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Dinning E, Muttana S, Bardarov S. Cor Adiposum as the Cause of Sudden Cardiac Death: A Case Report and Literature Review. Cureus 2024; 16:e55561. [PMID: 38576691 PMCID: PMC10993091 DOI: 10.7759/cureus.55561] [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] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
We present a case of sudden cardiac death in a 65-year-old patient who came to the emergency room with shortness of breath. The gross examination of the heart was significant for extensive left ventricular lipomatosis in association with myocardial fibrosis. Microscopic examination revealed extensive fatty replacement of the myocardial tissue throughout the entire thickness of the ventricular wall (transmural lipomatous myocardial remodeling). We suggest using the term "cor adiposum" to categorize this morphological condition when the transmural lipomatous transformation of the myocardium is present. The fatty replacement of the heart muscle would have led to impaired cardiac function, ultimately resulting in sudden cardiac death in this patient. We also hypothesize that the accumulation of fat in the myocardium might be a compensatory process to preserve ventricular wall compliance.
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Affiliation(s)
- Emily Dinning
- Pathology, Richmond University Medical Center, New York, USA
| | - Srinuvasula Muttana
- Pathology and Laboratory Medicine, Richmond University Medical Center, New York, USA
| | - Svetoslav Bardarov
- Pathology and Laboratory Medicine, Richmond University Medical Center, New York, USA
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2
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Javvaji CK, Reddy H, Vagha JD, Taksande A, Kommareddy A, Reddy NS. Immersive Innovations: Exploring the Diverse Applications of Virtual Reality (VR) in Healthcare. Cureus 2024; 16:e56137. [PMID: 38618363 PMCID: PMC11016331 DOI: 10.7759/cureus.56137] [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: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Virtual reality (VR) has experienced a remarkable evolution over recent decades, evolving from its initial applications in specific military domains to becoming a ubiquitous and easily accessible technology. This thorough review delves into the intricate domain of VR within healthcare, seeking to offer a comprehensive understanding of its historical evolution, theoretical foundations, and current adoption status. The examination explores the advantages of VR in enhancing the educational experience for medical students, with a particular focus on skill acquisition and retention. Within this exploration, the review dissects the applications of VR across diverse medical disciplines, highlighting its role in surgical training and anatomy/physiology education. While navigating the expansive landscape of VR, the review addresses challenges related to technology and pedagogy, providing insights into overcoming technical hurdles and seamlessly integrating VR into healthcare practices. Additionally, the review looks ahead to future directions and emerging trends, examining the potential impact of technological advancements and innovative applications in healthcare. This review illuminates the transformative potential of VR as a tool poised to revolutionize healthcare practices.
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Affiliation(s)
- Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshitha Reddy
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anirudh Kommareddy
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Naramreddy Sudheesh Reddy
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Almagazzachi A, Mustafa A, Eighaei Sedeh A, Vazquez Gonzalez AE, Polianovskaia A, Abood M, Abdelrahman A, Muyolema Arce V, Acob T, Saleem B. Generative Artificial Intelligence in Patient Education: ChatGPT Takes on Hypertension Questions. Cureus 2024; 16:e53441. [PMID: 38435177 PMCID: PMC10909311 DOI: 10.7759/cureus.53441] [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] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Uncontrolled hypertension significantly contributes to the development and deterioration of various medical conditions, such as myocardial infarction, chronic kidney disease, and cerebrovascular events. Despite being the most common preventable risk factor for all-cause mortality, only a fraction of affected individuals maintain their blood pressure in the desired range. In recent times, there has been a growing reliance on online platforms for medical information. While providing a convenient source of information, differentiating reliable from unreliable information can be daunting for the layperson, and false information can potentially hinder timely diagnosis and management of medical conditions. The surge in accessibility of generative artificial intelligence (GeAI) technology has led to increased use in obtaining health-related information. This has sparked debates among healthcare providers about the potential for misuse and misinformation while recognizing the role of GeAI in improving health literacy. This study aims to investigate the accuracy of AI-generated information specifically related to hypertension. Additionally, it seeks to explore the reproducibility of information provided by GeAI. Method A nonhuman-subject qualitative study was devised to evaluate the accuracy of information provided by ChatGPT regarding hypertension and its secondary complications. Frequently asked questions on hypertension were compiled by three study staff, internal medicine residents at an ACGME-accredited program, and then reviewed by a physician experienced in treating hypertension, resulting in a final set of 100 questions. Each question was posed to ChatGPT three times, once by each study staff, and the majority response was then assessed against the recommended guidelines. A board-certified internal medicine physician with over eight years of experience further reviewed the responses and categorized them into two classes based on their clinical appropriateness: appropriate (in line with clinical recommendations) and inappropriate (containing errors). Descriptive statistical analysis was employed to assess ChatGPT responses for accuracy and reproducibility. Result Initially, a pool of 130 questions was gathered, of which a final set of 100 questions was selected for the purpose of this study. When assessed against acceptable standard responses, ChatGPT responses were found to be appropriate in 92.5% of cases and inappropriate in 7.5%. Furthermore, ChatGPT had a reproducibility score of 93%, meaning that it could consistently reproduce answers that conveyed similar meanings across multiple runs. Conclusion ChatGPT showcased commendable accuracy in addressing commonly asked questions about hypertension. These results underscore the potential of GeAI in providing valuable information to patients. However, continued research and refinement are essential to evaluate further the reliability and broader applicability of ChatGPT within the medical field.
