Manu Kaushik

Recurrent Stress Cardiomyopathy With Variable Regional Involvement Insights Into Etiopathogenetic Mechanisms

A fifty-nine year old woman presented to a tertiary care center with a few hours of increasing chest pain suspicious for angina. She reported persistent bouts of nausea and vomiting for 2 days before the onset of chest pain, but denied abdominal pain or hematemesis. She denied any recent physical or emotional stressors. Notably, the patient was congenitally deaf, and all history was obtained through a sign language interpreter. Patient also reported chronic cannabis abuse for many years. Physical examination was remarkable for prominent jugular venous pulsation, bilateral lung crackles, and left ventricular gallop, apart from sensorineural hearing loss. Her ECG showed poor R-wave progression, ST-segment elevation, and T-wave inversion in the precordial leads. An echocardiogram revealed a left ventricular ejection fraction of 20% to 25%, severe hypokinesis of apical and midsegments, and hypercontractile basal segments. Laboratory workup revealed elevated troponin-I (2.1 ng/mL) and creatine kinase myocardial band (16.2 ng/mL). Metabolic panel and blood counts were normal. Urine drug screen was positive for tetrahydrocannabinol . Cardiac catheterization revealed normal epicardial coronaries …

Comparison of percutaneous device closure versus surgical closure of peri‐membranous ventricular septal defects: A systematic review and meta‐analysis

While percutaneous device closure (PDC) is a first‐line therapy for isolated muscular ventricular septal defects (mVSD), surgery is still the preferred approach for peri‐membranous ventricular septal defects (pmVSD).

Fenofibric acid for hyperlipidemia

Introduction: 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (i.e., statins) are the mainstay of therapy for hyperlipidemia, as per the current National Cholesterol Education Program (NCEP) recommendation. However, the role of other agents, such as the fibrates, is continually being debated in the context of incremental risk reduction, especially in the setting of mixed dyslipidemia. Results from the ACCORD Trial have further added to the confusion. Fibrates also have a role to play in familial hyperlipidemias and in hypertriglyceridemia. Fenofibric acid is one of the newly approved forms of fenofibrate with enhanced bioavailability and was recently approved by the Food and Drug Administation (FDA) for the treatment of various types of hyperlipidemia, in conjunction with statins. Areas covered: This article reviews the role of fenofibric acid in the context of results from recent randomized trials on fenofibrate, including the ACCORD Trial. It discusses the current status of fenofibric acid in the management of dyslipidemia, especially in combination with statins, and also addresses the comparative efficacy and safety profile of this new molecule against other agents in its class. Expert opinion: fenofibric acid in combination with low- to moderate-dose statins is an effective and safe option in the treatment of mixed dyslipidemia, although the long-term effects on cardiovascular risk reduction need to be explored further.

Efficacy and safety of transulnar coronary angiography and interventions--a single center experience.

To evaluate the efficacy and long‐term safety of transulnar approach in complex coronary interventions.

Distinction of “Fat Around the Heart”

We were greatly interested by the study by Wong et al. ([1][1]) on pericardial fat and atrial fibrillation (AF) outcomes. This study further highlights the association of pericardial fat with cardiac disease. The authors remark that pericardial fat may predict the severity and symptomatic burden of

Targeting residual risk: the rationale for the use of non-HDL cholesterol.

There is a wealth of epidemiological and clinical data linking low-density lipoprotein cholesterol (LDLc) with atherosclerotic cardiovascular disease. Numerous primary and secondary prevention trials have demonstrated that reduction in LDLc leads to significant decrease in cardiovascular event rates. However, patients continue to be at significant risk for recurrent events despite aggressive LDLc lowering, reflecting a substantial residual risk. Numerous parameters like apolipoprotein B, LDL particle size, number and non-high density lipoprotein cholesterol (non-HDLc) measurement have been used to assess and address this high residual risk. Herein, we discuss the rationale and the evidence supporting the use of non-HDLc. We also discuss therapeutic options and provide a practical approach to residual risk reduction from a primary care perspective.

