Intracranial Hemorrhage Induced Takotsubo Cardiomyopathy: A Case Report.

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or "broken heart syndrome," is a reversible cardiac disorder characterized by left ventricular dysfunction without significant obstructive coronary artery disease. It is classically secondary to emotional stress in postmenopausal women but can also be secondary to physical stress. This report presents a unique case of takotsubo cardiomyopathy induced by intracranial hemorrhage in an 80-year-old female who presented with syncope.

Analysis of STEMI and NSTEMI in a Community Cohort of Marijuana Users.

Background: Marijuana is the most commonly used illicit drug in the United States. Current research has yet to come to a consensus on its association with acute coronary syndrome (ACS). Herein, we aimed to analyze how marijuana use relates to acute ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Methods: Using a retrospective study design, we gathered data from August 2014 to September 2020 on all percutaneous coronary interventions (PCIs) done at Brookdale University Hospital Medical Center (BUHMC) in patients with NSTEMI and STEMI. To compare marijuana users (MUs) with non-users, t-tests and Chi-square tests were used. A total of 195 patients were included, with mean age at presentation of 47 years old; 59 were females (30.3%) and 136 were males (69.7%). We identified 37 patients who were MUs. MUs were younger than non-users (P < 0.01), had higher rates of alcohol (P = 0.025), opiate (P = 0.004) and cigarette (P ≤ 0.001) use. On admission, MUs had lower creatinine (P = 0.031), blood urea nitrogen (BUN) (P = 0.031), pro-B-type natriuretic peptide (PBNP) (P = 0.052), BMI (P = 0.014) and lower right coronary artery (RCA) disease (P = 0.026). Results: After logistic regression analyses, results showed that the severity of coronary artery disease (CAD) and admission diagnosis of STEMI or NSTEMI were not found to be significantly related to marijuana use. Age, alcohol, cigarette, creatinine, BUN, PBNP, BMI and RCA disease were significantly related to marijuana use. There was a negative correlation between marijuana use and RCA disease (MUs = 29.7% vs. non-users = 50%, P = 0.026). There was no significant association with STEMI, NSTEMI or the severity of CAD. Conclusion: As daily cannabis use is on the rise, more researches are needed to further determine the effects of marijuana use on CAD.

Relationship between the Soluble F11 Receptor and Annexin A5 in African Americans Patients with Type-2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) is characterized by endothelial dysfunction, increased thrombogenicity, and inflammation. The soluble human F11 receptor (sF11R) and annexin A5 (ANXA5) play crucial roles in inflammatory thrombosis and atherosclerosis. We examined the relationship between circulating sF11R and ANXA5 and their impact on endothelial function. The study included 125 patients with T2DM. Plasma levels of sF11R and ANXA5 were quantified by ELISA. Microvascular function was assessed using the vascular reactivity index (VRI). Large artery stiffness was assessed by carotid-femoral pulse wave velocity (PWV). Carotid intima-media thickness (CIMT) was assessed by B-mode ultrasound imaging. The mean age of patients in the study was 59.7 ± 7.8 years, 78% had hypertension, 76% had dyslipidemia, and 12% had CKD. sF11R correlated positively with ANXA5 levels (ß = 0.250, p = 0.005), and correlated inversely with VRI and total nitic oxide (NO), (ß = −0.201, p = 0.024; ß = −0.357, p = 0.0001, respectively). Multivariate regression analysis revealed that sF11R was independently associated with ANXA5 in the total population and in patients with HbA1c > 6.5% (ß = 0.366, p = 0.007; ß = 0.425, p = 0.0001, respectively). sF11R and ANXA5 were not associated with vascular outcome, suggesting that they may not be reliable markers of vascular dysfunction in diabetes. The clinical significance of sF11R/ANXA5 association in diabetes warrants further investigation in a larger population.

Association between nitrated lipoproteins and vascular function in type 2 diabetes.

