&nbsp;Muhammad U Dogar,&nbsp;Erdal Cavusoglu,&nbsp;Sudhanva Hegde,&nbsp;Louis Salciccioli,&nbsp;Molly Piccione,&nbsp;Christian Abrahim,&nbsp;Mena Yacoub,&nbsp;Debora Ponce,&nbsp;Samy I McFarlane","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite advances in diagnostic and therapeutic interventions, coronary heart disease remains as one of the leading causes of death in developed countries. ST-segment elevation myocardial infarction is associated with the highest mortality and is an indication for emergent reperfusion therapy. Current guidelines for emergent reperfusion not only include ST segment elevations but also consider evidence of a new onset Left Bundle Branch Block (LBBB). However, accumulating evidence indicates that RBBB is also associated with poor outcome in coronary artery disease. To-date, guidelines do not comment on the urgency of reperfusion therapy with sole evidence of a new onset Right Bundle Branch Block (RBBB). Particularly we question whether clinicians should focus on new-onset RBBB as a ST-segment elevation equivalent. If so, appropriate management of patients with the new onset RBBB during cardiac ischemia can have a significant impact on cardiac function and outcomes. In this series, we present four cases of new-onset acute RBBB associated with chest pain in the setting of acute myocardial infarction with critical lesions of the left anterior descending artery. We also highlight the need to consider new RBBB as an additional indication for acute reperfusion therapy in acute myocardial infarction. This will call for revision in the current guidelines by American Heart Association following the initiative recently implemented by the European Society of Cardiology 2018.</p>","PeriodicalId":74775,"journal":{"name":"SciFed journal of cardiology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Group B Streptococcal Tricuspid Endocarditis: Case Report and Systematic Review.","authors":"Perry Wengrofsky,&nbsp;Ghassan Mubarak,&nbsp;Nabila Khondakar,&nbsp;Syed Haseeb,&nbsp;David Landman,&nbsp;Suzette Graham-Hill,&nbsp;Angelina Zhyvotovska,&nbsp;Samy I McFarlane","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Infective Endocarditis (IE), the microbial infection of the endocardial surface, is categorized by anatomy, microbiology, and valve nativity. Infective endocarditis generally affects older adults, and more commonly presents as a Left-sided IE (LSIE) affecting the mitral or aortic valves. Right-sided IE (RSIE) typically affects younger patients with less pre-existing valvular disease. RSIE is also more commonly associated with intravenous drug use (IVDU) and intra-cardiac instrumentation, such as pacemakers or defibrillators. While <i>Staphylococcus aureus</i> is the most common microorganism responsible for both LSIE and RSIE, <i>Streptococcos agalactiae,</i> or Group B Streptococcus (GBS), accounts for a very small percentage of IE, and, in such instances, rates of tricuspid endocarditis are dramatically lower than LSIE. GBS endocarditis usually affects patients with particular comorbidites, such as diabetes mellitus (DM) and cirrhosis. We present a case of GBS tricuspid endocarditis in a female patient without the typical risk factors for GBS endocarditis. We also present a systematic review of case reports and case series of GBS tricuspid endocarditis highlighting the risk factors, presentation and clinical characteristics, as well as up-to-date outcomes, and mortality rates of GBS endocarditis, a potentially fatal disease entity.</p>","PeriodicalId":74775,"journal":{"name":"SciFed journal of cardiology","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10541022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial Infarction after Snakebite Envenomation: A Scoping Study.","authors":"Pramod Theetha Kariyanna,&nbsp;Apoorva Jayarangaiah,&nbsp;Haroon Kamran,&nbsp;Joshua Schechter,&nbsp;Stanley Soroka,&nbsp;Abhimanyu Amarnani,&nbsp;Justina Ray,&nbsp;Mena Yacoub,&nbsp;Michael Post,&nbsp;Sama Al-Bayati,&nbsp;Samy I McFarlane","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite underreporting and \"dry\" bites (bites by venomous snakes without envenoming), snake envenomation is a cause of high morbidity and mortality in the suburban and rural areas of tropical and subtropical world. In addition to local effects at the site of the bite, envenomation affects almost all the tissues in the body both primarily or secondarily. Envenomation is known to cause cardiotoxicity. Multiple case reports of myocardial infarction (MI) following snake bites have been reported. We hereby present the first systematic review of such cases. Our review revealed that MI following envenomation is mostly reported in young adult males from tropical and subtropical world with no history of coronary artery risk factors. Most of the cases presented 60 minutes after the bite. Among the cases that reported electrocardiography (EKG) findings, 63% had ST-segment elevation. 