Pub Date : 2022-01-01Epub Date: 2022-08-24DOI: 10.26502/fccm.92920284
Finosh G Thankam, Mohamed Radwan, Angelo Keklikian, Manreet Atwal, Taj Rai, Devendra K Agrawal
Background: Despite the recent advancements in the cardiac regenerative technologies, the lack of an ideal translationally relevant experimental model simulating the clinical setting of acute myocardial infarction (MI) hurdles the success of cardiac regenerative strategies.
Methods: We developed a modified minimally invasive acute MI model in Yucatan miniswine by catheter-driven controlled occlusion of LCX branches for regenerative cardiology. Using a balloon catheter in three pigs, the angiography guided occlusion of LCX for 10-15 minutes resulted in MI induction which was confirmed by the pathological ECG changes compared to the baseline control.
Results: Ejection fraction was considerably decreased post-procedure compared to the baseline. Importantly, the highly sensitive MI biomarker Troponin I was significantly increased in post-MI and follow-up groups along with LDH and CCK than the baseline control. The postmortem infarct zone tissue displayed the classical features of MI including ECM disorganization, hypertrophy, inflammation, and angiogenesis confirming the MI at the tissue level.
Conclusions: The present model possesses the advantage of minimal mortality, simulating the pathological features of clinical MI and the suitability for injectable regenerative therapies suggesting the translational significance in regenerative cardiology.
{"title":"Fluoroscopy Guided Minimally Invasive Swine Model of Myocardial Infarction by Left Coronary Artery Occlusion for Regenerative Cardiology.","authors":"Finosh G Thankam, Mohamed Radwan, Angelo Keklikian, Manreet Atwal, Taj Rai, Devendra K Agrawal","doi":"10.26502/fccm.92920284","DOIUrl":"https://doi.org/10.26502/fccm.92920284","url":null,"abstract":"<p><strong>Background: </strong>Despite the recent advancements in the cardiac regenerative technologies, the lack of an ideal translationally relevant experimental model simulating the clinical setting of acute myocardial infarction (MI) hurdles the success of cardiac regenerative strategies.</p><p><strong>Methods: </strong>We developed a modified minimally invasive acute MI model in Yucatan miniswine by catheter-driven controlled occlusion of LCX branches for regenerative cardiology. Using a balloon catheter in three pigs, the angiography guided occlusion of LCX for 10-15 minutes resulted in MI induction which was confirmed by the pathological ECG changes compared to the baseline control.</p><p><strong>Results: </strong>Ejection fraction was considerably decreased post-procedure compared to the baseline. Importantly, the highly sensitive MI biomarker Troponin I was significantly increased in post-MI and follow-up groups along with LDH and CCK than the baseline control. The postmortem infarct zone tissue displayed the classical features of MI including ECM disorganization, hypertrophy, inflammation, and angiogenesis confirming the MI at the tissue level.</p><p><strong>Conclusions: </strong>The present model possesses the advantage of minimal mortality, simulating the pathological features of clinical MI and the suitability for injectable regenerative therapies suggesting the translational significance in regenerative cardiology.</p>","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"6 5","pages":"466-472"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9534332/pdf/nihms-1837495.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33492824","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}
S. Rehman, A. Siddiqui, Aysha Almas, Aamir Hameed Khan
ST Elevation Myocardial Infarction (STEMI)-Should Worried?. Abstract Background and Objective: Young women with STEMI fare worse than men. Data for such patients in particular South Asians (SA) is sparse. Therefore, this study explored the common risk factors, angiographic features and outcomes in these patients. Methods: It was a cross-sectional study done from 2013-2019 on female STEMI patients <45 years who underwent Coronary Catheterization and revascularization at Aga Khan University Hospital, Pakistan. Subjects with revascularizations or MI were excluded. with Anterior STEMI and PCI was the commonest mode of revascularization. Majority, (82%, n=19) had Single vessel disease with lesions in Left Anterior Descending (LAD). Proximal LAD lesions required stents 27.6 (+10) mm long and 3.0 (+0.4) mm wide on average. Mortality was seen in one patient. A third of patients (n=9) presented with heart failure whereas a quarter (n=7) with hypotension. A minority required mechanical ventilation, Cardiopulmonary resuscitation or temporary pacemaker. Conclusions: STEMI is relatively uncommon in young SA women. Associated risk factors are Diabetes, obesity and positive family history. SVCAD with LAD involvement is the most common pattern. Rates of mortality, heart failure admissions or repeat revascularizations are minimal.
