Silent Myocardial Ischemia Revisited, Another Silent Killer, Emphasis on the Diagnostic Value of Stress Echocardiography with Focused Update and Review.

Silent myocardial ischemia (SMI) is a relatively common phenomenon in patients with coronary artery disease (CAD). The original description of SMI dates back to the 1970s. We performed an extensive search of the literature starting from 2000, using MEDLINE or PubMed, and 676 documents were analyzed, and only 45 articles found suitable for the study were selected.

A polo ball in the right atrium, importance of echocardiographic characteristics of intracardiac myxomas: a case report.

Background: Myxomas are the most prevalent type of heart tumors, mainly occurring in the left atrium, with approximately 20% of cases found in the right atrium. Timely diagnosis and appropriate management of myxomas are crucial for favorable outcomes and to minimize complications.

Case Presentation: A 77-year-old Asian male with no significant medical history presented with intermittent trepopnea and palpitations.

Loculated pericardial hematoma compressing the right atrium post mechanical aortic valve replacement and the role of point-of-care echocardiography: a case report.

Background: Bleeding in the postoperative period after cardiac surgery is relatively frequent, especially in patients with early anticoagulant therapy, as in the case of mechanical valve replacement. Diffuse hemopericardium is relatively easy to diagnose; however, loculated pericardial hematomas leading to hemodynamic collapse are relatively rare and their diagnosis is more challenging.

Case Presentation: This report is of a 75-year-old Asian woman who presented dyspnea, confusion and hemodynamic collapse related to loculated pericardial hematoma compressing the right atrium 3 days after mechanical aortic valve replacement.

Impact of COVID-19 on Workload and Workflow in Echocardiography Unit in a Tertiary Care University Hospital: A Monocentric Observational Study.

Background: The COVID-19 pandemic is a new unexpected worldwide condition with a heavy burden on health-care institutions and health-care workers.

Objective: We sought to examine the impact of COVID-19 on workload and workflow in the echocardiography unit in a tertiary care university hospital.

Methods: We conducted a monocentric observational study, evaluating workload and workflow during the COVID-19 year relative to the previous year.

Quality Assurance and Improvement Project in Echocardiography Laboratory: The Pivotal Importance of Organizational and Managerial Processes.

Echocardiography plays a vital role in the diagnosis and management of cardiovascular conditions. Echocardiography use is progressively increasing nowadays, and this is correlated to the evolving echo indications, to the relatively new available echocardiography modes (tissue Doppler imaging, speckle tracking imaging, three-dimensional mode, etc.) and modalities (transthoracic, transesophageal, and intracardiac) along with the various available clinical approaches (point of care echo, portable echo, etc.

Sensing and Detection Functions in Implantable Cardioverter Defibrillators: The Good, the Bad and the Ugly.

Implantable cardioverter defibrillators are small devices that have been proven to be beneficial by preventing sudden cardiac death, whether in primary or secondary prevention. Appropriate functioning of implantable cardioverter defibrillators is mainly dependent on the "good" sensing of ventricular electrogram waves, allowing for the adequate detection of ventricular arrhythmias in order to deliver appropriate therapy of either antitachycardia pacing or by delivering a shock according to the detected rhythm. Basic sensing function in defibrillators is based on detection rate and detection duration; additional parameters that are involved in the process of adequate detection include ventricular electrogram sensing, auto-adjusting sensitivity, supraventricular arrhythmia discrimination criteria, noise detection, and various dedicated algorithms.

Stress Echocardiography: Concept and Criteria, Structure and Steps, Obstacles and Outcomes, Focused Update and Review.

Stress echocardiography (SEC) is a technique established more than 35 years ago; however, it is still poorly implemented in many countries and institutions, and this reluctance may be related to many obstacles such as operator skills, lack of awareness or institutional policy. Stress echo was initially used for assessing coronary artery disease (CAD), with respect to myocardial viability, using wall motion response; however, current use of stress echo extends beyond CAD, such as valvular heart disease and diastolic stress test. Dobutamine is a commonly used agent when pharmaceutical approach is implemented.

