Regional Variations in the Management and Outcomes of Pulmonary Embolism: A Five-Year United States Analysis.

Background: Acute pulmonary embolism (PE) is one of the most common causes of cardiovascular mortality in the United States. Significant variations in the management of various cardiovascular conditions have previously been reported, but this has been poorly elucidated for pulmonary embolism.

Methods: During 2016-2020, adult (≥ 18 years) nonelective admissions with PE, admitted to Northeast, Midwest, South, and West geographic regions were identified using the National Inpatient Sample.

'July effect' in management and outcomes of patients admitted with pulmonary embolism in the United States, 2016 to 2021.

Background: This study sought to assess the outcomes of pulmonary embolism (PE) admissions at teaching and nonteaching hospitals in the month of July, when new trainees begin their training in the United States.

Methods: During 2016-2021, adult (≥18 years) nonelective admissions with PE, admitted to urban teaching hospitals in the months of May and July, were identified using the National Inpatient Sample and compared to nonteaching admissions. Outcomes of interest included in-hospital mortality, complications, variations in management, total hospitalization costs, and hospitalization duration.

Renal artery stent thrombosis as a complication of percutaneous renal artery revascularization and stent placement.

We present the case of a 46-year-old man with bilateral renal artery stenosis and a previous stent placed on the left renal artery who presented with a hypertensive emergency with flash pulmonary edema and acute-on-chronic renal failure. A renal angiogram revealed extensive thrombosis and in-stent restenosis, which were treated with thrombectomy, angioplasty, and stenting. Our case highlights the importance of careful patient selection for renal artery stenting and close monitoring post-stenting due to the risk of serious complications.

Variations in Management and Outcomes of Pulmonary Embolism in Uninsured Compared With Privately Insured Individuals.

Despite previously noted healthcare disparities, there are limited data on the management and outcomes of uninsured patients presenting with pulmonary embolism (PE). All adult (>18 years) nonelective admissions with a primary diagnosis of PE with either private or uninsured (self-pay or no charge) primary payor were identified using the National Inpatient Sample (2016-2022). We excluded admissions with Medicare and Medicaid payor status.

Target doses of guideline-directed medical therapeutic agents predicts response to cardiac resynchronization therapy.

Background: The mainstay of therapy in patients with heart failure with reduced ejection fraction (HFrEF) has long been guideline-directed medical therapy (GDMT). This is further complicated by those who have concomitant ventricular dyssynchrony due to conduction abnormalities requiring implantable cardioverter-defibrillators or cardiac resynchronization therapy (CRT). The aim in our study was to investigate the role of GDMT in predicting response to CRT.

Clinical Outcomes With Postprocedural Anticoagulation Versus No Anticoagulation in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: A Meta-Analysis.

Postprocedural anticoagulation (PPAC) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) can mitigate thrombotic events. However, current clinical guidelines do not recommend PPAC after PCI considering the scarce evidence supporting its use. A comprehensive literature search of electronic databases was conducted to identify studies comparing PPAC to no anticoagulation (AC) after PCI for AMI.

Management and Outcomes of Pulmonary Embolism in Women of Reproductive Age Admitted to Urban Versus Rural Areas Compared to Men.

There are limited and conflicting data on sex and urban-rural disparities in outcomes of patients with pulmonary embolism (PE) in the reproductive age group. Our object was to assess sex disparities in the reproductive age group cohort. All adult non-elective admissions in the reproductive age group (18-49 years) with a primary diagnosis of PE and with no missing sex/age data were identified using the National Inpatient Sample.

Short-term and long-term outcomes of cardiac arrhythmias in patients with cardiogenic shock.

Introduction: Cardiogenic shock is severe circulatory failure that results in significant in-hospital mortality, related morbidity, and economic burden. Patients with cardiogenic shock are at high risk for atrial and ventricular arrhythmias, particularly within the subset of patients with an overlap of cardiogenic shock and cardiac arrest.

Areas Covered: This review article will explore the prevalence, definition, management, and outcomes of common arrhythmias in patients with cardiogenic shock.

Utilization of inpatient palliative care services in cardiac arrest complicating acute pulmonary embolism.

Introduction: The role of palliative care services in patients with cardiac arrest complicating acute pulmonary embolism has been infrequently studied.

Methods: All adult admissions with pulmonary embolism complicating cardiac arrest were identified using the National Inpatient Sample (2016-2020). The primary outcome of interest was the utilization of palliative care services.

Race, Ethnicity, and Gender Disparities in Acute Myocardial Infarction.

Cardiovascular disease continues to be the leading cause of morbidity and mortality in the United States. Despite advancements in medical care, there remain persistent racial, ethnic, and gender disparity in the diagnosis, treatment, and prognosis of individuals with cardiovascular disease. In this review we seek to discuss differences in pathophysiology, clinical course, and risk profiles in the management and outcomes of acute myocardial infarction and related high-risk states.

