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Titus A, Syeed S, Baburaj A, Bhanushali K, Gaikwad P, Sooraj M, Saji AM, Mir WAY, Kumar PA, Dasari M, Ahmed MA, Khan MO, Titus A, Gaur J, Annappah D, Raj A, Noreen N, Hasdianda A, Sattar Y, Narasimhan B, Mehta N, Desimone CV, Deshmukh A, Ganatra S, Nasir K, Dani S. Catheter ablation versus medical therapy in atrial fibrillation: an umbrella review of meta-analyses of randomized clinical trials. BMC Cardiovasc Disord 2024; 24:131. [PMID: 38424483 PMCID: PMC10902941 DOI: 10.1186/s12872-023-03670-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/13/2023] [Indexed: 03/02/2024] Open
Abstract
This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.
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Affiliation(s)
- Anoop Titus
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | | | | | | | | | - Mannil Sooraj
- Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Kanakapura, Karnataka, India
| | | | | | | | | | | | | | - Aishwarya Titus
- Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | | | | | - Arjun Raj
- University Hospital of Leicester, Leicester, UK
| | | | - Adrian Hasdianda
- Brigham and Women's Hospital, Harvard University, Cambridge, MA, USA
| | | | - Bharat Narasimhan
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Nishaki Mehta
- Beaumont Hospital Royal Oak, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | | | - Sarju Ganatra
- Department of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, 41 Mall Road, Burlington, MA, 10805, USA
| | - Khurram Nasir
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Sourbha Dani
- Department of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, 41 Mall Road, Burlington, MA, 10805, USA
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Dasari M, Sherif A, Arun Kumar P, Bhattad PB, Yukselen Z, Mishra AK, Pacifico L, Ramsaran E. Atrioventricular Synchrony Restoration Aided by a Temporary Permanent Pacemaker in Right Ventricular Infarction and Complete Heart Block. Cureus 2024; 16:e54631. [PMID: 38523997 PMCID: PMC10959470 DOI: 10.7759/cureus.54631] [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: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Pacemakers are effective treatments for a variety of bradyarrhythmias. Cardiac pacemakers generally consist of a pulse generator and one or more leads. The conventional temporary transvenous ventricular cardiac pacemaker utilizing a passive fixation lead is commonly associated with multiple complications such as increased infection rate, lead dislodgement, venous thrombosis, longer duration of hospital stay, and atrioventricular (AV) dyssynchrony. On the other hand, temporary permanent pacemakers (TPPM) utilize active fixation leads; hence, they provide lower capture thresholds, reliable pacing, lower rates of displacement, and fewer pacemaker-related infections. Here, we present a case of TPPM aiding AV synchrony restoration in complete heart block accompanying right ventricular (RV) infarction with refractory cardiogenic shock. Pacemakers are effective treatments for a variety of bradyarrhythmias. Cardiac pacemakers generally consist of a pulse generator and one or more leads. We present a case of TPPM aiding AV synchrony restoration in complete heart block accompanying RV infarction with refractory cardiogenic shock. TPPM pacing is a safe and effective technique for temporary bridge pacing to prevent AV dyssynchrony in hemodynamically unstable patients with cardiogenic shock from RV infarction and complete heart block. It also hastens recovery compared to a traditional single-chamber temporary pacemaker.
