Cardiology

How to interpret troponins in renal disease?

October 21, 2009
How to interpret troponins in renal disease?

Ivan Saraiva MD

Case: A 68-year-old man, with a history of stable angina and end-stage renal disease treated by hemodialysis for the past three years, presents to the hospital with leg swelling and shortness of breath. He also complains of intermittent chest pain unrelated to exertion. Physical exam reveals bilateral pitting lower extremity edema, pulmonary crackles, and an elevated jugular venous pressure. Initial electrocardiogram is notable for some nonspecific repolarization abnormalities. Troponin I levels drawn at 0, 6, and 12 hours after initial presentation are …

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What is Wellens’ Syndrome?

October 7, 2009
What is Wellens’ Syndrome?

Erin Ducharme MD

Faculty peer reviewed

Wellens’ syndrome refers to a pattern of ECG signs occurring during chest-pain free periods in patients with unstable angina, heralding critical, proximal left anterior descending artery (LAD) stenosis . The eponym honors Dr. Hein J.J. Wellens who first described this ECG phenomenon in 1982. Wellens and colleagues identified a subgroup of patients with unstable angina who demonstrated a pattern of inverted precordial T-waves which strongly correlated with early large anterior myocardial infarction (MI) and a poor prognosis . In …

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Diseases 2.0: Calcific Uremic Arteriolopathy (CUA)

August 26, 2009
Diseases 2.0: Calcific Uremic Arteriolopathy (CUA)

Rebecca Hall MD

Faculty Peer Reviewed

Diseases 2.0 – Bringing you the latest updates on disease pathophysiology and treatment

Patient S.J. is a 36 year old female with a 20 year history of lupus and lupus nephritis now with end stage renal disease (ESRD) on hemodialysis. She presented with indurated, violaceous skin lesions with ulceration on both thighs. The lesions worsened and became increasingly painful over the last 6 months. Her extensive four month hospital course has been complicated by numerous episodes of superinfection and …

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Systemic Lupus Erythematosus and Premature Coronary Artery Disease

June 17, 2009
Systemic Lupus Erythematosus and Premature Coronary Artery Disease

Ishmeal  Bradley MD

Faculty Peer Reviewed

Ms. W is a 35 yo woman with a history of systemic lupus erythematosus diagnosed 10 years ago. Her only medications are hydroxychloroquine and prednisone for occasional disease flares. She is otherwise healthy. She has no known personal or family history of cardiac disease or stroke, but does smoke ½ pack of cigarettes per day. Currently, she denies any chest pain, shortness of breath, urinary symptoms, lower extremity edema, or menstrual irregularities, but does report occasional mild joint pain …

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Class Act: Cardiac CT to Assess Coronary Artery Calcium

May 17, 2009
Class Act: Cardiac CT to Assess Coronary Artery Calcium

Matthew Nayor

Faculty Peer Reviewed

The patient: a 55 year old male nonsmoker with an HDL of 46, LDL of 120, triglycerides of 70, BP of 135/80 (on meds) and total cholesterol of 180. (Framingham 10-year risk of MI = 12%)

Coronary artery disease is the leading cause of death worldwide. Despite our understanding of how family history, toxic habits, cholesterol, and blood pressure affect the risk of myocardial infarction (MI), there is a clear need to further refine the methods of risk stratification. The …

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What is the Role of Colchicine in Recurrent Pericarditis?

March 14, 2009
What is the Role of Colchicine in Recurrent Pericarditis?