Palliative care in the cardiovascular intensive care unit: A systematic review of current literature.

Background: There has been an evolution in the disease severity and complexity of patients presenting to the cardiac intensive care unit (CICU). There are limited data evaluating the role of palliative care in contemporary CICU practice.

Methods: PubMed Central, CINAHL, EMBASE, Medline, Cochrane Library, Scopus, and Web of Science databases were evaluated for studies on palliative care in adults (≥18 years) admitted with acute cardiovascular conditions - acute myocardial infarction, cardiogenic shock, cardiac arrest, advanced heart failure, post-cardiac surgery, spontaneous coronary artery dissection, Takotsubo cardiomyopathy, and pulmonary embolism - admitted to the CICU, coronary care unit or cardiovascular intensive care unit from 1/1/2000 to 8/8/2022.

Training Paradigms in Critical Care Cardiology: A Scoping Review of Current Literature.

Background: Over the past decade there has been increasing interest in critical care medicine (CCM) training for cardiovascular medicine (CV) physicians either in isolation (separate programs in either order [CV/CCM], integrated critical care cardiology [CCC] training) or hybrid training with interventional cardiology (IC)/heart failure/transplant (HF) with targeted CCC training.

Objective: To review the contemporary landscape of CV/CCM, CCC, and hybrid training.

Methods: We reviewed the literature from 2000-2022 for publications discussing training in any combination of internal medicine CV/CCM, CCC, and hybrid training.

Prevalence of respiratory failure and use of mechanical ventilation in heart failure patients undergoing left atrial appendage occlusion device implantation.

Background: We sought to evaluate respiratory complications in heart failure patients undergoing left atrial appendage occlusion (LAAO) for stroke prevention in atrial fibrillation.

Methods: Adult admissions (>18 years) undergoing LAAO during 2016-2020 were identified from the National Inpatient Sample. Heart failure (HF) was stratified into systolic (SHF) and diastolic heart failure (DHF) and were compared to those without HF.

Society of Cardiovascular Angiography and intervention Stage-B cardiogenic shock: An interventional-heart failure-critical care conundrum.

The Society of Cardiovascular Angiography and Intervention (SCAI) classified cardiogenic shock (CS) into five stages ranging from A-E. There remains significant ambiguity regarding the assessment and management of SCAI Stage B. Given its nebulous nature that can rapidly escalate, prompt interventions are needed.

Valve-in-valve transcatheter mitral valve replacement procedure in prosthetic valve stenosis.

A patient presented with acute respiratory failure and shock due to severe prosthetic mitral valve stenosis. A valve-in-valve transcatheter mitral valve replacement procedure was performed via the transeptal approach due to his high-risk presentation with good results.

Constrictive Pericarditis: A Diagnostic Conundrum.

A 65-year-old male presented with chest pain, tachycardia, tachypnea, and diminished breath sounds. His lab investigations revealed an elevated leukocyte count, erythrocyte sedimentation rate, and B-type natriuretic peptide. Transthoracic echocardiography and chest imaging revealed the presence of pericardial effusion without tamponade and he was treated for presumed acute idiopathic pericarditis.

Myocarditis post-COVID-19 vaccination.

There has been much interest in the possible adverse events associated with available anti-coronavirus disease of 2019 (COVID-19) vaccines, given the rapid pace at which they had to be developed during the pandemic. One such adverse event is myocarditis post-COVID-19 vaccination. Several pathophysiological mechanisms have been proposed that might help us understand the relationship between the messenger ribonucleic acid (mRNA) vaccine and the occurrence of myocarditis, though we are yet to ascertain the causal link between them.

Anti-N-methyl-D-aspartate receptor encephalitis in pregnancy associated with teratoma.

A 36-year-old pregnant woman with a prior history of depression and recent gunshot wounds presented with sudden deterioration in her mental status. Clinical examination revealed psychosis, hallucinations, and lack of orientation, with an otherwise normal neurological and cardiorespiratory examination. Computed tomographic scan of her head was normal, and she was diagnosed with acute psychosis and excited delirium.

RIGHT VENTRICULAR DYSFUNCTION IN SEPSIS: AN UPDATED NARRATIVE REVIEW.

Sepsis is a multisystem disease process, which constitutes a significant public health challenge and is associated with high morbidity and mortality. Among other systems, sepsis is known to affect the cardiovascular system, which may manifest as myocardial injury, arrhythmias, refractory shock, and/or septic cardiomyopathy. Septic cardiomyopathy is defined as the reversible systolic and/or diastolic dysfunction of one or both ventricles.

Efficacy and safety of angiotensin II in cardiogenic shock: A systematic review.

Background: Cardiogenic shock (CS) is associated with high morbidity and mortality. In recent times, there is increasing interest in the role of angiotensin II in CS. We sought to systematically review the current literature on the use of angiotensin II in CS.