Current Trends in Hypertension Identification and Management: Insights from the National Health and Nutrition Examination Survey (NHANES) Following the 2017 ACC/AHA High Blood Pressure Guidelines.

BACKGROUND: Hypertension is a global health issue associated with increased cardiovascular morbidity and mortality. This study aimed to investigate contemporary hypertension identification and management trends following the 2017 American College of Cardiology/American Heart Association guidelines. METHODS AND RESULTS: Data from the National Health and Nutrition Examination Survey conducted from 2017 to 2020 were analyzed. Participants between 20 and 79 years of age were included. Participants were stratified into different treatment groups based on indication and guideline adherence. Descriptive statistics were used to compare medication use, diagnosis rates, and blood pressure control. A total of 265 402 026 people met the inclusion criteria, of which 19.0% (n=50 349 209) were undergoing guideline antihypertensive management. In the guideline antihypertensive management group, a single antihypertensive class was used to treat 45.7% of participants, and 55.2% had uncontrolled blood pressure. Participants not undergoing guideline antihypertensive management qualified for primary prevention in 11.5% (n=24 741 999) of cases and for secondary prevention in 2.4% (n=5 070 044) of cases; of these, 66.3% (n=19 774 007) did not know they may have hypertension and were not on antihypertensive medication. CONCLUSIONS: Adherence to guidelines for antihypertensive management is suboptimal. Over half of patients undergoing guideline treatment had uncontrolled blood pressure. One-third of qualifying participants may not be receiving treatment. Education and medical management were missing for 2 in 3 qualifying participants. Addressing these deficiencies is crucial for improving blood pressure control and reducing cardiovascular event outcomes.

Symptomatic Myocarditis Post COVID-19 Vaccination.

There are few major adverse events after the coronavirus disease 2019 (COVID-19) vaccination. However, increasing cases of myocarditis and pericarditis are being reported to the Vaccine Adverse Event Reporting System (VAERS) in young people, primarily after the second dose of messenger RNA (mRNA) COVID-19 vaccines. We present a case series of myopericarditis post mRNA (Moderna) and myocarditis post vector-based (Johnson & Johnson) COVID-19 vaccines. We intend to highlight the importance of early diagnosis and treatment of vaccine-related myocarditis to reduce mortality and morbidity.

Double Trouble - Spontaneous Coronary Artery Dissection of the Left Anterior Descending and Posterior Descending Arteries in a Right Dominant Circuit: A Case Report.

Acute myocardial infarction is a condition that classically presents with chest pain and corresponding biomarkers and changes on electrocardiogram. Although most causes of acute coronary syndrome are due to acute plaque rupture resulting in coronary thrombosis, an increasingly prevalent condition known as spontaneous coronary artery dissection (SCAD) is becoming more commonly diagnosed. SCAD is characterized by a tear in the tunica media resulting in an intramural hematoma. Depending on the size of the hematoma, progressive extension can ultimately lead to coronary occlusion. Our team presents a 52-year-old female patient that presented with substernal chest pain and positive cardiac enzymes. Urgent coronary catheterization revealed bilateral SCAD involving the left anterior descending and posterior descending arteries in a right coronary dominant circuit. Our patient was treated with medical therapy alone and was safely discharged to home after close monitoring in the coronary care unit. Our team hopes to contribute to a growing body of evidence that bilateral SCAD can occur and can be successfully treated without percutaneous coronary intervention.

Left Atrial Myxoma Masquerading as Pulmonary Embolism on Electrocardiogram: A Case Report.

Primary cardiac tumors are an incredibly rare finding. Cardiac myxomas are the most primary cardiac tumors that often occur within the left atrium. When left untreated, they pose a high risk of causing hemodynamic collapse by obstruction or can embolize and result in thromboembolic stroke. The presentation of cardiac myxoma varies greatly and can be associated with significant morbidity and mortality when undiagnosed. A careful physical examination and high degree of suspicion is crucial in early diagnosis and intervention. Our team presents a 46-year-old female patient with no significant past medical history that presented to the emergency department with a neurological deficit that was concerning for a transient ischemic attack. Initial laboratory workup and electrocardiogram was suggestive for pulmonary embolism; however, upon evaluation with imaging, the patient was found to have a 1.6 × 3.4 cm mass fixed to the mitral leaflet that was then confirmed on transthoracic echocardiography. Our patient was found to have non-obstructive coronary artery disease on cardiac catheterization and ultimately underwent successful mass resection by cardiothoracic surgery.

Anomalous Coronary Arteries: A Case of Rare and Incidental Findings.

Anomalous coronary artery from the opposite sinus (ACAOS) is an uncommon, yet highly variable anatomical abnormality. These coronary anatomy variants are often discovered incidentally during cardiac catheterization. These variants can be challenging intraoperatively and require adjustment by the operator. We present the case of a 93-year-old female who presented for shortness of breath due to severe mitral regurgitation (MR), who was found to have an anomalous left main coronary artery (LMCA) from the right sinus of Valsalva (RSOV). This asymptomatic finding was managed conservatively and patient underwent successful MitraClip treatment.

