Three's a Crowd - An Extremely Rare Case of Cor Triatriatum Dexter.

Introduction: Cor triatriatum is a congenital cardiac anomaly in which the left (sinister) or right (dexter) atrium is divided into two compartments by residual embryonic tissue, resulting in a tri-atrial heart. As cor triatriatum dextrum can present clinically in various ways and have multiple associated cardiac anomalies, this report attempts to contribute to what is known about this exceedingly rare disorder.

Case: A 40 year old Hispanic man with a medical history of gastritis presented with complaints of palpitations, dizziness and bilateral lower extremity edema.

LIPOMATOUS HYPERTROPHY OF INTRA ATRIAL SEPTU.

Lipomatous hypertrophy of the intra-atrial septum (IAS) is often misdiagnosed on routine imaging as a possible intra-cardiac mass, often leading to unnecessary and invasive surgical interventions. The use of transesophageal echocardiography can help to better diagnose this condition and avoid needless invasive procedures.

FOOD FOR THOUGHT: MITRAL STENOSIS WITH A SIDE OF MAC AND CHEESE.

Caseous mitral annular calcification (CMAC) is a rare variant of mitral annular calcification (MAC), most commonly seen in elderly women on the posterior mitral annulus. CMAC is usually diagnosed incidentally and has a benign course. However, it may cause abnormal blood flow across the mitral valve resulting in mitral regurgitation, and rarely, functional mitral stenosis.

Prevalence of conduction abnormalities in a systolic heart failure population by race, ethnicity, and gender.

Background: There is paucity of data regarding conduction abnormalities in the Hispanic population with systolic heart failure (HF). We aimed to evaluate the prevalence of electrocardiogram (ECG) abnormalities in a systolic HF population, with attention to the Hispanic population.

Methods: A cross sectional study of 926 patients enrolled in a systolic HF disease management program.

Pathways in heart failure disease management across socioeconomic spectra.

Caring for heart failure patients with a low socioeconomic status presents a unique set of challenges for health care providers. Heart failure disease management programs can integrate the use of teaching DVDs to overcome deficiencies in health literacy and take advantage of the Wal-Mart/Target $4 dollar medication program to provide life-saving medical therapy. In addition, open discussions with the patient and family regarding the costs of medications and the reality of what they can afford to pay monthly on a long term basis can guide the physician to prescribing medications by prioritizing use with a focus on evidence-based data for the medications with the highest mortality reduction.

Feasibility of a heart failure disease management program in eastern Europe: Tbilisi, Georgia.

Background: Little is known about the importation of a heart failure disease management program (HFDMP) into low- and middle-income countries. We examined the feasibility of importing a HFDMP into the country of Georgia, located in the Caucuses.

Methods And Results: Patients with ejection fraction ≤40% were enrolled into a prospective, observational study consisting of a new HFDMP staffed by local cardiologists.

Eliminating disparities in hypertension care for Hispanics and blacks using a heart failure disease management program.

Objectives: This study assessed if patients enrolled in a heart failure disease management program (HFDMP) reach the JNC VII target goals for blood pressure (BP) control, eliminate disparities in hypertension control by race/ ethnicity and the impact BP control has on survival.

Methods: Patients (N = 898) with an ejection fraction <40% were enrolled into two HFDMPs and screened for hypertension, defined as BP > 130/80.

Results: Mean baseline systolic BP (SBP) 132 ± 25.

Routine serial echocardiography in systolic heart failure: is it time for the heart failure guidelines to change?

The authors sought to obtain objective evidence for impacting the American College of Cardiology Heart Failure Guidelines for the routine use of serial echocardiography by assessing the reliability of the use of clinician-assessed patient symptoms and New York Heart Association (NYHA) functional classification compared with ejection fraction (EF) measured by echocardiography. A prospective study in 256 patients with systolic heart failure (HF) enrolled into an HF disease management program with EF ≤40% and at least 2 annual echocardiograms were included. Only 86 of 256 (33.

Prevalence of stroke in systolic heart failure.

Background: Heart disease is a major independent risk factor for stroke, ranking third after age and hypertension. Heart failure (HF) patient constitutes an important subgroup of patients with stroke, because of their poor outcome and high rates of mortality and stroke recurrence. We examined the prevalence of stroke in patients with heart failure from 3 different geographic regions.

Low serum sodium as a poor prognostic indicator for mortality in congestive heart failure patients.

Background: The incidence of congestive heart failure (CHF) has not significantly declined over the past 50 years, and overall survival rates are low at 5 years following diagnosis. Numerous studies have shown low serum sodium to be a poor prognostic indicator of all cause mortality in CHF patients.

Hypothesis: The goal of this hypothesis was to validate if hyponatremia is an important predictor of mortality in an outpatient population of CHF patients on maximal combined angiotensin-converting enzyme inhibitor (ACEI) and β-blocker therapy.

Prevalence of vaccination rates in systolic heart failure: a prospective study of 549 patients by age, race, ethnicity, and sex in a heart failure disease management program.

Healthy People 2010 aims at immunizing 60% of high-risk adults annually against influenza and once against pneumococcal disease. The aim of this study was to evaluate the use of a standardized approach to improve vaccination rates in patients with heart failure (HF); to determine whether disparities exist based on age, race, ethnicity, or sex at baseline and follow-up; and to evaluate the impact of clinical variables on the odds of being vaccinated. A prospective study of 549 indigent patients enrolled in a systolic HF disease management program (HFDMP) began enrollment from August 2007 to January 2009 at Jackson Memorial Hospital.

Prevalence of erectile dysfunction in systolic heart failure patients in a developing country: Tbilisi, Georgia, Eastern Europe.

