Hena Patel

Plant-Based Nutrition: An Essential Component of Cardiovascular Disease Prevention and Management

Purpose of ReviewThis review aims to summarize and discuss the role of plant-based nutrition as an adjunct to the management of cardiovascular disease (CVD). Discussion of nutrition and the benefits of a plant-based diet should be highlighted during healthcare provider visits as an essential part of the overall CVD prevention and management care plan.Recent FindingsEvidence from prospective cohort studies indicates that a high consumption of predominantly plant-based foods, such as fruit and vegetables, nuts, and whole grains, is associated with a significantly lower risk of CVD. The protective effects of these foods are likely mediated through their multiple beneficial nutrients, including mono- and polyunsaturated fatty acids, omega-3 fatty acids, antioxidant vitamins, minerals, phytochemicals, fiber, and plant protein. In addition, minimizing intake of animal proteins has been shown to decrease the prevalence of CVD risk factors.SummarySubstantial evidence indicates that plant-based diets can play an important role in preventing and treating CVD and its risk factors. Such diets deserve more emphasis in dietary recommendations.

Overcoming left bundle branch block by permanent His bundle pacing: Evidence of longitudinal dissociation in the His via recordings from a permanent pacing lead

Introduction Narrowing of the QRS and overcoming left bundle branch block (LBBB) with His bundle pacing (HBP) has been previously described. We present the first 2 reported cases of left bundle branch (LBB) delay with evidence of a split His electrogram during unipolar mapping from the tip of the His bundle (HB) lead during pacemaker implantation. These findings suggest that the site of LBB delay is intraHisian, thus further validating the theory of “longitudinal dissociation in the HB.”

Sex Differences in Ischemic Heart Disease: Advances, Obstacles, and Next Steps

Evolving knowledge of sex-specific presentations, improved recognition of conventional and novel risk factors, and expanded understanding of the sex-specific pathophysiology of ischemic heart disease have resulted in improved clinical outcomes in women. Yet, ischemic heart disease continues to be the leading cause of morbidity and mortality in women in the United States. The important publication by the Institute of Medicine titled “Women’s Health Research—Progress, Pitfalls, and Promise,” highlights the persistent disparities in cardiovascular disease burden among subgroups of women, particularly women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment. These important health disparities reflect underrepresentation of women in research, with the resultant unfavorable impact on diagnosis, prevention, and treatment strategies in women at risk for cardiovascular disease. Causes of disparities are multifactorial and related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. Lack of awareness in both the public and medical community, as well as existing knowledge gap regarding sex-specific differences in presentation, risk factors, pathophysiology, and response to treatment for ischemic heart disease, further contribute to outcome disparities. There is a critical need for implementation of sex- and gender-specific strategies to improve cardiovascular outcomes. This review is tailored to meet the needs of a busy clinician and summarizes the contemporary trends, characterizes current sex-specific outcome disparities, delineates challenges, and proposes transformative solutions for improvement of the full spectrum of ischemic heart disease clinical care and research in women.

Healthy Plant-Based Diet: What Does it Really Mean?∗

SEE PAGE 411 D espite improvements in cardiovascular mortality rates over the past several decades, cardiovascular disease (CVD) remains a leading cause of death in the United States. Multiple studies have linked dietary patterns with incidence of CVD and found that groups consuming predominantly plant-based foods, versus animalbased, have lower rates of heart disease (1,2). Plantbased dietary patterns are becoming increasingly popular because of a variety of reported health benefits to overall health and cardiovascular risk and disease in particular (3,4). However, the concept of “plant-based diet” varies widely in definition, ranging from exclusion of all animal products (3) to only having “high factor loadings for vegetables, fruits, fruit juice, cereal, beans” while including “fish, poultry, and yogurt” (5). Some plant-based diets reduce or eliminate intake of highly refined plant foods such as white flours, sugars, and oils. Other publications categorize plantbased diets by actual content, (e.g., semi-vegetarian [typical American diet with smaller portions or lower frequency of animal products], pescovegetarian [seafood with or without eggs and dairy], lactoovovegetarian [eggs and dairy], and vegan [no animal products] diets). Randomized controlled trials and epidemiological studies indicate that plant-based diets, particularly vegan diets, are associated with significant improvement in CVD events, lowering risk factors such as diabetes and hypertension (1) and decreasing symptomatic and scintigraphic myocardial ischemia (6) and coronary artery disease (7); thus,

Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association

South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) make up one quarter of the worlds population and are one of the fastest-growing ethnic groups in the United States. Although native South Asians share genetic and cultural risk factors with South Asians abroad, South Asians in the United States can differ in socioeconomic status, education, healthcare behaviors, attitudes, and health insurance, which can affect their risk and the treatment and outcomes of atherosclerotic cardiovascular disease (ASCVD). South Asians have higher proportional mortality rates from ASCVD compared with other Asian groups and non-Hispanic whites, in contrast to the finding that Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) aggregated as a group are at lower risk of ASCVD, largely because of the lower risk observed in East Asian populations. Literature relevant to South Asian populations regarding demographics and risk factors, health behaviors, and interventions, including physical activity, diet, medications, and community strategies, is summarized. The evidence to date is that the biology of ASCVD is complex but is no different in South Asians than in any other racial/ethnic group. A majority of the risk in South Asians can be explained by the increased prevalence of known risk factors, especially those related to insulin resistance, and no unique risk factors in this population have been found. This scientific statement focuses on how ASCVD risk factors affect the South Asian population in order to make recommendations for clinical strategies to reduce disease and for directions for future research to reduce ASCVD in this population.

Myocardial viability–State of the art: Is it still relevant and how to best assess it with imaging?

Despite major advances, ischemic cardiomyopathy (ICM) remains a significant cause of death and disability worldwide, with coronary artery disease (CAD) the leading cause of left ventricular (LV) systolic dysfunction. Coronary revascularization may improve LV function, heart failure symptoms and cardiovascular outcomes in high-risk patients with myocardial viability. Multiple imaging modalities have been utilized to detect viable myocardium and predict functional recovery following revascularization. Dobutamine stress echocardiography (DSE), nuclear imaging and cardiac MRI (CMR) are frequently used to assess viability. This review will summarize the extant literature on this topic, describe the role and methods for viability imaging in modern clinical practice, provide a patient-centered perspective regarding the controversies surrounding the current utility of viability imaging, as well as discuss future directions.

Hypothyroid cardiomyopathy in a patient post-doxorubicin chemotherapy

Hypothyroidism may cause decreased cardiac output and heart failure—and when severe, bradycardia and pericardial effusions may develop. Chemotherapies, particularly doxorubicin, are known and often irreversible causes of cardiomyopathy. As such, when cardiomyopathy develops in patients who have been exposed to anthracycline chemotherapy, the importance of ruling out other reversible causes such as hypothyroidism cannot be overstated. We present a case of acute systolic heart failure in a patient post-doxorubicin chemotherapy and radiation therapy for alveolar rhabdomyosarcoma, found to have severe hypothyroidism as a reversible cause of cardiomyopathy.

The Cardiologist and the Cancer Patient: Challenges to Cardio-Oncology (or Onco-Cardiology) and Call to Action

B eginning with known problems regarding adoption of an appropriate name for this subspecialty (cardio-oncology vs. oncocardiology), this new and promising field is beset with some rectifiable challenges. A search on PubMed reveals that the first mention of cardio-oncology was in 1996 by Cardinale (1). In reality, the subspecialty of cardio-oncology was born much earlier with the recognition of daunorubicin-induced cardiotoxicity in 1967 (2). Doxorubicin, first produced in 1969 as an improved form of daunorubicin, and used for treatment of various malignancies by the 1970s (3), is the pivotal reason for the development of cardiooncology as a field. Recognition of its cardiotoxic effects, associated risk factors, and possible preventive strategies are all factors that eventually led to the birth of this important discipline. Since then, cardiotoxic effects of other anticancer drugs, including trastuzumab, cyclophosphamide, cisplatin, and 5fluorouracil, and even newer so-called targeted therapies such as tyrosine kinase inhibitors, checkpoint inhibitors, and chimeric artificial T cell receptor immunotherapies, have been described (4). As cancer patients live longer with the development of improved treatments (including chemo-, radiation, endocrine, and targeted therapies), cardiovascular disease (CVD) is a major cause of shortand long-term morbidity and mortality, next to second malignancy (5). As such, the field of cardiooncology is critical for the development of survivorship strategies after the application of successful

Fibrosing mediastinitis-related pulmonary artery and vein stenosis-limiting chemotherapy

A 74-year-old woman presented for second opinion of dyspnoea management. Her medical history included breast cancer treated with mastectomy, doxorubicin, cyclophosphamide and tamoxifen. She developed recurrent metastatic disease in the mediastinum, managed with 89 six-week cycles of paclitaxel over 10 years that was well tolerated and effective in stabilising the disease initially but eventually discontinued due to new sternal metastasis diagnosed on imaging and increasing dyspnoea. Examination revealed diminished left-sided breath sounds. Routine labs were normal. Echocardiogram showed normal left ventricular function and dilated right chambers. Repeat chest CT demonstrated: (1) extensive calcification …

What is this image? 2017: image 3 result

A 73-year-old female with history of previously treated breast cancer with partial right mastectomy, chemotherapy, and radiation, now in remission, and endstage renal disease presented for pre-operative risk stratification prior to possible listing for kidney transplantation. Recent bilateral mammography for surveillance showed post-lumpectomy and radiation changes, without masses, calcifications or other concerning findings in either breast.