Right Ventricular Outflow Tract Velocity Time Interval: An Invaluable Yet Forgotten Echocardiographic Variable.

Background: Echocardiographic examination of the right ventricular outflow tract (RVOT) has been invaluable in examining pulmonary artery (PA) flows and RV hemodynamics in response to increasing afterload. Currently, the TAPSE/PASP ratio is the preferred noninvasive variable for this assessment.

Methods: Our main aim was to determine the specific relationship that might exist between RVOT VTI Doppler measurements and TAPSE/PASP ratios across a wide range of different left ventricular (LV) ejection fractions and PASP values.

Heart Failure Treatment in Underserved Populations: A Comprehensive Analysis of Sacubitril/Valsartan and Sodium-Glucose Transporter 2 Inhibitor (SGLT2i) Prescription Trends at a Safety Net Hospital.

Background Sacubitril/valsartan and sodium-glucose transporter 2 inhibitors (SGLT2is) are emerging classes of medications that have become key components of guideline-directed medical therapy for patients with heart failure (HF) with reduced ejection fraction and New York Heart Association class II, III, or IV symptoms. Both sacubitril/valsartan and SGLT2is have demonstrated the ability to improve morbidity and mortality in HF patients. This analysis evaluates current prescribing trends of sacubitril/valsartan and SGLT2is in a safety net hospital setting.

No-Show Rates in a Cardiology Clinic During the COVID-19 Pandemic: A Retrospective Analysis From a Safety-Net Hospital.

Background: The COVID-19 pandemic proved to be a formidable crisis leading to massive disruptions in healthcare delivery that compromised routine access to care across the United States. The strain of the pandemic on the healthcare system limited routine outpatient visits and regular follow-up for all patients. Patients struggling with social determinants of health (SDOH) have long suffered from limited access to healthcare and the pandemic exacerbated this issue.

Significant Reduction in Peak Left Ventricular Global Longitudinal Strain in Multiple Myeloma Patients: A Pilot Random Awareness Analysis.

Background and methods Multiple myeloma (MM) is a malignancy associated with cardiovascular complications. Though echocardiography plays a crucial role in assessing cardiac function, its use in the follow-up of MM patients is limited. For this descriptive analysis, we report several recommended objective measures of left ventricular (LV) systolic function, peak global longitudinal strain (PGLS), and right ventricular (RV) systolic function in 147 MM patients at various stages of their treatment who were referred to our echocardiography laboratory at the University of Arkansas for Medical Sciences (Little Rock, AR, USA).

Aortic Dissection Presenting as Cardiac Tamponade with Hemopericardium Initially Identified by Echocardiography.

In this case, a 79-year-old white male is seen in the emergency department complaining of acute chest pressure, shortness of breath, diaphoresis, and dizziness that began for 4 h from the time of presentation. Physical examination showed signs concerning for cardiac tamponade in the presence of hypotension. Echocardiography showed a large amount of hemopericardium.

Concealed Truths Always Hide behind the Shadows of the Not So Obvious: Deadly Chest Pain Presentation.

Acute aortic dissection (AAD) is a critical condition characterized by the tearing of the aortic wall, posing significant diagnostic challenges due to its diverse clinical presentations. We present the case of a 61-year-old male with hypertension and dyslipidemia who presented with acute abdominal and chest pain, initially raising suspicion of myocardial infarction. Despite an unremarkable electrocardiogram and initially normal troponin levels, the patient experienced ventricular fibrillation, prompting further evaluation.

The Heart's Secret Bridge: Ruptured Sinus of Valsalva Aneurysm Masquerading as a Gerbode Defect.

Our case presents a 53-year-old male with type 2 diabetes and dyslipidemia presenting to the emergency department with symptoms of chest pressure, palpitations, dyspnea, and exercise intolerance. On initial imaging, an abnormal color flow signal was seen that was initially thought to be secondary to a Gerbode defect. However, using more detailed imaging, cardiac computed tomography angiography suggested the possibility of a noncoronary sinus of Valsalva aneurysm (SOVA) rupture into the right atrium, making the diagnosis challenging.

Calcific aortic valve disease and cardiometabolic triggers: an explanation behind progression of aortic valvular disease and failure of medical therapy interventions.

Calcific aortic valve disease (CAVD), a nonrheumatic stenosis of the trileaflet aortic valve, is a complex, multifaceted cardiovascular condition involving a widespread inflammatory process and an analogous atheromatous process affecting the arteries. It is currently the most encountered valvular abnormality in cardiology. Although distinctive abnormal mechanical forces are at the core propelling a responsive mechanosensitive feedback cascade, implicated in both initiation and perpetuation of CAVD; we propose a conundrum of metabolic abnormalities including hypertension, elevated fasting blood sugar, decreased high-density lipoprotein, hypertriglyceridemia, and abdominal obesity as perpetuators of this process.

Uric acid and cardiovascular diseases: a reappraisal.

Serum uric acid (SUA) has garnered an increased interest in recent years as an important determinant of cardiovascular disease. Uric acid, a degradation product of purine metabolism, is affected by several inheritable and acquired factors, such as genetic mutation, metabolic syndrome, chronic kidney disease, and medication interactions. Even though elevated SUA have been commonly associated with the development of gout, it has significant impact in the development of hypertension, metabolic syndrome, and cardiovascular disease.

Nonobstructive epicardial coronary artery disease: an evolving concept in need of diagnostic and therapeutic guidance.

For decades, we have been treating patients presenting with angina and concerning electrocardiographic changes indicative of ischemia or injury, in whom no culprit epicardial coronary stenosis was found during diagnostic coronary angiography. Unfortunately, the clinical outcomes of these patients were not better than those with recognized obstructive coronary disease. Improvements in technology have allowed us to better characterize these patients.

