Evaluation of pharmacogenetic automated clinical decision support for clopidogrel.

Clopidogrel requires activation to have antiplatelet effects. Pharmacogenetic testing to identify patients with impaired function can be coupled with clinical decision support (CDS) alerts to guide antiplatelet prescribing. We evaluated the impact of alerts on clopidogrel prescribing.

Case Report: Non-ischemic Papillary Muscle Rupture due to MRSA Myocarditis with Concurrent Thromboembolic Myocardial Infarction Secondary to Infective Endocarditis.

Non-ischemic papillary muscle rupture (PMR) is rare. PMR caused by myocarditis in the presence of concurrent infective endocarditis (IE) and myocardial infarction (MI) has not been described. We report a 46-year-old male with recurrent MRSA bacteremia who presented in septic shock and suffered cardiac arrest.

Pericardial Effusion as a Complication of Severe Primary Hypothyroidism.

Large pericardial effusions with associated cardiac tamponade are a rare manifestation of hypothyroidism. We present the case of a 63-year-old female with chronic heart failure and newly diagnosed hypothyroidism, who presented to her primary care physician complaining of progressively worsening dyspnea. Chest radiography showed cardiomegaly and transthoracic echocardiography (TTE) revealed a large pericardial effusion with tamponade physiology.

Clinical impact of preemptive pharmacogenomic testing on antiplatelet therapy in a real-world setting.

CYP2C19 genotyping to guide antiplatelet therapy after patients develop acute coronary syndromes (ACS) or require percutaneous coronary interventions (PCIs) reduces the likelihood of major adverse cardiovascular events (MACE). Evidence about the impact of preemptive testing, where genotyping occurs while patients are healthy, is lacking. In patients initiating antiplatelet therapy for ACS or PCI, we compared medical records data from 67 patients who received CYP2C19 genotyping preemptively (results >7 days before need), against medical records data from 67 propensity score-matched patients who received early genotyping (results within 7 days of need).

A Case of Intraventricular Coronary Artery Perforation Following Percutaneous Coronary Intervention in the Setting of Myocardial Bridge of Left Anterior Descending Artery.

Coronary artery perforation during percutaneous coronary intervention is a rare but potentially fatal complication. Intraventricular rupture is more commonly seen in setting of myocardial bridging where the epicardial coronary artery takes an intramuscular course. We describe a case of acute thrombotic in-stent restenosis of the intramyocardial (myocardial bridge) distal left anterior descending artery complicated by intraventricular perforation in the setting of an anterior ST elevation myocardial infarction managed by covered stenting.

Heart Failure with Preserved Ejection Fraction: Concise Review.

Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent disease, causing a significant burden to the elderly population. Due to the inconsistencies in the standard definition and criteria for diagnosis, HFpEF is often underdiagnosed and left untreated. Although diastolic dysfunction is one of the key driving factors of the disease process, other factors like systolic limitations, endothelial dysfunction, arterial stiffness, and poor ventricular-arterial coupling are also contributing factors.

Complex Coronary Intervention - When Time Is of Essence: Ping Pong Technique.

Coronary artery disease (CAD) continues to be a significant cause of morbidity and mortality in the U.S. The prognosis and treatment of which is dependent on various factors including type, size, localization and extent of the coronary plaque and severity of the stenosis.

Impact of Emergency Medical Service Provider Training and Institutional Volume Experience on ST-Elevation Myocardial Infarction Patient Outcomes in Rural Setting.

Introduction: Rural sites provide management challenges for ST-elevation myocardial infarction (STEMI) patients. The impact of emergency medical service (EMS) training and institutional volume experience on STEMI outcomes was examined.

Methods: All STEMI patients transferred to Sanford from 32 sites in rural South Dakota from 2010-2019 were analyzed.

ST Elevation MI with Normal Coronary Arteries: A MINOCA Case.

Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a syndrome characterized by clinical evidence of myocardial infarction with normal or near-normal coronary arteries on angiography.

Case Report: A 35-year-old female patient presented with typical chest pain. EKG revealed sinus rhythm, 1 mm ST elevation in DI-aVL, prominent R waves in V1-V3 and ST-segment depression in DIII-aVF.

Transcatheter tricuspid valve-in-valve implantation for very early bioprosthetic tricuspid stenosis secondary to pacemaker lead entrapment: a case report.

Background: Tricuspid stenosis (native and prosthetic) is rare. Redo-sternotomy for isolated tricuspid replacement is associated with a higher risk. The efficacy and durability of transcatheter valve implantation for severe tricuspid stenosis are unclear.

ST-Segment Elevation Myocardial Infarction Due to an Ectatic Infarct-Related Coronary Artery: Case Series and Review of the Literature.

Coronary artery ectasia is an infrequent finding seen in a localized or diffuse fashion in patients undergoing coronary angiogram. This angiographic entity is attributed to coronary artery atherosclerosis. The ectatic coronary artery segment may be a culprit and perpetuate the thrombus formation in patients with acute myocardial infarction due to the altered normal laminar flow and deranged platelet and endothelial activation.

