When Anticoagulation Matters: A Case of Large Left Atrial Thrombus After Left Atrial Appendage Ligation.

Atrial fibrillation (AF) is the most frequently encountered arrhythmia in the clinical practice and is associated with stroke. In clinical practice, CHAD2DS2-VASc score is used as a tool to decide whether anticoagulation is needed. In those patients with high bleeding risk or falls, surgical ligation of the left atrial appendage (LAA) or percutaneous closure devices are strategies used to mitigate these challenges.

Evaluation of pharmacogenetic automated clinical decision support for clopidogrel.

Clopidogrel requires activation to have antiplatelet effects. Pharmacogenetic testing to identify patients with impaired function can be coupled with clinical decision support (CDS) alerts to guide antiplatelet prescribing. We evaluated the impact of alerts on clopidogrel prescribing.

Therapy duration and improvement of ventricular function in de novo heart failure: the Heart Failure Optimization study.

Background And Aims: In patients with de novo heart failure with reduced ejection fraction (HFrEF), improvement of left ventricular ejection fraction (LVEF) is expected to occur when started on guideline-recommended medical therapy. However, improvement may not be completed within 90 days.

Methods: Patients with HFrEF and LVEF ≤ 35% prescribed a wearable cardioverter-defibrillator between 2017 and 2022 from 68 sites were enrolled, starting with a registry phase for 3 months and followed by a study phase up to 1 year.

Clinical impact of preemptive pharmacogenomic testing on antiplatelet therapy in a real-world setting.

CYP2C19 genotyping to guide antiplatelet therapy after patients develop acute coronary syndromes (ACS) or require percutaneous coronary interventions (PCIs) reduces the likelihood of major adverse cardiovascular events (MACE). Evidence about the impact of preemptive testing, where genotyping occurs while patients are healthy, is lacking. In patients initiating antiplatelet therapy for ACS or PCI, we compared medical records data from 67 patients who received CYP2C19 genotyping preemptively (results >7 days before need), against medical records data from 67 propensity score-matched patients who received early genotyping (results within 7 days of need).

Multicenter registry and test bed for extended outpatient hemodynamic monitoring: the hemodynamic frontiers in heart failure (HF) initiative.

Background: Hemodynamic Frontiers in Heart Failure (HF) is a multicenter academic research consortium comprised of 14 US institutions with mature remote monitoring programs for ambulatory patients with heart failure (HF). The consortium developed a retrospective and prospective registry of patients implanted with a wireless pulmonary artery pressure (PAP) sensor.

Goals/aims: HF registry collects demographic, clinical, laboratory, echocardiographic (ECHO), and hemodynamic data from patients with PAP sensors.

Transient Complete Atrioventricular Block Associated With Herbal Supplement Use.

Introduction: Increasing and easy availability of so-called natural/herbal supplements pose the unique challenge of identifying associated side effects, including arrhythmias in otherwise-healthy individuals.

Case Presentation: A 25-year-old female patient presented to the emergency department with fatigue and lightheadedness. The electrocardiogram showed complete AV block with a junctional escape rhythm at 55 beats per minute with QT prolongation (542ms).

Right Atrial and Endocardial Lead Mass Secondary to Anterior Mediastinal Mass Encasing Left Subclavian Vein.

Introduction: Multimodality cardiac imaging is a valuable tool for the noninvasive evaluation of right atrial masses (tumor, vegetation, or thrombus).

Case Presentation: We report a case of right atrial mass that was discovered on a transthoracic echocardiogram ordered for pacemaker-pocket erythema in a 101-year-old man with heart failure/reduced left-ventricular ejection fraction and a dual-chamber pacemaker. Transthoracic and transesophageal echocardiogram showed a large hypoechoic mobile RA mass extending from the superior vena cava, with pacemaker device lead attachment.

A Case of Intraventricular Coronary Artery Perforation Following Percutaneous Coronary Intervention in the Setting of Myocardial Bridge of Left Anterior Descending Artery.

Coronary artery perforation during percutaneous coronary intervention is a rare but potentially fatal complication. Intraventricular rupture is more commonly seen in setting of myocardial bridging where the epicardial coronary artery takes an intramuscular course. We describe a case of acute thrombotic in-stent restenosis of the intramyocardial (myocardial bridge) distal left anterior descending artery complicated by intraventricular perforation in the setting of an anterior ST elevation myocardial infarction managed by covered stenting.

Delayed Presentation of Inferior STEMI Complicated by Ventricular Septal Rupture: An Indirect Consequence of the COVID-19 Pandemic.

The COVID-19 pandemic has adversely impacted healthcare delivery. An indirect consequence of the rational fear of contracting the virus is delayed medical attention for life threatening conditions. We present the case of inferior ST elevation myocardial infarction leading to the rare complication of a ventricular septal rupture reflecting transmural infarction.

ST Elevation MI with Normal Coronary Arteries: A MINOCA Case.

Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a syndrome characterized by clinical evidence of myocardial infarction with normal or near-normal coronary arteries on angiography.

