Aiman Hamdan

Acute ST-segment elevation myocardial infarction in young adults: who is at risk?

ObjectiveLess than 10% of patients presenting with acute myocardial infarction (AMI) are young adults. The primary objective of this study was to provide an overview of similarities and dissimilarities among younger and older patients presenting with AMI with the expectation of using the information as an aid in primary and secondary preventions in the future. MethodsFrom the database of 3527 patients with AMI admitted from January 2001 to December 2008, young adults aged 21–40 years (n=43) who were diagnosed with ST-segment elevation myocardial infarction were identified. They were then compared with their older counterparts who were admitted from January 2007 to December 2008 subdivided into age groups of 41–60 (n=86) and 61–80 years (n=51). Data on clinical cardiovascular risk factors, demographic features, and angiographic findings were gathered and analyzed. ResultsOnly 2.58% of ST-segment elevation myocardial infarction patients who were admitted to our hospital over an 8-year period were less than 40 years. Young adults were found to be predominantly male patients (P=0.04) and had positive family history for coronary artery disease (P=0.0005). Diabetes and hypertension were less prevalent in the younger group (P=0.048 and 0.078). Analysis of lipid profile showed comparatively higher total cholesterol, low-density lipoprotein and high-density lipoprotein values in the younger group (⩽P=0.004). Angiographically, youngsters had propensity toward single-vessel involvement (P=0.0001). ConclusionThe risk factor profile and the angiographic involvement differ considerably in the high-risk younger adults and substantiate the need for an aggressive approach directed toward primary and secondary preventions of premature cardiovascular disease.

Percutaneous Coronary Interventions in Nonagenarians: In‐Hospital Mortality and Outcome at One Year Follow‐up

Limited information is available regarding outcome of very elderly patients referred for percutaneous coronary intervention (PCI).

Acute Myocardial Infarction Caused by Infective Endocarditis

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 65-year old man with a history of intravenous drug use and bioprosthetic aortic valve replacement 1 year ago because of infective endocarditis presented to our emergency department with new-onset chest

The Prevalence of Peripheral Arterial Disease in HIV Patients

Background: The actual prevalence of Peripheral Arterial Disease (PAD) in Human Immunodeficiency Virus (HIV) infected patients is still unknown. Aim: The aim of our study was to assess the prevalence of PAD using Ankle Brachial Index (ABI) (both rest and exercise) measurement in HIV infected patients with head-to-head comparison with the sex-matched non-HIV controls. Methods: We randomly enrolled total of 214 patients (70 HIV patients and 144 non-HIV controls), from March 2009 to December 2009. The Edinburg Claudication Questionnaire and ABI were used as study tools. Normal ABI was defined as 0.9 to 1.3. Data was analyzed using the Fischer’s Exact Test. Various cardiovascular and infectious risk factors for PAD were also analyzed. Results: Claudication was reported using Edinburgh questionnaire in 28.5% HIV patients as compared to 12.5 % patients in non-HIV group (p value 0.0069). Abnormal ABI suggestive of PAD i.e. ABI 15% absolute drop on exercise was reported in 10% HIV patients as compared to 1.3% in non-HIV group (p value 0.006). Based on multivariate analysis, age, Caucasian race, hypertension, diabetes mellitus, hyperlipidemia, metabolic syndrome and low CD4 count were found to be independent predictors of PAD. Conclusions: The prevalence of PAD is higher in HIV patients as compared to sex-matched non-HIV controls. Hence, HIV patients should be routinely screened for PAD using rest and exercise ABI. Apart from correlation with cardiovascular risk factors, strong association between lower CD4 cell count and abnormal ABI exists. This warrants more aggressive approach in managing cardiovascular and infectious markers in HIV patients with abnormal ABI.

Importance of performing transesophageal echocardiography in acute stroke patients older than fifty.