{"title":"Young South Asian Women with ST Elevation Myocardial Infarction (STEMI)-Should we be Worried?","authors":"S. Rehman, A. Siddiqui, Aysha Almas, Aamir Hameed Khan","doi":"10.26502/fccm.92920246","DOIUrl":"https://doi.org/10.26502/fccm.92920246","url":null,"abstract":"ST Elevation Myocardial Infarction (STEMI)-Should Worried?. Abstract Background and Objective: Young women with STEMI fare worse than men. Data for such patients in particular South Asians (SA) is sparse. Therefore, this study explored the common risk factors, angiographic features and outcomes in these patients. Methods: It was a cross-sectional study done from 2013-2019 on female STEMI patients <45 years who underwent Coronary Catheterization and revascularization at Aga Khan University Hospital, Pakistan. Subjects with revascularizations or MI were excluded. with Anterior STEMI and PCI was the commonest mode of revascularization. Majority, (82%, n=19) had Single vessel disease with lesions in Left Anterior Descending (LAD). Proximal LAD lesions required stents 27.6 (+10) mm long and 3.0 (+0.4) mm wide on average. Mortality was seen in one patient. A third of patients (n=9) presented with heart failure whereas a quarter (n=7) with hypotension. A minority required mechanical ventilation, Cardiopulmonary resuscitation or temporary pacemaker. Conclusions: STEMI is relatively uncommon in young SA women. Associated risk factors are Diabetes, obesity and positive family history. SVCAD with LAD involvement is the most common pattern. Rates of mortality, heart failure admissions or repeat revascularizations are minimal.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346216","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}
β 1 -Adrenoceptors (β 1 -AR) blocker are an established therapy for the treatment of chronic left ventricular dysfunction. In the acute setting, however, the administration in patients with left ventricular failure is seen controversial, specifically as a potential negative inotropic effect and antagonism of the applied inotropic agents may possibly worsen the clinical situation of the patient. Recently the super selective short acting β 1 -AR Landiolol has been used in patients with acute left ventricular decompensation and, in conjunction with inotropic agents, did not deteriorate but improved the cardiovascular status of the patients. The present work summarizes the theories how a β 1 -AR blocker may act additive to inotropic agents in patients with acute cardiac failure. Specifically , receptor bindings models are presented in which the β 1 -AR blocker Landiolol can induce a positive inotropic response. These models are based on the fact that in patients with left ventricular dysfunction the plasma levels of catecholamines exceed their dissociation constants and rather decrease than improve the inotropic response due to negative cooperativity at the occupied receptor dimers. Low distinct Landiolol concentrations then reduce the negative cooperation and shift the receptor response curve into a more positive inotropic range. This article may thus help to minimise the reservations to the treatment of acute left ventricular deterioration with the super selective beta blocker Landiolol and positive inotropic agents. More so as the dose range calculated for Landiolol in these models and the one’s used in the intensive care setting prove to be identical.
