Fayez Siddiqui

Long (>12 Months) and Short (<6 Months) Versus Standard Duration of Dual Antiplatelet Therapy After Coronary Stenting: A Systematic Review and Meta-Analysis.

Dual antiplatelet therapy (DAPT) is recommended for 6–12 months after drug-eluting stent (DES) implantation to prevent ischemic events and late stent thrombosis. The optimal duration of DAPT has not been established. We performed a meta-analysis of the comparative effects of short and long versus standard duration DAPT duration on adverse cardiovascular and major bleeding. We conducted an EMBASE and MEDLINE search for studies in which patients were randomized to treatment with a different duration of DAPT. We included studies that provided data on DES selection, DAPT regimen and duration, and incidence of the selected endpoints at the end of the follow-up period. We identified 5 prospective randomized studies comparing short versus standard duration DAPT and 3 comparing long versus standard duration DAPT with a total of 28,343 patients. Short-term DAPT has similar incidence of stent thrombosis, MI, and death compared to standard duration DAPT, whereas major bleeding was significantly lower in short duration DAPT. Long-term DAPT was associated with lower rates of stent thrombosis and MI but significantly increased major bleeding and all-cause mortality compared to standard duration DAPT. In this meta-analysis of prospective controlled studies we found that short duration DAPT is safer and as effective as standard duration DAPT in patients with second-generation DES. Extended DAPT is associated with less ischemic events at the expense of high bleeding and mortality rates.

Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign

Central venous catheter (CVC) insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ) central venous catheter (CVC) insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE) revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization.

Myoepithelial carcinoma in the mediastinum involving the left atrium

We report a case of a 56-year-old male who presented with typical atrial flutter and was diagnosed with a large mediastinal mass, posterior to the ascending aorta, noted within the left atrium, compressing the superior vena cava and right superior pulmonary vein, and measuring >9.0 cm at its greatest diameter. Histopathological studies showed a myoepithelial carcinoma. The patient underwent tumor debulking and radiation therapy. This is the first report of a mediastinal myoepithelial carcinoma involving cardiac chambers.

Spontaneous Distal Right Coronary Artery Dissection in a Patient With Massive Pulmonary Embolism: Thrombolyze or Not?

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial ischemia, myocardial infarction, and sudden cardiac death. We report a case with SCAD of distal right coronary secondary to pulmonary thromboembolism. Reported treatment options for SCAD include medical therapy, thrombolysis, balloon angioplasty, and coronary artery bypass surgery. The decision as to which one depends on the clinical and angiographic factors. The benefit of thrombolysis in these patients is controversial. The prognosis in patients surviving the initial event is generally believed to be favorable. In patients who remain stable, conservative management seems to be safe and is compatible with a good long-term outcome.

HOSPITALIZATION BURDEN OF DIASTOLIC HEART FAILURE IN THE UNITED STATES: 2007-2012

Introduction: Diastolic heart failure is a major cause of morbidity, mortality and financial burden in the United States. However, recent nationwide trends in healthcare resource utilization and in-hospital outcomes are sparse. Methods: National Inpatient Sample database 2007-2012, from Healthcare

Esophageal Microperforation due to Calcified Mediastinal Lymph Node Leading to Tracheoesophageal Fistula

A 42-year-old male presented with worsening gastroesophageal reflux disease symptoms and cough. The clinical symptoms during the early course of illness were striking for aspiration pneumonia. He was given a prescription of proton pump inhibitors and antibiotics. Rapid decline in the clinical condition with worsening respiratory status was noted. Worsening symptoms of fever, cough, and chest pain prompted further diagnostic work-up suggesting esophageal microperforation. Esophagogram was found to be suggestive of tracheoesophageal fistula. The tracheoesophageal fistula was due to subcarinal lymph node of nontuberculous origin.

PREVENTION OF RECURRENT PERICARDITIS WITH COLCHICINE: AN UPDATED META-ANALYSIS

Colchicine has been suggested to be beneficial in preventing recurrent pericarditis. The goal of this study was to review all randomized controlled trials that assess the effects of colchicine to prevent recurrence of pericarditis or post-pericardiotomy syndrome. We performed a meta-analysis of the

Trileaflet aortic valve commissural fusion: a rare cause of aortic valve disease and systolic ejection sounds

We report two cases of patients who were referred for echocardiographic evaluation of systolic crescendo–decrescendo murmur and systolic ejection click sound over the aortic area 1 and were diagnosed with partial commissural fusion of trileaflet aortic valve by the use of 3D transesophageal echocardiogram (TEE) (Fig. 1). Both cases occurred in relatively young patients, with some degree of aortic stenosis, without evidence of bicuspid aortic valve or rheumatic valvular disease, in whom the transthoracic echocardiogram (TTE) was not diagnostic for the underlying condition. Therefore, 3D TEE examination allows accurate evaluation and prompt identification of TAVCF presenting usually as mild to moderate AS, sclerotic leaflets with systolic doming and accompanied by systolic ejection sounds (Videos 1 and 2).