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Noori MAM, Mohammadian M, Saeed H, Romero J, Shruti J, Fichadiya H, Elkattawy S, Jawed Q, Shah D, Shah KK, Loumiotis I, Joshi MB, Fyfe B. Giant-Cell Aortitis-Induced Acute Aortic Insufficiency: An Underestimated Etiology. Am J Case Rep 2022. [DOI: 10.12659/ajcr.937836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Muhammad Atif Masood Noori
- Department of Internal Medicine, RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, USA, NJ
| | - Mahsa Mohammadian
- Department of Internal Medicine, RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, USA, NJ
| | - Hasham Saeed
- Department of Internal Medicine, RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, USA, NJ
| | - Jesus Romero
- Department of Internal Medicine, RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, USA, NJ
| | - Jesani Shruti
- Department of Internal Medicine, RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, USA, NJ
| | - Hardik Fichadiya
- Department of Internal Medicine, RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, USA, NJ
| | - Sherif Elkattawy
- Department of Internal Medicine, RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, USA, NJ
| | - Qirat Jawed
- Department of Internal Medicine, RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, USA, NJ
| | - Dhaval Shah
- Department of Cardiology, St. Joseph's University Hospital, Paterson, USA, NJ
| | - Kalpesh K. Shah
- Department of Cardiology, St. Joseph's University Hospital, Paterson, USA, NJ
| | - Ioannis Loumiotis
- Department of Cardiothoracic Surgery, RWJ Barnabas Health/Newark Beth Israel Medical, Newark, USA, NJ
| | - Meherwan B. Joshi
- Department of Internal Medicine, RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, USA, NJ
| | - Bille Fyfe
- Department of Pathology, Rutgers Barnabas Health System/Newark Beth Israel Medical Center, Newark, USA, NJ
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Roman S, Fichadiya H, Rushdy A, AbuArqob S, Bhavsar M, Noori MAM, Meherwan J. The great invasion, a case of lung mass invading the heart through the pulmonary veins. Radiol Case Rep 2022; 17:3219-3223. [PMID: 35814818 PMCID: PMC9256550 DOI: 10.1016/j.radcr.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sherif Roman
- Department of Medicine, St. Joseph's University Medical Center, Paterson, NJ, USA
- Corresponding author.
| | - Hardik Fichadiya
- Department of Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Abanoub Rushdy
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Sewar AbuArqob
- Department of Medicine, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Maurvi Bhavsar
- Department of Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | | | - Joshi Meherwan
- Department of Cardiology, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
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Mirza H, Noori MAM, Akbar H, Fichadiya H, Kaur IP, Sachdeva S, Grewal J, Khakwani MZ, Levitt H, Chang W, Wasty N, Patton C, Shah A, Angi P, Mughal MS. Hypertension as an Independent Risk Factor for In-Patient Mortality in Hospitalized COVID-19 Patients: A Multicenter Study. Cureus 2022; 14:e26741. [PMID: 35836713 PMCID: PMC9275529 DOI: 10.7759/cureus.26741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 01/08/2023] Open
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Alyacoub R, ElKattawy S, Jesani S, Hernandez CP, Fichadiya H, Noori MAM, Elkattawy O, Williams E. Early Left Ventricular Thrombus Following Ventricular Fibrillation/Ventricular Tachycardia Electrical Storm. Eur J Case Rep Intern Med 2022; 9:003327. [PMID: 35821907 PMCID: PMC9267715 DOI: 10.12890/2022_003327] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Left ventricular thrombus (LVT) formation is a serious clinical complication of low-flow states that may be seen in an ischaemic, arrhythmic heart. While LVT formation has a poor prognosis, in the setting of myocardial infarction it is usually a result of post-infarct sequelae such as left ventricle aneurysms, and inflammatory changes from damaged tissue, with the LVT taking several days to form. Arrythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF) may also lead to thrombus formation, as they contribute to stasis due to decreased cardiac output. Large anterolateral myocardial infarctions can cause electrical or arrhythmic storm, characterized by more than three episodes of VT or VF in a 24-hour period. This prolonged state of dyskinesis further increases the risk of thrombosis, creating a compounding effect. Here, we report the case of a patient who had a VF cardiac arrest with electrical storm secondary to anterolateral myocardial infarction complicated with LVT formation found on echocardiogram after the cardiac arrest, which was absent on presentation. This thrombus formation occurred particularly early during the course of the patient’s arrest, possibly due to the compounding factors increasing the risk of thrombosis. Herein, we discuss in detail the risk factors for LVT formation, its mechanism and management options. A review of the literature also shows that LVT formation in the acute phase of arrest, as seen in our patient, is rare.