88% of the cases had elevated troponin levels. 75% of the reported echocardiograms had wall motion abnormality. All patients who had emergent coronary angiography were noted to have a \"culprit\" vessel. 25% of the cases suffered cardiac arrest and 25% subsequently passed away. The pathophysiology of MI following envenomation is multifactorial. When MI is suspected, coronary angiography should be considered after hemodynamic stability and anti-venom therapy is ensued.</p>","PeriodicalId":74775,"journal":{"name":"SciFed journal of cardiology","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammation beyond the Joints: Rheumatoid Arthritis and Cardiovascular Disease.","authors":"Arielle Urman,&nbsp;Nicholas Taklalsingh,&nbsp;Cristina Sorrento,&nbsp;Isabel M McFarlane","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Rheumatoid Arthritis (RA), a chronic systemic inflammatory disease which affects approximately 1% of the population, is classically characterized by inflammation and synovitis that leads to cartilage damage and juxta-articular bone destruction. Accumulating evidence indicates that a major cause of death among RA patients is Cardio Vascular Disease (CVD), in excess of that in the general population. In this review, we discuss the epidemiology of CVD in RA populations, the underlying pathophysiologic mechanisms of CVD in RA including the role of chronic inflammation in driving accelerated atherosclerosis, the obesity paradox and altered metabolic pathways leading to pro-inflammatory HDL formation and insulin resistance. We also discuss the pitfalls in the evaluation of CVD utilizing traditional risk scores which tend to underestimate CVD risk in RA population and the efforts directed to find more accurate predictors for early CVD detection. Finally, we will present the latest developments in the evaluation and management of CVD in RA patients, given recent evidence on the role of inflammation and its impact on CVD.</p>","PeriodicalId":74775,"journal":{"name":"SciFed journal of cardiology","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9090215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Air Embolism During Coronary Angiography : A Systematic Review.","authors":"Pramod Theetha Kariyanna,&nbsp;Amog Jayarangaiah,&nbsp;Apoorva Jayarangaiah,&nbsp;Sudhanva Hegde,&nbsp;Jonathan D Marmur,&nbsp;Syed Haseeb,&nbsp;Teresa Song,&nbsp;Navneet Singh,&nbsp;Samy I McFarlane","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Coronary air embolism (CARE) is a rare complication during transluminal coronary angiography or angioplasty and is almost always iatrogenic. CARE can cause significant morbidity and mortality as shown in animal studies. CARE is known to cause acute chest pain, hypotension, bradycardia, ST-segment elevation myocardial infarction (STEMI), and death. Multiple isolated case reports of CARE have been reported. We here present a systematic review of cases of CARE during transluminal coronary angiography or angioplasty. Multiple databases were searched to identify cases, the cases were thoroughly read and findings were tabulated. Our analysis revealed that CARE most often resulted in chest pain or loss of consciousness. Most of the patients developed bradycardia and hypotension. STEMI was the most common electrocardiography (EKG) finding and discrete vessel cut off was the most common angiographic finding. Coronary angiography technique including avoidance of air in the angiogram equipments by education of physicians and paramedical staff new to coronary angiography or angioplasty plays a vital role in prevention of CARE. Physicians should be aware of CARE as one of the cause of chest pain, hypotension, bradycardia, STEMI and arrhythmias during transluminal coronary angiography or angioplasty.