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Affiliation(s)
| | - Ahmed Mustafa
- Internal Medicine, Capital Health System, Trenton, USA
| | | | | | | | - Muhanad Abood
- Internal Medicine, Capital Health System, Trenton, USA
| | | | | | - Talar Acob
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Bushra Saleem
- Internal Medicine, Capital Health System, Trenton, USA
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4
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Nalawade DD, Chigulapalli S, Jadhav AK, Malani SK, Gandhi MA. Peripartum Cardiomyopathy: A Case Series Emphasizing the Significance of Left Ventricular Global Longitudinal Strain Imaging. Cureus 2023; 15:e51331. [PMID: 38288176 PMCID: PMC10824279 DOI: 10.7759/cureus.51331] [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] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Peripartum cardiomyopathy (PPCM) poses diagnostic and management challenges, while left ventricular global longitudinal strain (LV GLS) provides crucial insights into myocardial function. This case series explores the significance of LV GLS imaging in diagnosing and managing PPCM. Three distinct cases of varying severity highlight the significance of LV-GLS in assessing myocardial function during the peripartum period. Each case exhibited varying degrees of cardiac impairment, with LV GLS serving as a sensitive indicator of dysfunction. Treatment response, closely monitored through LV GLS changes, emphasizes the importance of this imaging technique in evaluating therapy efficacy. The discussion underscores deviations from traditional management approaches, emphasizing the need for personalized strategies in PPCM. Nonetheless, the study's limitations stress the need for broader research to validate these findings across diverse populations and settings, as well as long-term follow-up of the patients who had persistence of abnormal global longitudinal strain values despite recovery of left ventricular ejection fraction.
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Affiliation(s)
- Digvijay D Nalawade
- Cardiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Sridevi Chigulapalli
- Cardiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Ajitkumar K Jadhav
- Cardiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Susheel K Malani
- Cardiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Madhura A Gandhi
- Central Research Facility, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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5
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Maqbool S, Ali MS, Rehman A, Ur Rehman ME, Iqbal J, Razzaq A, Kamal A, Shivamadhu SS, Afzal M, Fazal F, Basit J, Khalid SA. Efficacy and Safety Profile of Ticagrelor Versus Clopidogrel in Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS): A Systematic Review and Meta-Analysis. Cureus 2023; 15:e46455. [PMID: 37927743 PMCID: PMC10623206 DOI: 10.7759/cureus.46455] [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: 09/08/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
The utilization of individualized anti-platelet therapy is of paramount significance in this era of cardiovascular advancement. This meta-analysis is also aiming to get more information relating to the effectiveness of ticagrelor versus clopidogrel among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). A comprehensive literature search was done through various databases like PubMed, Google Scholar, EMBASE, Web of Science, and the Cochrane Database Library from January 15, 2023, to February 23, 2023. After careful screening, eight articles with highly significant variables were involved in the synthesis of this meta-analysis. Data analysis was done through Review Manager (RevMan, Version 5.4; The Cochrane Collaboration, Copenhagen, Denmark). In our study, ticagrelor and clopidogrel were evaluated in 10614 and 14662 patients, respectively. Ticagrelor was significantly superior to Clopidogrel in terms of all-cause mortality (RR 0.79, 95% CI 0.69-0.91, p = 0.001), risk of MI (RR 0.74, 95% CI 0.61-0.89, p = 0.001), and stroke (RR 0.64, 95% CI 0.42-0.98, p = 0.04), but a higher risk of bleeding events was observed with Ticagrelor (RR 1.36, 95% CI 1.04-1.79, p = 0.03). The two regimens were comparable in terms of stent thrombosis. Ticagrelor was found to be best in terms of reducing post-PCI myocardial infarction, stroke, stent thrombosis, and all other mortality events in comparison to Clopidogrel. However, the bleeding events were of significant concern for the utilization of ticagrelor and required further investigations.
