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  Clinical Characteristics And Outcomes in Patients with Coronary Artery Aneurysms (CAA) Presenting with Acute Coronary Syndrome (ACS) or Cardiomyopathy

  Advaitha Misra, Mathangi Keshavan, Ersida Zerdelija, Zain Abidi, Alexandra Corrado, James Benke, Hassan Dalloul, and Anton Salwan

  Publication Date: 5-9-2024

  Coronary artery aneurysms and ectasia are rare conditions with an incidence estimated at < 1% [1]. It is defined as either a focal or diffuse dilation of a coronary segment of at least one and a half times the adjacent normal segment [2,3].The most common etiology is atherosclerosis, although a variety of other culprits are implicated in its pathogenesis, such as vasculitidies and connective tissue disorders [3,4,5]. Its management is largely driven by the etiology of the coronary artery segment dilation and the presentation of disease at the time of diagnosis. Management strategies employ a judicious combination of medical therapy, percutaneous and surgical interventions. The presence of coronary artery aneurysm or ectasia has been associated with poor long-term outcomes [6,7,8]. Complications from coronary artery aneurysm influence management, largely guided by clinician judgment and limited published data. Given the paucity of evidence in the management of these conditions, we present a case series of three patients with coronary artery aneurysm or ectasia with varying presentations and their corresponding management. We aim to contribute to the growing body of evidence for the management of this elusive cardiac condition.

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  Effect of Comorbidities and Choice of Treatment on Overall Survival in Elderly Patients with Acute Myeloid Leukemia: A Beaumont Experience

  Bilal M. Ali, Emma Herrman, James Huang Huang, and Mohammad Muhsin Chisti

  Publication Date: 5-2023

  First line therapy for Acute Myeloid Leukemia (AML) is 7+3 regimen. It often cannot be used in elderly patients due to intensity. Venetoclax + hypomethylating agent (HMA) is approved for AML treatment in these patients. We investigate the efficacy of this treatment in a community setting where patients do not have the same resources available to them as a large academic center. Primary outcome was survival of patients greater than 60 years of age with a diagnosis of AML who received 7+3 therapy versus those who received venetoclax + HMA. Secondary outcomes included characteristics of those who received the two therapies.

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  Pillow CPR: Using a Low Resource Method to Teach Hands-Only CPR to Hispanic Adolescents in a Community Setting

  Benjamin Goldstein, Ekaterina Clark, Alan Silverman, and Virginia Uhley

  Publication Date: 5-2023

  Hands-only Cardiopulmonary resuscitation (CPR) training for adolescents in community settings is often limited by training device availability. This pilot study’s objective was to investigate the feasibility, participant knowledge gains, and attitude changes through hands-only CPR training using a pillow for skill development.

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  A Retrospective Review of Catheter-Directed Therapy for Patients with Intermediate Risk Pulmonary Embolisms

  Austin Lehew and Michael Tucciarone

  Publication Date: 5-2023

  Each year, hundreds of patients present to the William Beaumont hospital system with intermediate risk pulmonary embolisms (IRPE) with common symptoms of chest pain, shortness of breath, and hypoxia. Conventional treatments include anticoagulants alone, or a more aggressive approach with systemic thrombolytics which come with a higher risk of major bleeding and death. However, in the last few years, catheter-directed therapies (CDT) have been developed to mechanically remove clots in a minimally invasive fashion. The goal of this study is to determine the safety and efficacy of novel CDT at Beaumont Troy and Royal Oak.

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  Transition of continuous intravenous epoprostenol to oral treprostinil in a patient with pulmonary arterial hypertension: A patient case report

  Tania Saeed, Heidi Klotz, Klea Noskey, Jacqueline Brewer, Samuel Allen, and Rebecca Baker

  Publication Date: 9-28-2023

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  Changes in Electrocardiographic and Cardiac Implantable Electronic Device Parameters Following Transcatheter Aortic Valve Replacement

  Elizabeth Seeley, Luai Madanat, and Nishaki Mehta

  Publication Date: 5-2023

  Transcatheter aortic valve replacement (TAVR) is known to cause conduction abnormalities leading to the need for permanent pacemaker implantation. However, the impact of TAVR-related conduction abnormalities on cardiac implantable electronic device (CIED) parameters in patients with preexisting devices is not known. We sought to investigate and describe changes in EKG and CIED parameters following TAVR in patients with preexisting CIEDs.