{"title":"The Superselective β1-Blocker Landiolol Enhances Inotropy of Endogenous and Exogenous Catecholamines in Acute Heart Failure","authors":"Thomas J. Feuerstein, G. Krumpl","doi":"10.26502/fccm.92920291","DOIUrl":"https://doi.org/10.26502/fccm.92920291","url":null,"abstract":"β 1 -Adrenoceptors (β 1 -AR) blocker are an established therapy for the treatment of chronic left ventricular dysfunction. In the acute setting, however, the administration in patients with left ventricular failure is seen controversial, specifically as a potential negative inotropic effect and antagonism of the applied inotropic agents may possibly worsen the clinical situation of the patient. Recently the super selective short acting β 1 -AR Landiolol has been used in patients with acute left ventricular decompensation and, in conjunction with inotropic agents, did not deteriorate but improved the cardiovascular status of the patients. The present work summarizes the theories how a β 1 -AR blocker may act additive to inotropic agents in patients with acute cardiac failure. Specifically , receptor bindings models are presented in which the β 1 -AR blocker Landiolol can induce a positive inotropic response. These models are based on the fact that in patients with left ventricular dysfunction the plasma levels of catecholamines exceed their dissociation constants and rather decrease than improve the inotropic response due to negative cooperativity at the occupied receptor dimers. Low distinct Landiolol concentrations then reduce the negative cooperation and shift the receptor response curve into a more positive inotropic range. This article may thus help to minimise the reservations to the treatment of acute left ventricular deterioration with the super selective beta blocker Landiolol and positive inotropic agents. More so as the dose range calculated for Landiolol in these models and the one’s used in the intensive care setting prove to be identical.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346704","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}
G. Latsios, M. Leopoulou, A. Synetos, Evangelia Stamatopoulou, C. Parisis
{"title":"Greek CPR BLS Certified Providers have Confidence in Covid19 Vaccination. A Cohort Analysis in the Pre-Mandatory Vaccination Period by the Hellenic Society of Cardiology","authors":"G. Latsios, M. Leopoulou, A. Synetos, Evangelia Stamatopoulou, C. Parisis","doi":"10.26502/fccm.92920299","DOIUrl":"https://doi.org/10.26502/fccm.92920299","url":null,"abstract":"","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346835","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}
The new 2021 Kidney Disease Improving Global Outcomes (KDIGO) guidelines on the management of blood pressure in chronic kidney disease (CKD) patients were published in March 2021 in Kidney International. The full issue exceeds 80 pages. The author of this article aims to provide a succinate summary of the main points of the guidelines with special emphasis on the changes introduced since the previous 2012 guidelines. These KDIGO guidelines are evidence-based, and they are graded accordingly. As with any recent hypertension guidelines, they incorporate and emphasize the results of The Systolic Blood Pressure Intervention Trial (SPRINT) published in 2015.
{"title":"Current Trends in Hypertension: Takeaways from the 2021 KDIGO Guidelines for the Management of Blood Pressure in Chronic Kidney Disease","authors":"M. Tinawi","doi":"10.26502/fccm.92920239","DOIUrl":"https://doi.org/10.26502/fccm.92920239","url":null,"abstract":"The new 2021 Kidney Disease Improving Global Outcomes (KDIGO) guidelines on the management of blood pressure in chronic kidney disease (CKD) patients were published in March 2021 in Kidney International. The full issue exceeds 80 pages. The author of this article aims to provide a succinate summary of the main points of the guidelines with special emphasis on the changes introduced since the previous 2012 guidelines. These KDIGO guidelines are evidence-based, and they are graded accordingly. As with any recent hypertension guidelines, they incorporate and emphasize the results of The Systolic Blood Pressure Intervention Trial (SPRINT) published in 2015.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346096","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}
Fariba Yazdanpanah, Bulent Zaim, C. Hunter, Robyn Anderson, Vivek Bahl
Introduction: Acute pulmonary embolism (PE) is one of the presentations of venous thromboembolism (VTE) which can be potentially life-threatening by causing cardiovascular collapse. Commonly, a negative D-dimer assay is accepted for ruling out PE; however, there have been cases such as this case that challenge current practice. Case presentation: This case report presents an 83-year-old female with sudden onset shortness of breath associated with low oxygen saturation on the physical exam. Initial workup revealed elevated levels of troponin-T and pro-B-type natriuretic peptide with preliminary normal D-dimer assay. At the start, the patient managed as Right Ventricular (RV) infarction with remarkable findings of RV dysfunction and pressure overload in transthoracic echocardiogram. Eventually chest CT angiogram documented extensive bilateral pulmonary emboli (PE), and interestingly, D-dimer became positive 5 days after the diagnosis of PE. Cardiol Cardiovasc Med 2022; 6 (3): 301-307 DOI: 10.26502/fccm.92920265 Cardiology and Cardiovascular Medicine Vol. 6 No. 3 – June 2022. [ISSN 2572-9292] 302 Conclusions: This case report is a rare case of initial negative D-dimer in the setting of extensive bilateral PE which caused right ventricular infarction. The literature review demonstrated only a few cases of PE in the setting of negative D-dimer. This unusual clinical scenario presents a diagnostic challenge in patients with low or moderate clinical probability for PE; even some current practices indicate stopping further diagnostic work-up if the D-dimer is negative in these groups. To mitigate negative outcomes in patients with low or moderate clinical probability, other strategies have been proposed to make an early diagnosis of PE such as triple combination modalities; however, they require additional analysis and consideration before they can be routinely recommended.