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Affiliation(s)
- Ramez Alyacoub
- Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Sherif ElKattawy
- Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Shruti Jesani
- Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Carlos Perez Hernandez
- Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Hardik Fichadiya
- Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | | | - Omar Elkattawy
- Department of Internal Medicine, Rutgers NJMS, Elizabeth, NJ, USA
| | - Edward Williams
- Department of Cardiology, Trinitas Regional Medical Center, Elizabeth, NJ, USA
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Noori MAM, Mohammadian M, Saeed H, Abboud R, Polyak A, Jawed Q, Shah D, Singh P, Ibrahim M, Joshi M. Pericardial Cyst, A Rare Incidental Finding in an Uncommon Location: A Case Report. Cureus 2022; 14:e26037. [PMID: 35859963 PMCID: PMC9288816 DOI: 10.7759/cureus.26037] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 12/02/2022] Open
Abstract
A pericardial cyst is one of the rare causes of mediastinal masses. Most of the cases are secondary to congenital incomplete fusion of the pericardial sac. More than two-thirds of the cases are present in the right cardiophrenic angle, and the left cardiophrenic angle is the second most common location. In our study, we illustrated an incidental finding of the pericardial cyst in a patient who presented with nonspecific symptoms and was found to have a left-sided cardiophrenic pericardial cyst, which is only found in about 20% of the cases. A CT scan and echocardiogram confirmed the diagnosis of a 4.39-centimeter cyst with no signs of complications like tamponade or pericarditis. As the patient's symptoms resolved, outpatient follow-up with serial echocardiogram was advised. Through this report, we aim to raise awareness of the importance of further investigation for nonspecific symptoms like atypical chest tightness and differentiating simple pericardial cysts from other pericardial lesions. Based on the symptoms, size, and compression effect of the cyst, management may vary from serial echocardiogram to aspiration or surgical resection.
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Fichadiya H, Shah KK, Noori MAM, Khandait H, Rath P, Latif A, Patel R, Pullatt R. A Rare Case of Eustachian Valve Endocarditis in a Young Male With Poorly Controlled Type 1 Diabetes Mellitus. Cureus 2022; 14:e25314. [PMID: 35755565 PMCID: PMC9227728 DOI: 10.7759/cureus.25314] [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] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
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Noori MAM, Fichadiya H, Saeed H, Jawed Q, Jesani S, Latif A, Joshi M. Coincidence of Events Causing Paradoxical Hypotension in a Patient with an Intra-Aortic Balloon Pump. Eur J Case Rep Intern Med 2022; 9:003341. [PMID: 35774733 PMCID: PMC9239020 DOI: 10.12890/2022_003341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 11/06/2022] Open
Abstract
The left ventricular outflow tract is a region of the left ventricle that lies between the anterior leaflet of the mitral valve and the ventricular septum. Dynamic left ventricular outflow tract obstruction (LVOTO) has classically been observed in patients with hypertrophic obstructive cardiomyopathy (HOCM) where it occurs secondary to asymmetric septal hypertrophy and systolic anterior motion (SAM) of the mitral valve. However, there are some instances that lead to hypercontractility of the myocardium, and with a combination of other physiological conditions, result in SAM of a mitral valve leaflet, leading to LVOTO in the absence of phenotype. We present such a case of an acute inferolateral wall myocardial infarction that was complicated by cardiogenic shock, requiring an intra-aortic balloon pump (IABP) and inotropic support which paradoxically provoked LVOTO. A reduction in IABP counterpulsation from 1:1 to 1:3 and the addition of intravenous fluids and a beta blocker resulted in significant improvement in blood pressure with rapid tapering of pressors. Inotropes and IABP, although helpful in cardiogenic shock, have the potential to induce or worsen the LVOTO, which can lead to a vicious cycle of worsening hypotension and increasing adrenergic drive that further deteriorates myocardial viability. Timely diagnosis with an echocardiogram and the withdrawal of inotropic and IABP support has the potential to improve haemodynamics and, thereby, outcome.
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Affiliation(s)
| | - Hardik Fichadiya
- RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Hasham Saeed
- RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Qirat Jawed
- RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Shruti Jesani
- RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Asnia Latif
- RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Meherwan Joshi
- RWJ Barnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA
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Noori MAM, Fichadiya H, Jesani S, Abid F, Sachdeva N, Saeed H, Jawed Q, Elkattawy S, Joshi M. A Rare yet Morbid Complication of Cocaine Use: Brugada Type 1 on Electrocardiogram. Cureus 2022; 14:e24309. [PMID: 35602832 PMCID: PMC9122013 DOI: 10.7759/cureus.24309] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/05/2022] Open
Abstract
Cocaine is considered a leading non-opioid cause of drug overdose in the US. It acts as a sympathomimetic and increases the amount of catecholamines, thereby increasing the risk of ventricular irritability and resultant arrhythmias. Its sodium (Na) channel blockage is the principal mechanism behind the Brugada pattern on an electrocardiogram (ECG), which is often transient but is indistinguishable from that of Brugada syndrome, the autosomal dominant channelopathy. We are presenting a case of a 32-year-old male with a history of cocaine and nicotine abuse, who sought medical attention for sudden-onset palpitations and pressure-like chest pain after having snorted an impressive amount of cocaine. His ECG depicted a classical Brugada pattern with ST-elevation with T inversion in V1; however, previous ECGs were normal without ST changes, signifying the Brugada pattern unmasked by cocaine use. Other investigations including stress tests and nuclear imaging were equivocal. His symptoms as well as the ECG pattern reverted to baseline signifying the presence of Brugada phenotype in the absence of channelopathy. Hence, as a sodium channel blocker, cocaine may unmask latent Brugada syndrome in asymptomatic patients without a family history. Recognizing Brugada syndrome on ECG is vital to avoid misdiagnosis and mistreatment of the patient with and without a genetic predisposition.