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Affiliation(s)
- Shahzaib Maqbool
- Department of Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Abdur Rehman
- Department of Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Javed Iqbal
- Department of Neurosurgery, Mayo Hospital, Lahore, PAK
| | - Azeen Razzaq
- Department of Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Amer Kamal
- Department of Medicine, The University of Jordan, Amman, JOR
| | | | - Maham Afzal
- Department of Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | - Faizan Fazal
- Department of Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Jawad Basit
- Department of Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
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Kim AG, Park C, Tokavanich N, Sabanci R, Freel R, Hayes V, Thakur RK. Meteorological Influence on Atrial Fibrillation and Flutter: A Nationwide Observational Study in South Korea (2010-2022). Cureus 2023; 15:e46867. [PMID: 37954814 PMCID: PMC10638101 DOI: 10.7759/cureus.46867] [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] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Background and rationale The impact of meteorological factors, including atmospheric temperature, humidity, and wind speed, on the incidence of atrial fibrillation and flutter (AF) has been the subject of several studies, but the findings have been inconsistent. Given the complex and multifaceted nature of this relationship, a larger-scale study was necessary to provide sufficient statistical power and elucidate potential associations between them. The aim of this study was, thus, to investigate the potential associations between meteorological factors and the incidence of AF. Methods The South Korean government provides open access to national health insurance and weather data for its citizens; the data was available from January 2010 to July 2022. The national health insurance data includes the monthly number of patients diagnosed with a specific condition, reflecting the incidence and prevalence of the condition. Pearson correlation analyses were performed using the statistical analysis software, SAS® OnDemand for Academics (SAS Institute Inc., Cary, North Carolina, United States), to examine the association between each month's national average climate data and the number of patients diagnosed with AF. Results The number of patients diagnosed with AF in the total population showed a statistically significant correlation only with average wind speed (correlation coefficient (r)=-0.42, 95%CI -0.55 to -0.28, p<0.001) and sunshine duration (r=0.27, 95%CI 0.12 to 0.41, p<0.001). Among females aged 20-24 years, there was a statistically significant association with other variables, including average temperature, precipitation, humidity, and atmospheric pressure (p<0.05). Diurnal temperature variation showed inconsistent associations across different age and sex groups. Conclusion The number of patients diagnosed with AF is negatively correlated with average wind speed and positively correlated with sunshine duration in the general population, particularly among the elderly. There was no significant association between the number of patients diagnosed with AF and average temperature, precipitation, or humidity, except for females aged 20-24 years, who exhibited a significant association with these variables. However, it is important to note that these correlations do not establish causality.
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Affiliation(s)
- Andrew G Kim
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Chanjoo Park
- General Practice, Catholic Kwandong University, Gangneung, KOR
| | - Nithi Tokavanich
- Cardiac Electrophysiology, University of Michigan, Ann Arbor, USA
| | - Rand Sabanci
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Rebeccah Freel
- Cardiac Electrophysiology, Sparrow Hospital, Lansing, USA
| | - Victoria Hayes
- Cardiac Electrophysiology, Sparrow Hospital, Lansing, USA
| | - Ranjan K Thakur
- Cardiac Electrophysiology, Michigan State University, East Lansing, USA
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Munoz NR, Agwuegbo CC, Ghorbani A, Vincent Coralde JM, Abdelmalik R. Takotsubo Cardiomyopathy Induced by Stress From Amyotrophic Lateral Sclerosis and a Mechanical Fall. Cureus 2023; 15:e47068. [PMID: 38021968 PMCID: PMC10653622 DOI: 10.7759/cureus.47068] [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] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Named after the Japanese octopus trap, Takotsubo cardiomyopathy is an acute myocardial condition characterized by a reversible ventricular dysfunction with ballooning of the left ventricle (LV) during systole. A catecholamine surge is likely the primary mechanism responsible for myocardial damage in this condition. The association between amyotrophic lateral sclerosis (ALS) and Takotsubo cardiomyopathy has not been well established. We present a unique case of Takotsubo cardiomyopathy diagnosed in a patient with ALS who presented after a fall with shortness of breath, generalized weakness, and hypotension. She was found to have troponinemia, elevated brain natriuretic peptide, and Osborn waves without ST-segment changes noted on electrocardiography (EKG). The diagnosis of Takotsubo cardiomyopathy was confirmed via transthoracic echocardiography (TTE), which revealed reduced left ventricular ejection fraction, apical ballooning of the LV, akinesis of the ventricular apex, and hyperkinesis of the base of the heart. Coronary angiography revealed no coronary artery disease. She was managed medically and was hemodynamically stable at the time of discharge.