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Affiliation(s)
- Mahati Dasari
- Internal Medicine, Saint Vincent Hospital, Worcester, USA
| | - Akil Sherif
- Cardiology, Saint Vincent Hospital, UMass Chan Medical School, Worcester, USA
| | | | | | | | - Ajay K Mishra
- Cardiovascular Medicine, Saint Vincent Hospital, Worcester, USA
| | - Luigi Pacifico
- Cardiovascular Medicine, Saint Vincent Hospital, UMass Chan Medical School, Worcester, USA
| | - Eddison Ramsaran
- Cardiovascular Medicine, Saint Vincent Hospital, UMass Chan Medical School, Worcester, USA
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Kasireddy TR, Yukselen Z, Muthyala A, Bansal K, Dasari M, Arun Kumar P, Anugu VR, Majmundar V, Nakhla M, Sharma G, Nasir K, Warraich HJ, Ganatra S, Dani SS. Association of Psychosocial Risk Factors and Outcomes in Heart Failure: Does COVID-19 Affect Outcomes? Curr Probl Cardiol 2023; 48:101795. [PMID: 37207818 PMCID: PMC10191728 DOI: 10.1016/j.cpcardiol.2023.101795] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 05/21/2023]
Abstract
Psychosocial risk factors (PSRFs) have emerged as crucial nontraditional risk factors affecting outcomes in patients with heart failure (HF). There is a paucity of data studying these risk factors in HF nationally. Additionally, whether the COVID-19 pandemic impacted outcomes remains unexplored, given the increased psychosocial risk during these times. Our objective is to assess the impact of PSRFs on the outcomes of HF and their comparison across non-COVID-19 and COVID-19 eras. Patients with a diagnosis of HF were selected using the 2019-2020 Nationwide Readmissions Database. Two cohorts were created based on the presence or absence of PSRFs and compared across non-COVID-19 and COVID-19 eras. We examined the association using hierarchical multivariable logistic regression models. A total of 305,955 patients were included, of which 175,348 (57%) had PSRFs. Patients with PSRFs were younger, less likely to be female, and had a higher prevalence of cardiovascular risk factors. All-cause readmissions were higher in patients with PSRFs in both the eras. All-cause mortality [odds ratio, OR 1.15 (1.04-1.27), P = 0.005] and composite of MACE [OR 1.11 (1.06-1.16), P < 0.001] were higher in patients in the non-COVID-19 era. Compared to 2019, patients with PSRFs and HF in 2020 had significantly higher all-cause mortality [OR 1.13 (1.03-1.24), P = 0.009]; however, the composite of MACE was comparable [OR 1.04 (1.00-1.09), P = 0.03]. In conclusion, the presence of PSRFs in patients with HF is associated with a significant increase in all-cause readmissions in COVID-19 and non-COVID-19 eras. The worse outcomes evident in the COVID-19 era highlights the importance of multidisciplinary care in this vulnerable population.
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Affiliation(s)
| | - Zeynep Yukselen
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA; School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA
| | - Anjani Muthyala
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Kannu Bansal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | | | | | - Vidit Majmundar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Michael Nakhla
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Garima Sharma
- Department of Cardiovascular Medicine, Inova Heart And Vascular Institute, Falls Church, VA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist, Houston, TX
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA and Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA.
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Bansal K, Majmundar V, Muthyala A, Arun Kumar P, Dasari M, Kasireddy TR, Yukselen Z, Singh T, Nakhla M, Anugu VR, Desai N, Ganatra S, Dani SS. Association Between Psychosocial Risk Factors and Readmissions After Acute Myocardial Infarction: Role of COVID-19 Pandemic. Curr Probl Cardiol 2023; 48:101881. [PMID: 37336310 PMCID: PMC10276487 DOI: 10.1016/j.cpcardiol.2023.101881] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Psychosocial risk factors (PSRFs) are known to be associated with worse cardiovascular (CV) outcomes. However, there are limited data on the impact of PSRFs on readmissions after acute myocardial infarction (AMI) before and during the COVID-19 (Coronavirus Disease 2019) pandemic. Therefore, we aimed to examine this association and whether the effects of PSRFs were amplified during the COVID-19 pandemic. We queried the 2019 and 2020 Nationwide Readmissions Database for adult (age ≥18 years) index admissions with AMI as the primary diagnosis. They were then divided into 2 cohorts based on the presence or absence of ≥1 PSRF and compared across non-COVID-19 (2019) and COVID-19 (2020) time periods. The primary outcome was 30-day all-cause readmissions. Secondary outcomes included cause-specific readmissions (cardiac, noncardiac, AMI, heart failure). Multivariable hierarchical logistic regression was conducted to evaluate differences in outcomes. The study included 380,820 patients with index AMI, of which 214,384 (56%) had ≥1 PSRFs. Patients with PSRFs were younger, more likely to be female, and had a higher prevalence of CV risk factors. Of 30-day all-cause readmissions were higher in patients with PSRFs in both eras. Moreover, noncardiac and heart failure readmissions were also higher in patients with PSRFs admitted with AMI in 2019 and 2020. This study of a nationally representative population magnifies the association of PSRF with more unplanned readmissions after AMI in both pre-COVID-19 and COVID-19 times.
