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1.
Cardiol Ther ; 10(2): 561-568, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34643895

RESUMEN

INTRODUCTION: This prospective pharmacodynamic (PD) study assessed the effect of the sodium-glucose co-transporter-2 inhibitor (SGLT2i), dapagliflozin, on platelet reactivity. METHODS: Patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) (n = 27) who were on maintenance dual antiplatelet therapy (DAPT) of aspirin 81 mg daily, and clopidogrel 75 mg daily were recruited. Platelet function was evaluated with the VerifyNow™ P2Y12 assay (Werfen, Bedford, MA, USA) and assessed prior to initiation of and after 10 days of treatment with dapagliflozin 10 mg once-daily dose regimen. Results were compared with a paired t test. RESULTS: Treatment with dapagliflozin significantly decreased P2Y12 reaction units (PRU) by 20%, (95% confidence interval (CI) 8.5-32.6%, p value 0.002). The mean difference in PRU was 36.70 (95% CI 16.66-56.75). No patients experienced any serious adverse events (SAEs). CONCLUSIONS: Significantly diminished platelet reactivity was observed on dapagliflozin as compared to without dapagliflozin. This dedicated pharmacodynamic study could be potentially informative and applicable for Trinidadian stable CAD patients with T2DM on DAPT. Further studies are required to confirm these exploratory findings. CLINICAL TRIAL REGISTRATION: EDGE ClinicalTrials.gov number NCT04400760.

2.
Cureus ; 13(7): e16681, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34466318

RESUMEN

The Africanized honey bee commonly referred to as the "killer bee," is a hybrid of the East African lowland honey bee with various European honey bees. These bees tend to be more hostile as compared to other bee species. Their stings may have devastating clinical sequelae, including cardiovascular, cerebrovascular events, and fatalities. We report the first-in-Caribbean case of a middle-aged woman who experienced stress-related, Takotsubo cardiomyopathy (also known as stress-related cardiomyopathy [SRC]) after being afflicted with innumerable Africanized honey bee stings. Key clinical message: The clinician should be cognizant of Takotsubo's cardiomyopathy as a potential sequela of Hymenoptera envenomation and anaphylaxis.

3.
Int Med Case Rep J ; 14: 385-391, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34135644

RESUMEN

Pectus excavatum (PEX) is an anterior chest wall deformity with sternal depression relative to the costal cartilages. We describe a patient status post remote PEX repair who presented with presyncope attributed to bifascicular block, partial right ventricular outflow tract (RVOT) obstruction, and right coronary artery (RCA) ischemia. Key Clinical Message: The clinician should be cognizant of the hemodynamic impact and electrocardiographic changes in a symptomatic patient status post pectus excavatum repair.

4.
J Investig Med High Impact Case Rep ; 9: 23247096211024027, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34121486

RESUMEN

Ventricular noncompaction is a rare, heterogeneous cardiomyopathy characterized by marked trabeculations and deep intertrabecular spaces with clinical sequelae of heart failure, arrhythmias, and cardioembolic events. In this article, we describe a patient with isolated right ventricular noncompaction who presented with submassive pulmonary embolism, which was managed with long-term direct oral anticoagulation.


Asunto(s)
Cardiomiopatías , Insuficiencia Cardíaca , Embolia Pulmonar , Cardiomiopatías/complicaciones , Cardiomiopatías/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico por imagen
5.
Cureus ; 13(3): e13890, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33880246

RESUMEN

We describe a case of a suspected cutaneous hypersensitivity reaction to ticagrelor. The patient displayed a localized bullous fixed drug eruption after being loaded with ticagrelor, which resolved with oral antihistamines and topical steroids after one week. Clopidogrel and rivaroxaban were successfully administered as alternative antithrombotic therapy without any apparent further hypersensitivity skin reaction.

6.
Cardiol Ther ; 10(1): 189-199, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33306161

RESUMEN

INTRODUCTION: This prospective pharmacodynamic (PD) study aimed to assess the effect of the sodium-glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin on platelet reactivity. METHODS: Patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) (n = 20) who were actively treated with dual antiplatelet therapy (DAPT) of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow™ P2Y12 assay (Instrumentation Laboratory, Massachusetts, USA) and assessed before the initiation of and after 10 days of treatment with empagliflozin 25 mg once daily maintenance dose regimen. Results were compared with a paired t test. RESULTS: The mean P2Y12 reaction units (PRU) on empagliflozin was significantly less than without empagliflozin at baseline (187.35, 95% confidence interval (CI) 155.38-219.32 vs. 217.25, CI 180.60-253.90; p < 0.030). The mean difference in PRU was 29.90 (95% CI 3.17-56.63). No patients experienced any serious adverse events (SAEs). CONCLUSIONS: Significantly attenuated platelet reactivity was observed on empagliflozin as compared to without empagliflozin. This dedicated pharmacodynamic study could be clinically pertinent for Trinidadian patients with stable CAD and T2DM on DAPT. Further studies are required to confirm these exploratory findings. (Funded by the University of the West Indies, St. Augustine; EFFECT). CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number NCT04342819.