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  A Rare Case of Radial Arteriovenous Formation After Transradial Cardiac Catheterization

  Barbara Senger, Hassan Eidy, Andrew Gray, and Robert Grodman

  Publication Date: 5-4-2023

  In the United States, more than one million cardiac catheterization procedures are performed each year for diagnostic and therapeutic purposes.

  ▪ Right heart catheterizations allow for direct measurement of right-sided cardiac and pulmonary hemodynamics while left heart catheterizations provide a diagnostic and therapeutic role in those with coronary artery disease.

  ▪ In 1989, Lucien Campeau proposed the use of a smaller caliber catheter to access the small radial artery as a way to reduce the rates of bleeding complications.

  ▪ Advantages of utilizing the transradial artery (TRA) approach over the transfemoral artery (TFA) approach include: – Improved patient quality-of life metrics. – Reduced major bleeding and access site complications. – Lower total hospital costs.

  ▪ Access-site complications including radial artery occlusion and arteriovenous fistula (AVF) formation from TRA are rare and usually of minimal clinical impact.

  ▪ AVF may present with pain and edema at the puncture site, a pulsatile thrill, and/or visible dilated superficial veins.

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  A comparative study of medication profiles from AD, MCI and non-demented patients

  Md Golam Sharoar, Bhavya Koganti, Vaibhavkumar Falki, Zakia Zaman, Tammy Osentoski, and Stewart F. Graham

  Publication Date: 12-2023

  Background: The ever-increasing incidence of Alzheimer’s disease (AD) and the lack of effective therapeutics to treat the disease are leading to a “silver tsunami”. Current FDA-approved drugs to treat the disease are limited as their benefit is simply momentary relief of the symptoms. Due to the chronic and progressive nature of AD, patients are routinely prescribed multiple non-AD medications to preserve their ability to perform daily activities and to improve their quality of life. However, how those medications affect AD pathology remains unknown. In the present study, we have compared medication profiles of AD (n = 135), mild cognitive declined (MCI; n = 120), and non-demented (n = 259) patients, with an aim to determine the effects of top-ranked drugs on AD pathology.

  Methods: Study subjects (≥65 years) were recruited from an academic geriatric practice that is heavily focused on memory disorders. All subjects underwent for the following cognitive assessments: a) Clinical dementia rating scale (CDR), b) MiniMental Status Examination (MMSE), c) logical memory test, d) digit span forward and backward, e) category fluency test, f) ordering test, g) trails A&B, and finally the Geriatric Depression Scale. Individual medication for each subject was listed and they were categorized into major drug classes. Statistical analysis was performed to determine the frequency of each drug in each class.

  Results: Eight top-ranked drug classes were categorized from a list of 453 individual medications. Vitamins (30-40%) and anti-inflammatory (∼30%) drugs were the major categories for each cohort. Interestingly, 11% of drugs were proton pump inhibitors in non-demented patients, and this decreased by 8% in MCI, and 5% in AD. We found a reduced (8%) Lipitor prescriptions for AD patients compared MCI (11%) and non-demented (13%) patients. We are investigating the effects of these highly prescribed drugs on β-amyloid production/aggregation, cytotoxicity, plaque load, and tau phosphorylation in vitro and in vivo using cell culture and AD mouse models. Conclusion: While the effects of routinely prescribed drugs on AD pathology are not well known, we found reduced vitamins, proton pump inhibitors, and Lipitor in the medication profiles of AD patients compared to the non-AD population.