Successful Percutaneous Balloon Angioplasty in a Patient Presenting With STEMI and Acute Intracranial Hemorrhage.

Percutaneous coronary interventions (PCI) mandates the administration of anti-platelet and anti-thrombotic agents to prevent intracoronary and post-procedural thrombosis upon introducing thrombogenic foreign bodies such as intracoronary wires, balloons, or stents, especially in the setting of acute coronary syndrome (ACS) given the hypercoagulable state associated with it. This is a case of a 54-year-old female who presented to the emergency department with left-sided weakness and dysarthria for an unknown duration. A CT scan of the head showed acute right middle cerebral artery distribution infarct. She subsequently underwent a successful thrombectomy. Four hours later, the patient became lethargic and nauseous. Electrocardiogram showed anterior wall ST elevation with new-onset anterior wall akinesia on transthoracic echocardiogram. Repeat CT of the head showed acute intracranial hemorrhagic conversion. She then developed cardiac arrest mandating emergent cardiac catheterization. Coronary angiogram revealed 100% occlusion in a mid left anterior descending artery (LAD) and 80% in a left circumflex artery (LCX) and chronic total occlusion of the right coronary artery (RCA). After weighing risks and benefits, PCI was performed with rapid plain old balloon angioplasty (POBA) to the 100% thrombotic lesion in the LAD with successful restoration of flow without administering anti-platelet or anti-thrombotic agents given the acute intracranial hemorrhage, She was then discharged to a rehab facility a few days later in stable condition. This case demonstrates successful percutaneous coronary intervention in the 100% occluded LAD in a life-threatening situation despite not using anticoagulation or antiplatelet therapy due to active intracranial hemorrhage.

Average e' velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation.

BACKGROUND: Studies have demonstrated the value of transthoracic echocardiogram (TTE) diastolic parameters in predicting left atrial appendage (LAA) thrombus; however, these studies have been small. We aim to clarify the relationship between TTE diastolic parameters, in particular average e', and LAA thrombus or sludge. METHODS: A case-control review was conducted of subjects with non-valvular atrial fibrillation (n = 2263) who had undergone TEE (transesophageal echocardiogram) and had a TTE within 1 year of TEE. Cases of LAA sludge or thrombus were matched to controls by age, sex, left ventricular ejection fraction (LVEF), and anticoagulation status. RESULTS: Forty-three subjects (mean age 73 ± 12, 65% male, LVEF 47%, 44% on anticoagulation) with LAA sludge or thrombus were identified. Compared to matched controls, average TTE e' (7.3 ± 2.1 cm/s vs 8.7 ± 2.1 cm/s, P < 0.001) and the E:e' ratio (15 ± 7 cm/s vs 12 ± 5 cm/s; P = 0.005) were significant predictors of LAA sludge or thrombus. Average TTE e' value of >11 cm/s had 100% sensitivity for ruling out LAA sludge or thrombus. CONCLUSION: In individuals with atrial fibrillation, average e' >11 cm/s on TTE is a promising independent predictor of the absence of LAA sludge or thrombus on TEE.

Transradial Artery Access in Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock.

Early revascularization is the gold standard for management of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The use of transradial artery access (TRA) in percutaneous coronary intervention (PCI) has increased in recent years and has emerged as a safe and effective approach to PCI in high-risk patients, with advantages in reduced major bleeding events, other peri-procedural complications, and all-cause mortality when compared with transfemoral artery access (TFA). Multiple randomized clinical trials have demonstrated these advantages of TRA vs. TFA PCI in STEMI patients. Although there remains a lack of dedicated randomized trials in CS, observational data suggest benefits on the same endpoints as in STEMI with TRA vs. TFA PCI in CS. This review summarizes the existing literature on the use of TRA compared to TFA for STEMI and CS patients; the reduction of major bleeding events, other peri-procedural complications, and mortality associated with TRA in STEMI and CS; and technical considerations and challenges in the care of these high-risk patient populations.

The existence of myocardial repair: mechanistic insights and enhancements.

The lack of myocardial repair after myocardial infarction and the heart failure that eventually ensues was thought of as proof that myocardial cell regeneration and myocardial repair mechanisms do not exist. Recently, growing experimental and clinical evidence has proven this concept wrong. Cardiac stem cells and endogenous myocardial repair mechanisms do exist; however, they do not produce significant myocardial repair. Similarly, the preliminary results of stem cell therapy for myocardial repair have shown early promise but modest results. Preclinical studies are the key to understanding stem cell senescence and lack of cellular contact and vasculature in the infarcted region. Additional laboratory studies are sure to unlock the therapeutic mechanisms that will be required for significant myocardial repair.