{"title":"Right Ventricular Infarction Secondary to Extensive Bilateral Pulmonary Emboli in the Setting of Negative D-dimer: A Case Report and Mini-Review","authors":"Fariba Yazdanpanah, Bulent Zaim, C. Hunter, Robyn Anderson, Vivek Bahl","doi":"10.26502/fccm.92920265","DOIUrl":"https://doi.org/10.26502/fccm.92920265","url":null,"abstract":"Introduction: Acute pulmonary embolism (PE) is one of the presentations of venous thromboembolism (VTE) which can be potentially life-threatening by causing cardiovascular collapse. Commonly, a negative D-dimer assay is accepted for ruling out PE; however, there have been cases such as this case that challenge current practice. Case presentation: This case report presents an 83-year-old female with sudden onset shortness of breath associated with low oxygen saturation on the physical exam. Initial workup revealed elevated levels of troponin-T and pro-B-type natriuretic peptide with preliminary normal D-dimer assay. At the start, the patient managed as Right Ventricular (RV) infarction with remarkable findings of RV dysfunction and pressure overload in transthoracic echocardiogram. Eventually chest CT angiogram documented extensive bilateral pulmonary emboli (PE), and interestingly, D-dimer became positive 5 days after the diagnosis of PE. Cardiol Cardiovasc Med 2022; 6 (3): 301-307 DOI: 10.26502/fccm.92920265 Cardiology and Cardiovascular Medicine Vol. 6 No. 3 – June 2022. [ISSN 2572-9292] 302 Conclusions: This case report is a rare case of initial negative D-dimer in the setting of extensive bilateral PE which caused right ventricular infarction. The literature review demonstrated only a few cases of PE in the setting of negative D-dimer. This unusual clinical scenario presents a diagnostic challenge in patients with low or moderate clinical probability for PE; even some current practices indicate stopping further diagnostic work-up if the D-dimer is negative in these groups. To mitigate negative outcomes in patients with low or moderate clinical probability, other strategies have been proposed to make an early diagnosis of PE such as triple combination modalities; however, they require additional analysis and consideration before they can be routinely recommended.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346598","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}
Pub Date : 2021-10-26DOI: 10.21203/rs.3.rs-984152/v1
A. Caddell, Edwin Moses Bamwoya, Andrew D. Moeller
Background There has been a paradigm shift in residency training over the last several years wherein Competency by Design (CBD) is being integrated to replace more traditional time-based models of training. The Residency Program Committee (RPC) for the Cardiology training program at Dalhousie University in Halifax, Canada addressed the Transition to Practice stage by approving a trial of adjusting the resident call responsibilities to reflect the transition to CBD curriculum. The goal of this adjustment was three-fold: i. Gradually increase accountability of the senior cardiology resident as they transition to practice; ii. Address a gap in training that allows the senior resident to have a gradual transition to the role of a practicing cardiologist while on call; iii. Allows further evolution of skills and abilities. Methods A survey was administered to the practitioners involved in this competency-based change to the call responsibilities. Surveys were distributed to the final year Cardiology Residents, Staff Cardiologists, and Senior Internal Medicine residents to assess their experience and opinions of the current, competency-based change of the on-call curriculum. The survey consisted of eleven questions, of which, four were assessed on a Likert scale and 3 were yes/no questions. Results Four PGY6 cardiology residents, five senior internal medicine residents and eleven staff cardiologists completed the survey. Amongst those who completed the survey there was agreement that the change to the on-call responsibilities improved cardiology residents’ skills, accountability and preparedness to practice. All groups felt the changes were useful for the cardiology training program. There was mild negative effect of perceived accountability by the internal medicine residents. Conclusion Overall the change in call structure led to improved perceived preparedness to practice amongst the cardiology residents and addressed a gap in the Transition to Practice phase of CBD training. This study provides some evidence to the potential benefit of CBD and specifically in the benefits towards transitioning to practice.
