An Unusual Cause of Coronary Occlusion During an Abdominal Aortic Aneurysm Repair: Reperfusion With Diagnostic Angiography Only.

We present a unique case of a type I peri-operative myocardial infarction during an extensive abdominal aortic aneurysm repair occurring due to the occlusion of a severe stable ostial plaque stenosis by a small overlying thrombus. During coronary angiography, the thrombus was dislodged by the diagnostic catheter which restored normal flow without stent placement. We demonstrate a care approach that was carefully arrived upon through multidisciplinary management with vascular surgery and anesthesiology colleagues.

Sinus bradycardia with haemodynamic compromise following lithium intoxication.

Lithium is a well-established treatment for mood disorders and considered first-line pharmacological therapy for bipolar disorder as per the American Psychiatric Association guidelines. However, lithium is associated with significant toxicity. Cardiotoxicity including sinus node dysfunction is a rare but clinically significant presentation of lithium intoxication.

Left Axillary Intra-Aortic Balloon Pump Prolapsing in the Ascending Aorta in an End-Stage Heart Failure Patient Awaiting Transplant.

Patients with end-stage heart failure with reduced ejection fraction requiring mechanical support while awaiting heart transplant present a clinical dilemma. Intra-aortic balloon pump (IABPs) provide a modest improvement in hemodynamics and are easy to implant. Left axillary IABP implantation allows patients to engage in daily physical activity pre-transplant.

Cardiac Amyloid for the Internist.

Cardiac amyloid is an uncommon cause of diastolic dysfunction the recognition of which requires the internist to have clinical suspicion to guide diagnosis and treatment. Cardiac amyloid is an infiltrative cardiomyopathy with significant morbidity and mortality. Appropriate diagnosis is important because management of cardiac amyloid differs from typical heart failure with preserved ejection fraction.

Bilateral Vertebral Artery Dissection: A Case Report with Literature Review.

Vertebral artery dissection (VAD) is a rare cause of ischemic stroke in young patients. The largely nonspecific symptoms and delayed presentation pose a serious diagnostic challenge. Medical management with either anticoagulation or antiplatelet therapy is recommended, but there are no reports of successful dual therapy.

Importance of measurement site on assessment of lesion-specific ischemia and diagnostic performance by coronary computed tomography Angiography-Derived Fractional Flow Reserve.

Background: Values of fractional flow reserve (FFR) by coronary computed tomography angiography (CTA) decline from the ostium to the terminal vessel, irrespective of stenosis severity. The purpose of this study is to determine if the site of measurement of FFR impacts assessment of ischemia and its diagnostic performance relative to invasive FFR (FFR).

Methods: 1484 patients underwent FFR; 1910 vessels were stratified by stenosis severity (normal; <25%, 25-50%, 50-70%, and >70% stenosis).

Concomitant use of direct oral anticoagulants and aspirin versus direct oral anticoagulants alone in atrial fibrillation and flutter: a retrospective cohort.

Background: The benefit of combining aspirin and direct oral anticoagulants on the reduction of cardiovascular events in atrial fibrillation or flutter is not well studied. We aimed to assess whether concurrent aspirin and direct oral anticoagulant therapy for atrial fibrillation or flutter will result in less coronary, cerebrovascular and systemic ischemic events compared to direct oral anticoagulant therapy alone.

Methods: Retrospective study of adult patients between 18 and 100 years old who have nonvalvular atrial fibrillation or flutter and were started on a direct oral anticoagulant (apixaban, rivaroxaban, or dabigatran), between January 1, 2010 and September 1, 2015 within the Beaumont Health System.

Diagnosis of Transthyretin Amyloid Cardiomyopathy.

Transthyretin amyloid cardiomyopathy (ATTR-CM) continues to be an easily overlooked, life-threatening, yet treatable cause of heart failure. Furthermore, its elusive diagnosis leads to late or misdiagnosis. As therapeutic advancements such as tafamidis usher in a promising new era in the management of ATTR-CM, the need for disease awareness and efficient diagnostic evaluation is crucial.