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Fichadiya H, Noori MAM, Khandait H, Patel L, Jesani S. A Rare Case of Elevated Osmolar Gap in Diabetic Ketoacidosis/Hyperosmolar Hyperglycaemic State in the Absence of Concomitant Toxic Alcohol Ingestion. Eur J Case Rep Intern Med 2022; 9:003248. [PMID: 35402334 PMCID: PMC8988505 DOI: 10.12890/2022_003248] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 11/05/2022] Open
Abstract
The serum osmolar gap, defined as the difference between measured osmolality and calculated osmolarity, is a convenient method to screen for toxins in serum. In normal circumstances, the difference between the two is 6–10 mol/kg. Typical contributors to serum osmolarity are sodium bicarbonate, sodium chloride, glucose and urea. An elevated gap, defined as a difference >10 mol/kg, can occur if a sufficient quantity of an additional solute other than those mentioned above is present in the serum or there are inaccuracies in sodium measurement secondary to hyperlipidaemia and hyperproteinaemia. An elevated serum osmolar gap should thus prompt clinicians to check for toxic alcohol levels. Treatment with fomepizole should not be delayed if suspicion is high. Isolated diabetic ketoacidosis can occasionally present with an elevated osmolar gap in the absence of concomitant alcohol ingestion. This finding is attributed to the production of acetone and glycerol. We describe the case of a 62-year-old man presenting with diabetic ketoacidosis/hyperosmolar hyperglycaemic state and an elevated osmolar gap in the absence of toxic alcohol ingestion.
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Affiliation(s)
- Hardik Fichadiya
- Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | | | - Harshwardhan Khandait
- Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Latika Patel
- Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Shruti Jesani
- Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
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Noori MAM, Younes I, Latif A, Fichadiya H, Elkattawy S, Khandait H, Nawachukwu O, Garg V. Reactivation of Tuberculosis in the Setting of COVID-19 Infection. Cureus 2022; 14:e23417. [PMID: 35481299 PMCID: PMC9033637 DOI: 10.7759/cureus.23417] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) was declared a pandemic by WHO in March 2020. The causative organism has since undergone a series of mutations. COVID-19 primarily being a respiratory illness causes pre-existing pulmonary diseases to show worse clinical outcomes. About one-third of the world’s population is thought to be infected with latent Mycobacterium tuberculosis (MTB). Both previous and newly developed tuberculosis (TB) infection are risk factors for COVID-19 and are associated with poor outcomes. T lymphocytes play a pivotal role in defense against MTB and with evidence suggesting depletion of T lymphocytes in COVID-19, it can be postulated that COVID-19 can increase the risk of reactivation of latent TB. Given that a large population around the globe is infected with latent tuberculosis, it is interesting to study and note cases where the virus leads to the reactivation of latent tuberculosis infection. Herein, we present a 76-year-old Brazilian male recently treated for COVID-19 pneumonia, presenting with new-onset cough and weakness diagnosed with latent MTB reactivation.
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Fichadiya H, Noori MAM, Patel BD, Bhavsar M, Visveswaran GK, Sommer RJ, Joshi M. A RARE CASE OF MULTIPLE PULMONARY VEIN STENOSIS ASSOCIATED WITH DERMATOMYOSITIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04188-2] [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: 11/29/2022]
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Noori MAM, Shah K, Fichadiya H, Adeosun M, Jesani S, Edmund Appiah-Kubi EAK, Saeed H, Sherif Elkattawy SE, Joshi M. Painless Presentation of a Deadly Disease: Type A Aortic Dissection Requiring the Bentall Procedure. Eur J Case Rep Intern Med 2022; 9:003197. [PMID: 35402333 PMCID: PMC8988510 DOI: 10.12890/2022_003197] [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: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 12/02/2022] Open
Abstract
Aortic dissection is a relatively uncommon, although catastrophic, disease which requires early and accurate diagnosis and treatment for patient survival. Aortic dissection can be difficult to diagnose due to the diverse symptom presentation, which can lead to later diagnosis, resulting in a higher mortality rate. Here we present a case of type A aortic dissection with a varied symptom presentation, highlighting the importance of early detection and the Bentall procedure for management of such cases. A 50-year-old man with no known medical history presented with bilateral lower extremity swelling and fatigue for 2 weeks. The patient denied any chest pain or dyspnoea. Vital signs showed blood pressure of 160/76 mmHg, pulse of 103 bpm, respiratory rate of 18, and temperature of 36.7°C. Laboratory findings indicated a BNP of 1901 pg/ml and troponin of 0.5 ng/ml. An initial diagnosis of decompensated heart failure was made, and IV Lasix was started. Subsequently, an echocardiogram indicated an EF of 50–55% and ascending dissection of the aorta. A CT angiogram of the chest and abdomen confirmed this diagnosis. This patient presented with unusual symptoms of aortic dissection without the typical presentation of chest pain. It is important to consider aortic dissection in a cardiac-related case as prompt imaging can help confirm the diagnosis. We explore the risks and benefits of the Bentall procedure for the management and early detection of aortic dissection.
