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Tin S, Lim W, Humayun A, Galligan S. A Rare Case of Takotsubo Cardiomyopathy in a Patient With No Identifiable Emotional or Physical Stressors. Cureus 2021; 13:e17281. [PMID: 34540501 PMCID: PMC8448168 DOI: 10.7759/cureus.17281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 12/04/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a cardiac condition that presents with features of acute myocardial infarction and transient systolic dysfunction without angiographic findings of obstructive coronary heart disease. Common presenting symptoms include acute substernal chest pain, dyspnea and syncope. It is usually triggered by recent emotional or physical stress such as head trauma, stroke, sepsis, overproduction of catecholamines such as pheochromocytoma or following Myasthenia crisis. We are here to report a case of TCM who does not have any identifiable emotional or physical stress prior to the event. The patient was a 76-year-old Caucasian female with a past medical history of hypertension who presented to the hospital with chest pain which initially was treated as non-ST elevation myocardial infarction (NSTEMI) with aspirin, ticagrelor and heparin infusion. Cardiac catheterization later revealed non-obstructive coronary artery disease but showed akinesis of inferior, apical and anterior walls with hyperdynamic basal segments indicating TCM.
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Affiliation(s)
- Swann Tin
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - William Lim
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Anum Humayun
- Internal Medicine, Richmond University Medical Center, new york, USA
| | - Sean Galligan
- Internal Medicine/Cardiology, Richmond University Medical Center, Staten Island, USA
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Lim W, Suhail M, Galligan S. A Case of Three-Vessel Coronary Artery Disease Associated With Marijuana Use. Cureus 2021; 13:e14481. [PMID: 34007737 PMCID: PMC8120919 DOI: 10.7759/cureus.14481] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Marijuana is one of the most popular psychotropic drugs among adolescents and young adults. With the recent surge in marijuana use across the United States, it is very important for physicians to understand the clinical implications associated with marijuana use. In this case report, we discuss a case of a young adult who presented to the emergency department with chest pain and was found to have three-vessel coronary artery disease (CAD). The patient did not have any significant past medical history or family history of cardiac diseases but reported a significant history of marijuana use. This case report aims to add to the growing area of research on the association between myocardial infarction (MI) and marijuana use.
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Affiliation(s)
- William Lim
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Maham Suhail
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Sean Galligan
- Internal Medicine/Cardiology, Richmond University Medical Center, Staten Island, USA
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Abstract
The localized or diffused dilation of a coronary artery lumen is referred to as coronary artery ectasia (CAE). Though it is well recognized, CAE is a rare finding that is encountered in the diagnostic procedure of coronary angiography. This form of atherosclerotic coronary artery disease (CAD) can be found in 1.4-4.9% of all coronary angiography patients. CAE can manifest in combination with stenotic lesions or present as an isolated condition. Its risk factors are similar to those of atherosclerosis. The underlying pathophysiology involves a vascular remodeling response to atherosclerosis. Enzymatic degradation by matrix metalloproteinases (MMP) and accumulation of lipoproteins play an important role in the remodeling process. CAE can be diagnosed with the help of imaging modalities such as coronary CT angiogram (CTA) and coronary magnetic resonance angiogram (MRA); coronary angiography is considered the gold standard procedure. The management strategies include treating the cardiovascular risk factors, prevention of thromboembolic events, and percutaneous/vascular revascularization. CAE can be managed medically, but percutaneous/surgical revascularization [coronary artery bypass grafting (CABG)] is an option to treat patients with co-existing symptomatic obstructive lesion refractory to medical treatment. Further trials are required to optimize the management guidelines related to CAE. In this report, we describe the case of a 42-year-old man with a past medical history of hypertension, hyperlipidemia, and asthma who presented with shortness of breath and minimally elevated troponin level. Coronary angiography revealed three vessels with ectasia and severe left ventricular dysfunction on ventriculography.
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Affiliation(s)
- Rana Al-Zakhari
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Safa Aljammali
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Sean Galligan
- Cardiology, Richmond University Medical Center, Staten Island, USA
| | - Francesco Rotatori
- Interventional Cardiology, Richmond University Medical Center, Staten Island, USA
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Abstract
Myopericarditis is inflammation of the pericardium with concurrent myocardial involvement. The clinical presentation of myopericarditis is often with varying degrees of cardiac symptomatology. Its etiology is often idiopathic, but it may also be related to infectious and inflammatory prodrome. Symptoms are proportional to the extent and pattern of myocardial involvement. Many are diagnosed sub-clinically during the management of other systemic illnesses. Echocardiography and cardiac magnetic resonance imaging are important tools in the evaluation of myopericarditis, as the diagnosis of left ventricular dysfunction greatly affects the management, follow-up, and prognosis of these patients. The acute management of myopericarditis remains without clear direction and focuses on symptom control. The use of NSAIDs is often cautioned, as it has been described to actually accelerate the myocarditic process in animal models, possibly increasing mortality. Colchicine, a well-established anti-inflammatory agent, may have a role in the management of acute myopericarditis. We present two cases, each involving a young male, without underlying medical conditions, who presented to the emergency room with acute onset chest pain. Both were found to have elevated cardiac biomarkers and electrocardiographic (EKG) changes, admitted as in-patients and eventually diagnosed with acute myopericarditis. They made full recoveries and were eventually discharged home. Both were started on colchicine during hospitalization, which were continued for several months upon discharge. Overall, there is limited published data regarding the medical management of myopericarditis. There need to be prospective studies and registries to further our knowledge in the management of this illness.
