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Singh M, Momah D, Palaniappan D, Nadig V, Mah JW. Therapeutic Dilemma: Acute Myocardial Infarction in a Patient with Traumatic Hepatic and Mesenteric Injuries: A Case Report. A A Pract 2024; 18:e01741. [PMID: 38572854 DOI: 10.1213/xaa.0000000000001741] [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] [Indexed: 04/05/2024]
Abstract
ST-elevation myocardial infarction (STEMI) in a trauma patient with solid abdominal organ or vascular injuries can present complex diagnostic and therapeutic challenges. Evidence for managing such demanding cases is scarce, and isolated case reports remain the source of information in treating these patients. We present a patient with traumatic mesenteric and hepatic injuries who developed acute STEMI in the immediate postoperative period.
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Affiliation(s)
- Manila Singh
- From the Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Deandra Momah
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Vidya Nadig
- Department of Cardiovascular Medicine, Hartford Hospital, Hartford, Connecticut
| | - John Wesley Mah
- Division of Emergency General Surgery and Critical Care, Department of Surgery, Hartford Hospital, Hartford, Connecticut
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Yabut J, Nadig V, Arora S, Hirsch D, Duvall WL. Case of Biopsy-Proven Wild-Type ATTR Cardiac Amyloidosis With Abnormal CMR and Negative 99mTc-HDP and PYP Nuclear Scintigraphy. Circ Cardiovasc Imaging 2024; 17:e015734. [PMID: 38146653 DOI: 10.1161/circimaging.123.015734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Affiliation(s)
- Jevin Yabut
- Department of Medicine, University of Connecticut, Farmington (J.Y.)
| | - Vidya Nadig
- Department of Cardiology (V.N., S.A., W.L.D.), Hartford Healthcare, CT
| | - Sabeena Arora
- Department of Cardiology (V.N., S.A., W.L.D.), Hartford Healthcare, CT
| | - David Hirsch
- Department of Pathology (D.H.), Hartford Healthcare, CT
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Patel E, Nadig V, Fernandez AB. LEFT VENTRICULAR APICAL DIVERTICULUM IN AN ASYMPTOMATIC 18-YEAR-OLD ATHLETE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02909-1] [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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Muacevic A, Adler JR, Nadig V, Kunkes J. Statin-Induced Myositis with Concomitant Myocarditis. Cureus 2022; 14:e31871. [PMID: 36579236 PMCID: PMC9792361 DOI: 10.7759/cureus.31871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
Statins are commonly prescribed medications that provide many significant cardiovascular benefits for both primary and secondary prevention in patients with and without coronary artery disease. Known adverse effects of these medications include varying degrees of muscle toxicity, including myalgia, myopathy, and rare cases of necrotizing myositis, hepatic dysfunction, and central nervous system changes. Despite known adverse effects, statins are rarely associated with myocarditis. Statins can cause skeletal muscle myopathy and myositis by upregulating HMG-CoA reductase (HMGCR) in muscle tissue, resulting in antibody-mediated inflammation. A similar proposed mechanism is likely possible within cardiac myocytes. We present a rare case of statin-induced necrotizing myositis with concomitant cardiac involvement. Severe skeletal muscle myositis was confirmed by lower extremity MRI and biopsy findings. In association, elevated and plateaued high-sensitivity troponin without evidence of cardiac ischemia warranted cardiac MRI, which further confirmed myocarditis due to inflammation within a non-vascular distribution. Given its rare presentation, the treatment for statin-induced cardiac toxicity is unclear; however, the patient in this case report was treated with pulse-dose intravenous steroids and indefinite discontinuation of statin medications.
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Aandal G, Nadig V, Yeh V, Rajiah P, Jenkins T, Sattar A, Griswold M, Gulani V, Gilkeson RC, Seiberlich N. Evaluation of left ventricular ejection fraction using through-time radial GRAPPA. J Cardiovasc Magn Reson 2014; 16:79. [PMID: 25315256 PMCID: PMC4180954 DOI: 10.1186/s12968-014-0079-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 09/01/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The determination of left ventricular ejection fraction using cardiovascular magnetic resonance (CMR) requires a steady cardiac rhythm for electrocardiogram (ECG) gating and multiple breathholds to minimize respiratory motion artifacts, which often leads to scan times of several minutes. The need for gating and breathholding can be eliminated by employing real-time CMR methods such as through-time radial GRAPPA. The aim of this study is to compare left ventricular cardiac functional parameters obtained using current gold-standard breathhold ECG-gated functional scans with non-gated free-breathing real-time imaging using radial GRAPPA, and to determine whether scan time or the occurrence of artifacts are reduced when using this real-time approach. METHODS 63 patients were scanned on a 1.5T CMR scanner using both the standard cardiac functional examination with gating and breathholding and the real-time method. Total scan durations were noted. Through-time radial GRAPPA was employed to reconstruct images from the highly accelerated real-time data. The blood volume in the left ventricle was assessed to determine the end systolic volume (ESV), end diastolic volume (EDV), and ejection fraction (EF) for both methods, and images were rated for the presence of artifacts and quality of specific image features by two cardiac readers. Linear regression analysis, Bland-Altman plots and two-sided t-tests were performed to compare the quantitative parameters. A two-sample t-test was performed to compare the scan durations, and a two-sample test of proportion was used to analyze the presence of artifacts. For the reviewers´ ratings the Wilcoxon test for the equality of the scores' distributions was employed. RESULTS The differences in EF, EDV, and ESV between the gold-standard and real-time methods were not statistically significant (p-values of 0.77, 0.82, and 0.97, respectively). Additionally, the scan time was significantly shorter for the real-time data collection (p<0.001) and fewer artifacts were reported in the real-time images (p<0.01). In the qualitative image analysis, reviewers marginally preferred the standard images although some features including cardiac motion were equivalently rated. CONCLUSION Real-time functional CMR with through-time radial GRAPPA performed without ECG-gating under free-breathing can be considered as an alternative to gold-standard breathhold cine imaging for the evaluation of ejection fraction in patients.