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Affiliation(s)
- Kannu Bansal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Vidit Majmundar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Anjani Muthyala
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | | | - Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | | | - Zeynep Yukselen
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA; School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA
| | - Tejveer Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Michael Nakhla
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | | | - Nihar Desai
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA.
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Dasari M, Arun Kumar P, Bhattad PB, Jha A, Sherif AA, Mishra AK, Ramsaran E. Yamaguchi syndrome - An updated review article of electrocardiographic and echocardiographic findings. Am J Med Sci 2023; 366:27-31. [PMID: 37003508 DOI: 10.1016/j.amjms.2023.03.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Apical hypertrophic cardiomyopathy (ApHCM) is thought to be an uncommon variant of hypertrophic cardiomyopathy (HCM). This article is a literature review focusing on the characteristic electrocardiogram (EKG) and 2D echocardiogram findings as currently there are no specific ACC/AHA/ESC guidelines set as diagnostic criteria for ApHCM.
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Affiliation(s)
- Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA.
| | - Pramukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | | | - Anil Jha
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Akil A Sherif
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Ajay K Mishra
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Eddison Ramsaran
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
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Yukselen Z, Singh Y, Malempati S, Dasari M, Arun Kumar P, Ramsaran E. Virtual patient education for hypertension: The truth about behavioral change. World J Cardiol 2023; 15:324-327. [PMID: 37397829 PMCID: PMC10308268 DOI: 10.4330/wjc.v15.i6.324] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/26/2023] Open
Abstract
Anti-hypertensive education is an important public health intervention to decrease the mortality and burden of the disease. Using digital technologies for education as a part of preventive measures for hypertension is a cost-effective approach and helps low-income communities and vulnerable populations overcome barriers to healthcare access. The coronavirus disease 19 pandemic further highlighted the need of new health interventions to address health inequalities. Virtual education is helpful to improve awareness, knowledge, and attitude toward hypertension. However, given the complexity of behavioral change, educational approaches do not always provide a change in behavior. Some of the obstacles in online hypertensive education could be time limitations, not being tailored to individual needs and not including the different elements of behavioral models to enhance behavior change. Studies regarding virtual education should be encouraged and involve lifestyle modifications emphasizing the importance of Dietary Approaches to Stop Hypertension diet, salt restriction, and exercise and should be used adjunct to in-person visits for the management of hypertension. Additionally, to stratify patients according to hypertension type (essential or secondary) would be useful to create specific educational materials. Virtual hypertension education is promising to increase awareness regarding risk factors and most importantly motivate patients to be more compliant with management helping to decrease hypertension related complications and hospitalizations.
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Affiliation(s)
- Zeynep Yukselen
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, United States
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Sarat Malempati
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Pramukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Eddison Ramsaran
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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Arun Kumar P, Patel B, Dasari M, Bhattad PB, Prabhu S, Hadley M. Anomalous aortic origin of right coronary artery from left coronary cusp: a management conundrum: a case report. J Med Case Rep 2023; 17:191. [PMID: 37161579 PMCID: PMC10170789 DOI: 10.1186/s13256-023-03921-1] [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: 02/20/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Coronary artery anomalies are characterized by an abnormality in the course or origin of three main coronary arteries. There needs to be more scientific evidence to promptly treat coronary artery anomalies with poorly understood prognostic implications, especially anomalous aortic origin of the right coronary artery from the left coronary cusp. CASE PRESENTATION A 58-year-old Caucasian female presented multiple times over 6 months with atypical chest discomfort and palpitations. The treadmill exercise test demonstrated exercise-induced non-sustained ventricular tachycardia. A coronary angiogram revealed no obstructive coronary artery disease and an anomalous aortic origin of the right coronary artery from the left coronary cusp with an interarterial course. She was managed conservatively with medications, despite persistent recurrent symptoms. CONCLUSION It is essential to identify subtle symptoms and insidious onset of anomalous aortic origin of the right coronary artery symptoms as seen in our patient, which can contribute to significant morbidity. There are discrepancies in existing guidelines between different cardiovascular societies in managing selected subgroups of patients with anomalous aortic origin of the right coronary artery who do not have high-risk features, but continue to remain symptomatic.
