Rajesh Pradhan

Cardiovascular Toxicities of Cancer Chemotherapy

Cancer chemotherapy has improved over the years with the advent of newer agents, including more targeted chemotherapeutic drugs, resulting in better patient survival. However, with continued use and patient exposure to these drugs, important cardiovascular adverse effects are becoming realized, such as left ventricular dysfunction and heart failure, myocardial ischemia, hypertension, arrhythmias, and pulmonary arterial hypertension. In this article, we review the most common cardiovascular toxicities and their related pathophysiology that occur with the use of these agents.

Left Atrial Appendage Aneurysm: A Systematic Review of 82 Cases

Aneurysm of the left atrial appendage is rare. We sought to systematically review the published literature on left atrial appendage aneurysm (LAAA) to address its demographic features, clinical characteristics, treatment, complications, and outcomes.

Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease

BACKGROUND Rapid atrial fibrillation (AF) is commonly associated with ST-segment depressions. ST-segment depression during a chest pain episode or exercise stress testing in sinus rhythm is predictive of obstructive coronary artery disease (CAD), but it is unclear if the presence or magnitude of ST-segment depression during rapid AF has similar predictive accuracy. METHODS One hundred twenty-seven patients with rapid AF (heart rate ≥120 beats per minute) who had cardiac catheterization performed during the same hospital admission were retrospectively reviewed. Variables to compute thrombolysis in myocardial infarction (TIMI) risk score, demographic profiles, ST-segment deviation, cardiac catheterization results, and cardiac interventions were collected. RESULTS Thirty-five patients had ST-segment depression of 1 mm or more, and 92 had no or less than 1 mm ST depression. Thirty-one patients were found to have obstructive CAD. In the group with ST-segment depression, 11 (31%) patients had obstructive CAD and 24 (69%) did not. In the group with less than 1 mm ST-segment depression, 20 (22%) had obstructive CAD and 72 (78%) did not (P = .25). Sensitivity, specificity, and positive and negative predictive values for presence of obstructive CAD were 35%, 75%, 31%, and 78%, respectively. The presence of ST-segment depression of 1 mm or more was not associated with presence of obstructive CAD before or after adjustment of TIMI variables. The relationship between increasing grades of ST-segment depression and obstructive CAD showed a trend toward significance (P = .09), which did not persist after adjusting for TIMI risk variables (P = .36). CONCLUSION ST-segment depression during rapid AF is not predictive for the presence of obstructive CAD.

Right atrial appendage aneurysm: a systematic review.

Right atrial appendage aneurysm (RAAA) is rare with fewer than 20 cases reported in the literature. We sought to systematically review the published cases of RAAA in terms of demographics, clinical characteristics, treatment, complications, and outcome.

Papillary fibroelastoma of the aortic valve: An unusual cause of angina

Papillary fibroelastoma of the aortic valve is an uncommon benign tumor of the heart that can present with embolic events. We report a case of 54-year-old lady with exertional chest pain and prior history of ST segment elevation myocardial infarction who was subsequently found to have a fibroelastoma of the aortic valve. The absence of angiographically significant coronary artery disease and resolution of anginal symptoms post-surgery in our patient points to the possibility of fibroelastoma causing these anginal symptoms. Although uncommon, fibroelastoma are being recognized more frequently with the help of transesophageal echocardiography. Hence, in the absence of significant coronary artery disease, we emphasize the importance of consideration of papillary fibroelastoma of the aortic valve as a cause of angina. We also discuss the key aspects of the fibroelastoma including presentation, diagnostic modalities and treatment options.