</p>","PeriodicalId":74775,"journal":{"name":"SciFed journal of cardiology","volume":"2 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9100378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Takotsubo Cardiomyopathy and Chronic Kidney Disease: A Scoping Study.","authors":"Pramod Theetha Kariyanna,&nbsp;Panid Borhanjoo,&nbsp;Apoorva Jayarangaiah,&nbsp;Syed Haseeb,&nbsp;Aarti Shenoy,&nbsp;Sudhanva Hegde,&nbsp;Adam Budzikowski,&nbsp;Prabash Koneru,&nbsp;Rodaina Ahmed,&nbsp;Samy I McFarlane","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sympathetic nervous system hyperactivity and elevated catecholamine levels are known features of chronic kidney disease (CKD). On the other hand, CKD itself is a high risk for Cardiovascular disease (CVD) and in fact most patients with CKD die before reaching dialysis. Furthermore, Many CKD risk factors such as obesity, hypertension, diabetes are also associated with sympathetic hyperactivity. Sympathetic hyperactivity and elevated catecholamine levels also play a key role in the pathogenesis of takotsubo cardiomyopathy (TKCM). Owing to the high sympathetic tone and elevated catecholamine levels in CKD/ESRD patients, an acute stress such as infection/sepsis or surgery makes these patients highly susceptible to TKCM. Multiple isolated case reports of TKCM in CKD/ESRD patients have been reported. We here present the first scoping study of such cases. The purpose of this review is to identify the characteristic features of ESRD/CKD who developed TKCM. Analysis of 30 cases of TKCM in CKD/ESRD primarily happens in women (87% of the cases) with a mean age of 64 ± 13 yrs (Median 63 yrs). Dyspnea (60%) was most presenting complaint, followed by chest pain (37%), fatigue (10%), lower limb edema (3%), seizures (3%) and confusion (3%). The majority of TKCM was noted after exposure to an acute physiological or psychological stressor. Physicians should have a high clinical suspicion for TKCM amongst other differential diagnosis in CKD/ESRD patients who present with chest pain or dyspnea in the setting of acute physiological or psychological stressor.</p>","PeriodicalId":74775,"journal":{"name":"SciFed journal of cardiology","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10534509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabis and Myocardial Infarction: Risk Factors and Pathogenetic Insights.","authors":"Justin Lee,&nbsp;Navneet Sharma,&nbsp;Farnam Kazi,&nbsp;Irini Youssef,&nbsp;Alyson Myers,&nbsp;Jonathan D Marmur,&nbsp;Moro O Salifu,&nbsp;Samy I McFarlane","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cannabis use in the US is rising with increased legalization. It has been noted that there is a five-fold increase risk of Myocardial Infarctions (MI) in the first hour after cannabis use. Traditional risk factors for MI include diabetes, hypertension and dyslipidemia. The rising use of cannabis may have ushered in an additional MI risk factor to be added to the list; that is cannabis. In this review, we discuss the growing use of cannabis and potential link with MI, highlighting the common pathogenic hypotheses linking these risk factors.</p>","PeriodicalId":74775,"journal":{"name":"SciFed journal of cardiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36553649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Angiographic Findings of Acute Myocardial Infarction Associated With Marijuana Use: Consecutive Case Series.","authors":"Navneet Sharma,&nbsp;Justin Lee,&nbsp;Carla Saladini Aponte,&nbsp;Jonathan D Marmur,&nbsp;William E Lawson,&nbsp;Noelle N Mann,&nbsp;Moro O Salifu,&nbsp;Irini Youssef,&nbsp;Samy I McFarlane","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Marijuana use has been increasingly legalized in the United States resulting in substantial rise in the number of users especially in the younger populations. While our group and others had described various metabolic effects of this drug, little is known about its association with acute myocardial infarction.</p><p><strong>Objective: </strong>To present a series of 8 patients with 10 events of ST-elevation MI (STEMI) associated with marijuana use; highlighting their demographic, clinical presentation, laboratory results and angiographic characteristics.</p><p><strong>Methods: </strong>Retrospective chart review of patients with STEMI presenting to our inner city hospital Coronary Care Unit over a period of 4 years (December 2013-April 2017).