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Affiliation(s)
| | - Kalpesh Shah
- Department of Cardiology, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Hardik Fichadiya
- Department of Medicine, Rutgers Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | | | - Shruti Jesani
- Department of Medicine, Rutgers Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | | | - Hasham Saeed
- Department of Medicine, Rutgers Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | | | - Meherwan Joshi
- Department of Medicine, Rutgers Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA
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Shah K, Noori MAM, Fichadiya H, Patel BD, Guragai N, Shah D, Joshi M, Shamoon FE. INCIDENTALLY DIAGNOISED LARGE RIGHT VENTRICULAR PSEUDOANEURYSM IN PATIENT WITH REMOTE HISTORY OF TRAUMA. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03677-4] [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: 11/27/2022]
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Atif Masood Noori M, Rushdy A, Fichadiya H, Sherif R, Younes I, Lenchur PD, Lenchur PM, Shamoon F. Stemi mimicking post COVID: a case of focal myopericarditis post COVID infection. J Community Hosp Intern Med Perspect 2021; 11:769-771. [PMID: 34804387 PMCID: PMC8604530 DOI: 10.1080/20009666.2021.1980964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Since the beginning of the coronavirus disease 2019 (COVID19) pandemic, several cases of myocarditis related to COVID-19 infection have been reported. These cases range from asymptomatic disease to fulminant heart failure or sudden cardiac death. Cardiac injury has also been found in asymptomatic patients and patients who recovered from the disease. Data regarding cardiovascular involvement due to COVID-19 infection are still limited, and the actual prevalence of myocarditis due to COVID-19 infection is still unknown. We present a case of focal myopericarditis in a patient recently recovered from COVID-19 pneumonia with electrocardiogram showing ST elevation in inferior and lateral leads. This case highlights the need for studying the long-term cardiovascular complications of COVID-19 and reinforces the use of cardiac magnetic resonance (CMR) and cardiac biomarkers in the diagnosis of COVID-19-related myocarditis.
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Affiliation(s)
| | - Abanoub Rushdy
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Hardik Fichadiya
- Department of Medicine, Rutgers New Jersey Medical School, Elizabeth, NJ, USA
| | - Roman Sherif
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Islam Younes
- Department of Medicine, Rutgers New Jersey Medical School, Elizabeth, NJ, USA
| | - Peter D Lenchur
- Department of Medicine, New York Medical College, Valhalla, NY, USA
| | - Peter M Lenchur
- Department of Cardiology, Robert Wood Johnson University Hospital, Rahway, NJ, USA
| | - Fayaz Shamoon
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
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Bendaram S, Elkattawy S, Atif Masood Noori M, Fichadiya H, Ayad S, Kaur P, Pullatt R, Shamoon F. Management of Wolff-Parkinson-White syndrome in a patient with peripartum cardiomyopathy. J Community Hosp Intern Med Perspect 2021; 11:839-842. [PMID: 34804402 PMCID: PMC8604443 DOI: 10.1080/20009666.2021.1978155] [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] [Received: 07/11/2021] [Accepted: 09/03/2021] [Indexed: 12/03/2022] Open
Abstract
Wolf-Parkinson-White (WPW) syndrome is a congenital heart condition in which the atrioventricular (AV) node is bypassed by an accessory pathway that connects the atria and ventricle directly along with symptoms of syncope or palpitations. WPW syndrome in patients with a history of peripartum cardiomyopathy (pregnancy-related cardiomyopathy) is associated with a high risk of morbidity and mortality secondary to failure of the pump and the conduction system of the heart. Management of these cases deals with arrhythmia and systolic heart failure, which becomes more challenging in pregnant patients as it requires treatment methods that minimize risks to the fetus. We report a case of a young female patient with WPW syndrome and peripartum cardiomyopathy presenting with symptomatic arrhythmias (tachycardia).
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Ayad S, Alyacoub R, Gergis K, Noori MAM, Elkattawy S, Abdelazeem B, Pullatt R. Fever and Hyponatremia Unmasking Brugada Pattern Electrocardiogram in a Patient With SARS-CoV-2 Infection. Cureus 2021; 13:e18578. [PMID: 34760421 PMCID: PMC8572016 DOI: 10.7759/cureus.18578] [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: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
Brugada syndrome is an autosomal dominant genetic disorder that primarily affects myocardial sodium channels and has been associated with an increased risk of ventricular tachyarrhythmias and sudden cardiac death. Here, we report a case of a 58-year-old Hispanic male with a history significant for prior pulmonary tuberculosis infection who presented with pleuritic left-sided chest pain associated with body aches, productive cough, fevers, and chills and was found to be positive for SARS-CoV-2 by real-time reverse-transcription-polymerase chain reaction (rRT-PCR). Electrocardiogram (ECG, EKG) on presentation demonstrated a coved ST-segment elevation in V1-V2, suggesting Brugada pattern type 1 without evidence of ischemic changes. EKG changes normalized once fever and hyponatremia improved.