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Affiliation(s)
- Gunhild Aandal
- Radiology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA.
- Haraldsplass Deaconess Hospital, Bergen, Norway.
| | - Vidya Nadig
- Cardiology, MetroHealth Medical Center at Case Western University, Cleveland, OH, USA.
| | - Victoria Yeh
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Prabhakar Rajiah
- Radiology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Trevor Jenkins
- Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Abdus Sattar
- Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA.
| | - Mark Griswold
- Radiology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA.
- Biomedical Engineering, Case Western Reserve University, Room 309 Wickenden Building 2071 Martin Luther King Jr. Drive, Cleveland, OH, 44106-7207, USA.
| | - Vikas Gulani
- Radiology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA.
- Biomedical Engineering, Case Western Reserve University, Room 309 Wickenden Building 2071 Martin Luther King Jr. Drive, Cleveland, OH, 44106-7207, USA.
| | - Robert C Gilkeson
- Radiology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Nicole Seiberlich
- Biomedical Engineering, Case Western Reserve University, Room 309 Wickenden Building 2071 Martin Luther King Jr. Drive, Cleveland, OH, 44106-7207, USA.
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Nadig V, Yeh V, Gulani V, Gilkeson RC, Seiberlich N. Quantification of left ventricular ejection fraction using through-time radial GRAPPA for real-time imaging. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559986 DOI: 10.1186/1532-429x-15-s1-p45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rafiq I, Nadig V, Freeman LJ. Sarcoidosis, microvascular angina and aortitis: New dimensions of the 'Takayasu syndrome' - A case report. Int J Angiol 2012; 16:113-4. [PMID: 22477304 DOI: 10.1055/s-0031-1278261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
A case of Takayasu aortitis associated with sarcoidosis presenting with recurrent angina is reported. This association has been called 'Takayasu syndrome', which reflects what is likely a shared etiology. Myocardial perfusion abnormalities have recently been documented in sarcoidosis, but this case clarifies for the first time that the angina in Takayasu syndrome is likely due to small vessel coronary arteritis. Corticosteroids and cytotoxic therapy have been shown to be beneficial in all forms of sarcoidosis related to vasculitis. Initiation of steroid therapy may provide relief of angina in patients with evidence of reversible ischemia in normal coronary arteries.
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Affiliation(s)
- Isma Rafiq
- Department of Cardiology, Norfolk and Norwich University NHS Trust, Norwich, United Kingdom
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Helton TJ, Nadig V, Subramanya SD, Menon V, Ellis SG, Shishehbor MH. Outcomes of cardiac catheterization and percutaneous coronary intervention for in-hospital ventricular tachycardia or fibrillation cardiac arrest. Catheter Cardiovasc Interv 2011; 80:E9-14. [DOI: 10.1002/ccd.23196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 03/31/2011] [Indexed: 11/07/2022]
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Chadwick R, Nadig V, Oscroft NS, Shneerson JM, Smith IE. Weaning from prolonged invasive ventilation in motor neuron disease: analysis of outcomes and survival. J Neurol Neurosurg Psychiatry 2011; 82:643-5. [PMID: 20392974 DOI: 10.1136/jnnp.2009.193631] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Non-invasive ventilation (NIV) improves prognosis in patients with motor neuron disease (MND) in the absence of major bulbar involvement. However, some experience a rapid and unexpected decline in respiratory function and may undergo emergency tracheal intubation. Weaning from invasive ventilation can be difficult, and reported independence from invasive ventilation is uncommon with poor prognosis. The outcomes of patients with MND referred to a specialist weaning service following emergency tracheal intubation were examined and compared with MND patients electively initiating NIV. METHODS A case note review was performed on all patients with MND invasively ventilated and referred to a specialist weaning service between 1992 and 2007. Outcomes were compared with those electively commenced on NIV during the same period. RESULTS Thirty patients were referred for weaning from invasive ventilation which was started in 17 before MND was diagnosed. Fourteen patients (47%) were weaned from invasive ventilation but still required NIV, 13 failed to wean, and three died. Seventeen were discharged home from hospital. The median survival from tracheal intubation was 13.7 months (95% CI 0 to 30.8) for those previously diagnosed and 7.2 months (95% CI 5.1 to 9.4) for those not previously known to have MND. Comparison with patients initiated electively on NIV demonstrated similar survival estimates to that from emergency intubation (median 9.4 (95% CI 6.9 to 12.0) vs 7.8 (95% CI 2.6 to 12.9) months respectively). CONCLUSION The prognosis in MND following acute respiratory failure and intubation is not always complete ventilator dependence if patients are offered a comprehensive weaning programme.