7.
Int Med Case Rep J ; 13: 623-629, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33209063

RESUMEN

Coronary artery disease (CAD) is amongst the leading causes of death in human immunodeficiency virus (HIV)-infected persons. Severe left main disease (LMD) occurs in approximately five percent of HIV-infected patients, with chronic total occlusion (CTO) of this vessel being an even rarer phenomenon. We describe a non-adherent HIV-infected patient with a left main coronary artery (LMCA) CTO that presented with heart failure with mildly reduced ejection fraction (HFrEF) and ventricular tachycardia (VT).

8.
BMC Psychiatry ; 20(1): 498, 2020 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-33032571

RESUMEN

BACKGROUND: This study aimed to screen cardiovascular patients for depressive symptoms at a tertiary centre in Trinidad and Tobago; and to determine any significant associations amongst patients' demographics, comorbidities, and cardiovascular medications with depressive symptoms. METHODS: In this observational, cross-sectional study, patients (n = 1203) were randomly selected from the cardiology outpatient clinics at the Eric Williams Medical Sciences Complex. After meeting selection criteria, informed consent was obtained, and patients were administered a case report form, which included the Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses included frequency, percentage and summary statistics. Inferential analyses included 95% confidence intervals (CIs), independent sample t-test, Fisher's exact test, Chi-square test, and multivariate logistic regression. RESULTS: The study had a 96% respondent rate, whereby the average age was 62 years old. Slightly less than half were male, and 52.5% were female. Over 90 % of the sample had cardiovascular disease (CVD). One-quarter of the sample had a PHQ-9 score of ≥10, with almost one-fifth having no depressive symptoms. Females, lower levels of education and income were all found to be statistically significant at risk for depressive symptoms (all p-values < 0.001). Comorbidities associated with depressive symptoms included hypertension, prior cerebrovascular events, chronic kidney disease, and chronic obstructive pulmonary disease with odds ratios (ORs) and 95% confidence intervals (CIs) of OR 1.988 (CI 1.414-2.797), OR 1.847 (CI 1.251-2.728), OR 1.872 (CI 1.207-2.902) and OR 1.703 (CI 1.009-2.876) respectively. Only the cardiovascular medication of ticagrelor was found to be significantly associated with depressive symptoms (p-value < 0.001). CONCLUSIONS: Twenty-five percent of screened cardiovascular patients displayed significant depressive symptoms with a PHQ-9 ≥ 10. This study also highlights the importance of implementing a multidisciplinary approach to managing cardiovascular disease and screening for depressive symptoms in this subpopulation. Further studies are required to validate these findings. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT03863262 . This trial was retrospectively registered on 20th February 2019.


Asunto(s)
Depresión , Cuestionario de Salud del Paciente , Estudios Transversales , Depresión/diagnóstico , Depresión/epidemiología , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Trinidad y Tobago/epidemiología
9.
Cardiol Ther ; 9(2): 493-503, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32766961

RESUMEN

INTRODUCTION: This prospective, pharmacodynamic study aimed to explore the potential applicability of a low-dose ticagrelor regimen in a heterogeneous Trinidadian subpopulation. METHODS: Patients with stable coronary artery disease (n = 25) who were actively treated with dual antiplatelet therapy of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, CA, USA) and assessed before initiation of and after 14 days of treatment with a low-dose ticagrelor 45 mg twice daily maintenance dose regimen. Results were compared with a paired t test. RESULTS: The mean P2Y12 reaction units (PRU) score on ticagrelor was significantly less compared to that of clopidogrel (50.4, 95% confidence interval (CI) 29-73.9; vs. 149.6, 95% CI 129.4-169.9; p value < 0.001). Of the patients, 4% experienced Medical Research Council class 1 dyspnea, and Bleeding Academic Research Consortium class 1 bleeding on the ticagrelor regimen (one patient each). CONCLUSIONS: Significantly attenuated platelet reactivity was seen on the low ticagrelor maintenance dose as compared to clopidogrel. This dedicated pharmacodynamic study could be applicable and informative for Trinidadian stable coronary artery disease patients. Further studies are required to confirm these exploratory findings.(Funded by the University of the West Indies, St. Augustine). TRIAL REGISTRATION: ClinicalTrials.gov number NCT04206176.