QTc Interval: A frequently unrecognized electrocardiographic interval.

The QT interval, an electrocardiographic temporal representation of the ventricular depolarization and repolarization, is an integral parameter that must be carefully evaluated to gather critical information regarding electrical instability that may cause malignant ventricular dysrhythmias or sudden cardiac death. The QT interval is affected by several inheritable and acquired factors, such as genetic mutations, electrolyte disturbances, and medication interactions. We strongly believe that prompt and accurate recognition of any QT interval abnormalities is critical in many clinical settings.

Abnormal Resting Myocardial Contrast Echocardiographic Uptake: Clue of an Ongoing Acute Coronary Artery Event.

Acute coronary syndromes (ACSs) present most frequently with chest pain, but angina equivalents such as dyspnea, diaphoresis, and fatigue are not uncommon. Atypical presentations are especially seen in women, the elderly, and diabetics. Cardiac evaluation using a transthoracic echocardiogram is almost always done before or immediately after someone undergoes left heart catheterization for ACS.

Heart Failure with Preserved Left Ventricular Ejection Fraction: A Complex Conundrum Simply Not Limited to Diastolic Dysfunction.

Over the last two decades, the changing paradigm of heart failure with preserved ejection fraction (HFpEF) has transformed our understanding not only of the pathophysiology of this clinical entity but also the diagnostic and therapeutic approaches aimed at treating this complex patient population. No longer HFpEF should be seen as simply left ventricular diastolic dysfunction but as a group of that in addition of having small and thick left ventricles with abnormal diastolic filling patterns as their main pathophysiologic abnormality; they also have whole host of different abnormalities. In fact, this heterogeneous clinical entity embodies numerous mechanisms and is linked to multiorgan dysfunction, with hypertension and obesity playing a major role.

Epigenetic Regulation and its Effects on Aging and Cardiovascular Disease.

Cardiovascular disease (CVD), specifically coronary atherosclerosis, is regulated by an interplay between genetic and lifestyle factors. Most recently, a factor getting much attention is the role epigenetics play in atherosclerosis; particularly the development of coronary artery disease. Furthermore, it is important to understand the intricate interaction between the environment and each individual genetic material and how this interaction affects gene expression and consequently influences the development of atherosclerosis.

Growth Differentiation Factor 15 (GDF-15), a New Biomarker in Heart Failure Management.

The emergence of biomarkers across medicine's subspecialties continues to evolve. In essence, a biomarker is a biological observation that clearly substitutes a clinical endpoint or intermediate outcome not only are more difficult to observe but also, biomarkers are easier, less expensive and could be measured over shorter periods. In general, biomarkers are versatile and not only used for disease screening and diagnosis but, most importantly, for disease characterization, monitoring, and determination of prognosis as well as individualized therapeutic responses.

Profiling Cardiometabolic Health in Jordan: A Call to Action to Improve Cardiovascular Health.

Over the past decades, Jordan has witnessed unprecedented growth in the prevalence of cardiometabolic diseases, with a crude prevalence of 48.2% in 2020, up from 38% in 2009. This is slightly higher than the reported prevalence of 40% in the US population.

True relationship between tricuspid annular motion and velocity displacement components: Potential role in assessing right ventricular decoupling.

Background: Although measures of longitudinal displacement of the tricuspid annulus measured by M-mode as tricuspid annular systolic plane excursion (TAPSE) and systolic velocity by tissue Doppler imaging (TA TDI s) are routinely used for assessment of right ventricular (RV) systolic function; these measures describe different phenomena and should not be used interchangeably.

Methods: Previously published data was used to determine the individual relationship between TAPSE and TA TDI s with increasing pulmonary artery systolic pressures (PASP).

Results: In this retrospective analysis, 488 patients were divided into 2 groups based on TAPSE (Group 1: <1.

Early repolarization: Electrocardiographic cues to distinguish benign from malignant variants.

Historically, early repolarization (ER) has been considered a marker of good health as it is more prevalent in athletes, younger persons, and at slower heart rates. However, contemporary reports, largely based on data from resuscitated sudden cardiac arrest patients, suggest an association between ER and an increased risk for sudden cardiac death and the development of malignant ventricular arrhythmias. Therefore, after we present a brief-case presentation, we intend to review a challenging topic in recognition of malignant variants and propose a four-step comprehensive approach to simplify ECG discrimination when assessing ER changes.

Vasospastic Angina With ST-Segment Elevation Seen During Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring.

A 54-year-old man presented with significant ST-segment elevations noted on both channels displayed on the mobile cardiac outpatient telemetry (MCOT). Pertinent cardiac history was remarkable for syncope and episodes of atypical chest pain. The latter were described as infrequent and not associated with exercise intolerance.

Improving diagnostic assessments in the ever-changing landscape of atherosclerosis.

As our understanding of atherosclerotic vascular injury continues to evolve, so should our diagnostic approaches. Emerging data have recently challenged our basic understanding in linking ischemia to its adverse outcomes as well as the need for invasive testing for both diagnosis and treatment. The advent of coronary computed tomography in providing improved visualization of coronary arteries has led to the identification of both subclinical atherosclerosis and high-risk coronary lesions.

Echo-Doppler measures of right ventricular systolic function are affected by reduced left ventricular systolic function.

Background: Objective right ventricular (RV) systolic function assessment is attained using a series of well-described and validated echo-Doppler measurements. However, how left ventricular (LV) systolic function influences these RV functional measurements has not been previously studied. Consequently, we conducted a retrospective proof-of-concept analysis to answer this important question.