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Affiliation(s)
| | | | - Ali Ghorbani
- Internal Medicine, Southwest Healthcare, Temecula, USA
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8
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Sherlock D, Labchuk A, Hussain U, Khan MA, Wlodkowski P, Patel N. Late Presentation of Acute Coronary Syndrome Complicated by Ventricular Septal Rupture. Cureus 2023; 15:e43427. [PMID: 37706137 PMCID: PMC10495692 DOI: 10.7759/cureus.43427] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/15/2023] Open
Abstract
Acquired ventricular septal rupture (VSR) is a rare but potentially fatal complication of late-presenting myocardial infarction (MI). In the era of revascularization and reperfusion therapy, the incidence of VSR has significantly decreased. Ruptures occur predominantly in patients with late-presenting ST elevation MI. Patients may present with a wide variety of symptoms ranging from chest pain and mild hemodynamic instability to profound cardiogenic shock. Inotropes, vasopressors, and mechanical support with intra-aortic balloon pumps and extracorporeal membrane oxygenation can be used to bridge patients to surgery. Despite treatment with ventricular septal repair, postsurgical mortality remains high. There is a wide variety of complications that can occur in the postoperative period. A multidisciplinary approach is vital in these patients who develop VSR. Improving awareness among healthcare professionals regarding the symptoms of acute coronary syndrome can hopefully help prevent delayed presentation of patients to healthcare facilities.
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Affiliation(s)
- Daniel Sherlock
- Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, USA
| | - Andrii Labchuk
- Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, USA
| | - Umar Hussain
- Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, USA
| | - Muhammad A Khan
- Cardiology, Advocate Lutheran General Hospital, Park Ridge, USA
| | | | - Nishant Patel
- Cardiology, Advocate Lutheran General Hospital, Park Ridge, USA
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9
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Dunbar CW, Whaley M, Park E, Escobar J. T-wave Inversions in Precordial Leads: A Case Study of Arrhythmogenic Right Ventricular Cardiomyopathy in a Patient With Recurrent Syncope. Cureus 2023; 15:e43201. [PMID: 37692678 PMCID: PMC10486293 DOI: 10.7759/cureus.43201] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare sudden cardiac death (SCD) syndrome characterized by ventricular arrhythmias of right ventricular (RV) origin. This case follows the presentation of ARVC in an otherwise healthy 26-year-old male. The patient was observed for one week after being admitted from the emergency department secondary to pre-syncope with pathognomonic findings on his electrocardiogram (EKG), echocardiogram, and cardiac imaging. The patient was started on beta-blockers, which ultimately he could not tolerate due to bradycardia, and the recommendation of an automatic implantable cardioverter-defibrillator (AICD) was refused. He was discharged without any complications or ventricular arrhythmias on telemetry while hospitalized.
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Affiliation(s)
- Conner W Dunbar
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Monica Whaley
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Erin Park
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Javier Escobar
- Emergency Medicine, Tallahassee Memorial Healthcare, Tallahassee, USA
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10
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Roy R, Vinjamuri S, Baskara Salian R, Hafeez N, Meenashi Sundaram D, Patel T, Gudi TR, Vasavada AM. Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors in Heart Failure: An Umbrella Review. Cureus 2023; 15:e42113. [PMID: 37602002 PMCID: PMC10436676 DOI: 10.7759/cureus.42113] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Heart failure remains a leading cause of hospitalization and death, and presents a significant challenge for healthcare providers despite the advancements in its management. This umbrella review aimed to pool the results of meta-analyses on the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in the treatment of heart failure patients. A literature search was done on five databases: PubMed, Cochrane Library, Scopus, Global Index Medicus, and Science Direct for articles with full texts available online. Meta-analyses of five or more randomized controlled trials (RCTs) were included; the assessment of multiple systematic reviews (AMSTAR) was used to assess the quality of included studies. A systematic search identified 10 relevant meta-analyses of RCTs, with primary analyses including outcome data from 171,556 heart failure patients. A pooled review showed that SGLT-2 inhibitors significantly reduced the risk of heart failure hospitalization, cardiovascular death, mortality, serious adverse events, and improved quality of life. SGLT-2 inhibitors are likely safe and effective in managing patients with heart failure especially considering the acute outcomes.