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Affiliation(s)
- Pramukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA.
| | - Boskey Patel
- Division of Cardiovascular Medicine, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA
| | | | - Sushmita Prabhu
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA
| | - Michelle Hadley
- Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
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Dasari M, Arun Kumar P, Singh Y, Ramsaran E. New scoring system for acute chest pain risk stratification: Is it worth SVEAT-ing it? World J Cardiol 2023; 15:200-204. [PMID: 37124978 PMCID: PMC10130892 DOI: 10.4330/wjc.v15.i4.200] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
The emergency room is a very potent environment in the hospital. With the growing demands of the population, improved accessibility to health resources, and the onslaught of the triple pandemic, it is extremely crucial to triage patients at presentation. In the spectrum of complaints, chest pain is the commonest. Despite it being a daily ailment, chest pain brings concern to every physician at first. Chest pain could span from acute coronary syndrome, pulmonary embolism, and aortic dissection (all potentially fatal) to reflux, zoster, or musculoskeletal causes that do not need rapid interventions. We often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical decision-making. Over the years, the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular events. Recently, a new scoring system called SVEAT was developed and compared to the HEART score. We have attempted to summarize how these scoring systems differ and their generalizability. With an increasing number of scoring systems being introduced, one must also prevent anchorage bias; i.e., tools such as these are only diagnosis-specific and not organ-specific, and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.
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Affiliation(s)
- Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Pramukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Eddison Ramsaran
- Department of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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Arun Kumar P, Patel B, Dasari M, Arun Kumar S, Shah N, Laidlaw D. Aseptic presentation of interventricular septal abscess with progressive heart block: a case report. J Med Case Rep 2023; 17:131. [PMID: 37032324 PMCID: PMC10084690 DOI: 10.1186/s13256-023-03846-9] [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: 12/07/2022] [Accepted: 02/26/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Infective endocarditis can progress to an intracardiac abscess in 20% to 30% of cases, with interventricular septal abscess (IVSA) being one of the rare complications usually presenting with sepsis. We present a case of IVSA presenting with a new-onset second-degree heart block, which rapidly progressed to a complete heart block. CASE PRESENTATION A 80-year-old Caucasian female with a past medical history of hypertension and hyperlipidemia presented with exertional chest pain, lightheadedness, and shortness of breath with telemetry and electrocardiogram revealing persistent Mobitz type II second degree atrioventricular block. The rest of the vitals were normal. As she was being planned for a pacemaker placement, she spiked a temperature of 103F. Blood cultures grew methicillin-sensitive Staphylococcus aureus, and appropriate antibiotics were initiated. Transthoracic echocardiogram was grossly normal. However, transesophageal echocardiogram revealed a heterogeneous extension of an echodensity from the aortic root, along the aorto-mitral cushion and into the interventricular septum, indicating an interventricular septal abscess. Her course was complicated by altered mental status, with computed tomography of the brain revealing hypodense regions in the left lentiform nucleus and anterior caudate nucleus representing acute/subacute stroke. Surgery was deferred as she was deemed a poor candidate. She succumbed to her illness on day 6 of hospitalization. CONCLUSION Intracardiac abscesses should be considered a possible initial differential in patients with progressive heart block despite aseptic presentation and no risk factors.
