Predictive risk stratification using HEART (history, electrocardiogram, age, risk factors, and initial troponin) and TIMI (thrombolysis in myocardial infarction) scores in non-high risk chest pain patients: An African American urban community based hospital study.

Validated risk scoring systems in African American (AA) population are under studied. We utilized history, electrocardiogram, age, risk factors, and initial troponin (HEART) and thrombolysis in myocardial infarction (TIMI) scores to predict major adverse cardiovascular events (MACE) in non-high cardiovascular (CV) risk predominantly AA patient population.A retrospective emergency department (ED) charts review of 1266 chest pain patients where HEART and TIMI scores were calculated for each patient.

Contrast-Induced Nephropathy After Cardiac Catheterization: Culprits, Consequences and Predictors.

Background: Contrast-induced nephropathy (CIN) is a common complication after radiocontrast exposure.

Methods: A retrospective medical record review of 513 hospitalized patients who underwent cardiac catheterization from June-December 2014 was done, of which 38 patients with end-stage renal disease and 57 patients without preprocedural creatinine were excluded. Serum creatinine concentration before the procedure and each day for 3 days after the procedure was recorded.

Risk factor analysis of troponin-negative chest-pain patients who underwent cardiac catheterization.

Objective: The purpose of this study is to identify risk factors in chest-pain patients with negative troponins who underwent cardiac catheterization after a positive myocardial perfusion imaging study.

Background: Stress testing is beneficial to providing a prognosis for patients with known CAD. This study intends to identify pretest risk factors that will give the least number of false positive nuclear stress test results.

Paradoxical embolism, deep vein thrombosis, pulmonary embolism in a patient with patent foramen ovale: a case report.

Introduction: Coexistence of pulmonary embolism and systemic arterial embolism suggest the diagnosis of paradoxical embolism which suggests the presence of intracardiac defects such as patent foramen ovale (PFO).

Case Presentation: A 42 year old man was found to have a paradoxical embolism in the systemic arterial circulation, in the setting of pulmonary embolism and deep vein thrombosis (DVT) in the lower extremities.

Conclusion: Paradoxical embolism and intracardiac shunt should be immediately considered in a patient with pulmonary embolism and systemic arterial embolism.

Clenbuterol-contaminated heroin: cardiovascular and metabolic effects. A case series and review.

We report a series of six cases, admitted over a single weekend, following nasal inhalation of street drugs and exhibiting markedly atypical presentations. Clenbuterol, a beta2 adrenoceptor agonist, was identified as a contaminant. Increased awareness of the effects of specific adulterants is essential to the adequate management of these patients.

Inadvertent stenting of left main coronary artery complicated by later in-stent restenosis.

Stenting of both the protected and unprotected left main coronary artery has been described. This case presents a patient who had inadvertent left main stent deployment. A 47-year-old female presented with a non-Q-wave infarction and subsequent angina leading to angiography and angioplasty of her proximal ramus intermedius artery.

Cardiocutaneous fistula.

Infection of the Teflon pledgets on the heart suture line after left ventricular aneurysm repair, presenting late with a fistulous tract connecting the heart with the skin (cardiocutaneous fistula) is an uncommon but potentially serious condition. The case is reported of a 73 year old man who developed a cardiocutaneous fistula extending through the left hemidiaphragm and draining at the abdominal wall, which developed six years after left ventricular aneurysmectomy. Following radiographic evaluation, which established the diagnosis, the Teflon pledgets and fistulous tract were successfully surgically removed.

Successful coronary stenting without warfarin or intravascular ultrasound.

Although warfarin is typically recommended in the management of patients following coronary stent implantation, several studies have suggested a reduced incidence of subacute thrombosis if the antiplatelet drug ticlopidine is employed instead. Postdilatation with a high pressure balloon catheter is now commonly performed following stent deployment. However, there is uncertainty whether intravascular ultrasound is important in assessing adequacy of stent expansion.

Endocarditis in an urban hospital in the 1990s.

Objectives: To analyze the clinical characteristics and outcome of 159 consecutive patients with endocarditis who presented to an inner-city hospital from 1990 onward and to elucidate the most current problems and advances in the management of endocarditis.