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Affiliation(s)
- Raj Roy
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
| | - Saketh Vinjamuri
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
| | | | | | - Dakshin Meenashi Sundaram
- Internal Medicine, Employees State Insurance Corporation (ESIC) Medical College and Post Graduate Institute of Medical Sciences and Research (PGIMSR), Chennai, IND
| | - Tirath Patel
- Surgery, American University of Antigua, St. John, ATG
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11
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Moturu A, Bhuchakra HP, Bodar YP, Gandhi SK, Patel P, Gutlapalli SD, Arulthasan V, Otterbeck P. Unmasking a Silent Killer and Understanding Sudden Cardiac Death in Brugada Syndrome: A Traditional Review. Cureus 2023; 15:e41076. [PMID: 37519561 PMCID: PMC10375830 DOI: 10.7759/cureus.41076] [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: 05/21/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Brugada syndrome (BrS) is an intricate and heterogeneous genetic disorder that engenders a formidable risk of life-threatening ventricular arrhythmias (VAs). While initially regarded as an electrophysiological aberration, emergent studies have illuminated the presence of underlying structural anomalies in select BrS cases. Although mutations in the SCN5A gene encoding the α-subunit of the cardiac sodium channel were originally identified as a primary causative factor; they account for only a fraction of the syndrome's multifaceted complexity pointing at genetic heterogeneity as a contributing factor. Remarkably, BrS has been linked to a higher incidence of fatal arrhythmic incidents and sudden cardiac death (SCD) with about 4% of SCD cases thought to be caused by BrS. Patients who spontaneously exhibit type one Brugada ECGs are more likely to experience cardiac events, emphasizing the importance of early risk stratification. To aid in risk stratification, the Shanghai score; a multifactorial risk stratification scoring system that incorporates ECG, clinical history, family history, and genetic test results; is utilized to identify those most susceptible to SCD. Beyond single ECGs, evaluation of arrhythmic findings from 24-hour Holter monitoring, ECG variables, electrophysiologic study (EPS) status in the temporal domain, and EPS data collected over time are all critical factors in risk classification. Among management options avoidance of triggers, early risk stratification, and implantation of an Implantable Cardioverter-Defibrillator (ICD) are recommended for asymptomatic patients. For symptomatic patients, pharmacotherapy and ICD implantation are available, with the latter being a highly effective choice for treating and preventing lethal arrhythmias in BrS.
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Affiliation(s)
- Aadya Moturu
- Department of Internal Medicine, Sri Ramaswamy Memorial Medical College Hospital and Research Centre, Chennai, IND
| | - Hamsa Priya Bhuchakra
- Department of Internal Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, IND
| | - Yashvant P Bodar
- Department of Internal Medicine, Orenburg State Medical University, Orenburg, RUS
| | | | - Priyansh Patel
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
| | - Sai Dheeraj Gutlapalli
- Department of Internal Medicine, Richmond University Medical Center, New York City, USA
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Philip Otterbeck
- Department of Internal Medicine, Richmond University Medical Center, New York City, USA
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12
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Adedara VO, Sharma V, Nawaz H, Reyes-Rivera J, Afzal-Tohid S, Pareshbhai PT, Boyapati SP, Sharafshah A. Transesophageal Echocardiogram Before Cardioversion in Atrial Fibrillation Patients. Cureus 2023; 15:e39702. [PMID: 37398783 PMCID: PMC10309076 DOI: 10.7759/cureus.39702] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Transesophageal echocardiography (TEE) offers an invaluable, non-invasive avenue for diagnosing and managing various cardiac conditions, including atrial fibrillation (AF). As the most common cardiac arrhythmia, AF affects millions and can lead to severe complications. Cardioversion, a procedure to restore the heart's normal rhythm, is frequently conducted on AF patients resistant to medication. Due to inconclusive data, TEE's utility prior to cardioversion in AF patients remains ambiguous. Understanding TEE's potential benefits and limitations in this population could significantly influence clinical practice. This review aims to scrutinize the current literature on the use of TEE before cardioversion in AF patients. The principal objective is to understand TEE's potential benefits and limitations comprehensively. The study seeks to offer a clear understanding and practical recommendations for clinical practice, thereby improving the management of AF patients before cardioversion using TEE. A literature search of databases was conducted using the keywords "Atrial Fibrillation," "Cardioversion" and "Transesophageal echocardiography," resulting in 640 articles. These were narrowed to 103 following title and abstract reviews. After applying exclusion and inclusion criteria with a quality assessment, 20 papers were included: seven retrospective studies, 12 prospective observational studies, and one randomized controlled trial (RCT). Stroke risk associated with direct-current cardioversion (DCC) potentially results from post-cardioversion atrial stunning. Thromboembolic events occur post cardioversion, with or without prior atrial thrombus or cardioversion complications. Generally, cardiac thrombus localizes in the left atrial appendage (LAA), a clear contraindication to cardioversion. Atrial sludge without LAA thrombus in TEE is a relative contraindication. TEE before electrical cardioversion (ECV) in anticoagulated AF individuals is uncommon. In AF patients planned for cardioversion, contrast enhancement facilitates thrombus exclusion in TEE images, reducing embolic events. Left atrial thrombus (LAT) frequently occurs in AF patients, necessitating TEE examination. Despite the increased use of pre-cardioversion TEE, thromboembolic events persist. Notably, patients with post-DCC thromboembolic events had no LA thrombus or LAA sludge. The use of TEE-guided DCC has grown due to its ability to detect atrial thrombi pre-cardioversion, aiding risk stratification. Thrombus in the left atrium also signals an elevated risk of future thromboembolic events in AF patients. While atrial stunning post cardioversion detected by TEE is a significant risk factor for future thromboembolic events, further evidence is required. Therapeutic anticoagulation is essential during and post cardioversion, even if no atrial thrombus is detected. Current data recommends cardioversion guided by TEE, particularly in outpatient settings.
