Catastrophic Cardiac Complications of Takayasu\u27s Arteritis.

Takayasu\u27s arteritis (TA) causes inflammation and necrosis of vessel walls, leading to aneurysm formation, extensive coronary damage and valvular abnormalities. We review a case of recurrent coronary, aortic and mitral valve involvement in a patient with TA and discuss the various treatment options available for such patients

COVID-19 Cardiovascular Connection: A Review of Cardiac Manifestations in COVID-19 Infection and Treatment Modalities.

The coronavirus pandemic has crippled healthcare system since its outbreak in 2020, and has led to over 2.6 million deaths worldwide. Clinical manifestations of COVID-19 range from asymptomatic carrier to severe pneumonia, to life-threatening acute respiratory distress syndrome (ARDS). The early efforts of the pandemic surrounded treating the pulmonary component of COVID-19, however, there has been robust data surrounding the cardiac complications associated with the virus. This is suspected to be from a marked inflammatory response as well as direct viral injury. Arrhythmias, acute myocardial injury, myocarditis, cardiomyopathy, thrombosis, and myocardial fibrosis are some of the observed cardiac complications. There have been high morbidity and mortality rates in those affected by cardiac conditions associated with COVID-19. Additionally, there have been documented cases of patients presenting with typical cardiac symptoms who are subsequently discovered to have COVID-19 infection. In those who test positive for COVID-19, clinical awareness of the significant cardiac components of the virus is pertinent to prevent morbidity and mortality. Unfortunately, treatment and preventative measures developed for COVID-19 have been shown to be also be associated with cardiac complications. This is a comprehensive review of the cardiac complications and manifestations of COVID-19 infection in addition to those associated with both treatment and vaccination

Effect of a Reminder Statement on Echocardiography Reports on Referrals for Implantable Cardioverter-Defibrillators for Primary Prevention.

Numerous trials show the benefit of implantable cardioverter-defibrillators (ICDs) for primary prevention in patients with low ejection fraction (EF), a class I indication. However, underutilization is well documented. We retrospectively reviewed charts to see whether placing a reminder statement into echocardiogram reports for appropriate patients increased adherence to guidelines. From January through June 2013, a brief reminder of the ICD guidelines was automatically inserted into echocardiogram reports with EF ≤ 35% (reminder period). Charts were reviewed to determine if these patients (1) were referred to Electrophysiology (EP) within 6 months of the index echo and (2) received an ICD within 6 months of EP referral. Chart review of all patients who had an echocardiogram performed between March and August 2012 with an EF ≤ 35% provided a control period. More patients were referred to EP in the reminder period compared with control period, 68% (54 of 80) versus 51% (53 of 104), p = 0.03. There was also a higher rate of discussions in the reminder period between patients and physicians about ICD therapy (71% vs 54%, p = 0.02). Among patients appropriate for ICD, 52% of patients during the reminder period received an ICD versus 38% of patients during the control period (p = 0.11). A simple reminder statement on echocardiography reports led to a significant improvement in appropriate EP referrals and a trend toward increased ICD implantation in appropriate patients

