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Introduction: Patients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel coronary artery disease (CAD) have worst outcomes; yet the strategy of multi-vessel versus culprit on...
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Cardiac tamponade is a life-threatening emergency, characterized by rapid accumulation of pericardial fluid. There are multiple risk factors for cardiac tamponade, nephrotic syndrome is an uncommon one, especially in adults. Herein, we... more
Cardiac tamponade is a life-threatening emergency, characterized by rapid accumulation of pericardial fluid. There are multiple risk factors for cardiac tamponade, nephrotic syndrome is an uncommon one, especially in adults. Herein, we are reporting a 35-year-old African American woman with membranoproliferative glomerulonephritis secondary to human immunodeficiency virus-associated immune complex kidney disease (HIVICK), who presented with cardiac tamponade. The patient had pericardiocentesis and was discharged, with outpatient follow-up with cardiology, nephrology, and infectious disease. To the best of our knowledge, this is the first report of HIVICK nephrotic syndrome associated with cardiac tamponade.
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Background and aim of the study: Infective endocarditis (IE) is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The study aim was to evaluate the demographic, clinical, microbiological and... more
Background and aim of the study: Infective endocarditis (IE) is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The study aim was to evaluate the demographic, clinical, microbiological and inpatient mortality data of IE in hemodialysis patients. Methods: Data were analyzed for all IE patients admitted to the authors' 800-bed tertiary care hospital between January 2001 and December 2014. These data included demographics, comorbidities, clinical and microbiological characteristics, echocardiographic findings, complications, outcomes, and in-patient mortality. Results: A total of 296 patients, including 52 on hemodialysis, was admitted with a diagnosis of IE. The median age of patients with ESRD (28 females, 24 males) was 55.9 ± 15.47 years. The prevalences of comorbidities such as hypertension (80%) and diabetes mellitus (46%) were significantly higher in ESRD patients, whereas other comorbidities were similarly distributed in both groups. The mitral valve was the most commonly involved (55.8%), followed by aortic (21.7%), tricuspid (21.2%) and pulmonary (1.9%) valves. Staphylococcus aureus was the most common organism (40%), followed by Enterococcus sp. (13.7%), Gram-negative staphylococci (13.7%), coagulase-negative staphylococci (11.5%), and Streptococcus sp. (5.7%). Polymicrobes were found in 11.5% of patients and cultures were negative in 19%. The mean ejection fraction in these patients was 42 ± 4.19% and the mean area of vegetation was 63.5 ± 40 mm2. The in-hospital course of 11 patients was complicated by embolic events, while three patients had acute heart failure and one patient had heart block secondary to IE. A total of four patients (7.7%) died during the index hospitalization. Conclusions: IE in patients receiving chronic hemodialysis is a very frequent occurrence. Its diagnosis is complex and its presence should be considered in all hemodialysis patients with bacteremia. In the present study the etiology was shown to be multifactorial, with the mitral valve being the most commonly involved and S. aureus the most common organism.
Research Interests: Biomedical Engineering, Medicine, Comorbidity, Echocardiography, Humans, and 15 moreInternal Medicine, Female, Hemodialysis, Male, Bacteria, New Jersey, Aged, Prevalence, Middle Aged, Heart valves, Infective Endocarditis, Adult, Hospital Mortality, Heart valve disease, and Cardiovascular medicine and haematology
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AbstractCandida parapsilosis infective endocarditis is a rare presentation and is usually associated with infection involving a prosthetic valve. However, it has been reported in patients with native heart valves in few cases, citing less... more
AbstractCandida parapsilosis infective endocarditis is a rare presentation and is usually associated with infection involving a prosthetic valve. However, it has been reported in patients with native heart valves in few cases, citing less than 40 cases in the medical literature over the past 5 decades. There has been rising incidence of C. parapsilosis in the last decade due to improvement in diagnostic armamentarium. We report a case of native valve endocarditis with C. parapsilosis in the setting of intravenous drug use presenting with acute ischemic cerebrovascular accident (CVA), and acute coronary syndrome. It is distinctive because of the presenting neurologic syndrome reported only in 4 other cases, and to our knowledge, our patient is the first reported case of C. parapsilosis infective endocarditis with myocardial infarction as embolic complication. This article will also review 86 documented cases in literature with retrospective analysis to demographics, predisposing factors, and embolic complications.
