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Ahmed H, Ismayl M, Palicherla A, May J, Goldsweig AM, Thirumalareddy J. A case report of vaping-associated sudden cardiac arrest in a young healthy patient. Ann Med Surg (Lond) 2024; 86:3042-3046. [PMID: 38694286 PMCID: PMC11060229 DOI: 10.1097/ms9.0000000000001907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/25/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction and importance While vaping has increased significantly among young individuals, the effects of vape aerosol constituents on cardiac electrophysiological dynamics remain unknown. Case presentation A 22-year-old female with a history of energy vaping presented with cardiac arrest. Found to have no pulse, CPR was started and an initial rhythm of ventricular tachycardia was obtained. Shock was administered with a follow-up rhythm of ventricular fibrillation. She was emergently defibrillated and entered atrial fibrillation with rapid ventricular response. Toxicology and troponins were all negative. Left heart catheterization and cardiac MRI were unremarkable. She was discharged with an external defibrillation vest and a tentative plan for outpatient electrophysiology study in the setting of negative work-up for cardiopulmonary arrest. Clinical discussion Vaping-induced sudden cardiac arrest may be attributed to a reduction in cardiac repolarization reserve. Exposure to vegetable glycerin and propylene glycol, substances present in nearly all vape products, have been found to incite arrhythmias and disrupt cardiac conduction in animals. Acrolein, an aldehyde byproduct of glycerin, has also been found to induce arrhythmias due to autonomic dysfunction. Increased intracellular calcium concentration and free radical damage, which occur as a result of inhaling particulate matter generated from e-cigarettes, further propagates the risk of arrhythmia. Conclusion The effects of inhaling vape aerosols remain not fully understood. While there is a perceived notion that nicotine-free aerosols may be harmless, that remains unclear. Further studies are needed to evaluate proarrhythmogenic effects and autonomic dysfunction from the various chemical substances present in vape aerosols.
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Affiliation(s)
- Hasaan Ahmed
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anirudh Palicherla
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Joshua May
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Andrew M. Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Joseph Thirumalareddy
- Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
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Ahmed H, Ismayl M, Palicherla A, Heppler M, Petraskova T, Kousa O, Vargha J. A case report of postcardioversion device-related thrombus in a patient with left atrial appendage occlusion device on apixaban. Ann Med Surg (Lond) 2024; 86:1729-1733. [PMID: 38463065 PMCID: PMC10923387 DOI: 10.1097/ms9.0000000000001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/08/2024] [Indexed: 03/12/2024] Open
Abstract
Background Current guidelines recommend proceeding with cardioversion, without the explicit need for preprocedural transesophageal echocardiography (TEE), in patients compliant with oral anticoagulation for at least 3 weeks. The relevance of these guidelines remains unclear in those undergoing repeat cardioversion. Case summary A 66-year-old male with a history of atrial fibrillation (AF) and a left atrial appendage occlusion (LAAO) device, compliant with apixaban, presented with dyspnea and lightheadedness. He was cardioverted into sinus rhythm, 10 days before symptom onset, with TEE unremarkable at the time. An ECG revealed that the patient converted back into AF and a repeat cardioversion was scheduled. At the patient's request, a TEE was obtained, revealing a new 2 cm×1 cm thrombus in the left atrium above the WATCHMAN device. Cardioversion was canceled and the patient was hospitalized for AF management. Discussion Cardioverted patients are at risk for thrombus formation due to atrial stunning, a transitory dysfunction of the atrial appendage and atrium, which occurs immediately after cardioversion and can persist for several weeks. The likelihood of a thrombus is further propagated by individual risk factors for stroke. Conclusion Anticoagulation does not eliminate the risk of thrombus formation in those with increased risk factors for stroke. Further studies are warranted to assess the need for routine TEE, after cardioversion, in those with stroke risk factors on anticoagulation or who have LAAO.