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Affiliation(s)
- Rana Al-Zakhari
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Gautham Upadhya
- Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Sean Galligan
- Cardiology, Richmond University Medical Center, Staten Island, USA
| | - Fiona Shehaj
- Cardiology, Richmond University Medical Center, Staten Island, USA
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Abstract
Patient: Female, 36-year-old Final Diagnosis: Atrioventricular nodal reentrant tachycardia Symptoms: Palpitation Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Muhammed Atere
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Sean Galligan
- Department of Cardiology, Richmond University Medical Center, Staten Island, NY, USA
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Afzal A, Fung D, Galligan S, Godwin EM, Kral JG, Salciccioli L, Lazar JM. The effect of lower body weight support on arterial wave reflection in healthy adults. ACTA ACUST UNITED AC 2014; 8:388-93. [PMID: 24794204 DOI: 10.1016/j.jash.2014.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/05/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
Body weight support (WS) during treadmill exercise is used to rehabilitate orthopedic/neurological patients. WS lowers musculoskeletal strain and load. It compresses the lower body and increases intrathoracic volume. We studied short-term effects of WS on wave reflection indices using applanation tonometry during progressive WS of 25%, 50%, and 75% of body weight in 25 healthy men. WS decreased mean heart rate from 79 to 69 beats/min (P < .001). Peripheral and central mean arterial, systolic, and pulse pressures (PP) remained unchanged. There was a trend toward lower peripheral and central diastolic pressure. PP amplification ratio decreased significantly (P = .005). Reflected wave characteristics: Augmented pressure and index increased in a stepwise manner with WS (both P < .001). Both ejection duration and systolic duration of the reflected pressure wave (Ätr) increased progressively (both P < .001). The round-trip travel time (Δtp) was unchanged. Left ventricular workload and oxygen demand: Left ventricular wasted pressure energy increased (P < .001), and the subendocardial viability ratio decreased (P = .005), whereas the tension time index remained unchanged. In normal men, WS acutely decreases the PP amplification ratio, increases the amplitude and duration of the reflected aortic pressure wave, and increases measures of wasted left ventricular pressure energy and oxygen demand.
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Affiliation(s)
- Atif Afzal
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Daniel Fung
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Sean Galligan
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Ellen M Godwin
- Human Performance Laboratory, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - John G Kral
- Department of Surgery, State University of New York, Downstate Medical Center, Brooklyn, NY
| | - Louis Salciccioli
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Jason M Lazar
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.
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Bapat M, Musikantow D, Khmara K, Chokshi P, Khanna N, Galligan S, Kamran H, Salciccioli L, Barone FC, Lazar JM. Comparison of passive leg raising and hyperemia on macrovascular and microvascular responses. Microvasc Res 2012; 86:30-3. [PMID: 23261755 DOI: 10.1016/j.mvr.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 11/02/2012] [Accepted: 12/06/2012] [Indexed: 11/19/2022]
Abstract
Passive leg raising is a simple diagnostic maneuver that has been proposed as a measure of arterial vasodilator reserve and possibly endothelial function. While passive leg raising has previously been shown to lower blood pressure, increase flow velocity and cause brachial artery dilation, its effects on microvascular flow has not been well studied. Also, passive leg raising has been directly compared previously to upper arm but never to lower arm occlusion of blood flow induced hyperemia responses. We compared changes in macrovascular indices measured by brachial artery ultrasound and microvascular perfusion measured by Laser Doppler Flowmetry induced by passive leg raising to those provoked by upper arm and lower arm induced hyperemia in healthy subjects. Upper arm induced hyperemia increased mean flow velocity by 398%, induced brachial artery dilatation by 16.3%, and increased microvascular perfusion by 246% (p<.05 for all). Lower arm induced hyperemia increased flow velocity by 227%, induced brachial artery dilatation by 10.8%, and increased microvascular perfusion by 281%. Passive leg raising increased flow velocity by 29% and brachial artery dilatation by 5.6% (p<.05 for all), but did not change microvascular perfusion (-5%, p=ns). In conclusion, passive leg raising increases flow velocity orders of magnitude less than does upper arm or lower arm induced hyperemia. Passive leg raising-induced brachial artery dilatation is less robust than either of these hyperemic techniques. Finally, although upper arm and lower arm hyperemia elicits macrovascular and microvascular responses, passive leg raising elicits only macrovascular responses.