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Affiliation(s)
- R Chadwick
- Respiratory Support and Sleep Centre, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
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Raina R, Nadig V, Patel D, Jegalian A, Silver B, Heyka RJ. Spontaneous perinephric hematoma due to acquired factor X deficiency in AL amyloidosis. Clin Kidney J 2011; 4:101-3. [PMID: 25984124 PMCID: PMC4421590 DOI: 10.1093/ndtplus/sfq217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 10/29/2010] [Accepted: 12/23/2010] [Indexed: 12/04/2022] Open
Abstract
Spontaneous perinephric hematoma (SPH) is a rare entity whose diagnosis is challenging because of its varied clinical presentation and lack of any specific etiology. We report a 34-year-old African-American male who presented with left flank pain and was found to have a large left perinephric hematoma, in the setting of undiagnosed AL amylodosis. The case illustrates that while a SPH due to the vascular angiopathy of amyloid is rare, when amyloidosis is associated with abnormal coagulation studies or bleeding at multiple sites, it should be considered because of its protean systemic manifestations and potential response to chemotherapy.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology and Hypertension, Glickman Urology and Kidney Institute at Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Vidya Nadig
- Department of Nephrology and Hypertension, Glickman Urology and Kidney Institute at Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Deven Patel
- Department of Nephrology and Hypertension, Glickman Urology and Kidney Institute at Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Armin Jegalian
- Department of Hematologic Oncology and Blood Disorders at Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bernard Silver
- Department of Hematologic Oncology and Blood Disorders at Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert J. Heyka
- Department of Nephrology and Hypertension, Glickman Urology and Kidney Institute at Cleveland Clinic Foundation, Cleveland, OH, USA
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Nadig V, Patel D, Raina R, Lichtin A, Silver B, Heyka R. 205: Spontaneous Perinephric Hematoma. Am J Kidney Dis 2010. [DOI: 10.1053/j.ajkd.2010.02.212] [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: 11/11/2022]
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Smith I, Nadig V, Lasserson TJ. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2009:CD007736. [PMID: 19370691 DOI: 10.1002/14651858.cd007736] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [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: 11/05/2022]
Abstract
BACKGROUND Although effective in the treatment of obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) does not meet with universal acceptance by users. Educational, supportive and behavioural interventions may help people with obstructive sleep apnoea recognise the need for regular and continued use of continuous positive airway pressure. OBJECTIVES To critically assess strategies that are educational, or supportive, or behavioural in encouraging people who have been prescribed or offered CPAP to use their machines. SEARCH STRATEGY Searches were conducted on the Cochrane Airways Group Sleep Apnoea trials register. Searches are current to September 2008. SELECTION CRITERIA Randomised parallel group studies which assessed an intervention aimed to inform participants about CPAP or OSA, or to support them in using CPAP or to modify their behaviour in increasing their use of CPAP machines. Studies of any duration were considered. DATA COLLECTION AND ANALYSIS Two authors assessed studies to determine their suitability for inclusion in the review. Data were extracted independently and entered in to Review Manager software. MAIN RESULTS Seventeen studies met the review entry criteria (1070 participants). Support/encouragement offered on an ongoing basis led to increased average machine usage (0.59 hours/night (95% CI 0.26 to 0.92), although there was a significant degree of variation between the results of the studies. The effects of these interventions on the likelihood of study withdrawal, symptoms and quality of life were not statistically significant.Short-course educational intervention was not more successful in improving average machine usage than usual care.Cognitive behavioural therapy led to a significant improvement in average machine usage in two studies (2.92 hours/night (95% CI 1.93 to 3.92)), and a number needed to treat of 3 (95% CI 2 to 6) for one additional patient to achieve machine usage of six or more hours per night. Overall, In the control groups 85 people out of 100 had failed to comply with CPAP over 4 to 12 weeks, compared to 46 (95% CI 68 to 25) out of 100 for the cognitive behaviour groups. AUTHORS' CONCLUSIONS There is some evidence that a supportive intervention which encourages people to continue to use their CPAP machines leads to greater levels of CPAP machine usage than control, although the variation across the studies introduces some uncertainty over how consistent this effect is. We could not find evidence that a short-term educational intervention led to improvements in usage. Cognitive behavioural therapy led to the largest increases in average machine usage, partly because more participants were prepared to try out the treatment. Studies generally recruited CPAP naive patients whose sleep apnoea was severe. Trials in patients who have struggled to persist with treatment are required, as there is currently little evidence in this population. This could make a valuable contribution to our understanding of the complex relationship between initial motivation, ongoing perception of benefit and long-term health benefits.
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Affiliation(s)
- Ian Smith
- Respiratory Support and Sleep Centre, Papworth Hospital, Papworth Everard, Cambridge, UK, CB3 8RE.
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