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Affiliation(s)
- Hasaan Ahmed
- Department of Medicine, Division of Internal Medicine
| | - Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | | | | | | | - Omar Kousa
- Department of Medicine, Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, Nebraska
| | - Jalal Vargha
- Department of Medicine, Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, Nebraska
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Palicherla A, Ismayl M, Thandra A, Budoff M, Shaikh K. Evaluation of stable angina by coronary computed tomographic angiography versus standard of care: A systematic review and meta-analysis. Cardiovasc Revasc Med 2024; 59:67-75. [PMID: 37541837 DOI: 10.1016/j.carrev.2023.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION There is limited data comparing Coronary Computed Tomography Angiography (CCTA) versus the usual Standard of care (SOC) in patients with suspected stable coronary artery disease (CAD). We aimed to perform a systematic review and meta-analysis to compare CCTA versus SOC in patients with stable CAD. METHODS We searched multiple databases for randomized controlled trials (RCTs) comparing CCTA with SOC, which included various functional testing approaches for evaluating stable CAD. We used a random-effects model to calculate risk ratios (RRs) with 95 % confidence intervals (CIs). Outcomes included all-cause mortality, myocardial infarction (MI), hospitalization for unstable angina (UA), invasive angiography, revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). RESULTS We identified 6 RCTs with 19,881 patients with stable CAD, of which 9995 underwent CCTA, and 9886 underwent SOC. There were no significant differences between CCTA and SOC in terms of all-cause mortality (RR: 0.91; 95 % CI: 0.70-1.19; p = 0.50), MI (RR: 0.78; 95 % CI: 0.58-1.05; p = 0.11), hospitalizations for UA (RR: 1.20; 95 % CI: 0.95-1.51;p = 0.12), invasive angiography (RR: 0.71; 95 % CI: 0.32-1.61; p = 0.42), revascularization (RR:1.25; 95 % CI: 0.83-1.89; p = 0.29), PCI (RR: 1.20; 95 % CI: 0.78-1.85; p = 0.40), and CABG rates (RR: 0.89; 95 % CI: 0.530-1.49; p = 0.65). CONCLUSION In patients with stable CAD, CCTA is associated with similar outcomes compared to the usual Standard of care. Given its potential to quickly rule out severe obstructive disease, its ability to provide non-invasive physiology and identify non-obstructive CAD with plaque information makes it an attractive addition to the available armamentarium to evaluate chest pain.
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Affiliation(s)
- Anirudh Palicherla
- Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States of America.
| | - Mahmoud Ismayl
- Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States of America
| | - Abhishek Thandra
- Interventional Cardiology, Creighton University School of Medicine, Omaha, NE, United States of America.
| | - Matthew Budoff
- David Geffen School of Medicine at UCLA, Los Angeles, United States of America.
| | - Kashif Shaikh
- University of Tennessee, Knoxville, United States of America
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Palicherla A, Torres R, Walters RW, Thandra A, Narmi A, Smer A. Outcomes of Valvular Endocarditis in Patients With and Without Pericardial Effusion: A National Inpatient Sample Study. Curr Probl Cardiol 2023; 48:101863. [PMID: 37301489 DOI: 10.1016/j.cpcardiol.2023.101863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
Over the last decade, hospitalizations for infective endocarditis (IE) have been steadily increasing, leading to a significant healthcare burden. Pericardial effusion (PCE) has been identified as a serious complication of IE, yet no significant association with mortality has been established. Our study aims to further analyze and understand the significance of PCE in patients with IE. We performed a retrospective analysis using the national inpatient sample database to identify all the hospital admissions with IE using ICD 10 codes and stratified them into 2 groups based on the presence of PCE. The outcomes of interest were inhospital mortality, inhospital complications, need for cardiac surgery, and length of stay. From 2015 Q4-2019, a total of 76,260 hospitalizations were included (weighted: 381,300), of which 2.7% included a PCE diagnosis. Hospitalizations with a PCE diagnosis included patients that were younger (51 vs 61, P < 0.001), as well as slightly more males (58.0% vs 55.2%, P = 0.011), and black patients (16.9% vs 12.9%, P < 0.001). PCE was associated with higher in-hospital death (12.7% vs 9.0%, P < 0.001), longer lengths of stay (12 days vs 7 days, P < 0.001), higher rates of cardiac surgery (22.4% vs 7.3%, P < 0.001). The rates of heart failure, heart block, renal failure, cardiogenic shock, and embolic stroke were higher on PCE group. We found that presence of PCE is associated with higher inhospital mortality, longer length of stay, and greater utilization of cardiac surgery, as well as presence of heart failure, heart block, cardiogenic shock, and embolic stroke.
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Affiliation(s)
- Anirudh Palicherla
- Department of Medicine, Creighton University School of Medicine, Omaha, NE.
| | - Rosa Torres
- Department of Medicine, Creighton University School of Medicine, Omaha, NE
| | - Ryan W Walters
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE
| | - Abhishek Thandra
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Ann Narmi
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Aiman Smer
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE
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Palicherla A, Pusapati S, Anugula D, Thandra A. Marantic Endocarditis in Metastatic Lung Adenocarcinoma. Methodist Debakey Cardiovasc J 2023; 19:100-103. [PMID: 37547896 PMCID: PMC10402816 DOI: 10.14797/mdcvj.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Marantic endocarditis is a rare condition associated with autoimmune disease, malignancy, and hypercoagulable states. It is characterized by sterile friable vegetations composed of fibrin and platelets that confer a high risk of systemic embolism. Here we showcase imaging that led to the diagnosis of an interesting case of marantic endocarditis secondary to metastatic malignancy.