Vernakalant in Atrial Fibrillation: A Relatively New Weapon in the Armamentarium Against an Old Enemy.

Atrial fibrillation is the most common sustained cardiac arrhythmia, and its prevalence is increasing with age; also it is associated with significant morbidity and mortality. Rhythm control is advised in recent-onset atrial fibrillation, and in highly symptomatic patients, also in young and active individuals. Moreover, rhythm control is associated with lower incidence of progression to permanent atrial fibrillation.

Unfortunate Hand Positioning Yielding Inappropriate Defibrillator Shock: Another Paradigm of a Guilty Association Between Patient Awareness and Occupational Hazard.

A 64-year-old patient had a cardiac resynchronization therapy defibrillator implanted 4 years ago for dilated cardiomyopathy. He recently had an inappropriate shock as a result of an electrical leak from a refrigerator causing electromagnetic interference. An analysis of the patient case and a discussion of the features of this specific paradigm of inappropriate therapy are presented.

Predictors of Undiagnosed and Uncontrolled Hypertension in the Local Community of Byblos, Lebanon.

Objective: This study aimed to determine the prevalence and predictors of undiagnosed and uncontrolled hypertension (HTN) in a local community in Lebanon.

Design And Methods: In this cross-sectional study, we interviewed 911 adults in the local community of Byblos, Lebanon, and 691 were enrolled in the study. Blood pressure (BP), height, and weight were measured.

Knowing About Device Algorithms to Understand the Rhythm and Role of Managed Ventricular Pacing.

A 66-year-old patient with a DR pacemaker for intermittent atrioventricular block presented with an electrocardiogram (ECG) showing some P waves non followed by QRS complexes, raising suspicion of device dysfunction. The device was equipped with a special algorithm (Managed Ventricular Pacing; Medtronic), and the observed ECG tracing was a normal consequence of the function of such algorithms. Being aware of the function of specific algorithms is essential to adequately analyze rhythms.

Role of Biomarkers in the Diagnosis, Risk Assessment, and Management of Pulmonary Hypertension.

Pulmonary hypertension is a severe and debilitating disease with no definite cure, and the domain of targeted therapies is a promising field for better management of this severe condition. The disease comprises pulmonary arterial remodeling, hypoxia, endothelial dysfunction, and inflammation, with subsequent organ damage including right heart and liver dysfunction. Biomarkers have a valuable role at different levels of the disease, from diagnosis to risk assessment and management, in order to decrease the burden of the disease in terms of both morbidity and mortality.

Double Trouble in a Patient with Coronary Ectasia, Bradycardia with Angina: Epiphenomenal or Mechanistic Association.

Coronary artery ectasia is a rare angiographical finding, and it accounts for less than 5% of all coronary angiograms. We report a case of a 55-year-old male patient who presented with fatigue and exertional chest pain. Paraclinical tests revealed cardiac ischemia and sinus node dysfunction, as well as coronary artery ectasia without significant coronary stenosis.

Appropriate Use Criteria in Echocardiography: An Observational Institutional Study with the Perspective of a Quality Improvement Project.

Background: Appropriate use criteria (AUC) in echocardiography are essential tools for aligning the indications of echocardiography with the best clinical standards, improving clinical outcome, restraining abuse, and preserving health-care resources.

Objectives: The aim of this study was to ascertain the AUC for transthoracic echocardiography in a university hospital and create a quality improvement project (QIP).

Methods: The assessment of 501 inpatients who received transthoracic cardiac echo was conducted according to the 2011 AUC report.

Echocardiographic Assessment of the Right Ventricle, from the Conventional Approach to Speckle Tracking and Three-Dimensional Imaging, and Insights into the "Right Way" to Explore the Forgotten Chamber.

