23 research outputs found

    A complete heart block in a young male: a case report and review of literature of cardiac sarcoidosis.

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    Cardiac sarcoidosis is one of the uncommon causes of heart failure. Generally, it presents in the form of varying clinical manifestations ranging from asymptomatic to fatal arrhythmias such as ventricular tachycardia and complete heart block. It is difficult to make a diagnosis strictly based on clinical grounds. However, in the setting of extracardiac sarcoidosis and patients presenting with advanced heart block or ventricular arrhythmia, direct cardiac involvement should be suspected. The definitive diagnosis of cardiac sarcoidosis can be made from endomyocardial biopsy, but it is falling out of favor due to patchy myocardial involvement, considerable procedure-related risks, and advancement in additional imaging modalities. Once cardiac sarcoidosis has been diagnosed, management of the disease remains challenging. Steroids are considered the mainstay of therapy, and implantable cardioverter defibrillator therapy can be considered in a selected group of patients at greater risk for malignant ventricular arrhythmias

    Regional and seasonal variations in the US emergency department visits for acute pericarditis.

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    The pericardium is an avascular fibro-elastic enclosure surrounding the heart, composed of two layers divided by a potential cavity; the pericardial space. Inflammation of this space is termed acute pericarditis (AP), the etiology of which is believed to be multifactorial with the most common cause worldwide being idiopathic [1]. Seasonality of AP is often attributed to increased incidences of viral infection, but regional variations in AP have not been examined. We conducted this study to assess regional and seasonal trends of AP

    OBESITY IS NOT ASSOCIATED WITH A DIFFERENTIAL OUTCOME FOLLOWING CORONARY ARTERY BYPASS SURGERY

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    Background: Conflicting data exists regarding the impact of obesity on mortality and morbidity following coronary artery bypass graft (CABG) surgery with some suggesting a paradoxical reduction in adverse outcomes. We aimed to compare the in-hospital outcomes of CABG in obese and non-obese subjects. Methods: The Nationwide Inpatient Sample for years 2003- 2014 was used to identify adults (age ≥18 years) who underwent isolated CABG. Results: A total of 2,297,932 patients underwent CABG of which 554,857 (28.2%) surgeries were for acute coronary syndrome (ACS) and 1,743075 (74.2%) were elective. Obese patients in either group were younger, were more likely to be female and had more co-morbidities at baseline (Table 1). There was no difference in adjusted all-cause mortality in obese versus non-obese patients with ACS (2.7%-vs-4.2%, OR=1.03, 95% CI=0.98-1.07, p=0.25) or elective (0.9%-vs-1.5%, OR=0.98, 95% CI=0.94-1.03, p=0.47) CABG. Adjusted rates of acute kidney injury requiring dialysis and of wound infection were higher among obese patients whereas those of acute stroke were lower. Rates of blood transfusion were lower in obese patients undergoing CABG for ACS but not for elective indications. Obese patients with and without ACS more often received internal mammary artery grafts (90.8%-vs-88.5%, P\u3c0.001). Conclusion: Data from this comprehensive national database did not show a significant difference in in-hospital mortality among obese and non-obese patients undergoing CABG surgery

    Simulation-based training of transesophageal echocardiography for cardiology fellows.

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    Methods We created a curriculum on a TEE simulator (HeartWorks, Inventive Medical Ltd., London, UK) that applied B-mode imaging and a three-dimensional model (Fig. 1); Doppler functions and pathology cases were not available. The curriculum was divided into four sessions of 1–2 h duration; each session was a one-on-one between one experienced echocardiographer (DW, AW, RD, or CS) and one fellow. The topics for the four sessions were: (1) basic imaging planes and ventricular function; (2) aortic and mitral valve imaging; (3) pulmonary and tricuspid valve imaging; and (4) other structures (pulmonary veins, great vessels, interatrial septum). Fellows assessed the curriculum and TEE self-confidence with a five-point scale and narrative responses. The fellows’ curriculum evaluations were anonymized and their use was authorized for research purposes by our Institutional Review Board; the requirement for informed consent was waived. Results Between 2012 and 2014, 17 fellows completed the curriculum, of which 15 completed the assessment. All fellows were encouraged to complete the assessment; however, because they were anonymous, we could not directly encourage them further. The median self-confi- dence increased from 3 to 4 (P = 0.02, Wilcoxon signedrank test). After the training, all fellows reported that their self-confidence in TEE skills was at least ‘‘moderate’’ (Fig. 2). All fellows agreed or strongly agreed that the curriculum was ‘‘a valuable addition to my training’’; 86.7% felt the duration was appropriate. Multiple fellows indicated a preference for additional training on pathologic conditions. No negative comments were received. Discussion Cardiology fellows report value and increased self-confi- dence in TEE skills after completing a simulator-based training curriculum. Reports from other institutions using TEE simulators have found improvements in image acquisition and self-reported confidence [1–4]