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Affiliation(s)
| | - Suma Pusapati
- Creighton University School of Medicine, Omaha, Nebraska, US
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Palicherla A, Kousa O, Mohammed S. A RARE CASE OF ENDOMYOCARDIAL BIOPSY NEGATIVE AMYLOID LIGHT CHAIN CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03961-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Palicherla A, Abusnina W, Kapaganti S, Dahal K. SODIUM RESTRICTION IN HEART FAILURE: A META-ANALYSIS OF RANDOMIZED TRIALS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Palicherla A, Gill GS, Chakrala T, Kanmanthareddy A, Alla VM. CEREBRAL EMBOLIC PROTECTION DEVICES ARE PROTECTIVE AGAINST DISABLING STROKE IN TRANSCUTANEOUS AORTIC VALVE REPLACEMENT: A META-ANALYSIS OF RANDOMIZED TRIALS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Machanahalli Balakrishna A, Ismayl M, Palicherla A, Aboeata A, Goldsweig AM, Zhao DX, Vallabhajosyula S. Impact of prior coronary artery bypass grafting on periprocedural and short-term outcomes of patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Coron Artery Dis 2023; 34:42-51. [PMID: 36326179 DOI: 10.1097/mca.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The effect of prior coronary artery bypass graft (CABG) on the outcomes of transcatheter aortic valve replacement (TAVR) remains incompletely characterized. In this meta-analysis, we investigated the impact of prior CABG on TAVR outcomes. METHODS A systematic search was conducted in PubMed, Google Scholar, and Cochrane databases from inception to 24 July 2022, using the search terms 'TAVR', 'CABG', 'peri-procedural complications', and 'mortality'. The major outcomes were peri-procedural complications, intraprocedural mortality, 30-day mortality, and 30-day cardiac mortality. We used random-effects models to aggregate data and to calculate pooled incidence and risk ratios with 95% confidence intervals (CIs). RESULTS Among 116 results from the systematic search, a total of 8 studies (5952 patients) were included. Compared to patients without previous CABG, patients with prior CABG undergoing TAVR were younger, predominantly male sex, had more comorbidities, higher rates of peri-procedural myocardial infarction (MI) [relative risk (RR) 1.93; 95% CI, 1.09-3.43; P = 0.03], but lower rates of stroke (RR 0.71; 95% CI, 0.51-0.99; P = 0.04), major vascular complications (RR 0.70; 95% CI, 0.51-0.95; P = 0.02), and major bleeding (RR 0.70; 95% CI, 0.56-0.88; P = 0.002). There were no significant differences between the two cohorts in rates of pacemaker implantation, cardiac tamponade, acute kidney injury, intra-procedural mortality, 30-day mortality, and 30-day cardiac mortality. CONCLUSION Among patients undergoing TAVR, a history of prior CABG was not associated with an increased risk of periprocedural complications (except for acute MI) or short-term mortality compared to those without CABG.
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Affiliation(s)
| | - Mahmoud Ismayl
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Anirudh Palicherla
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Ahmed Aboeata
- Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Cruz Torres R, Bansal R, Palicherla A, Thandra A, Sharma A, Narmi A, Smer A. Outcomes of infective endocarditis in patients with and without pericardial effusion: a National Inpatient Sample study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Pericardial effusion (PE) in patients with infective endocarditis (IE) has been shown to be an independent risk factor for severe complications, however no significant association with mortality has been established. Our study aims to study the significance of pericardial effusion in patients with IE.
Methods
We performed a retrospective analysis using the United States National Inpatient Sample (NIS) database to identify all the hospital admissions with IE using ICD 10 codes and divided them into two groups based on the presence of PE. The outcomes of interest were in-hospital mortality, in-hospital complications, need for cardiac surgery, and length of stay (LOS).
Results
A total of 381,300 patients were hospitalized from 2016 to 2019 with IE, of whom 10,370 developed PE. Mean age of patients in the PE group was 51 years and in non-PE group was 61 years with males and Caucasian race being predominant in both groups. PE group had higher rates of in-hospital death (12.7% vs 9%, P≤0.001) and longer in-hospital stay (12 days vs 7 days, P≤0.001) compared to non-PE group. The rates of cardiac surgery were higher in PE group (26.1% vs 8.4%, P≤0.001). The rates of heart failure, heart block, renal failure, cardiogenic shock, and embolic stroke were higher in PE group [Table 1].
Conclusion
Our study shows that presence of PE in patients with IE is a predictor for in-hospital mortality, length of stay, and need for cardiac surgery. Also, these patients are at higher risk for heart failure, heart block, cardiogenic shock and embolic stroke.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Cruz Torres
- Chi Health Creighton University Medical Center - Bergan Mercy , Omaha , United States of America
| | - R Bansal
- Chi Health Creighton University Medical Center - Bergan Mercy , Omaha , United States of America
| | - A Palicherla
- Chi Health Creighton University Medical Center - Bergan Mercy , Omaha , United States of America
| | - A Thandra
- Chi Health Creighton University Medical Center - Bergan Mercy , Omaha , United States of America
| | - A Sharma
- Mayo Clinic, Endocrinology , Rochester , United States of America
| | - A Narmi
- University of Nebraska Medical Center, Cardiovascular Medicine , Omaha , United States of America
| | - A Smer
- Chi Health Creighton University Medical Center - Bergan Mercy , Omaha , United States of America
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