</p><p><strong>Results: </strong>Of the 10 case subjects studied who presented with chest pain, EKG evidence of STEMI with cannabis use, mean age at presentation was 40.1 ± 9.7 (years) SD, ranging from 26 to 59 years old. There were 9 males and one female, of them, 8 were Black, 2 Hispanic and 1 White. Of the 10 cases, 3 (30%) had no known cardiovascular disease (CVD) risk factors (RF) on admission, 1 patient had 3 RF, 4 patients had 2 RF and 2 had 1 CVD RF, which included age, diabetes mellitus type 2 (DM2), hypertension, dyslipidemia, smoking, and family history of premature coronary heart disease. Troponin I (cTnI) peak mean level was 93.5 ± 34.35 ng/ml, range 7.86 - 358.0 ng/ml. All patients had angiographic evidence of obstructive coronary angiography.</p><p><strong>Conclusion: </strong>In our study, marijuana use is associated with ST-elevation MI in largely minority population, occurring at a relatively younger age with half of the cases either low risk or CVD risk free. Additional studies are needed to further characterize this population given the increase in marijuana use.</p>","PeriodicalId":74775,"journal":{"name":"SciFed journal of cardiology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/a2/nihms968552.PMC6178223.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36586046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Angiographic Findings of Myocardial Infarction among Marijuana Users and Non-Users.","authors":"Justin Lee,&nbsp;Navneet Sharma,&nbsp;Carla Saladini Aponte,&nbsp;Seyed Zaidi,&nbsp;Daniel Fung,&nbsp;Jonathan D Marmur,&nbsp;Moro Salifu,&nbsp;Alyson Myers,&nbsp;William E Lawson,&nbsp;Noelle N Mann,&nbsp;Samy I McFarlane","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Marijuana use has been increasingly legalized in the United States resulting in substantial rise in the number of users especially in the younger populations. While our group and others had described various metabolic effects of this drug, little is known about its association with acute myocardial infarction (AMI).</p><p><strong>Objective: </strong>This follow up study presents contemporaneous cohort of non-THC user patients at a single, urban center hospital diagnosed with ST-elevation AMI; highlighting and comparing demographic, clinical, laboratory and angiographic characteristics based on exposure to THC at time of presentation.</p><p><strong>Methods: </strong>Retrospective chart review of patients with ST-elevation AMI presenting to our inner city hospital Coronary Care Unit over a period of 4 years (December 2013-April 2017).</p><p><strong>Results: </strong>Of the 10 case subjects studied whom presented with chest pain, EKG evidence of ST-elevation MI (STEMI) with cannabis use, mean age at presentation was 40 years old, which was 10 years younger than our control group with no marijuana use (n = 11, p = 0.107). Of the patients who had marijuana exposure upon admission, 3 (30%) had no known cardiovascular disease (CVD) risk factors (RF) on admission, 1 patient had 3 RF, 4 patients had 2 RF and 2 had 1 CVD risk factor, which included age, diabetes mellitus type 2 (DM2), hypertension, dyslipidemia, smoking status, and family history at time of triage. Patients who were negative for marijuana use had higher number of CVD risk factors present upon admission. ASCVD risk scores were 10% vs. 16% (p = 0.312). In angiographic findings, 100% of the marijuana users had 1 vessel disease compared with 55% in the non-users (p = 0.0351). Severity of stenosis for both groups was averaged at 93% for non-users vs 95% in THC users (p = 0.62414). Collateral vessels were visible during coronary arteriogram in 91% of non-THC users and in only 20% of THC users (p = 0.0019). Furthermore, non-users had 35% higher rate of Rentrop grade 1 collaterals (55% vs. 20%, p = 0.4872). Similar difference was shown in grade 2 collaterals between the two groups with non-users having 36% higher rate (36% vs. 0%, p = 0.0902). Amongst the patients who had collateral circulation present at the time of angiography (Rentrop grade >0), good collaterals (Rentrop grade 2 or 3) were present in 40% of non-THC users, while there was 0% presence of grade 2+ collaterals in THC users (p = 0.5152).</p><p><strong>Conclusion: </strong>In our study, marijuana use is associated with ST-elevation MI in largely minority population, occurring at a relatively younger age with half of the cases CVD risk free. Additional studies are needed to further characterize this population given the increase in marijuana use.</p>","PeriodicalId":74775,"journal":{"name":"SciFed journal of cardiology","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36128071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}