Introduction: In the past decade, there has been an increasing amount of published information regarding erectile dysfunction (ED) and heart failure (HF) in economically advanced, westernized populations. However, there is a paucity of data regarding ED and HF in developing countries. The country of Georgia is categorized as a lower-middle-income country (LMIC) with an emerging and developing economy.

Evidence-based medication adherence in Hispanic patients with systolic heart failure in a disease management program.

The Hispanic population is the fastest growing minority in the United States, yet there is a paucity of data regarding patient follow-up in heart failure disease management programs (HFDMPs) and evidence-based medication adherence. The purpose of this study is to measure the compliance of evidence-based medication use, specifically measuring angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and beta-blockers (BBs) in the Hispanic population, and compare these data to the white and black population. The authors conducted a cross-sectional study of 561 patients enrolled in an HFDMP at Jackson Medical Hospital in Miami, Florida.

The prevalence of peripheral arterial disease in patients with heart failure by race and ethnicity.

More than 5 million people live with heart failure (HF) in the United States, and this number is expected to rise due to several factors including increased life expectancy brought about by medical therapy and the aging of the population. HF and peripheral arterial disease (PAD) share many risk factors. A review of the literature reveals several studies supporting a higher prevalence of HF in patients with PAD than in those without PAD.

Handheld ultrasound, B-natriuretic peptide for screening stage B heart failure.

Objective: To determine if B-natriuretic peptide (BNP), handheld ultrasound, and echo interpretation was an accurate and reliable screening for stage B heart failure.

Methods: One hundred and forty-five indigent diabetic patients were prospectively enrolled, and their BNP levels were measured. Each patient underwent a handheld echo.

Epidemiology and survival of the five stages of chronic kidney disease in a systolic heart failure population.

Aims: The epidemiology of the five stages of chronic kidney disease (CKD) in systolic heart failure (HF) patients has predominantly been described in hospitalized White patients, with little known about the prevalence in outpatient Blacks and Hispanics. The purpose of this study was to compare the prevalence of the five stages of CKD by race, ethnicity (Whites, Blacks, and Hispanics), and gender in an outpatient systolic HF population and also to evaluate the impact of CKD on mortality.

Methods And Results: We conducted a prospective study of 1301 patients recruited from two hospital facilities in Louisiana and Florida, USA.

The impact of a standardized disease management program on race/ethnicity and gender disparities in care and mortality.

Background: Data on racial and gender differences in mortality in patients followed in a standardized heart failure disease management program (HFDMP) are scarce.

Methods: Survival was calculated by race/ethnicity and gender for 837 patients enrolled in a HFDMP. (The patients studied were indigent African American and White outpatients [39% African American, 36% female] enrolled into at Leonard J.

Prevalence of electrocardiographic abnormalities in a systolic heart failure disease management population by race, ethnicity, and sex.

The prevalence of electrocardiographic (ECG) abnormalities in systolic heart failure patients have predominantly been described in white patients, with relatively little known about their prevalence in black and Hispanic populations. The purpose of this study is to compare the prevalence of ECG abnormalities by race, ethnicity, and sex. The authors conducted an observational prospective study that included 926 patients from 2 hospital facilities.

Utility of the 6-minute walk test following lung transplantation.

Background: The 6-minute walk test (6-MWT) has replaced standard cardiopulmonary exercises for the evaluation of lung disease. However, data on the utility and characteristics of the 6-MWT following lung transplant are lacking. This study aimed to determine if 6-MWT distance has a normal distribution at 6 months post-transplant and if lower 6-MWT distance was predictive of all-cause mortality.

Metabolic syndrome increases mortality in heart failure.

Background: Metabolic syndrome (MetS) is a risk factor for diabetes, cardiovascular disease, and heart failure, but little is known about the impact of MetS in patients who already have heart failure (HF).

Hypothesis: MetS increases mortality in HF.

Methods: We performed an analysis in 865 indigent HF patients enrolled in a HF disease management program at the Chabert Medical Center in Louisiana.

Peripheral vascular disease and erectile dysfunction as predictors of mortality in heart failure patients.

Introduction: Seventy percent to 90% of patients with heart failure (HF) report erectile problems. There are no published data on whether erectile dysfunction (ED) and peripheral vascular disease (PVD) correlate with mortality in HF patients. Also, little is known regarding the impact of HF etiology on mortality in patients with ED.

Expansion of heart failure device therapy into a rural indigent population in Louisiana: potential economic and health policy implications.

Background: Research regarding the use of implantable devices in patients with congestive heart failure (CHF) has shown mortality benefits. The Center for Medicare and Medicaid Services (CMS) approved new criteria for expanding coverage for such therapies. The purpose of this study was to determine the percentages of CHF patients in a rural, indigent heart failure population that would be eligible for implantable defibrillators (ICD) and cardiac resynchronization therapy (CRT) based on the new CMS criteria.

Hurricanes and heart failure: a review of the who, what, when, and where of beta-blocker therapy.

beta-Blocker therapy has changed the landscape of treatment for chronic heart failure (HF). First recommended in published guidelines in 1999, the use of beta-blockers has become the cornerstone of therapy. beta-Blockers reduce both morbidity and mortality and also improve quality of life.

The effect of anemia on mortality in indigent patients with mild-to-moderate chronic heart failure.

Anemia has been described as an independent predictor of death in patients with chronic heart failure. Little is known, however, about the significance of anemia in heart failure patients with severely depressed socioeconomic backgrounds who receive comprehensive care in a heart failure management program. The impact of anemia on mortality was investigated in 410 indigent chronic heart failure patients, the majority of whom were in New York Heart Association functional class I-III and were treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and beta blockers at maximally tolerated doses.