Case Report: A 35-year-old female patient presented with typical chest pain. EKG revealed sinus rhythm, 1 mm ST elevation in DI-aVL, prominent R waves in V1-V3 and ST-segment depression in DIII-aVF.

Transcatheter tricuspid valve-in-valve implantation for very early bioprosthetic tricuspid stenosis secondary to pacemaker lead entrapment: a case report.

Background: Tricuspid stenosis (native and prosthetic) is rare. Redo-sternotomy for isolated tricuspid replacement is associated with a higher risk. The efficacy and durability of transcatheter valve implantation for severe tricuspid stenosis are unclear.

ST-Segment Elevation Myocardial Infarction Due to an Ectatic Infarct-Related Coronary Artery: Case Series and Review of the Literature.

Coronary artery ectasia is an infrequent finding seen in a localized or diffuse fashion in patients undergoing coronary angiogram. This angiographic entity is attributed to coronary artery atherosclerosis. The ectatic coronary artery segment may be a culprit and perpetuate the thrombus formation in patients with acute myocardial infarction due to the altered normal laminar flow and deranged platelet and endothelial activation.

Practitioners' Confidence and Desires for Education in Cardiovascular and Sudden Cardiac Death Genetics.

Background Educating cardiologists and health care professionals about cardiovascular genetics and genetic testing is essential to improving diagnosis and management of patients with inherited cardiomyopathies and arrhythmias and those at higher risk for sudden cardiac death. The aim of this study was to understand cardiology and electrophysiology practitioners' current practices, confidence, and knowledge surrounding genetic testing in cardiology and desired topics for an educational program. Methods and Results A one-time survey was administered through purposive email solicitation to 131 cardiology practitioners in the United States.

A Case of Bioprosthetic Mitral Valve Endocarditis with Severe Stenosis.

A 29-year-old female with a history of bioprosthetic mitral valve replacement was admitted with fever, chills, and shortness of breath of two weeks duration. Transthoracic echocardiography revealed a thickened bioprosthetic mitral valve with a 26 mmHg mean gradient consistent with severe mitral stenosis and associated large vegetation. Blood cultures demonstrated no growth.

MODERNA mRNA-1273 vaccine-associated myopericarditis in a patient with a subclinical autoimmune predisposition.

We present a rare case of myopericarditis developing one day after the injection of the second dose of the MODERNA mRNA-1273 vaccine (Cambridge, MA, USA). The patient complained of typical positional chest pain with initial laboratory results significant for elevated troponin, erythrocyte sedimentation rate, and C-reactive protein. Autoimmune predisposition was suggested by elevated anti-nuclear antibodies and anti-Sjögren's-syndrome-related antigen A autoantibodies titers.

Index Case of COVID-19 Myocarditis Requiring BiV-ICD for Primary Prevention of Sudden Cardiac Death.

Introduction: The severity of clinical presentation of COVID-19 myocarditis ranges from incidental identification of depressed left ventricular ejection fraction, cardiogenic shock requiring percutaneous mechanical circulatory support, to fatal fulminant myocarditis. In previously reported cases, surviving patients experienced improvement in left ventricular ejection fraction with the use of glucocorticoids and antivirals (+/- intravenous immunoglobulin/ convalescent plasma). We report the first case of COVID-myocarditis in a surviving patient where a persistently depressed left ventricular ejection fraction (less than 35 percent) despite optimal therapy prompted implantable cardioverter-defibrillator (ICD) implantation for primary prevention of sudden cardiac death.

A Case of Peripartum Ventricular Tachycardia due to Arrhythmogenic Right Ventricular Dysplasia.

Arrhythmogenic right ventricular cardiomyopathy is a predominantly inherited structural disease with a heterogeneous set of implicated genetic defects. For those patients not identified by targeted population screening programs, ventricular tachycardia can be their first presentation. We report a case of a female from the genetically isolated Hutterite colonies who presented with recurrent ventricular tachycardia.

Percutaneous Closure of a Cribriform Secundum Atrial Septal Defect and Patent Foramen Ovale.

Atrial septal defects (ASDs) and patent foramen ovale (PFO) are common congenital cardiac malformations that portend a higher risk of ischemic stroke. Percutaneous closure of ASDs using septal occluder devices has proven to be a safe and effective alternative to surgery. We present a case of symptomatic cribriform secundum ASD and PFO who underwent successful percutaneous closure using two Amplatzer occluder devices using a novel "sandwich technique.

Application of Genetic Testing in Unveiling the Diagnosis of Fabry Disease in a Patient with Hypertrophic Cardiomyopathy.

Fabry disease (FD) is a lysosomal storage disorder with an X-linked genetic pattern. It is caused by the genetic mutations in the galactosidase alpha gene on the long arm of the X-chromosome, resulting in the deficiency of the alpha-galactosidase A enzyme activity. This leads to an accumulation of globotriaosylceramide in a variety of cells, including cells in the heart.