{"title":"Addressing Transition to Practice: Assessing Perceived Effectiveness of a Competency Based Change to On-Call Responsibilities of Senior Cardiology Residents","authors":"A. Caddell, Edwin Moses Bamwoya, Andrew D. Moeller","doi":"10.21203/rs.3.rs-984152/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-984152/v1","url":null,"abstract":"\u0000 Background\u0000\u0000There has been a paradigm shift in residency training over the last several years wherein Competency by Design (CBD) is being integrated to replace more traditional time-based models of training. The Residency Program Committee (RPC) for the Cardiology training program at Dalhousie University in Halifax, Canada addressed the Transition to Practice stage by approving a trial of adjusting the resident call responsibilities to reflect the transition to CBD curriculum. The goal of this adjustment was three-fold: i. Gradually increase accountability of the senior cardiology resident as they transition to practice; ii. Address a gap in training that allows the senior resident to have a gradual transition to the role of a practicing cardiologist while on call; iii. Allows further evolution of skills and abilities.\u0000Methods\u0000\u0000A survey was administered to the practitioners involved in this competency-based change to the call responsibilities. Surveys were distributed to the final year Cardiology Residents, Staff Cardiologists, and Senior Internal Medicine residents to assess their experience and opinions of the current, competency-based change of the on-call curriculum. The survey consisted of eleven questions, of which, four were assessed on a Likert scale and 3 were yes/no questions.\u0000Results\u0000\u0000Four PGY6 cardiology residents, five senior internal medicine residents and eleven staff cardiologists completed the survey. Amongst those who completed the survey there was agreement that the change to the on-call responsibilities improved cardiology residents’ skills, accountability and preparedness to practice. All groups felt the changes were useful for the cardiology training program. There was mild negative effect of perceived accountability by the internal medicine residents.\u0000Conclusion\u0000\u0000Overall the change in call structure led to improved perceived preparedness to practice amongst the cardiology residents and addressed a gap in the Transition to Practice phase of CBD training. This study provides some evidence to the potential benefit of CBD and specifically in the benefits towards transitioning to practice.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43315239","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}
Pub Date : 2021-10-20DOI: 10.21203/RS.3.RS-658117/V1
Kriti Agarwal, A. Chidharla, S. Aedma, Ahmad Al-Awwa, U. Patel, Sameh Elias
Introduction: Methamphetamine use has been rising globally and results in significant morbidity and mortality. Methamphetamine is well known to affect multiple organs including neurological, cardiovascular, pulmonary, and renal. Cardiovascular manifestations like arrhythmias, pulmonary artery hypertension, cardiomyopathy, and cardiac arrest can occur from increased inflammation, myocardial fibrosis, and electrical remodeling. Case Presentation: We present a rare case of a 39year-old man with chronic methamphetamine abuse presenting with worsening shortness of breath and palpitations. Patient was eventually found to have acute onset left ventricular systolic dysfunction (ejection fraction 25-30%) from methamphetamine associated cardiomyopathy. He had a prolonged hospital course, however, a repeat echocardiogram performed 2 weeks later demonstrated near normal left ventricular function (ejection fraction 50-55%). Conclusions: This case emphasizes the temporal effects of drug overdose on the cardiovascular system and its life-threatening complications. It is aimed at raising awareness about consideration of Cardiol Cardiovasc Med 2022; 6 (2): 92-99 DOI: 10.26502/fccm.92920247 Cardiology and Cardiovascular Medicine Vol. 6 No. 2 – April 2022. [ISSN 2572-9292] 93 methamphetamine abuse as an important etiological factor when evaluating patients presenting with left ventricular systolic dysfunction and the importance of cessation of drug usage leading to reversal of cardiomyopathy.