EOSINO-FEEL-YA HEART BEAT FAST: A CASE OF VENTRICULAR TACHYCARDIA DUE TO EOSINOPHILIC MYOCARDITIS

Background: Eosinophilic myocarditis (EM) is a rare form of myocardial inflammation characterized by a predominantly eosinophilic infiltrate. The clinical presentation can vary, but EM is often fatal with a high in hospital mortality. Case: A 63 year old Caucasian male with a history of angioimmunoblastic T- cell lymphoma and subsequent hypereosinophilic syndrome (HES) presented with sudden onset of lightheadedness. The patient was found to be in pulsatile monomorphic sustained ventricular tachycardia (VT). He underwent cardioversion and initiation of amiodarone therapy. Labs demonstrated peripheral hypereosinophilia of 32% and pancytopenia. Cardiac MRI demonstrated a large area of organized fibrotic thrombus in the right and left ventricular (LV) apex consistent with his clinical HES along with a preserved LV ejection fraction. Decision-making: Amiodarone was initiated immediately and load commenced during his hospital stay. Glucocorticoids are the initial therapy of choice in this clinical scenario and they were promptly initiated. The strategy of defibrillator implantation in the setting of sustained ventricular arrhythmia due to myocarditis is not routine. Due to the possibility of cardiac fibrotic recovery with therapy and his pancytopenia, it was recommended that the patient undergo prolonged steroid therapy, oncology guided chemotherapy, with reassessment of his endomyocardium in 4-6 weeks. Guided by the observational registry of the AVID trial and the European guidelines, he was discharged with a LifeVest for secondary prevention. He also left on amiodarone along with therapeutic enoxaparin. Conclusion: This case demonstrates a clinical presentation of HES and the myocardial complications of thrombus formation, fibrosis and subsequent VT. It also illustrates the utility of a LifeVest in patients with transient conditions for which recovery is possible

Firibastat: A Novel Brain Aminopeptidase Inhibitor - A New Era of Antihypertensive therapy

Global incidence and prevalence of hypertension continues to increase and remains a significant challenge. The ever-increasing number of cases are due to comorbid conditions such as obesity and diabetes, as well as lifestyle indiscretions such as excessive salt intake. Hypertension, congestive heart failure, and kidney disease are all conditions resulting from abnormal Renin-Angiotensin-Aldosterone activation and adverse remodeling. Firibastat, a novel Brain Aminopeptidase inhibitor, may be able to help achieve blood pressure control in those with resistant hypertension. In this review article, we will discuss the biochemical pathway of firibastat and various trials assessing drug efficacy in animals and humans. This drug has the potential to curb the risk of uncontrolled hypertension and help improve long term cardiovascular morbidity and mortality

Valvular Heart Disease in Pregnancy: Anticoagulation and the Role of Percutaneous Treatment.

Valvular heart disease is present in about 1% of pregnancies, and it poses a management challenge as both fetal and maternal lives are at risk of complications. Pregnancy is associated with significant hemodynamic changes, which can compromise the cardiac status in women with underlying valvular disorders. Management of valvular heart diseases has undergone considerable innovation and advancement with newer techniques, approaches and devices being employed. The decision regarding the management of anticoagulation, especially in patients with prosthetic valves, raises distinct questions and challenges. In this review, we describe the management of common valvular heart diseases encountered during pregnancy, role of percutaneous catheter based therapeutic interventions, the importance of a team-based approach, and the challenges given existing gaps in the literature

Vericiguat: A Novel Soluble Guanylate Cyclase Stimulator For Use in Patients with Heart Failure.

Heart failure affects 6.2 million Americans and is increasing annually in its frequency. Treatment of heart failure has been at the forefront of medical advancements due to the financial burden on our health care system. As such, changes to the guidelines regarding standard of care has been evolving over the last decade with the recent additions of sacubitril-valsartan and SGLT2 inhibitors to standard of care in the treatment of heart failure. Despite the aforementioned expansions in treatment options, heart failure continues to have a significant impact on the American healthcare system. Most recently, a novel drug, Vericiguat that targets an unprecedented pathway for the treatment of heart failure, was FDA approved for the management of patients with heart failure with a reduced ejection fraction with a recent hospitalization or need for outpatient IV diuretics. In clinical trials, Vericiguat was associated with a reduction in death from cardiovascular causes and first hospitalization in comparison to placebo. The aim of this review is to provide a comprehensive literature analysis of the various trials surrounding the approval of Vericiguat, and to both inform and synthesize the data surrounding the clinical use of Vericiguat. The introduction of Vericiguat should be considered as a treatment option in patients to decrease the mortality/morbidity of heart failure with reduced ejection fraction, and to increase the quality of life