Muhammad Rizwan Sardar

The relationship between left ventricular ejection fraction and mortality in patients with acute heart failure: insights from the ASCEND-HF Trial

Acute decompensated heart failure (ADHF) is associated with significant morbidity and mortality but the relationship between LVEF and outcomes is unclear. We explored the association between LVEF and 30 and 180 day mortality in 7007 ADHF patients enrolled in the Acute Studies of Nesiritide in Decompensated Heart Failure (ASCEND‐HF) trial.

Recurrent takotsubo cardiomyopathy in the setting of transient neurological symptoms: a case report

IntroductionFirst described in Japan, takotsubo cardiomyopathy is increasingly becoming recognized worldwide as a cause of sudden and reversible diminished left ventricular function characterized by left apical ballooning and hyperkinesis of the basal segments, often with symptoms mimicking a myocardial infarction. Associated with physical or emotional stress, its exact pathogenesis has not been established, though evidence supports a neurohumoral etiology. Additionally, recurrence of this condition is rare. In this report, we present a rare case of recurrent takotsubo cardiomyopathy in a post-menopausal woman who presented with transient neurological complaints on both occasions.Case presentationWe present a rare case of a 76-year-old Caucasian woman with no history of congestive heart failure who presented to our emergency department twice with transient neurological complaints. On the first occasion, she was found to have transient aphasia which resolved within 24 hours, yet during that period she also developed symptoms of congestive heart failure and was noted to have a new, significantly depressed ejection fraction with apical akinesis and possible apical thrombus. One month after her presentation a repeat echocardiogram revealed complete resolution of all wall motion abnormalities and a return to baseline status. Seven months later she presented with ataxia, was diagnosed with vertebrobasilar insufficiency, and again developed symptoms and echocardiography findings similar to those of her first presentation. Once again, at her one-month follow-up examination, all wall motion abnormalities had completely resolved and her ejection fraction had returned to normal.ConclusionThough the exact etiology of takotsubo cardiomyopathy is unclear, a neurohumoral mechanism has been proposed. Recurrence of this disorder is rare, though it has been reported in patients with structural brain abnormalities. This report is the first to describe recurrent takotsubo cardiomyopathy in a patient with transient neurological symptoms. In our patient, as expected in patients with this condition, complete resolution of all left ventricular abnormalities occurred within a short period of time. It is important for clinicians to be aware of this increasingly recognized syndrome, including its association with recurrence, especially in the clinical setting of neurologic dysfunction.

Recurrent right ventricular cardiac myxoma in a patient with Carney complex: a case report

IntroductionCarney complex is a multiple neoplasia syndrome involving cardiac, endocrine, neural and cutaneous tumors with a variety of pigmented skin lesions. It has an autosomal dominant mode of inheritance. Approximately 7% of cardiac myxomas are related to the Carney complex. Myxomas that occur as part of the Carney complex affect both sexes with equal frequency. Cardiac myxomas with Carney complex are reported mostly in the left side of the heart and are less common on the right side. As per our review, this is the first reported case of Carney complex with right ventricle cardiac myxoma.Case presentationWe present a rare case of recurrent cardiac myxoma in a patient later diagnosed to have Carney complex. A 46-year-old Caucasian man with a history of thyroid hyperplasia came to out-patient cardiology department with new onset atrial fibrillation. A transthoracic echocardiogram revealed a right ventricular mass attached to his interventricular septum, which was later seen on a transesophageal echocardiogram and cardiac magnetic resonance imaging. He underwent resection of the ventricular mass which on pathology revealed myxoma. He later developed skin lesions, pituitary adenoma and Sertoli cell tumor suggesting Carney complex. Two years later he developed a new mass within his right atrium which was later resected.ConclusionsCarney complex is a rare autosomal dominant disease with variable penetrance. Since it involves multiple organs, patients diagnosed with Carney complex should undergo serial endocrine workup, neural assessments, echocardiograms and testicular ultrasounds. Of the total number of cases of Carney complex, 65% are linked to PRKAR1A gene mutation. It is important for clinicians to be cognizant of a link between cardiac myxoma and Carney complex. The use of multi-imaging modalities allows better delineation of the mass before planned resection. Carney complex-related cardiac myxoma comprises 7% of all cardiac myxomas. Right ventricular cardiac myxomas are rare. This case report is the first to describe right ventricular myxoma with Carney complex.

All at once: multivessel spontaneous coronary artery dissection with right coronary artery ST-segment elevation myocardial infarction.

