A-dip of the aortic valve by M-mode echocardiography

We present a case with the previously unreported finding of an a-dip in the M-mode tracing of the aortic valve. An a-dip is commonly seen in the M-mode tracing of the pulmonic valve motion, and represents near equalization of pulmonary artery and right ventricular end- -diastolic pressures during atrial contraction. M-mode echocardiography has become an ancillary study to the basic two-dimensional examination, but can often convey important features of cardiac hemodynamics quite elegantly, as the present case demonstrates

Comparison of Echocardiographic Measures in a Hispanic/Latino Population With the 2005 and 2015 American Society of Echocardiography Reference Limits (The Echocardiographic Study of Latinos)CLINICAL PERSPECTIVE

BACKGROUND: Reference limits for echocardiographic quantification of cardiac chambers in Hispanics are not well studied. METHODS AND RESULTS: We examined the reference values of left atrium and left ventricle (LV) structure in a large ethnically diverse Hispanic cohort. Two-dimensional transthoracic echocardiography was performed in 1818 participants of the Echocardiographic Study of Latinos (ECHO-SOL). Individuals with body mass index ≥30 kg/m(2), hypertension, diabetes mellitus, coronary artery disease, and atrial fibrillation were excluded leaving 525 participants defined as healthy reference cohort. We estimated 95th weighted percentiles of LV end systolic volume, LV end diastolic volume, relative wall and septal thickness, LV mass, and left atrial volume. We then used upper reference limits of the 2005 and 2015 American Society of Echocardiography (ASE) and 95th percentile of reference cohort to classify the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) target population into abnormal and normal. Reference limits were also calculated for each of 6 Hispanic origins. Using ASE 2015 defined reference values, we categorized 7%, 21%, 57%, and 17% of men and 18%, 29%, 60%, and 26% of women as having abnormal LV mass index, relative, septal, and posterior wall thickness, respectively. Conversely, 10% and 11% of men and 4% and 2% of women were classified as having abnormal end-diastolic volume and internal diameter by ASE 2015 cutoffs, respectively. Similar differences were found when we used 2005 ASE cutoffs. Several differences were noted in distribution of cardiac structure and volumes among various Hispanic/Latino origins. Cubans had highest values of echocardiographic measures, and Central Americans had the lowest. CONCLUSIONS: This is the first large study that provides normal reference values for cardiac structure. It further demonstrates that a considerable segment of Hispanic/Latinos residing in the United States may be classified as having abnormal measures of cardiac chambers when 2015 and 2005 ASE reference cutoffs are used

The Association of Blood Urea Nitrogen Levels and Coronary Artery Disease

Renal dysfunction has been associated with adverse cardiovascular outcomes. Estimates of renal function routinely utilize creatinine-based measures. Serum blood urea nitrogen (BUN) levels, however, may provide supplemental information in regard to renal function as renal proximal tubule cells may increase BUN reabsorption in the setting of increased neurohormonal activation. We performed a retrospective chart review on 156 consecutive adult patients presenting to the Montefiore Medical Center Emergency Department with symptoms of unstable angina and no known prior history of coronary artery disease (CAD) who underwent cardiac catheterization as part of their index hospitalization. On multivariate analysis, admission serum BUN was associated with an increased burden of CAD on cardiac catheterization and was not associated with ruling in for myocardial infarction (MI).

A White Suit

Gabriel Lyons Loeb is a young house-painter from Northfield, Minnesota. Towards the end of the summer Gabriel becomes fixated on an infomercial for a Jack Lallane Power Juicer and, on a whim, purchases a juicer for himself. However, his intentions are much more than a simple health craze or a hankering for fresh squeezed carrots. Gabriel is going to fill his swimming pool with juice. The juicer arrives and Gabriel begins his pursuits. With the help of a friend, Gabriel drains his pool and starts practicing with his new juicer. He paints houses by day and moonlights as a mixologist by night. Gabriel starts to get pretty good at juicing--inventing with new cocktails and always improving on his work-flow. His juicing exploits begins to take over his daily routine, spending nearly every waking moment behind the juicer. But, just as Gabriel becomes extremely comfortable juicing and the actions become mindless and repetitive, he cuts his finger on the blades of the juicer. The wound is incredibly painful but it does not deter him for long. Gabriel wraps up his hand and goes to work the next day. Gabriel has a few guests over to taste the juice he has been making, but when the tasting session is over, the last task if up to him alone. He sets up a juicing station in the outdoor shed and systematically fills large buckets with juice. He works with the juicer through the night, fills the entire pool, and then goes to sleep

The Left Ventricular Ejection Fraction: New Insights Into an Old Parameter

Accurate evaluation of cardiac function has become increasingly important as the treatment of cardiac disease has become more complex. At the same time, technological advances allow greater accuracy and precision in cardiac measurements. Measurement of left ventricular ejection fraction (LVEF) has been a pillar of cardiac evaluation. Several non-invasive modalities are available to assess LVEF; each has advantages and limitations. This review examines various modalities used to measure LVEF and focuses on the relative strengths and weaknesses of each modality. In some clinical settings, however, LVEF may be too insensitive to convey subtle changes in LV contractility. This review also highlights clinical situations in which use of LVEF may be an insufficient measure of left ventricular systolic function. Global longitudinal strain is one such parameter that has shown promise for detecting subtle reductions in left ventricular contractility in subjects with chemotherapy induced cardiotoxicity

Prevalence of myocardial infarction with non-obstructive coronary arteries (MINOCA) amongst acute coronary syndrome in patients with antiphospholipid syndrome

Antiphospholipid antibody syndrome (APLS) is well known to cause thrombotic events and premature atherosclerosis leading to coronary artery occlusion. The association of non-thrombotic acute myocardial infarctions (AMI) with APLS is not as clearly delineated. The objective of this study was to determine the relative prevalence of myocardial infarction with non obstructive coronary arteries (MINOCA) compared to MI from vaso-occlusive disease amongst patients with known APLS at our institution. Out of 575 patients with positive antiphospholipid antibodies, cardiac catheterizations were performed in 40 patients presented with AMI and had cardiac catheterizations. MINOCA was found in 8 patients. We found that MINOCA is common in patients with APLS presenting with ACS and that spasm may also play a role in AMI in patients with APLS