Return of a flight attendant to full duty following myocardial infarction and subsequent coronary artery bypass grafting through a high-intensity occupation-specific cardiovascular rehabilitation program.

Flight attendants play a vital role in the safety and security of air passengers during emergencies. A 61-year-old flight attendant who endured myocardial infarction and coronary artery bypass graft surgery wanted to return to full duty. To meet airline requirements, he chose to participate in our occupation-specific, high-intensity performance training program.

Cardiac rehabilitation testing of a high-intensity performance athlete firefighter after myocardial infarction, placement of stents and an implantable cardioverter-defibrillator.

Firefighters have one of the most stressful, physically demanding jobs to perform across the emergency services field and often suffer from job-related health conditions. A firefighter from California contacted our Baylor Heart and Vascular Hospital cardiac rehabilitation program with the hope of returning to work after myocardial infarction, placement of stents, and implantable cardioverter-defibrillator implantation. He underwent high-intensity performance testing (HIPT) developed for firefighters seeking to return to duty after cardiac events.

"Keep Your Move in the Tube" safely increases discharge home following cardiac surgery.

Background: Restrictive sternal precautions intended to prevent cardiac surgery patients from damaging healing sternotomies lack supporting evidence and may decrease independence and increase postacute care utilization. Data regarding the impact of alternative approaches on safety and outcomes are needed to guide evidence-based best practices.

Objective: To examine whether an approach allowing greater freedom during activities of daily living than permitted under commonly used restrictive sternal precautions can safely decrease postacute care utilization.

High-intensity, sport-specific cardiac rehabilitation training of a 22-year-old competitive cyclist after spontaneous coronary artery dissection.

A 22-year-old man with spontaneous coronary artery dissection wanted to assess the feasibility of returning to competitive cycling. He was referred to the cardiac rehabilitation (CR) program at Baylor Hamilton Heart and Vascular Hospital where staff designed a high-intensity, sport-specific training program that simulated the movements and forces associated with his goal activity. The program was symptom limited and enabled the patient to train earlier and at a higher intensity than is typically allowed in conventional CR programs.

Specificity of training in cardiac rehabilitation to facilitate a patient's return to strenuous work following aortic valve replacement.

A 30-year-old male roughneck worker on an oil rig underwent aortic valve replacement and subsequently enrolled in the Baylor Heart and Vascular Hospital exercise-based cardiac rehabilitation (CR) program. He expressed a strong desire to return to his physically demanding job. Based on his unique job requirements, CR staff designed and implemented comprehensive tests and a 5-week specific physical training program that included 6 exercises simulating his job functions.

Implementation of an Automatic Stop Order and Initial Antibiotic Exposure in Very Low Birth Weight Infants.

 To evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants.  We compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with birth weight <= 1500 g) born 2 years before (pre-ASO group,  = 313) to infants born in the 2 years after (post-ASO,  = 361) implementation of an ASO guideline. Early antibiotic exposure was quantified by days of therapy (DOT) and antibiotic use > 48 hours.

Specificity of testing in a cardiac rehabilitation setting resulting in a patient's return to high-intensity outdoor activity following aortic dissection repair.

A 66-year-old man who had undergone aortic dissection repair a year earlier sought to assess the feasibility of returning to the high-intensity outdoor activities he had long enjoyed. In response to his inquiry, the cardiac rehabilitation staff at Baylor Hamilton Heart and Vascular Hospital designed a comprehensive testing plan that simulated the specific movements and anticipated cardiac requirements associated with his goal activities. The activities included 1) lifting and manipulating a 50-pound suitcase, 2) hiking to the top of Half Dome in California's Yosemite National Park, and 3) scuba diving.

Heart transplantation in the Ehlers-Danlos syndrome.

We describe a woman with Ehlers-Danlos syndrome and aortic aneurysm who experienced a myocardial infarction due to spontaneous left circumflex coronary artery dissection 3 weeks postpartum. She developed end-stage heart failure and subsequently underwent a successful orthotopic heart transplantation. To our knowledge, this is the first report of a heart transplant performed in an individual with Ehlers-Danlos syndrome.

Spontaneous coronary artery dissection in a 22-year-old man on lisdexamfetamine.

Spontaneous coronary artery dissection (SCAD) is a rare cause of coronary events and sudden cardiac death. SCAD can present with a wide spectrum of clinical presentations and as an entity remains underrecognized. Several risk factors, such as female gender, peripartum and early postpartum state, and atherosclerotic disease, have been attributed to SCAD.

Usefulness of percutaneous closure of patent foramen ovale for hypoxia.

We report a patient with hypoxia secondary to a right-to-left shunt through a patent foramen ovale, following aortic root, valve, and arch replacement due to an aortic dissection in the setting of the Marfan syndrome. Following the operation, he failed extubation twice due to hypoxia. An extensive workup revealed a right-to-left shunt previously not seen.