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Affiliation(s)
- Sarah Ayad
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Ramez Alyacoub
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | | | - Muhammad Atif Masood Noori
- Internal Medicine, Dow Medical College, Karachi, PAK.,Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Sherif Elkattawy
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, USA
| | - Basel Abdelazeem
- Internal Medicine, McLaren Health Care, Michigan State University, Flint, USA
| | - Raja Pullatt
- Cardiology, Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
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Saeed H, Jawed Q, Noori MAM, Bin Waqar SH, Rehan A. An Unusual Case of Isolated Acute Aphasia in Multiple Sclerosis. Cureus 2021; 13:e18278. [PMID: 34722056 PMCID: PMC8545555 DOI: 10.7759/cureus.18278] [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: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
Acute flare of multiple sclerosis usually presents with sensorimotor deficits in limbs or one side of the face, optic neuritis, internuclear ophthalmoplegia, and/or cerebellar signs and symptoms. Isolated aphasia is observed only in a handful of cases. Herein, we present a case of a patient who presented with isolated transcortical motor aphasia. Initial thought was that the patient was having a cerebrovascular accident as he had a history of uncontrolled hypertension. It was only later found on magnetic resonance imaging (MRI) of the brain that the patient had demyelinating lesions compatible with his new symptoms. He exhibited an excellent response to intravenous methylprednisolone therapy and was discharged with outpatient evaluation for immunotherapy.
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Affiliation(s)
- Hasham Saeed
- Internal Medicine, Rutgers Health/Trinitas Regional Medical Center, Elizabeth, USA
| | - Qirat Jawed
- Internal Medicine, Rutgers Health/Trinitas Regional Medical Center, Elizabeth, USA
| | | | - Syed Hamza Bin Waqar
- Internal Medicine, NYC Health + Hospitals/Kings County, New York, USA.,Internal Medicine, Veterans Affairs Harbor Health Care, New York, USA.,Internal Medicine, State University of New York Downstate Health Sciences Center, New York, USA
| | - Aiman Rehan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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18
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Masood Noori MA, Saeed H, Rushdy A, Elkattawy S, Jawed Q, Guragai N, Shamoon F. Heart broken. An unusual case of biventricular takotsubo cardiomyopathy complicated by STEMI and Left ventricular thrombi. A case report. J Community Hosp Intern Med Perspect 2021; 11:703-707. [PMID: 34567469 PMCID: PMC8462894 DOI: 10.1080/20009666.2021.1942671] [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: 11/05/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a rare occurrence in patients with troponin-positive acute coronary syndrome (ACS). It usually manifests as transient apical ballooning of the left ventricle with concomitant occurrence of right ventricular involvement in only one-third of cases. Biventricular TCM is associated with more hemodynamic instability as compared to left sided alone. Depressed ventricular systolic function and localized ventricular dyskinesis can facilitate clot formation in ventricular cavity. We present a case of 80-year-old man who presented to the ED for evaluation of hypotension. An electrocardiogram suggested acute anterior wall myocardial infarction. He underwent emergent coronary angiography and was found to have mid to apical akinesis and basal hyperkinesis with normal left coronaries and chronic total right coronary artery occlusion with excellent collaterals from left. A transthoracic echocardiography (TTE) revealed left ventricular ejection fraction 25–30% and akinesis of left and right ventricle except in the basal region. TTE with definity showed sessile thrombus. In our patient, sepsis was the most important triggering factor given initial presentation of hypotension with leukocytosis. Broad spectrum antibiotics including vancomycin and Zosyn were started considering a combination of septic and cardiogenic shock. Repeat EKG showed resolution of ST-T segment elevation but our patient remained hemodynamically unstable even with two pressure support and, ultimately, died 72 hours after admission. Herein, we emphasize on the importance right ventricular involvement and its relation to hemodynamic instability. This case highlights the importance of anticipating hemodynamic instability and clot formation in patients with biventricular Takotsubo cardiomyopathy.
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Affiliation(s)
| | - Hasham Saeed
- Department of Medicine, Rutgers New Jersey Medical School, Elizabeth, NJ, USA
| | - Abanoub Rushdy
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Sherif Elkattawy
- Department of Medicine, Rutgers New Jersey Medical School, Elizabeth, NJ, USA
| | - Qirat Jawed
- Department of Medicine, Rutgers New Jersey Medical School, Elizabeth, NJ, USA
| | - Nirmal Guragai
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Fayez Shamoon
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
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19
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Elkattawy S, Mohammadian M, Williams N, Mowafy A, Ayad S, Noori MAM, Younes I, Singh KS, Millman A. Serratia marcescens Endocarditis. Cureus 2021; 13:e17346. [PMID: 34567887 PMCID: PMC8451257 DOI: 10.7759/cureus.17346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/12/2022] Open
Abstract
Infective endocarditis (IE) secondary to Staphylococcus aureus and streptococcus species comprises the majority of cases in literature with Gram negative bacterial insults occurring infrequently. Serratia marcescens is a Gram negative bacillus which is classified as motile, non-lactose fermenting, and a facultative anerobe. The presumed risk factor for the development of S. marcescens IE is intravenous drug use (IVDU). We report two cases of IE causes by S. marcescens: first case describes IE of tricuspid and aortic valve requiring surgical intervention further complicated by epidural abscess. The second case was associated with renal and splenic infarct. These cases highlight the severity and complicated nature of S. marcescens IE. Given S. marcescens IE has been infrequently described in the literature, we believe that our cases are worth reporting to contribute to the present incidence and management of S. marcescens IE.