A 35-year-old woman, 12 days post-partum presented to the emergency department from her physicians office with chest discomfort that started the previous night. She described the chest discomfort discomfort “on-and-off”, occurring at rest, and located in the central chest with radiation to the

Long-term Outcomes after Percutaneous Mitral Valvuloplasty in Colombia, South America

Objective: To evaluate the long term clinical results of percutaneous mitral balloon valvuloplasty in patients with rheumatic mitral stenosis in Colombia, South America. Background: In 1993, Colombia, South America began a National Mitral Balloon Valvuloplasty Registry. This multicenter database was designed to establish the longterm safety and efficacy of percutaneous mitral valvuloplasty, as well as rate of restenosis. Methods: Between January 1993 and December 2011, 182 patients >18 years old were treated for rheumatic mitral stenosis with percutaneous valvuloplasty in two centers in Colombia, South America. Clinical, echocardiographic and hemodynamic data were stored in an electronic database. The Inoue Balloon technique was used in 99% of patients. The longest follow-up period was 15 years. Results: 182 patients were included; women (89%), hypertension (19%), dyslipidemia (1.6%), smoking (8.8%), diabetes (5.5%) and renal failure (1%). Forty-six patients (25.7%) were NYHA functional class III-IV. Procedure related mortality was 1.09% (2 patients). Fourteen patients (7.69%) had significant post procedure mitral insufficiency (grades III-IV); 4 patients (2.19%) had cardiac tamponade and 6 patients (3.3%) had vascular site related complications. The survival rate at 12 months was 96%. At 50 months, 60.7% of patients were alive and free of mitral surgery and repeated mitral valvuloplasty. The percentage of severe restenosis of mitral valve was 4.8%, 19.2%, 15.2% at one, five and 10 years of follow-up. Conclusions: Percutaneous mitral valvuloplasty using the Inoue balloon technique improves the hemodynamic profile of severe mitral stenosis. Long-term follow-up suggest that it is a safe alternative to mitral valve surgery in well selected patients. *Corresponding Author: Wajeeha Saeed, Department of Medicine, Albert Einstein College of Medicine, 1650 Grand Concourse, Bronx, New York, NY 10457. Tel: +1 347-327-2736; E-mail: wajsaeed@yahoo.com Citation: Saeed, W., et al. Long-term Outcomes after Percutaneous Mitral Valvuloplasty in Colombia, South America. (2015) J Heart Cardiol 1(3): 1-5. Long-Term Outcomes after Percutaneous Mitral Valvuloplasty in Colombia, South America Carlos Uribe1, Wajeeha Saeed2*, Carlos Tenorio1, Carlos Eusse Carlos1, Carlos Rubio1, Julián A Ochoa3, Roland Njoh4, Muhammad Rizwan Sardar4, Bernardo Lombo5, John K Forrest5 Received date: July 07, 2015 Accepted date: Aug 31, 2015 Published date: Sep 10, 2015 Abbreviations: SD: Standard Deviation; NYHA: New York Heart Association; TAVI= Transcatheter Aortic-Valve Implantation; PMBV= Percutaneous Mitral balloon Valvuloplasty; MS= Mitral Stenosis DOI: 10.15436/2378-6914.15.012 2 for mitral stenosis. The treatment of mitral stenosis depends on the postulated cause. Rheumatic fever is the most prevalent cause of mitral stenosis (MS)[1]. Cardiac rheumatic disease is a chronic manifestation of rheumatic carditis, which occurs between 60 and 90% of cases in rheumatic fever[2-4]. Rheumatic mitral valvular disease continues to be an important public health problem, especially because it is a preventable disease; furthermore its incidence continues to grow in many developing third world countries. In Colombia, it is estimated that between 0.1 and 0.2% of deaths occur as a result of rheumatic disease[5]. Delay in the treatment of MS leads to complications like atrial fibrillation and pulmonary hypertension[6-8]. In 1984, Inoue et al described the first percutaneous mitral balloon valvuloplasty (PMBV) and since then, the Inoue technique has been shown to produce excellent hemodynamic results in patients with severe rheumatic mitral stenosis[9]. Multiple trials have been done comparing PMBV to surgical mitral valvotomy with follow-up ranging from one to seven years[10-21]. A recent meta-analysis showed comparable clinical outcomes between the two approaches[22]. The external validity of the clinical trials are one of the most important aspect which are often ignored in the current cardiovascular literature and expert guidelines[23,24]. The long-term follow-up data in mitral stenosis patients undergoing PMBV is not available for a country like Colombia, which is a third world country[3]. To address this, in 1993 the Colombian Mitral Balloon Valvuloplasty registry was created to collect baseline, post-procedural as well as long-term follow-up data of patients undergoing PMBV. We therefore seek to analyze the long-term clinical results of PMBV in patients.

PREVALENCE OF INTERNET USE FOR CONGESTIVE HEART FAILURE EDUCATION: A PILOT STUDY

Online patient-education has been shown to be an effective tool in managing several chronic medical problems. We sought to examine the frequency of the use of internet education in heart failure patients in 3 different communities and the factors that impede patient access to internet education.