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Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is a common occurrence in Hypertrophic cardiomyopathy (HCM), reported in approximately one third of cases. The 2011 ACC guidelines for management... more
Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is a common occurrence in Hypertrophic cardiomyopathy (HCM), reported in approximately one third of cases. The 2011 ACC guidelines for management of HCM with concomitant AF recommend use of Vitamin K Antagonists (VKA); however, new research and randomized clinical trials present data which favor the use of Novel Oral Anticoagulants (NOAC) over VKA to prevent serious outcomes. Purpose We aim to identify the difference between NOAC and VKA in preventing ischemic stroke and thromboembolism, and calculate the rate of intracranial hemorrhage, major bleeding and all cause mortality in both treatment groups. Methods We conducted a systematic review and meta-analysis with the aim to answer the following clinical question: What is the efficacy of NOACs vs VKA in preventing thromboembolism and what are the associated risks with each group? We followed PRISMA guidelines. Scientific databases (PubMed, Co...
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Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by an overwhelming inflammatory response in a subset of patients, resulting in respiratory compromise,... more
Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by an overwhelming inflammatory response in a subset of patients, resulting in respiratory compromise, multiorgan failure, and death. A common complication seen in patients hospitalized with COVID-19 infections is the development of venous and arterial thromboemboli. This occurs especially in patients who suffer from severe respiratory or systemic manifestations on the COVID-19 spectrum of disease. We present a case of acute limb ischemia as the initial presentation in a patient who tested positive for COVID-19.
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Introduction: A consistent, but puzzling clinical observation is that obesity confers an increased susceptibility to the development of cardiac disease, while at the same time affording protection against subsequent mortality (known as... more
Introduction: A consistent, but puzzling clinical observation is that obesity confers an increased susceptibility to the development of cardiac disease, while at the same time affording protection against subsequent mortality (known as obesity paradox). Obesity is associated with RV dysfunction, but its effect on RV remodelling in patients with pulmonary hypertension (PHTN) has not been studied. Hypothesis: We evaluated the effect of obesity, and its interplay with diabetes, in patients with PHTN using RV echocardiographic strain imaging. Methods: 185 patients underwent echocardiographic imaging and pulmonary artery pressure was calculated using tricuspid jet velocity. RV longitudinal strain was performed from a focused RV apical 4-chamber view using speckle tracking software. Global and regional (mid wall) peak systolic RV longitudinal strain was then calculated. Results: Our sample (n=185, mean age 62+/-11yrs) consisted of 41.6% males. Patients with coronary artery disease, left s...
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Introduction: SARS-CoV-2 infection has been associated with a multiple cardiovascular complications. It is not known if cardiac markers can be used for outcome prediction in the US population. Methods: We conducted a retrospective study... more
Introduction: SARS-CoV-2 infection has been associated with a multiple cardiovascular complications. It is not known if cardiac markers can be used for outcome prediction in the US population. Methods: We conducted a retrospective study on patients ≥ 18 years old with confirmed COVID 19, who were admitted to our hospital between 03/15/2020 and 05/25/2020. Individuals were included if they had a baseline troponin and brain natriuretic peptide (BNP) available, and if their outcome by the end of the study period was well defined as discharge alive, or deceased. Univariate and multivariate logistic regression methods were employed to identify the cardiac markers associated with mortality in COVID-19 patients. Results: The total number of confirmed COVID-19 hospitalized patients during the study period was 348, after excluding patients who did not have cardiac markers available, 233 patients were included in the study, 75 (32%) expired, and 158 (68%) were discharged alive. The median age...
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... Diabetes and hypertension were less prevalent in the younger group (P=0.048 and 0.078). Analysis of lipid profile showed comparatively higher total cholesterol, low-density lipoprotein and high-density lipoprotein values in the... more
... Diabetes and hypertension were less prevalent in the younger group (P=0.048 and 0.078). Analysis of lipid profile showed comparatively higher total cholesterol, low-density lipoprotein and high-density lipoprotein values in the younger group (≤P=0.004). ...