Background: The purpose of this study was to determine the value of transesophageal echocardiography (TEE) in determining the presence of cardiac manifestations that required anticoagulation in patients presenting with acute stroke. Methods: Of 626 consecutive stroke patients who underwent TEE, 188 patients with no obvious etiology for stroke were subcategorized according to age. TEE results were analyzed for cardiac findings suggestive of a cause for embolic stroke, including complex atheromas in the arch/ascending aorta, patent foramen ovale (PFO), atrial septal aneurysm (ASA), and intracavitary thrombi. Data were analyzed using Fishers exact test. Results: Of 188 patients, 66% (125/188) were older than 50 years and 34% (63/188) were younger than 50 years. The incidence of complex atheroma was 12.8% (16/125) in patients older than 50 years as compared to 0% (0/63) in patients who were younger than 50 years (P = 0.002). In patients older than 50 years, findings that indicated a need for anticoagulation based on TEE results were found in 22.4% (28/125) (atheroma = 16, PFO = 12, ASA = 5, thrombus = 3, PFO + ASA = 1) compared to 14.3% (9/63) (atheroma = 0, PFO = 5, ASA = 2, thrombus = 2, PFO + ASA = 1) in patients younger than 50 years. Conclusions: TEE plays an important role in suspected embolic stroke patients of all age groups. Due to the higher incidence of complex atheromas in patients older than 50 years of age, TEE might be of added importance in identifying the candidates who may benefit from anticoagulation. (Echocardiography 2010;27:1086‐1092)

Platelet reactivity unit in predicting risk of bleeding in patients undergoing coronary artery bypass graft surgery

Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of the total transfusions performed in the United States and Europe. The relationship between platelet reactivity, bleeding, and other adverse events after coronary artery bypass graft surgery (CABGS) has been incompletely characterized. This study investigated the relationship between platelet reactivity and bleeding as a clinical outcome after successful CABGS. A total of 238 patients who underwent CABGS were retrospectively followed for postoperative bleeding. Platelet reactivity unit (PRU) values for all patients were obtained preoperatively to assess the platelet reactivity. The data showed that a range of 180–200 PRU suggests the likelihood of bleeding after CABGS (P = 0.004), with a statistically significant association only for dual antiplatelet therapy with aspirin and clopidogrel. In conclusion, by using PRU values as a method to assess platelet reactivity and antiplatelet responsiveness, our findings suggest that it may be possible to stratify patients undergoing CABGS for the risk of postoperative bleeding particularly patients on dual antiplatelet therapy.

Cardiac Sequelae of Human Immunodeficiency Virus Disease

Abstract:Presently, patients with human immunodeficiency virus infection are living longer and are frequently encountered in medical practice. HIV infection is a systemic disease, which affects a wide spectrum of organs. Cardiac involvement is frequent, and the consequent clinical manifestations are a common reason to seek medical advice. In this review, we discuss the different cardiac sequelae of HIV infection.

Right Atrial Fibroelastoma Presenting as Typical Atrial Flutter: Rare Disease in Unusual Location

Typical atrial flutter as initial presentation of papillary fibroelastoma involving the cavotricuspid isthmus is not described before in literature. To our knowledge only 14 cases have been reported in literature involving the right atrium. Very unusual location is at the junction between inferior vena cava (IVC) and right atria as only 1 case has been reported.

Giant right coronary aneurysm and syncope.

Rupen Parikh, M.D,Hartaj Virk, M.D,Aiman Hamdan,M.D,FACC,FayezE. Shamoon, M.D, FACC, Eric Bronstein, M.D, Mahesh BikkinaM.D, MPH, FACC, FSCAI. Division of Cardiology (Parikh, Virk, Hamdan, Shamoon, Bikkina) & Dept of Cardio Thorasic Surgery(Bronstein), St. Joseph’s Regional Medical Center, Paterson, NJ Address for correspondence: Mahesh Bikkina, M.D, MPH Div. of Cardiology, 1st Floor St. Joseph’s Regional Medical Center 703Main St Paterson, NJ 07503 Phone: 973-754-2300Fax: 973-754-2325 maheshbikkina@yahoo.com