Outcomes and Safety of Catheter Ablation in the Elderly.

Catheter ablation has emerged as a first-line therapy for many arrhythmias. However, data on the safety and outcomes of catheter ablation in the elderly population remain limited. Here, we aimed to study the outcomes of catheter ablation in octogenarians.

Dislodged Right Ventricular Pacemaker Lead Detected Incidentally Two Years Post-implantation via Echocardiography: A Case Report.

Dislodgement of cardiac implantable electronic device (CIED) leads following implantation ideally should not be missed. However, more often than not, patients do not undergo post-operative imaging following these procedures due to a lack of evidence behind the role of imaging following uncomplicated pacemaker (PPM) implantation procedures, based on the most recent guidelines This is a case report of a dual-chamber pacemaker (DC-PPM) right ventricular (RV) lead that was found dislodged and coiled in the right ventricular outflow tract (RVOT) as an incidental finding via a routine transthoracic echocardiogram (TTE) study two years after implantation. We intend to shed light on the significance of timely detection of lead-related complications, as they can result in poor outcomes for patients.

Safety of cardioversion without anticoagulation in patients' status post left atrial appendage occlusion: A systematic review and meta-analysis.

Background: Direct current cardioversion (DCCV) is commonly used for rhythm control in atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) provides stroke prevention in patients with contraindications to oral anticoagulation (OAC), but the safety of DCCV without periprocedural anticoagulation in this group remains uncertain.

Objective: To evaluate the safety of performing DCCV without systemic anticoagulation in patients with prior LAAO.

Role of Medication Reconciliation in Managing Bradycardia: A Rare Cause of Medication-Induced Sinus Bradycardia.

Sinus bradycardia is defined as a heart rate of less than 60 beats per minute (bpm), and it can be attributed to many etiologies, some of which are reversible, including but not limited to acute coronary syndrome, active infections, electrolyte imbalances, hypothyroidism, and medications. We report the case of a 64-year-old man who was admitted to the intensive care unit for the management of status epilepticus, where he developed new-onset, life-threatening sinus bradycardia, requiring placement on support with two inotropic agents (epinephrine and dopamine) due to persistent hemodynamic instability. Cardiology was consulted as a result, and after extensive workup, including review of past medical conditions, laboratory testing, and telemetry review, including that for reversible etiologies, we identified one of the antiepileptic agents on his medication list as the culprit of his sinus bradycardia.

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.

Safety and outcomes of pulsed field ablation in the management of supraventricular arrhythmia: A systematic review.

Introduction: Pulsed field ablation (PFA) is an emerging non-thermal ablative technology that induces irreversible electroporation to selectively target cardiac tissue while minimizing damage to adjacent structures. While widely studied for atrial fibrillation, its role in managing supraventricular tachycardia (SVT) remains unclear. This systematic review aims to consolidate existing data on the safety and efficacy of PFA for SVT ablation.

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).

Metformin: Its salutary effects beyond diabetes mellitus.

Metformin, an oral hypoglycemic agent, is commonly used in patients with type II diabetes mellitus. Studies have shown its use is associated with a reduction in major cardiovascular events (MACE) in patients with type 2 diabetes such as hospitalization for acute myocardial infarction, stroke, transient ischemic attack, or cardiovascular death. There is also a suggestion that metformin may have effects beyond those relating to lowering of blood sugar.

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.

Comprehensive Metabolomics Profiling and Bioactivity Study of (Awsaj) Extracts with Particular Emphasis on Potential Anti-Malarial Properties.

Although malaria is one of the oldest known human diseases, it continues to be a major global health challenge. According to UNICEF, the global malaria mortality rate exceeded 600,000 annually in 2022, which includes more than 1000 children dying each day. This study aimed to investigate the comprehensive chemical profile and biological activities, particularly the antimalarial activity, of (Awsaj), a shrub traditionally used in the Arabian Peninsula, Middle East, India, and Africa to treat a myriad of ailments.

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.

Emerging Trends in Atherosclerosis: Time to Address Atherosclerosis From a Younger Age.

Over the past two decades, research efforts into cardiovascular disease (CVD) have uncovered findings that fundamentally challenge our understanding of CVD, particularly atherosclerosis. Atherosclerosis was primarily attributed to the well-described abnormal lipid accumulation theory, involving plaque growth with subsequent plaque hemorrhage resulting in acute vessel thrombosis that may or may not rupture. This perspective has now evolved to encompass more complex pathways, wherein the accumulation of abnormal products of oxidation and inflammation is the most likely factor mediating atherosclerotic plaque growth.

Obesity-Induced Hyperglycemia and Heart Failure Preserved Ejection Fraction: Uncharted Territories to Remission.

Until the end of World War II, food security was a global challenge. Consequently, in 1948, type 2 diabetes was relatively uncommon, with the majority of cases being type 1 diabetes requiring insulin therapy. Since then, food has become increasingly palatable and readily available, leading to a rise in obesity across all age groups.

Our Hidden Enemy: Ultra-Processed Foods, Inflammation, and the Battle for Heart Health.

Over the past few decades, we have witnessed unprecedented growth in new data that has fundamentally changed our traditional understanding of the progression of atherosclerotic plaques, as well as our strategies for preventing cardiovascular diseases, especially atherosclerosis. It was once believed that atherosclerosis was primarily caused by abnormal lipid buildup in the vessel intima, leading to plaque growth and luminal stenosis, with or without rupture. This perspective has now evolved to encompass more complex pathways, wherein the accumulation of abnormal products of oxidation and inflammation are the most likely factors mediating the growth of atherosclerotic plaques.

Role of Cardiac Biomarkers in Monitoring Cardiotoxicity in Chemotherapy Patients.

Purpose: This review aims to highlight the different types of chemotherapy-induced cardiotoxicity and will discuss the evidence base behind the use of different cardiac biomarkers to predict cardiovascular complications. Additionally, we will review the use of cardiac biomarkers to monitor cardiac outcomes and the role of cardioprotective medications in reducing cardiovascular side effects.

Recent Findings: Chemotherapy has been linked to an increased risk of cardiotoxicity and heart failure.

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.

National Trends of Percutaneous Mechanical Support Utilization During Percutaneous Coronary Interventions in Chronic Total Occlusion.

Coronary chronic total occlusion (CTO) is common in patients with multivessel coronary artery disease. Percutaneous coronary artery (PCI) interventions have shown favorable outcomes in patients with CTO. Nevertheless, the data regarding the utilization of mechanical circulatory support in CTO PCIs is not well established.

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.