Methods: One hundred eighty-two consecutive cases (in 159 patients) met diagnostic criteria for endocarditis, including histopathologic evidence or multiple positive blood cultures without another primary source, and appropriate signs or symptoms. Transthoracic echocardiography was performed for 171 cases, and 36 patients underwent transesophageal echocardiography.

Mitral valve repair for mitral regurgitation utilizing intraoperative transesophageal echocardiography--late results.

Ninety consecutive patients underwent mitral valve repair for mitral regurgitation (MR) utilizing intraoperative transesophageal echocardiography (TEE). Fifty-nine males and 31 females between the ages of 31 and 88 with a mean age of 67.9 years were evaluated.

Coronary stenting for aortocoronary dissection following balloon angioplasty.

We report a case of coronary dissection following percutaneous transluminal coronary angioplasty (PTCA) in which the dissection extended antegrade as well as retrograde into the aortic root. Emergent stenting was able to seal the dissection entry point, resulting in restoration of normal coronary flow and diminution in the degree of aortic dissection.

Pseudoaneurysm causing partial obliteration of the left atrium: case report and review.

We describe a case of left ventricular pseudoaneurysm with subepicardial dissection onto the left atrial wall, mimicking a smooth left atrial mass, causing partial obliteration of the left atrial cavity. This patient presented with a transient ischemic attack, most likely resulting from a thromboembolic episode to the brain. Emergent surgery was successfully performed and the patient is doing well at 1-year follow-up, with no signs of left atrial compression by transthoracic echocardiography.

Coronary artery bypass graft pseudoaneurysm communicating with the right atrium: a case report and review.

We report a pseudoaneurysm of the right coronary artery bypass graft with fistulous drainage into the right atrium. This patient presented with an acute myocardial infarction in a different vascular territory. Cardiac catheterization led to the diagnosis of the pseudoaneurysm.

Is cardiac catheterization necessary in the era of echocardiography? Cost-effective approach combining echocardiography and cardiac catheterization.

Definitive evaluation of cardiovascular disease is traditionally accomplished by cardiac catheterization. Advances in transthoracic and transesophageal Doppler echocardiography provides an accurate and cost-effective approach when compared to cardiac catheterization. Recent data suggests that for most adult patients with aortic or mitral valve disease, Doppler echocardiographic data enables the clinician to make the same decision reached with catheterization data.

Activated clotting-time variability in patients undergoing coronary angioplasty.

Although the activated clotting time (ACT) is commonly used to assess adequacy of anticoagulation during percutaneous transluminal coronary angioplasty (PTCA), there is uncertainty whether measurements on samples from the arterial and venous circulations are directly comparable. We performed ACT determinations on 115 patients undergoing PTCA at our institution. Blood samples were drawn in a sequential fashion from the arterial and femoral venous sheaths at the conclusion of each case, and ACT determination were performed in the catheterization laboratory immediately thereafter.

Intraoperative transesophageal echocardiography--an indispensable tool in valve reconstruction and congenital anomalies.

Transesophageal echocardiography (TEE) with color flow mapping has become an excellent tool for evaluating valve reconstruction and correction of congenital anomalies intraoperatively. From February 1990 to September 1990 we have utilized TEE intraoperatively in 14 consecutive patients. Their ages ranged from 25 to 77 years, with a mean age of 58.

Ventricular fibrillation during coronary angiography: reduced incidence with nonionic contrast media.

Ventricular fibrillation during coronary angiography with Renografin-76 has been attributed to the high osmolar ionic and calcium binding additive properties. Isovue-370 is a new low osmolar nonionic contrast medium lacking calcium binding additives. The present investigation compared the incidence of contrast media-induced ventricular fibrillation in patients undergoing coronary angiography with Renografin-76 to that with Isovue-370.

Doppler echocardiographic detection of traumatic ventricular septal defect--a case report.

A case of traumatic ventricular septal defect diagnosed by Doppler echocardiography is described. The characteristic pulsed Doppler findings of a left-to-right shunt were recorded and the two-dimensional echocardiographic images of septal interruption were shown. Combined Doppler and two-dimensional echocardiography enhances the ability to detect the presence of a ventricular septal defect.

Radiation-induced stenosis of the left main coronary artery.

A case of isolated left main coronary artery stenosis ten years following irradiation of the mediastinum for Hodgkin's disease is presented. Aortic biopsies were consistent with changes suggestive of radiation arteritis.