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Affiliation(s)
- Victor O Adedara
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Vagisha Sharma
- Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Hassan Nawaz
- Medicine, Nishtar Medical University and Hospital, Multan, PAK
| | | | | | | | - Sri P Boyapati
- Medicine, Siddartha Medical College, Dr. YSR University of Health Sciences, Vijayawada, IND
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13
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Safwat S, Safwat F, Sivanathan N, Daka N, Sadek M. Misdiagnosed Seizure-Like Activity in a Patient With Postural Orthostatic Tachycardia Syndrome: A Case Report. Cureus 2023; 15:e39565. [PMID: 37378164 PMCID: PMC10292221 DOI: 10.7759/cureus.39565] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Postural orthostatic tachycardia is a syndrome characterized by an elevated heart rate in response to standing. This syndrome typically presents in late adolescence and early adulthood, with a higher percentage occurring in females. This syndrome is often seen following a viral infection, pregnancy, surgery, or intense psychological stress. This condition presents a wide range of symptoms that vary depending on its unclear etiology. We present the case of a 21-year-old woman with convulsions associated with postural orthostatic tachycardia syndrome after being misdiagnosed with a psychiatric condition for many years.
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Affiliation(s)
- Sandra Safwat
- Internal Medicine, Washington University of Health and Science, San Pedro, BLZ
| | - Fady Safwat
- Medicine, Washington University of Health and Science, San Pedro, BLZ
| | - Nivetha Sivanathan
- Medicine, Richmond Gabriel University College of Medicine, Kingstown, VCT
| | - Natashah Daka
- Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Michael Sadek
- Internal Medicine, Swedish Covenant Hospital, Chicago, USA
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14
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Ganipineni VDP, Gutlapalli SD, Ajay Sai Krishna Kumar I, Monica P, Vagdevi M, Samuel Sowrab T. Exploring the Potential of Energy-Based Therapeutics (Photobiomodulation/Low-Level Laser Light Therapy) in Cardiovascular Disorders: A Review and Perspective. Cureus 2023; 15:e37880. [PMID: 37214067 PMCID: PMC10199710 DOI: 10.7759/cureus.37880] [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] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
Based on the review of the literature, this article examines the potential therapeutic benefits of photobiomodulation therapy (PBMT) or low-level laser therapy (LLLT) for the treatment of cardiovascular disorders. The methodology involved searching PubMed, Google Scholar, and Central databases for relevant articles published from inception till date. The articles included in this review were preclinical and clinical studies investigating the effects of PBMT and LLLT on the heart. The article summarizes the findings of nineteen studies investigating the effects of PBMT and LLLT on various parameters related to heart failure (HF) and myocardial infarction (MI), including inflammation, oxidative stress, angiogenesis, cardiac function, and remodeling. The studies suggest that PBMT and LLLT have potential therapeutic benefits for the treatment of cardiovascular diseases and could be used in combination with traditional pharmacological therapies to enhance their effects or as a stand-alone treatment for patients who are not responsive to or cannot tolerate traditional therapies. In conclusion, this review article highlights the promising potential of PBMT for the treatment of HF and MI and the need for further research to fully understand its mechanisms of action and optimize treatment protocols.