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Affiliation(s)
- Sherif Elkattawy
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Mahsa Mohammadian
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Neil Williams
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, USA
| | - Ahmed Mowafy
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Sarah Ayad
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | | | - Islam Younes
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Kerry S Singh
- Internal Medicine, St. George's University, St. George, GRD
| | - Arthur Millman
- Cardiology, Trinitas Regional Medical Center, Elizabeth, USA
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20
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Jesani S, Elkattawy S, Noori MAM, Ayad S, Abuaita S, Gergis K, Elkattawy O, Garg V. Vasopressor-Induced Digital Ischemia. Cureus 2021; 13:e16595. [PMID: 34466309 PMCID: PMC8396423 DOI: 10.7759/cureus.16595] [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: 07/23/2021] [Indexed: 11/05/2022] Open
Abstract
In patients who are critically ill and in circulatory shock, substantial dosages of vasopressors including norepinephrine and Neosynephrine are often required to sustain blood pressure. While these medications are necessary and can be lifesaving, they are often associated with several complications related to severe vasoconstrictions. One of these known but underreported side effects is digital ischemia (DI). DI refers to a decrease in digital perfusion. It is a rare and uncommon phenomenon that can lead to significant consequences and unfortunately can result in amputation of the digits. Herein, we report an unfortunate female with septic shock secondary to acute bowel ischemia who developed bilateral digital necrosis while on norepinephrine.
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Affiliation(s)
- Shruti Jesani
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Sherif Elkattawy
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | | | - Sarah Ayad
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Suha Abuaita
- Internal Medicine, St. George's University, True Blue, GRD
| | | | - Omar Elkattawy
- Internal Medicine, Rutgers New Jersey Medical Center, Newark, USA
| | - Vipin Garg
- Internal Medicine, Pulmonology, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
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21
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Guragai N, Vasudev R, Hosein K, Habib H, Patel B, Kaur P, Patel B, Santana M, Elkattawy S, Noori MAM, Younes I, Alyacoub R, Singh B, Pullatt R, Randhawa P, Shamoon F. Does Baseline Diuretics Use Affect Prognosis in Patients With COVID-19? Cureus 2021; 13:e15573. [PMID: 34277195 PMCID: PMC8272599 DOI: 10.7759/cureus.15573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 01/08/2023] Open
Abstract
The rapid emergence of coronavirus disease 2019 (COVID-19) has become the biggest healthcare crisis of the last century, resulting in thousands of deaths worldwide. There have been studies that evaluated the role of angiotensin-converting enzyme (ACE) inhibitors (ACEi) and angiotensin receptor blockers (ARBs) in treating patients with COVID-19. However, the prior use of diuretics and their effect on mortality in this setting remains unknown. The aim of the study was to evaluate the effect of diuretics in patients admitted with COVID-19. The current study was conducted between March 15, 2020, and April 30, 2020, during the COVID-19 pandemic in three different hospitals in Northern New Jersey, USA. The primary outcome was survival or in-hospital mortality from COVID-19 from the day of admission. The secondary outcome was severe or non-severe illness from COVID-19. This retrospective study included a total of 313 patients with a median age of 61.3 ± 14.6 years. There was a total of 68 patients taking diuretics at home and 245 patients who were not taking diuretics. There was a total of 39 (57.35%) deaths in patients taking diuretics as compared to 93 (37.96%) deaths in patients not taking diuretics (p-value 0.0042). Also, 54 (79.41%) patients who took diuretics had severe COVID-19 illness as compared to 116 (47.35%) who did not take diuretics (p-value <.0001). However, after adjusting for the confounding factors, there was no difference in mortality or severity of illness in COVID-19 patients taking diuretics at the time of admission. In conclusion, there was no effect of the baseline use of diuretics in the prognosis of COVID-19.