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  Transcatheter Aortic Valve Replacement: Volume Impact on Length of Stay and Readmissions

  Alexander M. Balinksi, Patrick Karabon, Girish Pathangey, and Amr E. Abbas

  Publication Date: 5-2-2022

  INTRODUCTION
  TAVR is an alternative to surgery in patients with severe aortic stenosis. Procedural volume impacts mortality but little is known of its effect on length of stay (LOS) and readmissions. We sought to examine the impact of transcatheter aortic valve replacement (TAVR) procedural volume on trends in LOS and hospital readmission rates from 2012 to 2016.

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  Apical Hypertrophic Cardiomyopathy: A Rare Variant of Hypertrophic Cardiomyopathies

  Alexandra Corrado-Kittel, Diana DeAngelis, Katharine Glover, and Gregory Hazergian

  Publication Date: 5-2022

  Introduction • AHCM is a rare morphological variant of hypertrophic cardiomyopathies • The AHA/ACC defines hypertrophic cardiomyopathy as left ventricular hypertrophy in the absence of abnormal loading conditions, or other cardiac, systemic, or other metabolic disease capable of producing the magnitude of hypertrophy observed on echocardiogram • Regardless of the morphology, understanding workup, management and follow up are crucial

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  Cannabis and Acute Coronary Syndrome: A Case Report Exploring Potential Links

  Fawaz Habba, Michael Hoban, and Scott Searing

  Publication Date: 5-2022

  Introduction • Cannabis is a commonly abused drug in the United States. It is paramount that physicians understand the risks of its use that may impact patient safety, particularly its effects on the cardiovascular system. • There are two cannabinoid receptors which the active component of marijuana, delta-9- tetrahydrocannabinol (THC), acts on: Cannabinoid receptor type 1 (CB1 ) and cannabinoid receptor type 2 (CB2 ). • THC causes stimulation of the sympathetic nervous system while inhibiting the parasympathetic nervous system. • While the precise pathophysiology behind myocardial infarction in patients consuming marijuana is unknown, it is postulated that sudden coronary occlusion is likely due to plaque disruption caused by the hemodynamic alterations cannabis causes on the cardiovascular system.

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  Does Aspirin Reduce Risk for Future Cardiovascular Events in Women with Diabetes?

  Olivia Hillier, Amna Zeb, and Pamela Marcovitz

  Publication Date: 5-2-2022

  INTRODUCTION
  The use of low dose aspirin (LDA) in primary prevention of cardiovascular events (CVE) is no longer recommended due to lack of benefit in prevention of primary outcome and increased bleeding risks. It’s postulated that LDA could still be of benefit in those with very high vascular risk including diabetes mellitus (DM) as it confers a higher risk for future CVE in women as compared to men. We conducted a meta-analysis to determine if use of low dose ASA is beneficial to lower CVE in women with multiple risk factors.

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  A Case of Isolated Pulmonic Valve Candida Endocarditis

  Michael Hoban and Scott Searing

  Publication Date: 5-2022

  • Endocarditis is a rare and potentially lethal disease affecting 3 to 10 per 100,000 in the United States, with 40,000 to 50,000 new cases per year. • The major risk factors for development of endocarditis are prosthetic valves, hemodialysis, venous catheters, immunosuppression, and IV drug use. • Fungal endocarditis accounts for 1-10% of all endocarditis cases and has been associated with increased mortality. • Isolated pulmonic valve endocarditis is extremely rare accounting for < 2% of patients with infective endocarditis. • Transthoracic echocardiography is the initial imaging modality of choice and has sensitivity of 50-90%. TEE is 90-100% sensitive.

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  Cardiorespiratory, Hemodynamic, and Perceived Exertion Responses to Seated Chair Exercise

  Ryan Khemraj, Cristian Solano, Neesirg Patel, and Roger Sacks

  Publication Date: 5-2-2022

  INTRODUCTION
  The increasing prevalence of cardiovascular disease (CVD) and its sequelae in the United States population has led to escalating health care expenditures. To favorably modify cardiovascular outcomes, exercise physiologists have developed varied exercise programs that are associated with mortality reduction, symptom relief, improved exercise tolerance, favorable risk factor modification and improved psychosocial well-being. For patients with significant disability and deconditioning, chair-based exercise may provide an alternative method of achieving the relative cardioprotective benefits of traditional exercise.