    Percutaneous coronary intervention and inpatient mortality in patients with advanced chronic kidney disease presenting with acute coronary syndrome.

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    Chronic kidney disease (CKD) is an important risk factor for coronary artery disease, yet patients with CKD are less likely to undergo coronary angiography and percutaneous coronary intervention (PCI). We retrospectively analyzed the 2006-2012 National Inpatient Sample Database to examine the temporal trends in coronary angiography and PCI among patients without CKD, with advanced CKD (CKD III-V), and with end-stage renal disease (ESRD) presenting with unstable angina/non-ST elevation myocardial infarction (NSTE-ACS) and ST-elevation myocardial infarction (STEMI). A total of 579,747 admissions for NSTE-ACS and 293,950 admissions for STEMI were studied. Patients with NSTE-ACS were less likely to undergo coronary angiography/PCI than those with STEMI, irrespective of CKD. Between 2006 and 2012, performance of PCI saw an uptrend across all CKD groups with NSTE-ACS (no CKD, 29.9%-36.8%; CKD III-V, 18.2%-21.5%; ESRD, 19.8%-27.5%; all Ptrends \u3c 0.01) and STEMI (no CKD, 57.0%-76.0%; CKD III-V, 33.0%-52.6%; ESRD, 29.9%-42.9%; Ptrends \u3c 0.01). Multivariate analyses revealed that PCI was associated with a lower risk of hospital mortality across all degrees of CKD in both NSTE-ACS (adjusted odds ratios: no CKD, 0.44; CKD III-V, 0.48; ESRD, 0.46; P \u3c 0.01) and STEMI (no CKD, 0.35; CKD III-V, 0.50; ESRD, 0.52; P \u3c 0.01). Performance of PCI increased over time among patients presenting with NSTE-ACS and STEMI in the presence of advanced CKD and independently predicted lower in-hospital mortalit

    Trends in the use of echocardiography in pulmonary embolism.

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    Pulmonary embolism (PE) is a devastating diagnosis which carries a high mortality risk. Echocardiography is often performed to risk stratify patients diagnosed with PE, and guide management strategies. Trends in the performance of echocardiography among patients with PE and its role in influencing outcomes is unknown.We analyzed the 2005 to 2014 National Inpatient Sample Database to identify patients with primary diagnosis of PE or secondary diagnosis of PE and ≥1 of the following diagnoses: syncope, thrombolysis, acute deep vein thrombosis, acute cardiorespiratory failure, and secondary pulmonary hypertension. Trends in the performance of echocardiography and in-hospital mortality were analyzed. The admissions were divided into 2 groups with echocardiography, and without echocardiography, and 1:2 propensity score matching (PSM) was performed for comparison. The primary end-point was in-hospital mortality. The secondary endpoints were length of stay and total hospitalization costs. Odd ratios (OR) with confidence intervals (CI) were reported.A total of 299,536 unweighted PE cases were studied. Performance of echocardiography among patients with PE patients increased from 3.5% to 5.6%, whereas in-hospital mortality decreased from 4.2% to 3.7% between years 2005 and 2014. Before matching, patients who received an echocardiogram were more likely to be younger, African American, admitted to a large, urban teaching institute, and had higher rates of concurrent acute deep vein thrombosis, and acute respiratory failure. Post-PSM, patients who received echocardiography during hospitalization had lower in-hospital mortality (odds ratio 0.75, 95% confidence intervals (CI) 0.68-0.83; P \u3c 0.001), longer length of stay (median 6 days vs 5 days; P \u3c .001) and higher mean hospitalization costs (34,379vs34,379 vs 27,803; P \u3c .001) compared to those without echocardiography.Performance of echocardiography among patients with a PE is increasing and is associated with lower in-hospital mortality
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