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Affiliation(s)
- Manasi Bapat
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203-2098, USA
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Schillace R, Pisenti N, Pattamanuch N, Galligan S, Marracci GH, Bourdette DN, Carr DW. Lipoic acid stimulates cAMP production in T lymphocytes and NK cells. Biochem Biophys Res Commun 2007; 354:259-64. [PMID: 17210133 PMCID: PMC4278348 DOI: 10.1016/j.bbrc.2006.12.195] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 12/28/2006] [Indexed: 01/10/2023]
Abstract
The anti-oxidant lipoic acid (LA) potently suppresses clinical and pathologic disease in the animal model of multiple sclerosis, experimental autoimmune encephalomyelitis, by inhibiting the migration of pathogenic T cells to the spinal cord. The mechanism by which this occurs is largely unknown. In this report we demonstrate that LA induces increases in cyclic AMP, a known immunosuppressant, in human T cells. The increase in cAMP is associated with increased adenylyl cyclase activity and is partially blocked by prostanoid receptor antagonists. We present evidence that LA also stimulates cAMP production in natural killer (NK) cells. This novel mechanism of action is highly relevant to the immunomodulatory effects of LA and provides further support for the study of LA as a therapeutic agent for multiple sclerosis and other autoimmune diseases.
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Affiliation(s)
- R.V. Schillace
- VAMC RD-8 3710 SW US Veterans Hospital Road, Portland, OR 97239
| | - N. Pisenti
- Portland Veterans Affairs Medical Center and Department of Endocrinology, Oregon Health & Science University, Portland, OR 97239; VAMC RD-8 3710 SW US Veterans Hospital Road, Portland, OR 97239
| | - N. Pattamanuch
- Portland Veterans Affairs Medical Center and Department of Endocrinology, Oregon Health & Science University, Portland, OR 97239; VAMC RD-8 3710 SW US Veterans Hospital Road, Portland, OR 97239
| | - S. Galligan
- Portland Veterans Affairs Medical Center and Department of Endocrinology, Oregon Health & Science University, Portland, OR 97239; VAMC RD-8 3710 SW US Veterans Hospital Road, Portland, OR 97239
| | - G. H. Marracci
- VAMC RD-65 3710 SW US Veterans Hospital Road, Portland, OR 97239
| | - D. N. Bourdette
- VAMC RD-65 3710 SW US Veterans Hospital Road, Portland, OR 97239
| | - D. W. Carr
- Portland Veterans Affairs Medical Center and Department of Endocrinology, Oregon Health & Science University, Portland, OR 97239; VAMC RD-8 3710 SW US Veterans Hospital Road, Portland, OR 97239
- Corresponding Author: Daniel Carr, Veterans Affairs Medical Center, RD8, 3710 SW US Veterans Hospital Road, Portland, OR 97239, tel: 503-721-7918, fax: 503-721-1082,
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Laurino JP, Fischberg-Bender E, Galligan S, Chang J. An immunochemical mass assay for the direct measurement of creatine kinase MB2. Ann Clin Lab Sci 1995; 25:252-63. [PMID: 7605108] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The isoforms of CK-MB have recently received attention as potential biochemical markers for the early diagnosis of an acute myocardial infarction. A sensitive (analytical sensitivity = 0.2 ng/ml) immunochemical mass assay for the direct measurement of the CK-MB2 isoform has been developed by us. This assay utilizes a specific monoclonal capture antibody directed against the B-subunit of CK-MB and a specific monoclonal antibody conjugate directed against the CK-M + lysine subunit. Owing to the lack of a World Health Organization standard for CK-MB, the percent CK-MB2 values had to be normalized by determining both CK-MB and CK-MB2 in assays which differ only in the specificity of the anti-CK-M conjugate. Thus, a related CK-MB immunochemical mass assay utilizing the identical capture antibody and a specific monoclonal antibody conjugate directed against the CK-M subunit was also developed. Analytical sensitivities of the CK-MB and CK-MB2 assays were determined to be 0.5 ng/ml and 0.2 ng/ml, respectively. Both CK-MB and CK-MB2 levels were determined in 46 hospitalized non-AMI patients and 35 non-hospitalized normal patients. Of the 46 hospitalized non-AMI patients (mean age = 70), 26 percent had either CK-MB and/or CK-MB2 values below the level of sensitivity of the CK-MB or CK-MB2 isoform assays. For patients with CK-MB values between 0.5 ng/ml and 2.99 ng/ml, the percent CK-MB2 values ranged from 35 percent to 97 percent. For patients with CK-MB values between 3.0 ng/ml and 6.5 ng/ml, the percent CK-MB2 values ranged from 23 percent to 72 percent. Similar results were obtained for the non-hospitalized group. This assay appears to be useful in determining the clinical utility of CK-MB2.
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Affiliation(s)
- J P Laurino
- Department of Pathology, Memorial Hospital of Rhode Island, Pawtucket 02860, USA
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