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Affiliation(s)
- Nirmal Guragai
- Cardiology, St Joseph University Medical Center, Paterson, USA
| | - Rahul Vasudev
- Cardiology, St Joseph University Medical Center, Paterson, USA
| | - Kevin Hosein
- Cardiology, St Joseph University Medical Center, Paterson, USA
| | - Habib Habib
- Cardiology, St Joseph University Medical Center, Paterson, USA
| | - Biren Patel
- Cardiology, St Joseph University Medical Center, Paterson, USA
| | - Parminder Kaur
- Cardiology, St Joseph University Medical Center, Paterson, USA
| | - Bhavik Patel
- Internal Medicine, St Michael's Medical Center, Newark, USA
| | - Melvin Santana
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Sherif Elkattawy
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical, Elizabeth, USA
| | - Muhammad Atif Masood Noori
- Internal Medicine, Dow Medical College, Karachi, PAK.,Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Islam Younes
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Ramez Alyacoub
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Balraj Singh
- Hematology/Oncology, St Joseph's University Medical Center, Paterson, USA
| | - Raja Pullatt
- Cardiology, Trinitas Regional Medical Center, Elizabeth, USA
| | | | - Fayez Shamoon
- Cardiology, St Joseph University Medical Center, Paterson, USA
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22
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Noori MAM, Rushdy A, Shah KK, Shamoon F, Naser M. Acute-Hypoxemia-Induced Right-To-Left Shunting in the Presence of Patent Foramen Ovale. Cureus 2021; 13:e16138. [PMID: 34262827 PMCID: PMC8260202 DOI: 10.7759/cureus.16138] [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: 07/02/2021] [Indexed: 12/01/2022] Open
Abstract
Patent foramen ovale (PFO) is a common congenital abnormality of the heart. It results from incomplete closure of foramen ovale that persists in adulthood. Most individuals with PFO are asymptomatic and are discovered incidentally. The left atrial pressure is generally higher than the right atrial pressure, which prevents blood flow against the gradient; however, any medical condition that increases the pulmonary artery pressure can lead to reversal of blood flow from right to left by elevating right atrial pressure. We present a case of a 59-year-old female who presented with complaints of shortness of breath associated with bilateral lower-extremity edema and was found to have acute decompensated heart failure and atrial fibrillation. Transesophageal echocardiogram (TEE) with cardioversion was performed. Propofol was given for conscious sedation; however, the procedure was terminated as patient became hypoxemic and was noted to have moderately dilated right ventricle (RV) with hypokinesia and PFO with right-to-left shunting. It also demonstrated mild mitral regurgitation, mild left ventricular hypertrophy, and a left ventricular ejection fraction of 55-60%. In contrast to TEE findings, while the patient was having normal oxygen saturation, transthoracic echocardiogram showed left-to-right shunting instead of right-to-left and no RV hypokinesia was noted. In conclusion, this case draws attention to the relationship between acute hypoxemia and right-to-left shunting in a patient with PFO. This case illustrates and highlights the need for more prospective studies to establish a relationship between acute hypoxemia and right-to-left shunting in the presence of PFO.
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Affiliation(s)
| | - Abanoub Rushdy
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Kalpesh K Shah
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Fayez Shamoon
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Mohammad Naser
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
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23
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Patel BD, Rushdy A, Patel B, Noori MAM, Joshi M, Shamoon F, Randhawa PM. RARE CASE OF CONSTRICTIVE PERICARDITIS DUE TO METASTATIC PERICARDIAL MALIGNANCY WITHOUT RECURRENCE TO PRIMARY MALIGNANT SITE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03652-4] [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: 11/29/2022]
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24
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Abstract
Naloxone-induced noncardiogenic pulmonary edema is a rare but reported entity that can occur following naloxone use in the reversal of opioid overdose. Proposed mechanisms include an adrenergic crisis secondary to catecholamine surge which causes more volume shift to pulmonary vasculature, subsequently leading to pulmonary edema. It appears to be more common when higher doses of naloxone are used. We present a case of a patient with opioid overdose came with altered mental status developed early features of pulmonary edema following the administration of multiple doses of naloxone. She responded well with the administration of diuretics and oxygen supplementation. Her oxygen requirements improved and didn’t require mechanical ventilation.
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Affiliation(s)
- Sherif Elkattawy
- Department of Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center Program, Elizabeth, NJ, USA
| | - Ramez Alyacoub
- Department of Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center Program, Elizabeth, NJ, USA
| | - Chidinma Ejikeme
- Department of Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center Program, Elizabeth, NJ, USA
| | - Muhammad Atif Masood Noori
- Department of Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center Program, Elizabeth, NJ, USA
| | - Carlos Remolina
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Trinitas Regional Medical Center, Elizabeth, NJ, USA
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25
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Noori MAM, Elkattawy S, Younes I, Alyacoub R, Desai D. An Atypical Presentation of Heroin Inhalation Induced Leukoencephalopathy (Chasing the Dragon). Cureus 2020; 12:e11215. [PMID: 33269145 PMCID: PMC7706144 DOI: 10.7759/cureus.11215] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Heroin leukoencephalopathy is associated with 'Chasing the dragon,' which is a heroin vapour inhalation method that is different from smoking or sniffing heroin. The clinical presentation ranges from mild to severe disease. Mild disease is characterized by inattentiveness and ataxia. In moderate diseases, extrapyramidal symptoms predominate, and finally, severe disease is characterized by generalized motor impairment, with death occurring in two-third of cases. We now report a rare presentation of the disease in a 60-year-old female with a past medical history of heroin abuse who presented to ED with signs and symptoms of confusion and restlessness. MRI brain without contrast showed diffuse symmetric increased intensity signals throughout the white matter. Electroencephalogram (EEG) revealed mild diffuse slowing with no lateralization. The patient was started on Vitamin E and was transferred to a rehab facility with following up neurology as an outpatient.