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Affiliation(s)
- Pramukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA.
| | - Boskey Patel
- Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA
| | - Sumukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA
| | - Neeta Shah
- Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Douglas Laidlaw
- Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
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Bhattad PB, Arun Kumar P, Dasari M, Sherif AA, Mishra AK, Filiberti AW. Dilated Cardiomyopathy: Beware of Diet Drugs Slimming the Heart. Cureus 2023; 15:e36874. [PMID: 37123787 PMCID: PMC10147345 DOI: 10.7759/cureus.36874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 03/31/2023] Open
Abstract
There have been rare reports of dilated cardiomyopathy from chronic use of phentermine/topiramate, although very limited data are available. Phentermine is an atypical amphetamine analog that has been contraindicated in patients with a history of cardiovascular disease. We present a case of nonischemic dilated cardiomyopathy in the setting of chronic phentermine/topiramate use, which is the most likely cause of her dilated cardiomyopathy.
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Titus A, Majmundar V, Patel N, Omkumar JM, Koshy RM, Sooraj M, Titus A, Sherif AA, Saji AM, Kumar PA, Dasari M, kadavath S, Vallabhajosyula S, Dani SS. INTRAVASCULAR ULTRASOUND-GUIDED PERCUTANEOUS CORONARY INTERVENTION IN NON-ST-ELEVATION MYOCARDIAL INFARCTION: NATIONAL INPATIENT SAMPLE 2016-2019. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01800-4] [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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Mishra AK, George AA, John KJ, Arun Kumar P, Dasari M, Afraz Pasha M, Hadley M. Takotsubo cardiomyopathy following envenomation: An updated review. World J Cardiol 2023; 15:33-44. [PMID: 36714368 PMCID: PMC9850669 DOI: 10.4330/wjc.v15.i1.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/15/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) can be diagnosed in patients presenting with clinical features of acute coronary syndrome (ACS) by using Mayo clinic criteria. Multiple precipitators have been attributed to causing TTC. Rarely it has been reported to occur following an acute envenomation.
AIM This review describes the various patterns, mechanisms, and outcomes of envenomation induced TTC.
METHODS In this review, we included all studies on “TTC” and “envenomation “published in the various databases before June 2022. To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation
RESULTS A total of 20 patients with envenomation induced TTC were identified. Most episodes of envenomation induced TTC were reported following a bee sting, scorpion sting, and snake envenomation. Fear and anxiety related to the sting, direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients. 95% of these patients presented with a clinical picture of ACS. Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC. Echocardiographic evidence of Apical TTC was noted in 72% of patients. 94% of these patients had clinical improvement following optimal management and 35% of these patients were treated with guideline directed medications for heart failure.
CONCLUSION Envenomation following multiple insect stings and reptile bites can precipitate TTC. Most reported envenomation related TTC has been due to bee stings and scorpion bites. Common mechanisms causing TTC were fear, anxiety, and stress of envenomation. Most of these patients present with clinical presentation of ACS, ST elevation, and elevated troponin. The most common type of TTC in these patients is Apical, which improved following medical management.
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Affiliation(s)
- Ajay K Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anu A George
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Kevin John John
- Department of Medicine, Tufts Medical Center, Boston, MA 02111, United States
| | - Pramukh Arun Kumar
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Mahati Dasari
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Mohammed Afraz Pasha
- Department of Medicine, North Alabama Medical Center, Florence, AL 35630, United States
| | - Michelle Hadley
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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Arun Kumar P, Dasari M, Sahu KK, Al-Seykal I, Mishra AK. Understanding the EKG changes in methemoglobinemia. Ann Hematol 2022; 101:2107-2110. [PMID: 35723711 DOI: 10.1007/s00277-022-04878-9] [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: 05/13/2022] [Accepted: 06/04/2022] [Indexed: 11/25/2022]
Abstract
Methemoglobin is a form of hemoglobin that has been oxidized, changing its heme iron configuration from the ferrous to the ferric state. Unlike normal hemoglobin, methemoglobin does not bind oxygen and as a result, cannot deliver oxygen to the tissues. At the presentation in the emergency department, an electrocardiogram (EKG) is usually performed as a reflex for patients admitted for shortness of breath to rule out acute coronary syndrome. Very limited data is available on EKG abnormalities in patients with methemoglobinemia. In this study, we retrospectively analyzed the pattern of EKG changes in patients with methemoglobinemia.
