Out-of-season, multiserotype acute coxsackie B myocarditis with concomitant thyrotoxicity.

Acute viral myocarditis and hyperthyroidism can present with acute coronary syndrome. However, the link between hyperthyroidism and myocarditis has hardly been explored apart from a small collection of published case reports. We report a case where a patient presents with severe chest pain and was found to have concomitant severe coronary vasospasm and acute myocarditis and was diagnosed with Graves' disease.

Feasibility and Safety of Impella-Assisted High-Risk PCI Before TAVR in Patients With Severe Aortic Stenosis.

Background: There are limited data on the feasibility of Impella-assisted percutaneous coronary intervention (PCI) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).

Methods: To assess the feasibility of the Impella-assisted PCI in patients with severe symptomatic AS, we retrospectively reviewed the medical records to identify patients who were electively admitted for Impella-assisted PCI with a subsequent TAVR at Weill Cornell Medical Center from 2016 to 2021.

Results: During the study period, 15 patients were identified to be eligible for the study, but the Impella failed to cross the aortic valve in 1 patient despite a concomitant balloon aortic valvuloplasty requiring a switch to an intra-aortic balloon pump to assist PCI.

Psychosocial responses to COVID-19 among nurses in two hospitals: a mixed method study at Eastern Nepal.

Background: Most documented studies have focused on mental health status of health care workers during the pandemic but there are very few studies, focusing on mitigation of mental health problems among nurses.

Aim: To study psychosocial responses to COVID-19 and the effectiveness of intervention among nurses.

Materials And Methods: A mixed-method study was conducted, including 278 nurses from two COVID-19 hospitals of the province by purposive sampling.

Comparision of Quality of Life of Senior Citizens Residing in Old Age Homes and Own Residence.

Background: Quality of life of elderly is becoming even more relevant with demographic shift happening towards an ageing society. With fast changing family condition and social contexts, lives of elderly people in Nepal have been changing dramatically. Old age homes have sprung up to cater to the needs of the elderly from different socio-economic backgrounds.

Functional Mitral Regurgitation in Heart Failure.

Functional mitral regurgitation (FMR) in the setting of left ventricular (LV) dysfunction and heart failure portends a poor prognosis. Guideline-directed medical therapy remains the cornerstone of initial treatment, with emphasis placed on treatment of the underlying LV dysfunction, as FMR is a secondary phenomenon and a disease due to LV remodeling. Surgical correction of FMR is controversial because it typically does not address the underlying mechanism and etiology of the condition.

Availability of Life Support Equipment and its Utilization by Ambulance Drivers.

Background: An effective ambulance is a vital requirement for providing an emergency medical service. Well-equipped ambulances with trained paramedics can save many lives during the golden hours of trauma care. The objective was to document the availability and utilization of basic life support equipment in the ambulances and to assess knowledge on first aid among the drivers.

Multimodality Imaging of the Right Ventricle.

Right ventricular (RV) structure and function is clinically important in a wide range of conditions. While conventional echocardiography (echo) methods are widely used, its limitations in RV assessment due its complex geometry are well recognized. New applications of traditional echo methods as well as emerging echo techniques including 3-dimensional (3D) echo and speckle tracking strain have the potential to overcome limitations of conventional echo, though widespread clinical use remains to be seen.

Fractional flow reserve to guide surgical coronary revascularization.

Coronary angiography has traditionally been used as the final diagnostic tool in the evaluation of coronary artery disease (CAD). However, conventional angiography identifies anatomically obstructive coronary disease, but it is limited in its ability to identify hemodynamically significant lesions. The emergence of fractional flow reserve (FFR) technology, in conjunction with angiography, offers a functional, as well as anatomic, assessment of epicardial coronary obstructions.

Practical Considerations of Fractional Flow Reserve Utilization to Guide Revascularization.

Invasive angiography has long been the gold standard for the diagnosis of obstructive coronary artery disease (CAD). However, the relationship between angiographic measures of stenosis and coronary blood flow is complex, and there is frequent discordance between the visual assessment of a stenotic lesion and its effect on myocardial perfusion. Fractional flow reserve is a rapidly emerging invasive means of assessing the physiologic significance of an epicardial stenosis.

Echocardiographic linear fractional shortening for quantification of right ventricular systolic function-A cardiac magnetic resonance validation study.

Background: Echocardiography (echo)-based linear fractional shortening (FS) is widely used to assess left ventricular dysfunction (LV ), but has not been systematically tested for right ventricular dysfunction (RV ).

Methods: The population comprised LV patients with and without RV (EF<50%) on cardiac MRI (CMR): Echo included standard RV indices (fractional area change [FAC], TAPSE, S', and FS in parasternal long-axis (RV outflow tract [RV ]) and apical four-chamber views (width [RV ], length [RV ]).

Results: A total of 168 patients underwent echo and CMR (3±3 days); FAC (46±9 vs 28±11), TAPSE (1.

Right Ventricular Dysfunction Impairs Effort Tolerance Independent of Left Ventricular Function Among Patients Undergoing Exercise Stress Myocardial Perfusion Imaging.

Background: Right ventricular (RV) and left ventricular (LV) function are closely linked due to a variety of factors, including common coronary blood supply. Altered LV perfusion holds the potential to affect the RV, but links between LV ischemia and RV performance, and independent impact of RV dysfunction on effort tolerance, are unknown.

Methods And Results: The population comprised 2051 patients who underwent exercise stress myocardial perfusion imaging and echo (5.

Comparison of Recent Trends in Patients With and Without Major Depression and Acute ST-Elevation Myocardial Infarction.

Depression has been associated with adverse outcomes after acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). However, trends over time in the incidence and inhospital treatment of STEMI for patients with co-morbid depression in the current era are unknown. We conducted a serial, cross-sectional analysis of patients with STEMI (weighted n = 3,057,998) in the National Inpatient Sample from 2003 to 2012.

Gender Differences in In-Hospital Outcomes After Coronary Artery Bypass Grafting.

Women historically have a greater risk of operative mortality than men after coronary artery bypass grafting (CABG). There is paucity of contemporary data in gender outcomes of surgical revascularization and understanding modifiable factors that contribute to gender differences are critical for quality improvement and practice change. We, therefore, sought to examine whether the gender gap in CABG outcomes is closing in the contemporary era by conducting a retrospective analysis from the Nationwide Inpatient Sample database from 2003 to 2012.

Iron deficiency thrombocytopenia: a case report.

Objective: To describe a rare case of thrombocytopenia secondary to iron deficiency.

Clinical Presentation And Intervention: A 34-year-old woman presented with severe microcytic hypochromic anemia and thrombocytopenia. Her ferritin was 1 ng/dl.

Alloimmune induction of endothelial cell-derived interferon-gamma-inducible chemokines.

Background: The interaction between host lymphocytes and endothelial cells on the transplanted organ is believed to play an important role in acute and chronic graft rejection. Trafficking and recruitment of lymphocytes to the site of inflammation is known to be controlled by several cytokines and chemokines. It is unclear whether endothelial cells themselves can be a source of inflammatory chemoattractant molecules on alloimmune induction.