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  Late Outcomes for Patients with Acute Chest Pain and Positive Fractional Flow Reserve by Computed Tomography

  Zach Rollins, Jason Schott, and Robert Safian

  Publication Date: 5-2-2022

  INTRODUCTION
  Testing with fractional flow reserve derived from computed tomography (FFRCT) can be used to stratify otherwise indeterminate grade stenoses on cardiac computed tomography angiography (CCTA). Long-term clinical outcomes using FFRCT have been reported in stable heart disease but not for acute chest pain (ACP). This study analyzes clinical outcomes in patients with ACP who underwent FFRCT, including the risk of mortality, myocardial infarction (MI), invasive coronary angiography (ICA), and revascularization.

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  Primary Carnitine Deficiency Induced Ventricular Fibrillation

  Andrew Sherman, Luai Madanat, Timothy Pow, and Akhil Gulati

  Publication Date: 5-13-2022

  Background: Children with primary carnitine deficiency (PCD) frequently develop cardiomyopathy; however it is not commonly seen in adults. Arrhythmias are less common and include forms of long QT-syndrome and ventricular fibrillation. ECG findings commonly involve peaked T-waves and short QT intervals that may resolve with supplementation of L-carnitine. Case presentation: An 18-year-old female with a family history of sudden cardiac death (SCD) presented to the emergency department following a witnessed out-of-hospital cardiac arrest. She was initially noted to be in ventricular fibrillation (VF) and was subsequently defibrillated twice on presentation. Her rhythm converted to supraventricular tachycardia at which time adenosine 6 mg IV was administered twice with reversion to sinus rhythm. ECG on presentation demonstrated peaked T waves and short QT interval. She was admitted to the cardiac intensive care unit for targeted temperature management. Carnitine level on admission was subtherapeutic at 1 nmol/mL (normal: 34-78 nmol/mL) due to suboptimal dosing at home. She was loaded with L-carnitine 12 g/day with repeat levels improving to 41 nmol/mL. Echocardiogram revealed an ejection fraction (EF) of 35% with a dilated right ventricle and global left ventricular hypokinesis. The patient later regained consciousness and was transferred out of the cardiac intensive care unit. Repeat echocardiogram two weeks later revealed no significant change in EF. Her hospital course was complicated by methicillinsensitive staphylococcus aureus pneumonia, for which ICD placement was delayed until completion of antibiotics. She was discharged home in stable condition with plans for 4 weeks of IV antibiotic therapy and close follow-up. Discussion: Primary carnitine deficiency can present as ventricular fibrillation with or without pre-existing cardiomyopathy in adults. Strategies for primary prevention of SCD should be considered in these patients, especially in those with a known family history of SCD.

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  What is the Incidence of QT Prolongation and Life-Threatening Arrhythmia Following IV Methadone Administration in Patients Undergoing Lumbar Fusion?

  Gregory Smith, Richard W. Easton, Kuldeep Shah, Daniel Silvasi, Matthew Lipphardt, Julie George, Shengchuan Dai, Brian Williamson, Brady Vibert, Bradley Ahlgren, and Nicholas Papakonstantinou

  Publication Date: 5-2022

  Postoperative analgesia is a significant challenge following major spine surgery. Utilizing a combination of opioid and non-opioid medications, optimizing their analgesic benefits while decreasing unwanted side effects, has been an effective multi-modal strategy in an Enhanced Recovery After Surgery (ERAS) protocol.

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  Prediabetes as a risk factor for major adverse cardiovascular events

  Muhammad A. Waheed, Ramy Mando, Adrian Michel, and Alexandra Halalau

  Publication Date: 5-2-2022

  INTRODUCTION
  Major adverse cardiac events (MACE) have been shown to be associated with Type II diabetes mellitus (DM) as it is a proinflammatory process. Some DM inflammatory markers may be present in prediabetes (pDM). Yet, the clinical relationship between pDM and MACE has not been well studied. Thus, this study’s primary goal is to see if pDM increases one’s risk for MACE.