Outcomes of mitral valve repair compared with replacement in patients undergoing concomitant aortic valve surgery: a meta-analysis of observational studies

Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. PubMed, Cochrane and Web of Science databases were searched up to 25 January 2014 for English language studies comparing outcomes of MV repair vs replacement in patients undergoing simultaneous AV replacement. Data of selected studies were extracted. Study quality, publication bias and heterogeneity were assessed. Analysis was performed using a random effects model (meta-analysis of observational studies in epidemiology recommendation). A total of 1202 abstracts/titles were screened. Of these, 20 were selected for full text review and 8 studies (3924 patients) were included in the final analysis: 1255 underwent MV repair and 2669 underwent replacement. Late outcome data were available in seven studies (cumulative follow-up: 15 654 patient-years). The early (in hospital and up to 30 days post-surgery) mortality [risk ratio (RR): 0.68, 95% confidence interval (CI): 0.53-0.87, P = 0.003] and late (>30 days post-surgery) mortality (RR: 0.76, 95% CI: 0.64-0.90 P = 0.001) were significantly lower in the MV repair group compared with the MV replacement group. The MV reoperation rate (RR: 1.89, 95% CI: 0.87-4.10, P = 0.108), thromboembolism (including valve thrombosis) (RR: 0.65, 95% CI: 0.38-1.13, P = 0.128) and major bleeding rates (RR: 0.88, 95% CI: 0.49-1.57, P = 0.659) were found to be comparable between the two groups. In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively), whereas the MV reoperation rate became significantly higher (RR: 5.10, 95% CI: 1.62-16.05, P = 0.005) with MV repair. In patients undergoing concomitant mitral and AV surgery, MV repair is associated with improved early and late survival without any increased risk for mitral valve reoperation. However, in patients with rheumatic heart disease MV repair does not impart any survival advantage while the risk for MV reoperation remains significantly higher.

Number of shocks during elective cardioversion predicts long term recurrence of atrial fibrillation

atrial fibrillation☆ Venkata M. Alla ⁎, Swapna Kanuri , Ojas Bansal , Yeruva M. Reddy , Manu Kaushik , Dennis Esterbrooks , Aryan Mooss a a Division of Cardiology, Creighton University Medical Center, Omaha, NE, United States b Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, United States c Department of Cardiology, University of Kansas Medical Center, Kansas City, United States

Clinical utility of valsartan in treatment of children and adolescents with high blood pressure

The incidence of hypertension in the pediatric population has been increasing secondary to lifestyle changes in children and adolescents. Recent studies have enhanced our understanding of the treatment of pediatric hypertension. Angiotensin-converting enzyme inhibitors have traditionally been the most commonly used class of medication in children with hypertension. This is partly due to the important role of the renin angiotensin aldosterone system pathway in the mediation of pediatric hypertension. Angiotensin receptor blockers provide a reasonable alternative to angiotensin-converting enzyme inhibitors. The need for better tolerated antihypertensives had led to development of many new antihypertensives. Valsartan is a relatively novel angiotensin receptor blocker that has been shown to be effective in the treatment of pediatric hypertension. Two recent trials have demonstrated the efficacy of valsartan monotherapy in the pediatric population aged 1–16 years. Once-daily oral preparations of valsartan achieve adequate blood pressure control in the pediatric population. Lack of generic formulations is an important disadvantage. Plasma levels are predictable and clearance is primarily by the liver. Valsartan should be prescribed cautiously for sexually active adolescent females due to concern about angiotensin receptor blocker fetopathy. Otherwise, the drug has infrequent side effects. In summary, valsartan is a new and useful alternative to conventional antihypertensive therapy in pediatric population.

Familial autosomal dominant sensorineural hearing loss associated with dilated cardiomyopathy.

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