Commentary by Sabina Berezovskaya MD, PGY-3

Faculty Peer Reviewed

Up to 32% of patients with acute pericarditis will have a recurrent episode. Acute attacks are commonly precipitated by infections, malignancy, cardiac trauma, myocardial infection, or autoimmune disease. Recurrent pericarditis usually presents with symptoms akin to the acute attack, including chest pain, fever, pericardial rub, typical electrocardiographic findings (i.e. diffuse ST elevations and PR depressions), pericardial effusion and, infrequently, tamponade. The time to relapse after acute pericarditis usually occurs within 18 to 20 months; however some …

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Mystery Quiz- The Answer

January 16, 2009
Mystery Quiz- The Answer

Posted by Daniel Frenkel MD PGY-3 and Jeffrey Lorin MD, Assistant Professor, NYU Division of Cardiology

Edited by Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors 

The answer to last week’s mystery quiz is accelerated idioventricular rhythm (AIVR)

AIVR is an ectopic ventricular rhythm with intermediate rates between an escape rhythm (<40 bpm) and ventricular tachycardia (>100-120 bpm). It has the usual features of ventricular arrhythmias including AV dissociation, fusion complexes, and capture complexes. …

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Coronary Artery Disease in South Asians

January 14, 2009
Coronary Artery Disease in South Asians

Commentary by Muhammad Ghumman MD, PGY-3

Faculty Peer Reviewed

South Asia (India, Pakistan, Bangladesh, Sri Lanka, and Nepal) comprises 25% of the global population yet contributes nearly 60% of the global cardiovascular disease burden. There are over 3 million South Asians living in North America (2 million in United States and nearly a quarter million in New York City alone). It is important to recognize that South Asians develop coronary artery disease (CAD) at a younger age, die from CAD at younger ages, and have …

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Mystery Quiz

January 8, 2009
Mystery Quiz

Posted by Daniel Frenkel MD PGY-3 and Jeffrey Lorin MD, Assistant Professor, NYU Division of Cardiology

Edited by Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors 

The patient is a 68 year old man with history of smoking, hypertension, hyperlipidemia, and stable exertional angina who presented with an acute posterior wall myocardial infarction. He was found to have a totally occluded left circumflex artery requiring bare metal stent placement. Several hours after stent placement, the nurse calls stating that the patient had …

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Grand Rounds: “The Cardiovascular Molecular Basis of CPVT and other arrythmias”

January 7, 2009
Grand Rounds: “The Cardiovascular Molecular Basis of CPVT and other arrythmias”

Commentary by Anjali Grover MD, PGY-2 

Please also see the clinical vignette presented before December 17th’s grand rounds.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is classified as an inherited disorder which manifests itself as an adrenergically driven polymorphic ventricular tachyarrythmias.  The molecular etiology of this arrythmogenic disorder stems from a disruption in the calcium channels found in the sarcoplasmic reticulum.   This type of arrhythmia is an important cause of syncope and sudden cardiac death in those individuals with structurally normal hearts.  Genetic studies have elucidated two …

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Cardiac MRI: Assessing Myocardial Viability

December 18, 2008
Cardiac MRI: Assessing Myocardial Viability

Commentary by Muhammad Ghumman MD, PGY-3

Faculty Peer Reviewed

Clinical Case:

A 65 year old male with hypertension, iron deficiency anemia, and atrial fibrillation (not anticoagulated due to prior gastrointestinal bleed,) presents with new onset lower extremity edema, dyspnea on exertion, orthopnea, and profound fatigue. Physical exam is significant for jugular venous distention to 17 cm, bilateral basilar crackles on lung exam, 3+ pitting edema in the lower extremities to mid thighs, and guaiac positive brown stool. Labs are significant for hemoglobin of 5.4, normal …

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Meeting Perspectives: American Heart Association Scientific Sessions 2008- Report from the cardiology fellows

December 16, 2008
Meeting Perspectives: American Heart Association Scientific Sessions 2008- Report from the cardiology fellows

Commentary by Steven Sedlis, MD Associate Professor of Medicine, Chief, Division of Cardiology Manhattan Veterans Administration Medical Center

The annual scientific session of the American Heart Association was held in New Orleans on November 8-12 2008, the second major cardiology meeting in New Orleans since Katrina. The city has obviously not recovered. The crowds on the streets are sparser and the lines at restaurants considerably shorter than they were before the hurricane. Charity Hospital is closed and a large sign for LSU Interim Hospital is …

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