Shahriar Dadkhah

Clot in Lung, Clot in Heart: A Case Report of Tumor-Like Thrombus in Right Atrium:

Tumor-like formation of thrombus in the right atrial cavity is rare. It may be mistaken for a myxoma. The exact pathophysiology of an isolated thrombus in the heart is still unclear. Management to prevent complications such as pulmonary thromboembolism depends on the clinical judgment of a cardiologist. This report describes a 76-year-old woman with right atrial thrombus causing subsequent pulmonary thromboembolism in right lung. She initially presented to us with pulmonary embolism, and later, an incidental finding of a mass in her right atrium revealed an association of thrombus in heart with thrombus in lung. The challenging management was to resect this thrombus which was fixed to atrial septum, and a trial of anticoagulation did not resolve it. Exact management of such incidental findings in right heart cavities is not well established. Some cases may benefit from resection of such formed fixed thrombus.

Exercise Induced Non-Sustained Ventricular Tachycardia and Indication for Invasive Management

Diagnostic stress echo testing is commonly performed in patients with known or suspected cardiovascular disease. There has been considerable debate in management of exercise induced non-sustained ventricular tachycardia (NSVT). In this case report, we present our experience with a case of exercise induced NSVT, and subsequent angiographically significant left anterior descending (LAD) coronary artery lesion.

A Patient Presenting with Cardiac Tamponade and the Challenges of Finding Its Cause: A Cardiac Angiosarcoma

Primary malignancies of the heart are so rare that most of the available data come from case reports or large single-center-based studies, with the overall incidence of 0.02% in the United States. Diagnosis in case of an isolated pericardial effusion as presentation is challenging, and determining that an angiosarcoma is even more challenging. Here, we presented a rare case of pericardial angiosarcoma which presented to us with tamponade. The patient eventually was diagnosed through pericardiectomy. A multimodality approach was attempted to treat the cancer. The clinical details of such a unique disease entity inspired us to present it as a case report.

Symptoms of Atrial Fibrillation

Atrial fibrillation (AF) is the most common clinically significant arrhythmia and is associated with significant morbidity and mortality. Symptoms linked to atrial fibrillation are variable and commonly include palpitations, dyspnea, chest pain, or an incidental electrocardiographic finding. Other less common presentations include anxiety or depression. Understanding the many possible presenting signs and symptoms of atrial fibrillation is critical when evaluating patients in the short stay unit as they can be associated with other commonly coexisting cardiac conditions such as heart failure. Long-term clinical outcomes based on rate versus rhythm control are similar; therefore, an individualized treatment approach directed at symptoms may be most beneficial. The objectives of this chapter are to describe the wide range of symptoms associated with atrial fibrillation, to review the proposed mechanisms responsible for these symptoms, to list atrial fibrillation symptom scoring tools, and to summarize targeted symptom management strategies.

EVALUATION OF CHEST PAIN IN THE EMERGENCY ROOM USING A 2 HOUR SENSITIVE TROPONIN I (CTNI)

Many chest pain patients are admitted to the hospital annually without coronary artery disease. In 1992, we randomized patients to direct admission versus a 4-hour serial cardiac marker protocol that led to the development of the 4-hour rule-out protocol. Our study demonstrated that patients could

Heart Failure and Kidney Disease: Management in the Short-Stay Unit

Both heart failure and kidney disease are among the fastest growing diagnoses in the United States. The presentation of a patient with heart failure and concomitant kidney disease describes one of the most complex patient populations to manage. Unfortunately, recent data indicates that more than half of heart failure patients have underlying kidney dysfunction. Current treatment options for managing acutely decompensated heart failure focus on improving heart function through reductions in preload, afterload, and increasing cardiac output. However, these modalities can damage renal function; therefore, additional treatment options must be considered when managing patients with heart failure and underlying renal dysfunction. This chapter explores diagnostic, therapeutic, and prognostic options that can be employed when dealing with this often overlooked patient population. Although there are well-established guidelines for managing heart failure and kidney disease alone, the lack of significant randomized clinical trials guiding management of their copresentation in the emergency department and short-stay unit has slowed development of evidence-based treatment guidelines. This chapter will mainly focus on the additional management of patients with heart failure and concomitant kidney disease in the short-stay unit. New York Heart Association heart failure class IV and end-stage renal disease will not be considered in this presentation.

Visual Evidence of Ischemic Preconditioning During PCI Using 80 Lead ECG Body Surface Mapping.

Ischemic preconditioning (IPC) is a well-documented phenomenon. Short episodes of sublethal ischemia provide cardioprotective effects for subsequent longer duration ischemic events. Although the exact mechanism of IPC is not yet known, the chemical basis of IPC seems to involve preservation of ATP or collateral vascularization recruitment. In this case report, we present visual evidence of ischemic preconditioning using Heartscape Technologies 80 Lead ECG device. The 80 Lead ECG is described as a body surface mapping modality, converting its inputted 80 lead ECG data into a 3-Dimensional color coded map. The 80 lead ECG device can detect instantaneous ischemic changes. Different studies have been performed to show different clinical and biochemical aspects of IPC. However data regarding direct visual evidence of this phenomenon is lacking. The secondary objective of this study is to show the ability of 80 lead ECG to identify ST-segment elevation and depression during ischemic events. The utility of 80 Lead ECG body surface mapping is enormous when evaluating ischemic events.

Epidemiology and Demography of Coronary Artery Disease

The study of epidemiology is vital in identifying the connections which exist between lifestyle, environment, and disease, thus providing knowledge of the factors, distribution, and pathology of disease. As the leading cause of death in the United States since 1900, save 1918, coronary artery disease continues to overwhelm mortality and morbidity statistics. In the United States, 1 in 5 deaths are attributed to CAD, the leading cause of death of both males and females. In fact, CAD kills approximately five times more females than does breast cancer. The estimated direct and indirect cost of CAD in 2008 is

The value of bedside cardiac multibiomarker assay in rapid and accurate diagnosis of acute coronary syndromes.

156 million. As a disease that manifests itself in the crib, it is not surprising that CAD is also the leading cause of death worldwide, becoming a pandemic. Coronary artery disease is a condition that is multifaceted, influenced by social status, genetics, lifestyle (culture), and environmental factors. The risk of development of CAD is said to increase with the transition of rural, agrarian, economically underdeveloped to urbanized, industrialized modern societies. Modernization leads to a more sedentary lifestyle, diets higher in calories, and psychosocial stresses. Risk factors such as hypertension, physical inactivity, tobacco use, and diet are modifiable risk factors, whereas genetics, age, race, and gender are nonmodifiable risk factors associated with CAD. Community education must continue to dominate efforts to reduce the major modifiable risk factors. As we continue to monitor the distribution of CAD in populations, epidemiology will provide us with better guidelines, which when applied appropriately can continue to decrease death rates caused by such a devastating disease worldwide.