Elsayed Abo-Salem

Antibiotic‐induced Cardiac Arrhythmias

This review aims to clarify the underlying risk of arrhythmia associated with the use of macrolides and fluoroquinolones antibiotics. Torsades de pointes (TdP) is a rare potential side effect of fluoroquinolones and macrolide antibiotics. However, the widespread use of these antibiotics compounds the problem. These antibiotics prolong the phase 3 of the action potential and cause early after depolarization and dispersion of repolarization that precipitate TdP. The potency of these drugs, as potassium channel blockers, is very low, and differences between them are minimal. Underlying impaired cardiac repolarization is a prerequisite for arrhythmia induction. Impaired cardiac repolarization can be congenital in the young or acquired in adults. The most important risk factors are a prolonged baseline QTc interval or a combination with class III antiarrhythmic drugs. Modifiable risk factors, including hypokalemia, hypomagnesemia, drug interactions, and bradycardia, should be corrected. In the absence of a major risk factor, the incidence of TdP is very low. The use of these drugs in the appropriate settings of infection should not be altered because of the rare risk of TdP, except among cases with high-risk factors.

Transitioning to and from the novel oral anticoagulants: a management strategy for clinicians.

Vitamin K antagonists have been the only available oral anticoagulant therapy for decades until the recent introduction of novel (new) oral anticoagulants. This breakthrough provides patients with alternative treatment choices that have predictable pharmacokinetics and do not require routine coagulation monitoring. Though more convenient from patient perspective, these drugs have distinct pharmacological properties that are particularly important to recognize when transitioning anticoagulant therapies. The following review focuses on transitioning to and from the novel oral anticoagulants, employing a practical pharmacokinetic- and pharmacodynamic-based approach.

Reversal of novel oral anticoagulants

The development of a new generation of non-vitamin K oral anticoagulants represents a potential breakthrough in the management of patients with thrombotic diseases, disorders and conditions. While a large and growing body of evidence from large-scale clinical trials and registries supports a favorable safety profile, having a means to rapidly reverse their anticoagulant effects represents an unmet need among practicing clinicians. Several targeted reversal agents are currently in development and the early results are promising. Idarucizumab is a monoclonal antibody that can immediately and specifically reverse dabigatran. Andexanet alfa is a recombinant modified factor Xa that can bind and reverse oral and parenteral factor Xa inhibitors, including rivaroxaban, apixaban and edoxaban, and low molecular weight heparin. Aripazine is a small molecule that can reverse the action of factor Xa inhibitors and possibly dabigatran as well through non-covalent binding and charge-charge interactions.

Cardiac Repolarization Abnormalities Among Patients With Various Stages of Chronic Kidney Disease

Patients with chronic kidney disease (CKD) are at increased risk of life‐threatening cardiovascular arrhythmias. Although these arrhythmias are usually secondary to structural heart diseases that are commonly associated with CKD, a significant proportion of cases with sudden cardiac death have no obvious structural heart disease. This study aims to explore the relationship of cardiac repolarization in patients with CKD and worsening kidney function.

Pulmonary Vein Stenosis After Minimally Invasive Stand‐alone Surgical Ablation of Atrial Fibrillation

We report a case of pulmonary vein stenosis following a standalone minimally invasive surgical ablation for atrial fibrillation. The etiology, diagnosis, and management of this complication are the subject of this review. doi: 10.1111/jocs.12579 (J Card Surg 2015;30:619–621)

Mediastinal thymoma diagnosed with Tc-99m tetrofosmin SPECT myocardial perfusion imaging

Nuclear myocardial perfusion imaging (MPI) is a commonly performed test for the evaluation of chest pain and preoperative risk stratification. The annual rate for MPI is 855 per 100,000 persons older than 30 years. Incidental extracardiac abnormalities are occasionally encountered during cardiac nuclear imaging (0.2%1.2%). Commonly encountered tumors are breast cancer, thymoma, and lung cancer. Other findings include goiter, diaphragmatic hernia, splenomegaly, pleural effusion, and pulmonary fibrosis. It is essential for the cardiologist to identify these pathologies with diagnostic or prognostic implications. These skills were emphasized by the Core Cardiology Training Symposium 3. Hereby, we present a case where MPI was the earliest clue for a diagnosis of myasthenia gravis.

Complex single ostium coronary artery from the right coronary sinus with unique course of anomalous left circumflex coronary artery

Single ostium coronary artery is a rare coronary artery anomaly. It is reported to occur in only 0.0448% of cases who underwent invasive coronary angiography. It can be associated with angina, arrhythmias, and possibly sudden death and is a clinically important entity to rule out in patients presenting with chest pain. We report the case of a 68-year old man who presented with worsening resting chest pain and underwent invasive coronary angiography and a single ostium coronary artery was identified. Subsequent coronary computed tomography (CT) angiography revealed it to be a unique variation of class R-III of Lipton classification of single ostium coronary artery. Lipton R-III single ostium coronary artery is rare and its incidence is reported to be 0.004% in patients who had invasive coronary angiography. In our case, anomalous left coronary circumflex artery was retroaortic course combined with intramyocardial course. It also divided into multiple obtuse marginal branches in the myocardium and never coursed along the anterior and lateral aspects of the arterioventricular groove. This variation has not been reported in the literature. Coronary CT angiography played an essential role to delineate this complex coronary anomaly. <Learning objective: Single ostium coronary artery is a rare coronary artery anomaly. However, it is a clinically important entity to rule out in the evaluation of patients with chest pain. Invasive coronary angiography can identify this anomaly; however, coronary computed tomography angiography is recommended to fully characterize this condition as demonstrated in our case. Depending on the detailed anatomical information of the anomaly, the clinical management needs to be tailored for these cases.>.

Correlation of Cardiac Sympathetic Nervous System Dysfunction with Diastolic Left Ventricular Dysfunction in Patients with Controlled Hypertension

Abstract Introduction. Sensitizer-induced occupational asthma (OA) has significant health and socioeconomic outcomes in affected subjects. Objective. To evaluate clinical and functional outcomes of sensitizer-induced OA in bakers and cotton workers three to five years after cessation of exposure to the offending workplace agent.Background: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of supraphysiologic ovarian stimulation but infrequently has been described in spontaneous pregnancy.Introduction: Sympathetic nervous system activity is increased in patients with systemic hypertension. Angiotensin converting enzyme inhibitors can effectively control hypertension without a reflex sympathetic stimulation. However, limited data are available about the role of sympathetic dysfunction in the pathophysiology of diastolic dysfunction among patients with controlled hypertension receiving angiotensin converting enzyme inhibitors.

Diagnosis of asymptomatic aortic dissection during pregnancy using contrast echocardiography

Spontaneous aortic dissection in pregnancy is rare and life-threatening for both the mother and the fetus. It is commonly associated with connective tissue disorders or aortic valvular abnormalities. We describe a case of a hypertensive pregnant woman in whom a dilated ascending aorta was identified in a routine transthoracic echocardiogram. Careful interrogation of the ascending aorta, with the use of intravenous contrast, revealed the presence of a type A aortic dissection flap. The particulars of the case are presented and the literature regarding acute aortic dissection in pregnancy is reviewed. <Learning objective: Challenges in diagnosis of aortic dissection in pregnancy.>.