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Affiliation(s)
| | | | - Kamal Kant Sahu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Kumar PA, Venkataramanan SVA, Dasari M, Sharma N, Kranis MJ. A RARE CASE OF VALVE-IN-VALVE-IN-VALVE TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03924-9] [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: 10/18/2022]
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Perry BI, Cooray SE, Mendis J, Purandare K, Wijeratne A, Manjubhashini S, Dasari M, Esan F, Gunaratna I, Naseem RA, Hoare S, Chester V, Roy A, Devapriam J, Alexander R, Kwok HF. Problem behaviours and psychotropic medication use in intellectual disability: a multinational cross-sectional survey. J Intellect Disabil Res 2018; 62:140-149. [PMID: 29349928 DOI: 10.1111/jir.12471] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/06/2017] [Accepted: 12/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Problem behaviours (PBs) are a common cause for clinician contact in people with disorders of intellectual development and may be a common cause for the prescription of psychotropic medication. We aimed to use a large, multinational sample to define the prevalence of PBs, the associations with psychotropic medication use, and to assess for any potential 'diagnostic overshadowing' by the label of PBs in a population of people with disorders of intellectual development. METHOD A multinational, multi-setting, cross-sectional service evaluation and baseline audit was completed. Data were collected from UK hospitals, UK community settings, Sri Lanka and Hong Kong. A semi-structured questionnaire was completed by treating clinicians, capturing demographic details, prevalence rates of intellectual disability and psychotropic medication use, alongside psychiatric co-morbidity. RESULTS A sample size of 358 was obtained, with 65% of included participants treated in an inpatient setting. Psychotropic use was prevalent (90%) in our sample, particularly antipsychotics (74%). The prevalence of PB was high (83%). There was no statistically significant association between psychotropic prescription and recorded psychiatric co-morbidity, suggesting prevalent 'off-label' use for PBs, or poor recording of psychiatric co-morbidity. There was some evidence of possible diagnostic overshadowing due to the PB classification. A higher dose of psychotropic medication was associated with aggression toward others (P = 0.03). CONCLUSIONS We found evidence of prevalent potential 'off-label' use for psychotropic medication, which may be due to PBs. We also found evidence of potential diagnostic-overshadowing, where symptoms of psychiatric co-morbidity may have been attributed to PBs. Our findings provide renewed importance, across borders and health systems, for clinicians to consider a holistic approach to treating PBs, and attempting to best understand the precipitants and predisposing factors before psychotropic prescribing.