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Affiliation(s)
- Vijay Durga Pradeep Ganipineni
- Department of General Medicine, SRM Medical College Hospital and Research Center, Chennai, IND
- Department of General Medicine, Andhra Medical College/King George Hospital, Visakhapatnam, IND
| | - Sai Dheeraj Gutlapalli
- Department of Internal Medicine, Richmond University Medical Center - Mount Sinai Health System/Icahn School of Medicine at Mount Sinai, Staten Island, USA
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Potru Monica
- Department of Medicine, Guntur Medical College, Guntur, IND
| | - Moparthi Vagdevi
- Department of Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, IND
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15
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Rastogi S, Sharma NR, Rastogi B, Pokhrel M, Sharma J. A Rent in the Left Ventricle: A Sea-Saw Between Life and Death. Cureus 2022; 14:e30665. [PMID: 36439584 PMCID: PMC9685679 DOI: 10.7759/cureus.30665] [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] [Accepted: 10/24/2022] [Indexed: 06/16/2023] Open
Abstract
Penetrating injuries to the precordium are life-threatening and require early detection and immediate intervention. We present a case of penetrating cardiac injury who presented with a definitive airway and hemodynamically unstable. During the primary survey, the patient had a cardiac arrest with pulseless ventricular tachycardia. The patient was resuscitated as per advanced cardiac life support (ACLS) and advanced trauma life support (ATLS) guidelines with manual digital compression at the penetrating site leading to a return of spontaneous circulation (ROSC). After ROSC, he was shifted for emergency explorative median sternotomy. During the sternotomy, we found a clotted rent in the anterior wall of the left ventricle, which was repaired. Aggressive resuscitation and appropriate management strategy in the emergency department (ED) resulted in a successful outcome, and he was discharged after 10 days of hospital stay. Our case highlights the importance of early diagnosing and managing penetrating cardiac trauma.
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Affiliation(s)
- Suman Rastogi
- Emergency Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok, IND
| | - Nava R Sharma
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | - Bandana Rastogi
- Medicine, National Medical College and Teaching Hospital, Birgunj, NPL
| | - Madalasa Pokhrel
- Internal Medicine, Montefiore Medical Center, New Rochelle, New Rochelle, USA
| | - Jagdish Sharma
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
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16
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Lakhana M, McGee J, George B, Whang W, Kanner L, Park WJ. Simultaneous Catecholaminergic Polymorphic Ventricular Tachycardia and Long QT Syndrome Gene Mutations. Cureus 2021; 13:e19195. [PMID: 34873534 PMCID: PMC8636151 DOI: 10.7759/cureus.19195] [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] [Accepted: 09/09/2021] [Indexed: 11/05/2022] Open
Abstract
Genetic channelopathies can predispose individuals to life-threatening arrhythmias. Two such channelopathies are long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). To the best of our knowledge, we present the first case of LQTS with novel combined genetic mutations of KCNH2 and cardiac ryanodine receptor (RYR2) genes.
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Affiliation(s)
| | - James McGee
- Internal Medicine, Mount Sinai South Nassau, Oceanside, USA
| | - Blessen George
- Internal Medicine, Mount Sinai South Nassau, Oceanside, USA
| | - William Whang
- Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Won Jun Park
- Cardiology, Mount Sinai South Nassau, Oceanside, USA
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17
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Moles WJ, Barnes AA, Khan A, Patel K, Bos N. Incidental Findings of Asystole in a Patient With Complaints of Near Syncope: A Case Report on Paroxysmal Ventricular Standstill. Cureus 2021; 13:e18438. [PMID: 34737906 PMCID: PMC8559582 DOI: 10.7759/cureus.18438] [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] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
Paroxysmal ventricular standstill (PVS) is an unusual cardiac phenomenon in which the heart experiences episodes of absent ventricular activity despite normal atrial functioning, often leading to cardiac arrest and syncope. In this case, we report the hospital stay of a 70-year-old male who was admitted to the hospital following an episode of near syncope at home. On admission, the patient’s initial electrocardiogram (ECG) showed sinus rhythm at 60 beats per minute without atrioventricular (AV) block. However, as orthostatic vitals were obtained, the patient became lightheaded for several seconds upon standing, which was noted to correspond with a nine second episode of asystole on telemetry and spontaneous return to sinus bradycardia afterward. Cardiology was immediately consulted and confirmed the diagnosis of paroxysmal ventricular standstill (PVS). Given continued episodes of PVS, the patient underwent successful urgent dual-chamber pacemaker placement, following which he became asymptomatic with resolution of bradycardia. Given the high mortality risk associated with PVS, this condition is an important differential to consider in any patient presenting with syncope or near syncope of unclear etiology.
