Publications by authors named "Nina Thakkar Rivera"

Article Synopsis
  • The study evaluated a personalized treatment plan for heart failure patients, focusing on improving their medication regimen and overall health outcomes.
  • The results showed significant improvements in both medication scores and heart function, with many patients experiencing better symptoms and fewer hospitalizations.
  • The approach led to lower mortality rates compared to expected figures, suggesting that this aggressive protocol can effectively bridge the gap between existing medical knowledge and practical treatment for heart failure.
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Article Synopsis
  • The study investigates different heart failure (HF) types in patients diagnosed with transthyretin cardiac amyloidosis (ATTR-CA), revealing that a significant portion present with impaired systolic function, specifically heart failure with reduced ejection fraction (HFrEF) or mildly reduced ejection fraction (HFmrEF).
  • A retrospective analysis of patients from 2016 to 2022 found that 21.6% had HFrEF, 17.8% had HFmrEF, and 60.6% had heart failure with preserved ejection fraction (HFpEF), indicating a notable prevalence of systolic dysfunction in ATTR-CA cases.
  • The findings suggest that clinicians should maintain a high level of suspicion
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  • This study examines the risk factors for worsening renal function (wRF) in patients with transthyretin cardiac amyloidosis (ATTR-CA), which is linked to poor outcomes.
  • Out of 134 patients studied, 41.8% experienced wRF within the first year, with significant predictors being a higher New York Heart Association (NYHA) class, a lack of prior ischemic heart disease, and not being on SGLT-2 inhibitors.
  • The findings highlight that renal dysfunction is a common issue after ATTR-CA diagnosis, indicating that certain patient characteristics can help forecast who is at greater risk for developing wRF.
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  • A woman with flu-like symptoms experienced syncope and tested positive for influenza B.
  • She quickly deteriorated into cardiogenic shock over two days, needing intense medication and temporary mechanical support.
  • The case emphasizes the critical need for early intervention and proper medical guidelines for treating severe myocarditis caused by influenza B.
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  • A heart transplant recipient in his 60s experienced syncopal episodes due to a complete atrioventricular block seven months post-surgery.
  • To address this, doctors implanted a leadless pacemaker, navigating the challenges of his immunocompromised condition and past cardiac device issues.
  • Five years after the pacemaker was successfully implanted, the patient has remained free of syncopal episodes and device-related complications.
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A 71-year-old female with heart failure who underwent left ventricular assist device (LVAD) placement presented for evaluation of low hemoglobin and dark stools. She also had leg pain, numbness, and weakness for which she was taking ibuprofen. She was found to have a gastrointestinal bleed, INR of 4.

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Randomized controlled trials have demonstrated mortality benefits for several medication classes in patients with heart failure (HF), especially with reduced ejection fraction (EF). However, the benefit of these traditional HF therapies in patients with HF from cardiac amyloidosis is unclear. our study aimed to evaluate the safety and efficacy of traditional HF therapies in patients with cardiac amyloidosis and HF with reduced EF or HF with mid-range EF (HFmrEF).

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A man in his early 20s with heart failure with reduced ejection fraction secondary to non-compaction cardiomyopathy (Titin (TTN) gene mutation positive) was transitioned from left ventricular assist device (LVAD) mechanical support to heart transplantation. Transplantation was successful; however, LVAD explantation resulted in innumerable complications secondary to penetration of the driveline into the peritoneal cavity. He developed an enterocutaneous fistula which led to concurrent malnutrition, poor wound healing, systemic infection, and allograft rejection in a patient less than 1 month after heart transplantation on immunosuppression.

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Article Synopsis
  • A 69-year-old man with ischemic cardiomyopathy experienced complications after receiving a left ventricular assist device (LVAD), including abdominal pain and infections related to the device.
  • Serial cultures revealed various bacteria and imaging suggested possible colonic involvement but no perforation was found.
  • Over 9 months, he developed an enterocutaneous fistula due to driveline erosion of the colon, highlighting the need for careful investigation of gastrointestinal sources when typical infection patterns change in LVAD patients.
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Purpose Of Review: Despite advances in the technology of mechanical circulatory support, the need for heart transplantation continues to grow. The longevity of heart transplants continues to be superior to mechanical solutions, though the short-term differences are shrinking. In this review, we cover three timely developments and summarize the recent literature.

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A 68-year-old female with end-stage heart failure presented to the hospital for heart transplant. She was diagnosed with achalasia 14 months prior and treated with frequent botulinum toxin injections. She underwent orthotopic heart transplant on the day of admission and was extubated a few days later.

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Cardiogenic shock (CS) remains a leading cause of morbidity and mortality among patients with cardiovascular disease. In the past, acute myocardial infarction was the leading cause of CS. However, in recent years, other etiologies, such as decompensated chronic heart failure, arrhythmia, valvular disease, and post-cardiotomy, each with distinct hemodynamic profiles, have risen in prevalence.

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The use of left ventricular assist devices (LVADs) is increasingly more common as the availability of donor organs in relation to failing hearts is outstandingly limited. Infections are the most common complications in LVAD recipients, particularly those caused by Staphylococcus spp. Refractory LVAD-related infections are not uncommon as achieving adequate source control is often not feasible before heart transplantation.

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Background: Human immunodeficiency virus (HIV) infection affects nearly 38 million people worldwide. Patients living with HIV (PLHIV) on modern highly active antiretroviral therapy face significant morbidity and mortality related to the progression of chronic diseases, which lead to an increase in the burden of end-stage organ disease and organ failure. PLHIV present a two fold increased risk of heart failure as compared with the general population, with a prevalence of clinical heart failure of 6.

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The American Heart Association reports the annual incidence of out-of-hospital cardiopulmonary arrests (OHCA) is greater than 300,000 with a survival rate of 9.5%. Bystander cardiopulmonary resuscitation (CPR) saves one life for every 30, with a 10% decrease in survival associated with every minute of delay in CPR initiation.

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Infection of implanted cardiac devices has a low rate of occurrence. Fungal infections of such devices represent an atypical phenomenon, associated with high mortality. Both medical and surgical therapies are recommended for a successful outcome.

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