{"title":"Breaking Bad or Good: A Case Report and Literature Review of Acute Reversible Methamphetamine Associated Cardiomyopathy","authors":"Kriti Agarwal, A. Chidharla, S. Aedma, Ahmad Al-Awwa, U. Patel, Sameh Elias","doi":"10.21203/RS.3.RS-658117/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-658117/V1","url":null,"abstract":"Introduction: Methamphetamine use has been rising globally and results in significant morbidity and mortality. Methamphetamine is well known to affect multiple organs including neurological, cardiovascular, pulmonary, and renal. Cardiovascular manifestations like arrhythmias, pulmonary artery hypertension, cardiomyopathy, and cardiac arrest can occur from increased inflammation, myocardial fibrosis, and electrical remodeling. Case Presentation: We present a rare case of a 39year-old man with chronic methamphetamine abuse presenting with worsening shortness of breath and palpitations. Patient was eventually found to have acute onset left ventricular systolic dysfunction (ejection fraction 25-30%) from methamphetamine associated cardiomyopathy. He had a prolonged hospital course, however, a repeat echocardiogram performed 2 weeks later demonstrated near normal left ventricular function (ejection fraction 50-55%). Conclusions: This case emphasizes the temporal effects of drug overdose on the cardiovascular system and its life-threatening complications. It is aimed at raising awareness about consideration of Cardiol Cardiovasc Med 2022; 6 (2): 92-99 DOI: 10.26502/fccm.92920247 Cardiology and Cardiovascular Medicine Vol. 6 No. 2 – April 2022. [ISSN 2572-9292] 93 methamphetamine abuse as an important etiological factor when evaluating patients presenting with left ventricular systolic dysfunction and the importance of cessation of drug usage leading to reversal of cardiomyopathy.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41575611","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}
Pub Date : 2021-10-01Epub Date: 2021-10-13DOI: 10.26502/fccm.92920221
Meredith Hay, Lee Ryan, Matthew Huentelman, John Konhilas, Christina Hoyer-Kimura, Thomas G Beach, Geidy E Serrano, Eric M Reiman, Kaj Blennow, Henrik Zetterberg, Sairam Parthasarathy
In critically ill COVID-19 patients, the risk of long-term neurological consequences is just beginning to be appreciated. While recent studies have identified that there is an increase in structural injury to the nervous system in critically ill COVID-19 patients, there is little known about the relationship of COVID-19 neurological damage to the systemic inflammatory diseases also observed in COVID-19 patients. The purpose of this pilot observational study was to examine the relationships between serum neurofilament light protein (NfL, a measure of neuronal injury) and co-morbid cardiovascular disease (CVD) and neurological complications in COVID-19 positive patients admitted to the intensive care unit (ICU). In this observational study of one-hundred patients who were admitted to the ICU in Tucson, Arizona between April and August 2020, 89 were positive for COVID-19 (COVID-pos) and 11 was COVID-negative (COVID-neg). A healthy control group (n=8) was examined for comparison. The primary outcomes and measures were subject demographics, serum NfL, presence and extent of CVD, diabetes, sequential organ failure assessment score (SOFA), presence of neurological complications, and blood chemistry panel data. COVID-pos patients in the ICU had significantly higher mean levels of Nfl (229.6 ± 163 pg/ml) compared to COVID-neg ICU patients (19.3 ± 5.6 pg/ml), Welch's t-test, p =.01 and healthy controls (12.3 ± 3.1 pg/ml), Welch's t-test p =.005. Levels of Nfl in COVID-pos ICU patients were significantly higher in patients with concomitant CVD and diabetes (n=35, log Nfl 1.6±.09), and correlated with higher SOFA scores (r=.5, p =.001). These findings suggest that in severe COVID-19 disease, the central neuronal and axonal damage in these patients may be driven, in part, by the level of systemic cardiovascular disease and peripheral inflammation. Understanding the contributions of systemic inflammatory disease to central neurological degeneration in these COVID-19 survivors will be important to the design of interventional therapies to prevent long-term neurological and cognitive dysfunction.