Patient characteristics and predictors of mortality associated with pericardial decompression syndrome: a comprehensive analysis of published cases

Background: Pericardial decompression syndrome (PDS) is a rare and potentially fatal complication of pericardial drainage, either by needle pericardiocentesis or surgical pericardiostomy. It manifests with paradoxical hemodynamic deterioration and/or pulmonary edema, commonly associated with ventricular dysfunction. We sought to elucidate factors associated with mortality in PDS. Methods: MEDLINE was systematically searched for PDS case reports and case series published between 1983 and 2013. For this analysis, clinical variables, echocardiographic and hemodynamic variables, details of drainage procedure and clinical outcomes were collected for each case. Results: A total of 35 cases (12 male, 23 female) were identified. PDS developed after pericardiocentesis, pericardiostomy, or both, in 18, 16, and one patients, respectively. Cardiac tamponade was the indication in 33 cases (94%). The mean age was 47 ± 17 years. The mean amount of effusion drained was 888 mL. The minimum amount of effusion drained was 450 mL. The onset of PDS after the procedure varied widely, ranging from ‘immediate’ to 48 hours. Presentations included 10 (29%) with cardiogenic pulmonary edema without shock, 14 (40%) with left ventricular failure, three (9%) with right ventricular failure, seven (20%) with biventricular failure, and one (3%) with non-cardiogenic pulmonary edema. Ten patients (29%) died of PDS. Mortality was associated only with surgical drainage (p<0.001). Severe LV dysfunction normalized in PDS survivors. Conclusions: PDS is a rare complication of pericardial drainage with a high mortality rate. Surgical pericardiostomy was associated with mortality in PDS.

A “Teapot” Atrial Septal Aneurysm with Spontaneous Thrombus in an Asymptomatic Patient

An 84-year-old woman with a history of hypertension, mild aortic stenosis, coronary artery bypass grafting, and a known atrial septal aneurysm (ASA) came to the cardiac clinic for a routine follow-up. She had no history of stroke or systemic embolism. Cardiovascular examination was notable for a grade 2/6 holosystolic murmur at the cardiac apex and a grade 3/6 mid-peaking crescendo/decrescendo murmur at right upper sternal border with radiation to bilateral carotids. The rest of the systemic examination was normal. She was noted to be in sinus rhythm. A follow-up transthoracic echocardiogram for her valvular heart disease revealed normal left ventricular (LV) chamber size with low normal LV systolic function. LV ejection fraction by biplane Simpson’s method was calculated to be 53%. LV wall thickness was increased with the presence of moderate concentric LV hypertrophy. There was the presence of moderate aortic stenosis and mild mitral regurgitation. The left atrium was severely enlarged with an indexed left atrial volume of 84 …

Left ventricular non-compaction presenting with heart failure and intramural thrombus

Left ventricular non-compaction (LVNC) is a rare disorder caused by the arrest of myocardial compaction during embryogenesis, leading to a non-compacted endocardial layer with marked trabeculations. The diagnosis is primarily based on echocardiographic demonstration of a spongy myocardium. Here, we present a young male with LVNC presenting with left heart failure and multiple left ventricular thrombi. We also review the presentation, diagnosis and management of this condition.

Recurrent orthostatic syncope due to left atrial and left ventricular collapse after a continuous-flow left ventricular assist device implantation

Left ventricular assist devices (LVADs) have become an established treatment for patients with advanced heart failure as a bridge to transplantation or for permanent support as an alternative to heart transplantation. Continuous-flow LVADs have been shown to improve outcomes, including survival, and reduce device failure compared with pulsatile devices. Although LVADs have been shown to be a good option for patients with end-stage heart failure, unanticipated complications may occur. We describe dynamic left atrial and left ventricular chamber collapse related to postural changes in a patient with a recent continuous-flow LVAD implantation.

An unusual cause of recurrent chest pain in an adult woman: a case of recurrent stress-induced (Takotsubo) cardiomyopathy

Recurrent Takotsubo cardiomyopathy is a relatively uncommon condition seen in patients with severe physical or emotional stress. We report a case of a 51-year-old woman who had recurrent Takotsubo cardiomyopathy with involvement of apical left ventricular (LV) segments, induced by intense emotional stress. On two occasions she presented with symptoms of acute coronary syndrome accompanied by LV regional wall motion abnormalities without a culprit coronary stenosis, and exhibited complete resolution of symptoms and restoration of normal LV wall motion.