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Affiliation(s)
- B I Perry
- Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | - J Mendis
- National Institute of Mental Health, Angoda, Sri Lanka
| | - K Purandare
- Central and North West London NHS Foundation Trust, London, UK
| | - A Wijeratne
- Central and North West London NHS Foundation Trust, London, UK
| | - S Manjubhashini
- South West London and St Georges Mental Health Foundation NHS Trust, London, UK
| | - M Dasari
- Humber NHS Foundation Trust, Driffield, UK
| | - F Esan
- Partnerships in Care, Diss, Diss, UK
| | | | | | - S Hoare
- Partnerships in Care, Diss, Diss, UK
| | - V Chester
- Partnerships in Care, Diss, Diss, UK
| | - A Roy
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - J Devapriam
- Leicestershire Partnership NHS Trust, Leicester, UK
| | | | - H F Kwok
- Faculty of Health Sciences, University of Macau, Zhuhai Shi, China
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Dasari M, Miller E, Puyana J. Implementation of an electronic surgical registry in a low-middle income
country: Assessing organizational readiness using the theoretical domains
framework approach. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.246] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Dasari M, Friedman L, Jesberger J, Stuve TA, Findling RL, Swales TP, Schulz SC. A magnetic resonance imaging study of thalamic area in adolescent patients with either schizophrenia or bipolar disorder as compared to healthy controls. Psychiatry Res 1999; 91:155-62. [PMID: 10641579 DOI: 10.1016/s0925-4927(99)00028-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [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: 11/26/2022]
Abstract
The purpose of this study was to compare thalamic size in adolescent patients with either schizophrenia or bipolar disorder and healthy controls. T2-weighted axial magnetic resonance images were used to manually define the area of the thalamus for 20 schizophrenia patients, 15 bipolar patients and 16 normal control subjects, all of whom were adolescents. Two orthogonal planned contrasts were tested: Contrast 1, patients with schizophrenia vs. patients with bipolar disorder; and Contrast 2, both patient groups taken as a single group compared to controls. Contrast 1 was not statistically significant for right or left thalamic area. Contrast 2 was statistically significant and indicated reductions in thalamic area in the patients as compared to controls. The same pattern of results emerged after adjustment for total brain volume. Our results indicate that thalamic abnormalities reported in adult schizophrenic and bipolar patients are also observed in adolescent patients. Our findings also add to the evidence implicating the thalamus in the pathophysiology of schizophrenia and bipolar disorder.
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Affiliation(s)
- M Dasari
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Crosby ET, Halpern S, Bill KM, Flynnn RJ, Moore J, Navaneelan C, Cunningham A, Yu PYH, Gamling DR, McMorland GH, Perreault C, Guay J, Gaudreault P, Hollman C, Meloche R, Hackman T, Sheps SB, Murray WB, Heiman PA, Slinger P, Triolet W, Jain U, Rao TLK, Dasari M, Pifarre R, Sullivan H, Calandra D, Friesen RM, Bjornson J, Hatton G, Parlow JL, Casey WF, Broadman LM, Rice LJ, Dailey M, Andrews WR, Stigi S, Jendrek V, Shevde K, Withington DE, Saoud AT, Ramsay JG, Bilodeau J, Johnson D, Mayers I, Doran RJ, Wong PY, Mullen BJ, Wigglesworth D, Byrick RJ, Kay JC, Stubbing JF, Sweeney BP, Dagher E, Dumont L, Lagace G, Chartrand C, Badner NH, Sandier AN, Leitch L, Koren G, Erian RF, Bunegin