10.
J Investig Med High Impact Case Rep ; 8: 2324709620951652, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32815420

RESUMEN

Penetrative cardiac injury can often result in life-threatening sequelae such as myocardial contusion or rupture, coronary vessel and valvular damage, pericardial effusion with tamponade, and arrhythmias of which gunshot injury is a chief culprit. We report a case of a suspected acute coronary syndrome after a cardiac gunshot injury that was conservatively managed.


Asunto(s)
Síndrome Coronario Agudo/etiología , Cuerpos Extraños/complicaciones , Derrame Pericárdico/etiología , Heridas por Arma de Fuego/complicaciones , Síndrome Coronario Agudo/diagnóstico , Taponamiento Cardíaco/etiología , Cuerpos Extraños/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico , Radiografía Torácica , Tomografía Computarizada por Rayos X
11.
SAGE Open Med Case Rep ; 8: 2050313X20933484, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32685152

RESUMEN

Cardiac myxomas are the most frequently encountered tumors of the heart. However, they are unusual to be newly diagnosed in the geriatric population. Myxomas are among the great mimickers, with a myriad of clinical presentations related to heart failure, embolic events, and constitutional symptoms. We describe a rare case of a giant atrial myxoma in a nonagenarian presenting with heart failure, which was medically managed.

12.
SAGE Open Med Case Rep ; 8: 2050313X20927596, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32551115

RESUMEN

Thymic carcinoma typically exhibits more clinically aggressive behavior and portends a worse prognosis as compared to thymoma. Venous thromboembolism is a significant cause of morbidity and mortality in oncologic patients. Traditionally, the standard-of-care management of cancer-associated venous thromboembolism has been therapeutic anticoagulation with low molecular weight heparins; however, with the advent of direct oral anticoagulants, there is an ongoing paradigm shift to transition to these novel agents in an attempt to attenuate cancer-associated venous thromboembolism events. We describe an exceedingly rare case of metastatic thymic carcinoma-associated right atrial thrombus with high-risk embolic features, which subsequently underwent near-complete dissolution with rivaroxaban after 3 months.

13.
J Investig Med High Impact Case Rep ; 8: 2324709620933425, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32525425

RESUMEN

In isolated partial anomalous pulmonary venous connections (PAPVCs), an abnormal vein connects venous blood from the pulmonary circulation to the systemic circulation, resulting in an extracardiac shunt. A single aberrant pulmonary vein (PV) is usually hemodynamically insignificant, and affected patients are generally asymptomatic. We describe a young Caribbean-Black woman with an isolated, singular PAPVC from the left inferior PV to the left innominate (brachiocephalic) vein that was hemodynamically significant, obfuscated by recurrent pleural effusions from catamenial pleural endometriosis.


Asunto(s)
Venas Braquiocefálicas/anomalías , Cardiopatías Congénitas/diagnóstico por imagen , Venas Pulmonares/anomalías , Síndrome de Cimitarra/diagnóstico por imagen , Adulto , Angiografía por Tomografía Computarizada , Ecocardiografía Transesofágica , Electrocardiografía , Femenino , Cardiopatías Congénitas/cirugía , Hemodinámica , Humanos , Imagen por Resonancia Magnética , Radiografía Torácica , Síndrome de Cimitarra/cirugía
14.
J Investig Med High Impact Case Rep ; 8: 2324709620925571, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32370558

RESUMEN

The coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that has significant potential cardiovascular implications for patients. These include myocarditis, acute coronary syndromes, cardiac arrhythmias, cardiomyopathies with heart failure and cardiogenic shock, and venous thromboembolic events. We describe a Caribbean-Black gentleman with COVID-19 infection presenting with atrial arrhythmias, namely, atrial flutter and atrial fibrillation, which resolved with rate and rhythm control strategies, and supportive care.


Asunto(s)
Fibrilación Atrial/diagnóstico , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/etiología , Fibrilación Atrial/terapia , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/terapia , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/terapia , SARS-CoV-2 , Tórax/diagnóstico por imagen
15.
J Investig Med High Impact Case Rep ; 8: 2324709620921626, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32389028

RESUMEN

The quadricuspid aortic valve is an exceedingly rare congenital valvular anomaly, characterized by a tetrad of leaflets that typically presents with aortic regurgitation. Almost one third of cases are associated with coexisting cardiac defects with one fifth warranting surgical intervention. In this article, we describe the first documented-in-Caribbean case and present a brief clinical review of its pathophysiology, diagnosis, and management.


Asunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Válvula Aórtica/anomalías , Válvula Aórtica Cuadricúspide/diagnóstico , Adulto , Válvula Aórtica/cirugía , Ecocardiografía , Electrocardiografía , Humanos , Masculino , Válvula Aórtica Cuadricúspide/cirugía , Tomografía Computarizada por Rayos X , Trinidad y Tobago
16.
Case Rep Cardiol ; 2019: 9027029, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31885934

RESUMEN

Brugada syndrome (BrS) is a genetic condition that accentuates the risk of potentially lethal ventricular arrhythmias and sudden cardiac death (SCD) in a structurally normal heart. The Brugada electrocardiographic pattern may manifest separately from the syndrome-this clinical scenario has been described as Brugada phenocopy (BrP). Many etiologies of BrP have been reported, but it has not yet been reported as a result of coronary slow flow (CSF) phenomenon. This case report highlights a suspected coronary slow flow-associated Brugada type 1 electrocardiographic pattern, which subsequently normalized following the institution of guideline-directed medical therapy for acute coronary syndrome.

17.
J Investig Med High Impact Case Rep ; 7: 2324709619874624, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31509019

RESUMEN

Pregnancy-associated spontaneous coronary artery dissection (PASCAD) accounts for less than 5% of spontaneous coronary artery dissection cases and is comparatively more fulminant or clinically aggressive. Several factors associated with PASCAD include black ethnicity, multiparity, hypertension, advanced maternal age, and age at first childbirth. This atypical case highlights a preeclamptic patient presenting with an ST-segment elevation myocardial infarction in which multivessel dissection of both the left anterior descending and right coronary arteries were deemed co-culprit lesions for the index event.


Asunto(s)
Anomalías de los Vasos Coronarios/etiología , Preeclampsia/diagnóstico , Enfermedades Vasculares/congénito , Adulto , Cineangiografía , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Electrocardiografía , Femenino , Humanos , Masculino , Preeclampsia/patología , Embarazo , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/diagnóstico , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/etiología
18.
Cardiol Ther ; : 229-237, 2019 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-31292901

RESUMEN

INTRODUCTION: This prospective study aimed to determine whether trimetazidine (TMZ) alters the pharmacodynamic (PD) effects of clopidogrel. METHODS: Patients with stable coronary artery disease (SCAD) (n = 24) who were actively treated with dual antiplatelet therapy (DAPT) of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, CA, USA) and assessed before the initiation of and after 14 days of treatment with TMZ. Results were compared using a paired t test. RESULTS: Almost 80% of the study population were of South Asian descent and had diabetes mellitus (DM). P2Y12 reaction units (PRUs) were higher in patients on TMZ (204 ± 56 compared with 174 ± 71 before TMZ, p = 0.005). The average increase in PRU score was 29 (95% confidence interval 8.8-49.7). Before TMZ, the proportion of patients with high on-treatment platelet reactivity (PRU > 208 units) was 25%, which increased to 42% for patients on TMZ. CONCLUSION: Higher platelet reactivity was seen in patients on TMZ, suggesting that TMZ attenuated the PD effects of clopidogrel in this study of a predominantly South Asian diabetic subpopulation. Alternative therapies should be considered and further research is warranted. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT03603249.

19.
Case Rep Vasc Med ; 2019: 6020393, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31285934

RESUMEN

Carotid artery pseudoaneurysms are infrequently encountered in clinical practice. Major contributory etiologies include blunt trauma, infections, cystic medial necrosis, fibromuscular dysplasia, arteriosclerosis, and congenital abnormalities. The authors report an exceedingly rare case of a dissected external carotid artery pseudoaneurysm in a 26-year-old female patient with neurofibromatosis complicated by preeclampsia at 28-week period of gestation, safely and successfully treated by coil embolization.

20.
Int Med Case Rep J ; 12: 179-183, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31354366

RESUMEN

Cardiac myxomas are the most common benign tumors of the heart. We describe the rare phenomenon of myxomatous embolization, resulting in a non-ST-elevation myocardial infarction treated successfully with surgical excision. The routine early use of both transthoracic and transesophageal echocardiography is pivotal in selecting an optimal management strategy for these patients.

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