Potential predictors for mental stress-induced myocardial ischemia in patients with coronary artery disease.

Background: Mental stress-induced myocardial ischemia (MSIMI) is closely associated with adverse cardiac events in patients with coronary artery disease (CAD) and we aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI.

Methods: This study enrolled 82 patients with documented CAD between June 1, 2017 and November 9, 2017. Patient blood samples were obtained at resting period and at the end of mental arithmetic.

A Malignant Squeeze: A Rare Cause of Cardiac Tamponade.

Primary cardiac lymphoma (PCL) is a rare condition described as a lymphoma localized to the heart or pericardium. Although cardiac involvement is seen in 10-20% of non-Hodgkin's lymphomas, PCL is extremely rare. It comprises merely 0.

A Very Rare Complication of Hepatitis A Infection: Acute Myocarditis-A Case Report with Literature Review.

Hepatitis A is a common viral infection with a benign course but in rare cases can progress to acute liver failure. It usually presents with abdominal pain, nausea, vomiting, diarrhea, jaundice, anorexia, or asymptomatically, but it can also present atypically with relapsing hepatitis and prolonged cholestasis. In addition, extrahepatic manifestations have been reported, including urticarial and maculopapular rash, acute kidney injury, autoimmune hemolytic anemia, aplastic anemia, acute pancreatitis, mononeuritis, reactive arthritis, glomerulonephritis, cryoglobulinemia, Guillain-Barre syndrome, and pleural or pericardial effusion.

Assessment of lesion-specific ischemia using fractional flow reserve (FFR) profiles derived from coronary computed tomography angiography (FFRCT) and invasive pressure measurements (FFRINV): Importance of the site of measurement and implications for patient referral for invasive coronary angiography and percutaneous coronary intervention.

Background: Fractional flow reserve (FFR)-derived from computed tomography angiography (CTA; FFRCT) and invasive FFR (FFRINV) are used to assess the need for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI). The optimal location for measuring FFR and the impact of measurement location have not been well defined.

Methods: 930 patients (age 60.

Cardiac Dedifferentiated Liposarcoma Requiring a Mitral Valve Replacement Complicated by Severe Paravalvular Leak: A Rare Case Report with Literature Review.

Cardiac sarcomas have a high infiltrative and metastatic potential and are often associated with poor prognosis. These tumors are often identified incidentally by thoracic and cardiac imaging. However, when symptomatic, their presentation can differ based on the localized structural effects on the endocardium, myocardium, pericardium, and valves as well as on dynamic effects on the cardiac function.

Cardiac Tamponade as the Initial Presentation of Acute Myeloid Leukemia: A Case Report with Review of the Literature.

Acute myeloid leukemia (AML) is a complex disease with a variety of presentations. A large pericardial effusion is rare, occurring in less than 0.5% of all patients with AML prior to treatment.

Aortic Dissection Presenting as Acute Pancreatitis: Suspecting the Unexpected.

Aortic dissection is a life-threatening condition in which the inner layer of the aorta tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). It is considered a medical emergency.

Preconditioning in neuroprotection: From hypoxia to ischemia.

Sublethal hypoxic or ischemic events can improve the tolerance of tissues, organs, and even organisms from subsequent lethal injury caused by hypoxia or ischemia. This phenomenon has been termed hypoxic or ischemic preconditioning (HPC or IPC) and is well established in the heart and the brain. This review aims to discuss HPC and IPC with respect to their historical development and advancements in our understanding of the neurochemical basis for their neuroprotective role.

Omega-3 fatty acid supplement prevents development of intracranial atherosclerosis.

Objectives: Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of stroke worldwide and, in particular, has been implicated as a leading cause of recurrent ischemic stroke. We adapted a rat model of atherosclerosis to study brain intracranial atherosclerosis, and further investigated the effect of omega-3 fatty acids (O3FA) in attenuating development of ICAS.