Post COVID-19 Large Atrial Thrombus Found Incidentally.

Background: Coronavirus disease 2019 (COVID-19) has become a leading cause of morbidity and mortality worldwide. One of the major complications of COVID-19 infection is the hypercoagulability state. Cardiac thrombi and venous thromboembolism (VTE) have been documented with severe COVID-19 infection.

COVID-19 and Cardiovascular Disease: A Comprehensive Review.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic that impacted the lives of billions of people worldwide. Angiotensin-converting enzyme 2 (ACE2) receptor act as a gate for viral cell entry through binding to virus S-protein. Cardiovascular patients are thought to be more susceptible to severe COVID-19 infection due to overexpression of ACE2 receptors in these patients.

Complete Heart Block Causing Takotsubo Syndrome: A Case Report.

The association of complete atrioventricular (AV) block with Takotsubo syndrome (TTS) is well known, but the cause-and-effect relationship has not been determined. We present the case of a 91-year-old female with complete AV block who went untreated for over a year and later developed Takotsubo syndrome. Reversal of wall movement defects was seen after a permanent pacemaker was implanted, and routine follow-up showed that the implanted pacemaker worked normally.

Patent Foramen Ovale Closure Indications: A Clinical Update.

Patent foramen ovale (PFO) is a commonly identified congenital cardiac defect, present in 25-30 percent of adults. Though usually clinically silent, PFOs can result in paradoxical embolization, resulting in platypnea-orthodeoxia syndrome (POS), migraines, myocardial infarctions, or cerebrovascular accidents. Patients with incidentally noted PFOs should be managed conservatively, but in patients with cryptogenic stroke and amenable anatomy, closure with a percutaneous closure device is recommended.

A Case of Bioprosthetic Mitral Valve Endocarditis with Severe Stenosis.

A 29-year-old female with a history of bioprosthetic mitral valve replacement was admitted with fever, chills, and shortness of breath of two weeks duration. Transthoracic echocardiography revealed a thickened bioprosthetic mitral valve with a 26 mmHg mean gradient consistent with severe mitral stenosis and associated large vegetation. Blood cultures demonstrated no growth.

Proprotein Convertase Subtilism/Kexin 9 (PCSK9) Inhibitors: Adding to the Armamentarium of the Primary Care Physician.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide, and its prevalence is expected to further increase in the next decade. It imparts a substantial burden on the healthcare system. Dyslipidemia, defined as low-density lipoprotein (LDL), total cholesterol, triglycerides, or lipoprotein levels more than 90th percentile, or an HDL level less than the 10th percentile, is significant risk factor for ASCVD and offers a therapeutic target to reduce the morbidity and mortality associated with ASCVD.

Approach to high intracoronary thrombus burden in the era of COVID-19.

Since the start of the COVID-19 pandemic, several cases have reported extensive multivessel coronary thrombosis as a cardiovascular manifestation of SARS-CoV-2 infection. This case describes a patient who developed non-ST elevation myocardial infarction during hospitalization for acute hypoxic respiratory failure due to COVID-19. We review the immediate and delayed revascularisation strategies of culprit and non-culprit lesions in the setting of high intracoronary thrombus burden induced by SARS-CoV-2.

New and Emerging Technology in Cardiovascular Therapeutics.

The last decade has seen the introduction of a number of important technological innovations in the management of advanced cardiovascular disease. These include transcatheter aortic valve replacement systems, a transcatheter mitral valve repair device, a left atrial appendage occluder device, coronary bioresorbable vascular scaffolds, leadless fully implantable pacemaker systems, wireless implantable pulmonary artery pressure monitors, transcatheter left ventricular assist pumping devices, drug-coated balloons, and robotic percutaneous coronary intervention devices. With the exception of drug coated balloon platforms, all have been utilized in our institution for patients from South Dakota and neighboring states.

Segmental Coronary Vasospasm Mimicking ST-Elevation Myocardial Infarction in an Incidentally COVID-Positive Patient.

Coronary vasospasm is an underdiagnosed cause of myocardial infarction in the absence of obstructive coronary artery disease. Systemic inflammation is one of several triggers associated with coronary vasospasm. We report the case of a 47-year woman incidentally found to be COVID-positive (RT-PCR) during evaluation of constitutional symptoms and breast cellulitis.

Percutaneous Closure of a Cribriform Secundum Atrial Septal Defect and Patent Foramen Ovale.

Atrial septal defects (ASDs) and patent foramen ovale (PFO) are common congenital cardiac malformations that portend a higher risk of ischemic stroke. Percutaneous closure of ASDs using septal occluder devices has proven to be a safe and effective alternative to surgery. We present a case of symptomatic cribriform secundum ASD and PFO who underwent successful percutaneous closure using two Amplatzer occluder devices using a novel "sandwich technique.