Comparison of force exerted on the sternum during a sneeze versus during low-, moderate-, and high-intensity bench press resistance exercise with and without the valsalva maneuver in healthy volunteers.

Sternal precautions are intended to prevent complications after median sternotomy, but little data exist to support the consensus recommendations. To better characterize the forces on the sternum that can occur during everyday events, we conducted a prospective nonrandomized study of 41 healthy volunteers that evaluated the force exerted during bench press resistance exercise and while sneezing. A balloon-tipped esophageal catheter, inserted through the subject's nose and advanced into the thoracic cavity, was used to measure the intrathoracic pressure differential during the study activities.

High-intensity, occupation-specific training in a series of firefighters during phase II cardiac rehabilitation.

Six male firefighters who were referred to phase II cardiac rehabilitation after coronary revascularization participated in a specialized regimen of high-intensity, occupation-specific training (HIOST) that simulated firefighting tasks. During each session, the electrocardiogram, heart rate, and blood pressure were monitored, and the patients were observed for adverse symptoms. No patient had to discontinue HIOST because of adverse arrhythmias or symptoms.

High-intensity cardiac rehabilitation training of a police officer for his return to work and sports after coronary artery bypass grafting.

A 39-year-old male police officer with coronary artery disease enrolled in our cardiac rehabilitation (CR) program after coronary artery bypass grafting. He wanted to return not only to his job but also to playing ice hockey and outdoor soccer, and his responses to a self-assessment scale confirmed that he identified strongly as an athlete. On the basis of this unique profile, the CR staff designed an occupation- and sport-specific exercise program that was symptom limited and enabled the patient to train safely, but earlier and at a higher intensity than is typically allowed in conventional CR programs.

High-intensity track and field training in a cardiac rehabilitation program.

A 65-year-old male athlete with coronary artery disease enrolled in our cardiac rehabilitation (CR) program after successful coronary artery bypass graft surgery following an acute myocardial infarction. Unlike the typical sedentary cardiac patient in his age group, he loved to participate in hurdle events at masters division track meets (competitions for athletes aged 30 years and older). He expressed a strong desire to return to his sport, so we designed a sport-specific, symptom-limited exercise program that enabled him to train safely but at a higher intensity than is typically allowed in conventional CR programs.

Implementation of an informational card to reduce family members' anxiety.

For surgical patients' family members, the wait during surgery can cause anxiety that can be exacerbated if staff members provide inadequate or inconsistent information about the patient's status. Educational interventions and other staff-intensive measures to help reduce family members' anxiety can be time consuming for staff members and impractical in a high-volume facility. To improve communication with patients' families, nurses at a heart and vascular hospital in Dallas, Texas, designed and distributed a card containing estimated procedure times, helpful telephone numbers, and other information.

Surgical treatment of atrial fibrillation with diode-pumped laser.

Twenty-eight patients from a single surgeon and center underwent atrial fibrillation surgery using a diode-pumped laser. A left-sided modified (pulmonary vein encircling with connecting lesions) or a complete modified Cox-Maze III operation was employed. Of the 28 patients, 23 were available for retrospective evaluation and Holter monitoring, and 21 patients elected to participate in a follow-up study.

Standardization of a surgical site precleansing technique for vascular patients.

Surgical site infection (SSI) is a serious complication that can increase hospital costs and length of stay and may be life threatening. The preoperative chlorhexidine shower is widely recommended to decrease SSI risk, although standardized guidelines for this practice and supporting clinical evidence are lacking. Because vascular patients often have comorbidities that hinder preoperative showering, OR nurses at a specialty hospital in Dallas, Texas, developed and implemented an intraoperative surgical site precleansing technique as standard practice for patients undergoing procedures involving the axilla or groin.

Challenging traditional activity limits after coronary artery bypass graft surgery: a simulated lawn-mowing activity.

Purpose: Physician advice and restrictions to patients following a cardiac event can, in some instances, lead patients to be fearful regarding their activities even to the point of inactivity. The purpose of this study was to test whether lawn mowing, one of the activities most strongly discouraged after coronary artery bypass surgery, could be safely performed in a supervised setting.

Method: Subjects participated in a 6-session simulated lawn-mowing protocol, calibrated to match the push and pull forces of using an outdoor nonpropelled lawn mower.

Sex proportion of offspring and exposure to radiation in male invasive cardiologists.

High radiation exposure among male radiologists has been reported to result in a significantly higher proportion of female offspring. This study examined whether work-related radiation exposure was associated with a higher propensity for female offspring among male interventional cardiologists. On behalf of the interventional committee of the Society for Cardiovascular Angiography and Interventions, an Internet-based questionnaire was sent to the society's 2063 members.