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26
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Abstract
Ventricular septal defect (VSD) is a rare but lethal complication of myocardial infarction. We present a case of a 65-year-old male who presented with a history of progressive shortness of breath associated with productive cough. Physical examination was significant for crepitation in both lower lung fields and bilateral lower extremity edema. Chest X-ray revealed bilateral reticular opacities with small bilateral pleural effusions. Polymerase chain reaction (PCR) for COVID was positive. Echo showed a left ventricular ejection fraction (LVEF) of 30-35%, ischemic cardiomyopathy, and muscular ventricular septal defects with left to right shunting and severely elevated pulmonary artery systolic pressure. Overtime during the hospital course, he developed respiratory and fulminant hepatic failure. Our patient had VSD due to an undiagnosed old myocardial infarction (MI). Initially heart failure was compensated and treated with medical management. Later on, he developed respiratory complications related to COVID-19 infection as well as hepatic failure in addition to a cardiomyopathy which made him a poor surgical candidate leading to death.
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Affiliation(s)
- Sherif Elkattawy
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Ramez Alyacoub
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | | | - Afrah Talpur
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Karim Khimani
- Internal Medicine, Rutger New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
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27
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Elkattawy S, Noori MAM, Sah A, Hasan Kazmi SM, Desai D. Lambl's Excrescences Associated With Left Frontal Ischemic Stroke: A Case Report. Cureus 2020; 12:e9371. [PMID: 32850239 PMCID: PMC7444991 DOI: 10.7759/cureus.9371] [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] [Received: 07/02/2020] [Accepted: 07/24/2020] [Indexed: 12/04/2022] Open
Abstract
Lambl's excrescences (LEs) are thin filiform strands of connective tissue found on the closure line of valves. Their exact etiology is unknown, and most of them are typically asymptomatic. We present a case of a 33-year-old African American male with a history of right upper extremity weakness that resolved on its own within a few minutes. On physical examination, no focal neurologic deficit was observed. MRI brain showed a tiny curvilinear focus of restricted diffusion with subtle T2-FLAIR hyperintensity in the left frontal/insular region, indicating a recent cortical infarct. Transesophageal echocardiogram (TEE) was performed as a part of cryptogenic stroke workup, which showed LE on aortic valve leaflet tips. Our patient had elevated blood pressure (BP) on arrival; however, in LE's presence, the embolic phenomena of stroke cannot be excluded. In conclusion, this case adds to a limited number of cases with such cardioembolic phenomena, which will help in further illustrating and highlighting the need for more prospective studies to establish a causal relationship between LE and cardioembolic strokes.
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Affiliation(s)
- Sherif Elkattawy
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Muhammad Atif Masood Noori
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
- Internal Medicine, Dow Medical College, Karachi, PAK
| | - Anuraag Sah
- Internal Medicine, Rutgers New Jersey Medical Center/Trinitas Regional Medical Center, Elizabeth, USA
| | | | - Dhaval Desai
- Cardiovascular Disease, Jersey Shore University Medical Center, Neptune, USA
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, USA
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28
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Elkattawy S, Younes I, Noori MAM. A Case Report of Polymerase Chain Reaction-Confirmed COVID-19 in a Patient With Right Ventricular Thrombus and Bilateral Deep Vein Thrombosis. Cureus 2020; 12:e8633. [PMID: 32685302 PMCID: PMC7364394 DOI: 10.7759/cureus.8633] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/15/2020] [Indexed: 11/05/2022] Open
Abstract
The new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that causes the highly contagious coronavirus disease 2019 (COVID-19) has led to an unprecedented global health crisis. Infected patients have been shown to trigger a heightened inflammatory response, increasing thrombotic risk. We report the case of a polymerase chain reaction (PCR)-confirmed COVID-19 in a Hispanic male with no past medical history who presented to the ED with upper respiratory tract symptoms including shortness of breath and cough, requiring continuous positive airway pressure (CPAP) therapy. He was found to have a right ventricular thrombus (RVT) and bilateral deep vein thrombosis (DVT) on the day of admission, which were detected on transthoracic echocardiogram and duplex venous ultrasound, respectively. The patient was started on therapeutic enoxaparin sodium, which led to an improvement in oxygenation, and he was eventually downgraded to the medical floors for further management.
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Affiliation(s)
- Sherif Elkattawy
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Islam Younes
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Muhammad Atif Masood Noori
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
- Internal Medicine, Dow Medical College, Karachi, PAK
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29
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Abstract
We report a case of partial mole and co-existing live fetus. This condition, uncommonly termed “sad fetus syndrome,” is a rare subclass of gestational trophoblastic disease. Our case involves a 25-year-old primigravid woman who presented to the outpatient department at 18 weeks of gestation with lower abdominal pain, vaginal spotting, and severe nausea. Ultrasound revealed a “grape bunch” appearance and a live, coexisting fetus. The patient underwent spontaneous abortion around the twentieth week of gestation. A postoperative ultrasound revealed an empty uterine cavity. She was discharged a few days afterward but was advised to follow up with serial repeat measurements of her beta-human chorionic gonadotropin levels.
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Affiliation(s)
| | - Ali Akhtar
- Internal Medicine, Combined Military Hospital, Islamabad, PAK
| | - Zia Ud Deen
- Internal Medicine, Dow University of Health Sciences, New York, USA
| | - Maham Khan
- Radiology, Armed Forces Institute of Radiology and Imaging, Rawalpindi, PAK
| | - Somia Jamal
- Internal Medicine, Abbasi shaheed hospital, Karachi, PAK
| | - Sana Sohail
- Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar, PAK
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