Background: The right ventricle (RV) has an essential function in cardiovascular physiology and pathology. Currently, it is gaining an increasing interest given its recognized role in many cardiovascular conditions. However, echocardiographic assessment of the RV in daily practice is frequently based on qualitative estimation, and it has been regarded as a neglected chamber.

Assessment of heart rate turbulence in hypertensive patients: rationale, perspectives, and insight into autonomic nervous system dysfunction.

Background: Heart rhythm turbulence is classically impaired in patients with previous myocardial infarction and congestive heart failure and is poorly investigated in patients with essential hypertension.

Objective: To evaluate heart rhythm turbulence parameters (turbulence onset, (TO); turbulence slope, (TS) in a series of hypertensive patients while gaining insight into autonomic nervous system dysfunction.

Setting And Design: University hospital, cross-sectional monocentric study.

The lebanese society of cardiology: plans and perspectives, navigating against contrary winds and progressing against all odds.

Scientific societies in medicine theoretically aim to improve a medical field as a science; however, this role is expanding nowadays to seeking also the improved practice of a certain medical field. In this regard, the current Lebanese Society of Cardiology (2013-2015) has laid many plans and considered many perspectives. These concern mainly, but not exclusively, the increase of public awareness regarding prevention, investment in research, implementation of guidelines, support of continuous medical education, organization of cardiology symposia and congresses, and achievement of national registries regarding main cardiac conditions, as well as the society's main objective of decreasing the burden of cardiovascular diseases in Lebanon.

Concealed Sinus Node Dysfunction and Paradoxical Effect of Atropine during Arrhythmia Diagnostic Pharmacological Testing.

A 78-year-old male patient presented with repetitive fainting episodes. His electrocardiogram showed sinus rhythm with persistent ventricular bigeminy. Concealed sinus node dysfunction (SND) with consecutive bradycardia-induced ventricular hyperexcitability was suspected.

Echocardiographic assessment of mitral valve regurgitation, pattern and prevalence, expanding clinical awareness through an institutional survey with the perspective of a quality improvement project.

Background: Mitral regurgitation (MR) is frequently reported in everyday echocardiograms; accurate assessment is essential for appropriate management and decision making.

Objective: We performed a self-audit in order to define the prevalence and pattern of MR and to evaluate methods of assessment with the perspective of developing a quality improvement project.

Methods And Setting: This retrospective analytical study was conducted in a university hospital.

Echocardiography practice: insights into appropriate clinical use, technical competence and quality improvement program.

Echocardiography accounts for nearly half of all cardiac imaging techniques. It is a widely available and adaptable tool, as well as being a cost-effective and mainly a non-invasive test. In addition, echocardiography provides extensive clinical data, which is related to the presence or advent of different modalities (tissue Doppler imaging, speckle tracking imaging, three-dimensional mode, contrast echo, etc.

Temporary Endocavitary Pacemakers and their Use and Misuse: the Least is Better.

Temporary pacemakers are classically indicated for severe bradydysrhythmia, especially when the clinical settings require prompt intervention. Implantation of a temporary pacemaker is not a benign procedure since it may be associated with serious adverse events such as infection, cardiac perforation, and lead dislodgment. Accordingly, we recommend, when the clinical condition allows, to proceed directly with permanent pacemaker implantation without prior use of a temporary pacemaker.

Implantable cardioverter defibrillator and inappropriate therapy: "black box" examination yielded both human and technical causes.

We report on a 70-year-old male patient who was recipient of GEM III DR 7275 Cardioverter Defibrillator, and who presented with inappropriate shocks. The patient had a documented slow ventricular tachycardia (VT), and the device was programmed to detect VT at rates >100 bpm, fast VT (FVT, via VT) at rates >150 bpm, and ventricular fibrillation (VF) at rates >188 bpm. After detection of FVT, efficient therapy was delivered; however, this was immediately followed by multiple inappropriate therapies.