Materials And Methods: Adult male Sprague-Dawley rats were divided into control normal-cholesterol or high-cholesterol diet groups with or without O3FA for up to 6weeks.

The correlation of D-dimer levels with patient outcomes in acute ischemic cerebrovascular disease complicating coronary heart disease.

Objective: To investigate the correlation between nerve function defect, their degree of recovery, and D-dimer levels in patients with acute ischemic cerebrovascular disease (AICVD) complicating coronary heart disease (CHD) in winter.

Methods: From 1 October, 2014 to 31 December, 2014, we enrolled patients in a consecutive manner with AICVD who were hospitalized in the Department of Neurology, Beijing Luhe hospital, Capital Medical University. The patients were selected that had an occurrence of AICVD within the last 14 days.

Acute recanalization of carotid stenosis is not proper: an experimental ischaemic stroke study.

Objectives: In a rat common carotid artery (CCA) stenosis model, the author determined the function of blood-brain barrier (BBB) at different time points and established an optimal time for CCA recanalization in rats with CCA stenosis combined with cerebral infarction.

Methods: Common carotid artery severe stenosis combined with cerebral infarction was divided into two groups: CCA stenosis group (n = 48) and CCA stenosis recanalization group (n = 48). Common carotid artery stenosis recanalization was opened at time points of 1, 2, 3, 5, 7 and 14  days.

Neuroprotection by peripheral nerve electrical stimulation and remote postconditioning against acute experimental ischaemic stroke.

Objective: Local electrical stimulation (ES) was reported to protect the brain during ischaemic injury, while the protective effect of limb remote ischaemic postconditioning (RIPostC) was confirmed. The aim of this study was to explore whether remote peripheral nerve ES exerted neuroprotection and whether this procedure shared the same neuroprotective mechanism underlying RIPostC.

Methods: Stroke in Sprague-Dawley rats was induced by distal middle cerebral artery occlusion (dMCAO).

Ethanol and normobaric oxygen: novel approach in modulating pyruvate dehydrogenase complex after severe transient and permanent ischemic stroke.

Background And Purpose: Ischemic stroke induces metabolic disarray. A central regulatory site, pyruvate dehydrogeanse complex (PDHC) sits at the cross-roads of 2 fundamental metabolic pathways: aerobic and anaerobic. In this study, we combined ethanol (EtOH) and normobaric oxygen (NBO) to develop a novel treatment to modulate PDHC and its regulatory proteins, namely pyruvate dehydrogenase phosphatase and pyruvate dehydrogenase kinase, leading to improved metabolism and reduced oxidative damage.

Reduced Apoptosis by Ethanol and Its Association with PKC-δ and Akt Signaling in Ischemic Stroke.

Along with thrombolytic therapy, which has a number of limitations, stroke outcome may be improved with neuroprotective therapies that disrupt ischemic cell death. Recent research has shown a neuroprotective role of ethanol administration during ischemic stroke, such as its ability to reduce infarct volume and neurologic deficit. In order to investigate this further, we assessed the hypothesis that ethanol's neuroprotective effect is through reduction of apoptosis and the modulation of the important apoptotic PKC-δ and Akt signaling pathway.

A neuroproteomic and systems biology analysis of rat brain post intracerebral hemorrhagic stroke.

Intracerebral hemorrhage (ICH) is a devastating form of stroke leading to a high rate of death and disability worldwide. Although it has been hypothesized that much of the IHC insult occurs in the subacute period mediated via a series of complex pathophysiological cascades, the molecular mechanisms involved in ICH have not been systematically characterized. Among the best approaches to understand the underlying mechanisms of injury and recovery, protein dynamics assessment via proteomics/systems biology platforms represent one of the cardinal techniques optimized for mechanisms investigation and biomarker identification.