Higher levels of nitrated lipoproteins (NT-HDL and NT-LDL) were found in blood and atherosclerotic plaques of patients with coronary artery disease. We aimed to examine the relationship between plasma NT-HDL and NT-LDL and diabetic vascular dysfunction. The study included 125 African-American patients with T2DM. NT-HDL and NT-LDL were quantified by ELISA. Microvascular function was assessed by vascular reactivity index (VRI). Large artery stiffness was assessed by carotid-femoral pulse wave velocity (PWV). Carotid intima-media thickness (CIMT) was assessed by B-mode ultrasound imaging. In univariate analysis, NT-HDL was associated with VRI in total population and in patients with HbA1c more than or equal to 7.0 percent (beta= -0.178, p= 0.034; beta = -0.265, p= 0.042; respectively). In contrast, NT-LDL was associated with CIMT in total population and in patients with HbA1c more than 7.0 percent (beta = -0.205, p= 0.022; beta = -0.244, p= 0.042; respectively). Multivariable-adjusted regression analysis demonstrated that NT-HDL independently predicted VRI outcome in total population and in well-controlled patients (beta = -0.282, p= 0.014; beta = -0.400, p= 0.035, respectively). These results suggest that NT-HDL could be used as marker to identify diabetic patients at risk of developing early microvascular complications.

A Rare Case of Resolution of High-Degree Atrioventricular Block Associated With COVID-19.

Cardiac arrhythmias have been reported in the setting of coronavirus disease 2019 (COVID-19) infection. To date various tachyarrhythmias have been noted. This case report describes an atypical clinical hospitalization course of high-degree atrioventricular (AV) block in the setting of COVID-19 infection which required no intervention. This case highlights the importance of an initial electrocardiogram (ECG) upon presentation and consideration for constant cardiac monitoring in select patients.

Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge.

Thrombus-in-transit is not uncommon in pulmonary embolism but Right Heart Transvalvular Embolus (RHTVE) complicating this is rare. A 54-year-old obese male with recent hospitalization presented with severe dyspnea and collapse. Initial investigations revealed elevated d-dimer and troponin. CTA showed saddle pulmonary embolus and bedside echocardiogram revealed right ventricular (RV) pressure overload and dilatation (RV > 41 mm), McConnell's sign, and mobile echodensity attached to tricuspid valve. Patient was immediately resuscitated and promptly transferred for surgical embolectomy under cardiopulmonary bypass. A long segment of embolus traversing through the tricuspid valve and extensive bilateral pulmonary artery embolus were removed. IVC filter was placed for a persistent right lower extremity DVT. Hypercoagulable work-up was negative. Patient continued to do well after discharge on Coumadin. Open embolectomy offers great promises where there is no consensus in optimal management approach in such patients. Bedside echocardiogram is vital in risk stratification and deciding choice of advanced PE treatment.

Obstructive sleep apnea and dyslipidemia: evidence and underlying mechanism.

INTRODUCTION: Over the past half century, evidence has been accumulating on the emergence of obstructive sleep apnea (OSA), the most prevalent sleep-disordered breathing, as a major risk factor for cardiovascular disease. A significant body of research has been focused on elucidating the complex interplay between OSA and cardiovascular risk factors, including dyslipidemia, obesity, hypertension, and diabetes mellitus that portend increased morbidity and mortality in susceptible individuals. CONCLUSION: Although a clear causal relationship of OSA and dyslipidemia is yet to be demonstrated, there is increasing evidence that chronic intermittent hypoxia, a major component of OSA, is independently associated and possibly the root cause of the dyslipidemia via the generation of stearoyl-coenzyme A desaturase-1 and reactive oxygen species, peroxidation of lipids, and sympathetic system dysfunction. The aim of this review is to highlight the relationship between OSA and dyslipidemia in the development of atherosclerosis and present the pathophysiologic mechanisms linking its association to clinical disease. Issues relating to epidemiology, confounding factors, significant gaps in research and future directions are also discussed.