Analyses of electronic health records utilization in a large community hospital.

Introduction: The Electronic Health Record (EHR) has become an integral component of healthcare delivery. Survey based studies have estimated that physicians spend 4-6 hours of their workday devoted to EHR. Our study was designed to use computer software to objectively obtain time spent on EHR.

Left Ventricular Outflow Tract Obstruction From Preserved Leaflet After Mitral Valve Replacement.

Left ventricular outflow tract obstruction (LVOTO) can be caused by multiple factors. One of the rare causes of LVOTO is preserved anterior mitral valve leaflet and chordal apparatus after mitral valve replacement. We describe a case of a patient with worsening chronic congestive heart failure secondary to LVOTO from systolic anterior motion of residual native anterior mitral leaflet.

Ondansetron induced .

A single dose of oral Ondansetron can precipitate torsades de pointes and other arrhythmias in patients with risk factors that may prolong QTc interval.

Convergent ablation for persistent atrial fibrillation: Single center experience.

Background: Endocardial catheter ablation has been shown to be effective in patients with paroxysmal atrial fibrillation (AF), and significantly less effective in patients with persistent AF (PAF). Lately, there is a trend toward a hybrid approach in the treatment of PAF that may be a more durable treatment for patients with PAF. In this manuscript we report our experience with the convergent ablation procedure in a PAF cohort.

Complete Myocardial Function Recovery with ECMO in a Woman Presenting with Cardiogenic Shock during Peripartum Period.

Peripartum cardiomyopathy is a potentially life-threatening cause of heart failure (HF) that affects women toward the end of pregnancy or in months after delivery. Treatment is similar to the treatment for HF with reduced ejection fraction (EF). Most women make full myocardial function recovery within 6 months on conventional HF therapy.

Distal Perfusion Cannulation and Limb Complications in Venoarterial Extracorporeal Membrane Oxygenation.

The utility of distal perfusion cannula (DPC) placement for the prevention of limb complications in patients undergoing femoral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is poorly characterized. Patients undergoing femoral VA ECMO cannulation at two institutions were retrospectively assessed. Patients were grouped into those who did and those who did not receive a DPC at the time of primary cannulation.

High-Frequency Percussive Ventilation Rescue Therapy in Morbidly Obese Patients Failing Conventional Mechanical Ventilation.

Background: Morbidly obese patients with respiratory failure who do not improve on conventional mechanical ventilation (CMV) often undergo rescue therapy with extracorporeal membrane oxygenation (ECMO). We describe our experience with high-frequency percussive ventilation (HFPV) as a rescue modality.

Methods: In a retrospective analysis from 2009 to 2016, 12 morbidly obese patients underwent HFPV after failing to wean from CMV.

High-Frequency Percussive Ventilation Facilitates Weaning from Extracorporeal Membrane Oxygenation in Adults.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an invaluable rescue therapy for patients suffering from cardiopulmonary arrest, but it is not without its drawbacks. There are cases where patients recover their cardiac function, yet they fail to wean to mechanical conventional ventilation (MCV). The use of high-frequency percussive ventilation (HFPV) has been described in patients with acute respiratory failure (RF) who fail MCV.

High-frequency percussive ventilation in cardiac surgery patients failing mechanical conventional ventilation.

Objectives: Failure of mechanical conventional ventilation (MCV) after cardiac surgery portends a dismal prognosis, with extracorporeal membrane oxygenation frequently utilized as a salvage therapy. We describe our experience with high-frequency percussive ventilation (HFPV) as a rescue therapy for hypoxaemia refractory to MCV after cardiac surgery.

Methods: In a 6-year retrospective analysis from 2009 to 2015, we identified 16 subjects who required HFPV after cardiac surgery.

Use of High-Frequency Percussive Ventilation to Expand Organ Donor Pool.

A 34-year-old woman was brought in to the emergency department after a motor vehicle accident. She had signs of traumatic head injury with Glasgow Coma Scale score of 3, and her neurological examination was consistent with brain death. She was persistently hypoxic on conventional mechanical ventilation and high-frequency percussive ventilation was initiated.

Transcatheter Aortic Valve Replacement in Type B Aortic Dissection.

Transcatheter aortic valve replacement (TAVR) has become an acceptable alternative to surgical aortic valve replacement in high-risk and inoperable patients. Several technical and anatomical considerations can increase the complexity and risk of the procedure, and therefore are considered as contraindications to TAVR. Patients with significant aortic disease such as aortic dissection are not usually considered for TAVR due to risk of aortic rupture or retrograde extension of the dissection.

Simultaneous Two-Vessel Subacute Stent Thrombosis Caused by Clopidogrel Resistance from CYP2C19 Polymorphism.

Clopidogrel resistance from CYP2C19 polymorphism has been associated with stent thrombosis in patients undergoing percutaneous coronary intervention with drug-eluting stents. We present a case of a 76-year-old male who received drug-eluting stents to the right coronary artery and left anterior descending artery for non-ST elevation myocardial infarction and was discharged on dual antiplatelet therapy with aspirin and clopidogrel. He subsequently presented with chest pain from anterior, anteroseptal, and inferior ST segment elevation myocardial infarction.

Superior vena cava syndrome from an invasive thymoma with transcaval invasion to the right atrium.

Invasive thymoma with transcaval extension to the right atrium is a rare cause of superior vena cava syndrome. We present a case on a 74-year-old female presenting with dyspnea on exertion, and facial and upper extremity swelling. Physical examination revealed mild facial swelling, non-pitting edema involving the upper extremities and distention of superficial veins of the anterior chest wall and jugular veins.

Fogarty Maneuver to Restore Coronary Flow in ST-Segment Elevation Myocardial Infarction: Desperate Times Call for Desperate Measures.

Nonatherosclerotic embolism is a rare cause (4%-7%) of coronary occlusion in ST-segment elevation myocardial infarction (STEMI) patients, approximately half of which occur in inadequately anticoagulated patients with prosthetic valves. We report a rare case of a patient with severe rheumatic heart disease and 3 mechanical valves presenting with STEMI that was successfully managed by Fogarty maneuver thrombus extraction after failed thrombus aspiration and balloon angioplasty. A 56-year-old woman presented with an acute anterior STEMI and Killip class III heart failure.

Cardiac Amyloidosis Presenting With Cardiogenic Shock.

Cardiac amyloidosis is an infiltrative disorder of the myocardium. It is the result of one of 4 types of amyloidosis: primary systemic (immunoglobulin light chain), secondary, familial (hereditary), or senile. Cardiac amyloidosis ultimately causes congestive heart failure due to irreversible restrictive cardiomyopathy.

A Bridge to a Woman's Heart as the Cause of Recurrent Chest Pain: A Case on Myocardial Bridge.

Myocardial bridge is a congenital structural variant of the coronary arteries where a segment of the epicardial vessel is surrounded by the myocardium. It is an uncommon entity that may go unnoticed in patients with recurrent chest pain. We present a case on a 36-year-old woman with recurrent chest pain.