L, Shulman DL, Burrows F, O’Sullivan K, Bouchier D, Kashin BA, Wynands JE, Villeneuve E, Blaise G, Guerrard MJ, Buluran J, Effa E, Vaghadia H, Jenkins LC, Janisse T, Scudamore CH, Patel PM, Mutch WAC, Ruta TS, McNeill BR, Murkin JM, Gelb AW, Farrar JK, Johnson GD, Adams MA, Lillicrap DP, Lindblad T, Beattie WS, Buckley DN, Forrest JB, Lessard MR, Trépanier CA, Baribault JP, Brochu JG, Brousseau CA, Cote JJ, Denault P, Whang P, Moudgil GC, Daly N, Morrison DH, Ogilvie R, Man J, Ehler T, Leitch LF, Dupuis JY, Martin R, Tessonnier JM, Barry AW, Milne B, Quintin L, Gillon JY, Pujol JF, DeMonte F, Zhang C, Hamilton JT, Zhou Y, Plourde G, Picton TW, Kellett A, Pilato MA, Bissonnette B, Lerman J, Brown KA, Dundee JW, Sosis M, Dillon F, Stetson JB, Voorhees WD, Bourland JD, Geddes LA, Shoenlein WE, O’Leary G, Teasdale S, Knill RL, Rose EA, Berko SL, Smith CE, Sadler JM, Bevan JC, Donati F, Bevan DR, Tellez J, Turner D, Kao YJ, Salidivia V, Roldan L, Orrego H, Carmicheal FJ, Kent AP, Parker CJR, Hunter JM, Finley GA, Goresky GV, Klassen K, McDiarmid C, Shaffer E, Vaughan M, Randolph J, Szalados JE, Lazzell VA, Creighton RE, Poon AO, Mclntyre B, Douglas MJ, Swenerton JE, Farquharson DF, Landry D, Petit F, Riegert D, Koch JP, Maggisano R, Devitt JH, Jense HG, Dubin SA, Silverstein PI, Rodriguez N, Wakefield ML, Williams R, Dubin S, Smith JJ, Hofmann VC, Jarvis AP, Forbes RB, Murray DJ, Dillman JB, Dull DL, Cohen MM, Cameron CB, Johnston RG, Konopad E, Jivraj K, Hunt D, Eastley R, Strunin L, Fairbrass MJ, Laganiere S, McGilvery M, Foster B, Young P, Weisel D, Parra L, Suarez Isla BA, Lopez JR, Hall RI, Hawwa R, Kashtan H, Edelist G, Mallon J, Kapala D, Dhamee MS, Reynolds AC, Olund T, Entress J, Kalbfleisch J, Bell SD, Goldberg ME, Bracey BJ, Goldhill DR, Bennett MH, Emmott RS, Innis RF, Yate PM, Flynn PJ, Gill SS, Saunders PR, Geisecke AH, Feldman JM, Banner MJ, Siriwardhana SA, Kawas A, Lipton JL, Giesecke AH, Doyle DJ, Volgyesi GA, Hillier SC, Gallagher J, Hargaden K, Hamil M, Cunningham AJ, Scott WAC, Sielecka D, Illing LH, Jani K, Scarr M, Maltby JR, Roy J, McNulty SE, Torjman M, Carey C, Bracey B, Markham K, Durcan J, Blackstock D, DaSilva CA, Demars PD, Montgomery CJ, Steward DJ, Sessler DI, Laflamme P, McDevitt S, Kamal GD, Symreng T, Tatman DJ, Durcharme J, Varin F, Besner JG, Dyck JB, Chung F, Arellano R, Lim G, Bailey DG, Bayliff CD, Cunningham DG, Ewen A, Sheppard SD, Mahoney LT, Bacon GS, Rice LR, Newman K, Loe W, Toth M, Pilato M, Classen K, McDiamid C, Burrows FA, Irish CL, Casey W, Hauser GJ, Chan MM, Midgley FM, Holbrook PR, Elliott ME, Man WK, Finegan BA, Clanachan AS, Hudson RJ, Thomson IR, Burgess PM, Rosenbloom M, Fisher JM, O’Connor JP, Ralley FE, Robbins GR, Moote CA, Manninen PH, English M, Farmer C, Scott A, White IWC, Biehl D, Donen N, Mansfield J, Cohen M, Wade JG, Woodward C, Ducharme J, Gerardi A, Mijares A, Code WE, Hertz L, Chung A, Meier HMR, Lautenschlaeger E, Seyone C, Wassef MR, Devitt FH, Cheng DCH, Dyck B, Chan VWS, Ferrante FM, Arthur GR, Rice L, Annallah RH, Etches RC, Loulmet D, Lacombe P, Hollmann C, Tanguay M, Blaise GA, Lenis SG, Fear DW, Lang SA, Ha HC, Germain H, Neion A, Dorian P, Salter D, Pollick C, Cervenko F, Parlow J, Pym J, Nakatsu K, Elliott D, Miller DR, Martineau RJ, Ewing D, Martineau RJ, Knox JWD, Oxorn DC, O’Connor JP, Whalley DG, Rogers KH, Kay JC, Mazer CD, Belo SE, Hew-Wing P, Hew E, Tessonier JM, Thibault G, Testaert E, Chartrand D, Cusson JR, Kuchel O, Larochelle P, Couture J. Abstracts. Can J Anaesth 1989. [DOI: 10.1007/bf03005330] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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