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Affiliation(s)
- William J Moles
- Internal Medicine, Edward Via College of Osteopathic Medicine, Salem, USA
| | - Anne A Barnes
- Internal Medicine, Edward Via College of Osteopathic Medicine, Salem, USA
| | - Ahmed Khan
- Internal Medicine, Edward Via College of Osteopathic Medicine, Salem, USA
| | - Kashyap Patel
- Internal Medicine, Lewis Gale Medical Center, Salem, USA
| | - Nadine Bos
- Internal Medicine, Graduate Medical Education, Lewis Gale Medical Center, Salem, USA
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18
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Atti V, Devarakonda PK, Raina S. Differential Effects of Cardiac Rehabilitation in Obese and Non-Obese Population. Cureus 2021; 13:e18227. [PMID: 34703710 PMCID: PMC8541824 DOI: 10.7759/cureus.18227] [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] [Accepted: 09/23/2021] [Indexed: 11/05/2022] Open
Abstract
Background Cardiac rehabilitation (CR) improves outcomes in patients with heart disease. We investigated the differences in outcomes of comprehensive phase II CR in obese and non-obese patients. Methods We performed a retrospective analysis of functional outcomes including metabolic equivalents (METS), heart rate (chronotropic competence - CC), and blood pressure response (BPR) in 178 patients undergoing CR based on underlying body mass index (BMI). Demographic and clinical variables were assessed for age, gender, race, smoking, hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, stroke, heart failure, medication use, and several sessions attended. Results Initial CC and METS were impaired in majority of patients attending CR, whereas BPR to exercise was mostly preserved. Significant improvement occurred in CC (non-obese: 0.71 ± 0.11 vs 0.76 ± 0.11, p < 0.001; obese: 0.72 ± 0.10 vs 0.75 ± 0.12, p = 0.0010) and METS (non-obese: 4.96 ± 1.98 vs 7.33 ± 2.94, p < 0.001; obese: 4.39 ± 1.81 vs 6.79 ± 3.34, p < 0.001). Post-CR obese patients were able to reach similar level of physical activity as non-obese patients (6.79 ± 3.34 vs 7.33 ± 2.94; p = 0.2). Improvement in BPR was only seen in non-obese patients (24.02 ± 20.07 vs 30.18 ± 21.93; p = 0.019). Improvement in functional variables occurred despite increase in BMI in non-obese (25.91 ± 2.85 vs 26.21 ± 2.96; p = 0.031), and there was no significant change in BMI in obese (35.30 ± 5.60 vs 34.93 ± 5.42; p > 0.05). Conclusion CR concurrently improves functional outcomes in both obese and non-obese patients despite no associated weight loss. The difference in BPR, however, is seen in only non-obese individuals. Future studies are needed to validate the role of weight-optimized CR protocols as a potential target for improving cardiac outcomes.
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Affiliation(s)
- Varunsiri Atti
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | | | - Sameer Raina
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, USA
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19
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Kang W, Ge LD, Patel P, Patel R, Kizhakekuttu T. Rare and Fascinating Case of ST-Elevation Myocardial Infarction Diagnosis From an Underlying Ventricular Paced Rhythm. Cureus 2020; 12:e8274. [PMID: 32596089 PMCID: PMC7314364 DOI: 10.7759/cureus.8274] [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] [Indexed: 11/05/2022] Open
Abstract
This is a case of a patient diagnosed with anterior ST-elevation myocardial infarction (STEMI) with a ventricular paced rhythm after the patient underwent a femoral-femoral bypass surgery for severe peripheral vascular disease. The case highlights the diagnosis of STEMI in the setting of paced rhythm in the appropriate clinical setting.
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Affiliation(s)
- Woosun Kang
- Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Liang D Ge
- Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Puja Patel
- Internal Medicine, American University of Antigua, Peoria, USA
| | - Raj Patel
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Tinoy Kizhakekuttu
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
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20
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Desai AR, Patel P, Patel R, Ghadiam H, Mukhopadhyay E. The Chicken or the Egg? An Interesting Case Presentation of Spontaneous Coronary Artery Dissection Versus Takotsubo Cardiomyopathy. Cureus 2020; 12:e7793. [PMID: 32455088 PMCID: PMC7243609 DOI: 10.7759/cureus.7793] [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: 11/26/2022] Open
Abstract
This is an interesting cardiovascular imaging and coronary angiography case of a 67-year-old female patient who presented with chest pain, abnormal electrocardiogram (EKG), and heart failure who was subsequently found to have spontaneous coronary artery dissection (SCAD) and Takotsubo cardiomyopathy (TCM) on imaging studies. The case presentation highlights the importance of imaging studies and prompt diagnosis in these patients. This study may also highlight the need for early medical intervention in patients with suspected systolic dysfunction due to either of these pathophysiologic processes.
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Affiliation(s)
- Anjali R Desai
- Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Puja Patel
- Internal Medicine, American University of Antigua, Peoria, USA
| | - Raj Patel
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | | | - Ekanka Mukhopadhyay
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
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