{"title":"Serum Neurofilament Light is elevated in COVID-19 Positive Adults in the ICU and is associated with Co-Morbid Cardiovascular Disease, Neurological Complications, and Acuity of Illness.","authors":"Meredith Hay, Lee Ryan, Matthew Huentelman, John Konhilas, Christina Hoyer-Kimura, Thomas G Beach, Geidy E Serrano, Eric M Reiman, Kaj Blennow, Henrik Zetterberg, Sairam Parthasarathy","doi":"10.26502/fccm.92920221","DOIUrl":"10.26502/fccm.92920221","url":null,"abstract":"<p><p>In critically ill COVID-19 patients, the risk of long-term neurological consequences is just beginning to be appreciated. While recent studies have identified that there is an increase in structural injury to the nervous system in critically ill COVID-19 patients, there is little known about the relationship of COVID-19 neurological damage to the systemic inflammatory diseases also observed in COVID-19 patients. The purpose of this pilot observational study was to examine the relationships between serum neurofilament light protein (NfL, a measure of neuronal injury) and co-morbid cardiovascular disease (CVD) and neurological complications in COVID-19 positive patients admitted to the intensive care unit (ICU). In this observational study of one-hundred patients who were admitted to the ICU in Tucson, Arizona between April and August 2020, 89 were positive for COVID-19 (COVID-pos) and 11 was COVID-negative (COVID-neg). A healthy control group (n=8) was examined for comparison. The primary outcomes and measures were subject demographics, serum NfL, presence and extent of CVD, diabetes, sequential organ failure assessment score (SOFA), presence of neurological complications, and blood chemistry panel data. COVID-pos patients in the ICU had significantly higher mean levels of Nfl (229.6 ± 163 pg/ml) compared to COVID-neg ICU patients (19.3 ± 5.6 pg/ml), Welch's t-test, p =.01 and healthy controls (12.3 ± 3.1 pg/ml), Welch's t-test p =.005. Levels of Nfl in COVID-pos ICU patients were significantly higher in patients with concomitant CVD and diabetes (n=35, log Nfl 1.6±.09), and correlated with higher SOFA scores (r=.5, p =.001). These findings suggest that in severe COVID-19 disease, the central neuronal and axonal damage in these patients may be driven, in part, by the level of systemic cardiovascular disease and peripheral inflammation. Understanding the contributions of systemic inflammatory disease to central neurological degeneration in these COVID-19 survivors will be important to the design of interventional therapies to prevent long-term neurological and cognitive dysfunction.</p>","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"5 5","pages":"551-565"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10105304","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}
Introduction: The aim of this investigation is to evaluate the possibilities of the method of cardiography from the coronary sinus (ECG-CS) in optimization of stenting bifurcation lesions (BL) of coronary arteries (CA). Materials and Methods: 43 patients with stable CHD with pseudo-BL of the anterior descending artery (ADA) were included in this investigation. We placed a 10-canal electrode into their coronary sinus at the beginning of percutaneous coronary intervention (PCI). Ischemic guidance was done with the WorkMate electrophysiological recording system. Results: In 11 patients (25%) out of 43 with CHD, the diagonal branch (DB) comprometation and ischemia dynamics (p<0.05) in intracardiac lead (CS 3-4) after ADA stenting were discovered according to ECG-CS. Nine patients (20.9%) underwent successful provisional-T-stenting, while a second stent was required for the other 2 patients. Conclusion: ECG-CS provides the possibility to optimize coronary intervention in the area of CA bifurcation.
{"title":"Tactics Optimization of Percutaneous Coronary Intervention in the Area of Bifurcation of the Anterior Descending Artery by Means of Cardiography from the Coronary Sinus","authors":"Y. Shevchenko, D. Ermakov, Vakhrameeva A.Y","doi":"10.26502/fccm.92920147","DOIUrl":"https://doi.org/10.26502/fccm.92920147","url":null,"abstract":"Introduction: The aim of this investigation is to evaluate the possibilities of the method of cardiography from the coronary sinus (ECG-CS) in optimization of stenting bifurcation lesions (BL) of coronary arteries (CA). \u0000 \u0000Materials and Methods: 43 patients with stable CHD with pseudo-BL of the anterior descending artery (ADA) were included in this investigation. We placed a 10-canal electrode into their coronary sinus at the beginning of percutaneous coronary intervention (PCI). Ischemic guidance was done with the WorkMate electrophysiological recording system. \u0000 \u0000Results: In 11 patients (25%) out of 43 with CHD, the diagonal branch (DB) comprometation and ischemia dynamics (p<0.05) in intracardiac lead (CS 3-4) after ADA stenting were discovered according to ECG-CS. Nine patients (20.9%) underwent successful provisional-T-stenting, while a second stent was required for the other 2 patients. \u0000 \u0000Conclusion: ECG-CS provides the possibility to optimize coronary intervention in the area of CA bifurcation.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49545112","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}
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