6^th World Congress on Cardiology November 29-30, 2015 San Antonio, USA

Subodh Devabhaktuni has completed internal medicine residency at University of Nevada School of Medicine, Las Vegas, NV. He is currently doing cardiology fellow at University of Nevada School of Medicine, Las Vegas, NV.

Introduction: Dabigatran is a new oral anticoagulant, a direct thrombin inhibitor approved for use in non- valvular atrial fibrillation and pulmonary embolism management. It was associated with statistically non-significant increase in risk of MI in several trials. Previous study showed that TRAP (thrombin receptor- activated peptide) mediated platelet aggregation is less with both dabigatran and warfarin, but there was less inhibition of platelet aggregation by dabigatran compared to warfarin. To our knowledge no study has reported the effect of dabigatran and warfarin on PRU (platelet reactivity unit) values assessed by point of care VerifyNow P2Y12 test. Hypothesis: We hypothesized that the trend towards increased MI events in patients receiving Dabigatran could be due to an increase in platelet reactivity as measured by the VerifyNow P2Y12 test. Methods: This is a proof of concept study. We enrolled 40 patients who have been on dabigatran or warfarin for at least 6 months into one of the two study arms: Dabigatran arm or Warfarin arm. Platelet reactivity was measured by Accriva’s VerifyNow device and the PRU values were recorded. Analysis was done using Student t-test. Results: The mean PRU value in Dabigatran group was 222.4 with SD of 35.19.The mean PRU value in Coumadin group was 235.25 with SD of 34.49. T value was 1.498.Two-tailed P value was 0.25 with 95 CI ranging from -35.47 to 9.77. Conclusion: Platelet reactivity assessed by Verify Now did not differ in the two groups. These findings do not explain the observed trend in increased events of MI in the large clinical trials with dabigatran.

Ali Hasan is a graduate of the Aga Khan University, Karachi, aspiring to gain a residency in pediatrics in the United States. He holds a special interest in pediatric cardiology and hopes that the impact of his research can be used for the benefit of pediatric patients world wide. He has also authored studies detailing the use of improved techniques to treat neonatal jaundice as well as an assessment of awareness of cardiovascular risk factors.

Tetralogy of Fallot (TOF) is a common congenital heart disease. Coronary catheterization is considered to be an important diagnostic step before surgical correction. Prevalence of abnormal coronaries in TOF is up to 9%. Coronary abnormalities are difficult to delineate intra-operatively because of thick epicardial fat layer and adhesions after surgical shunting. The retrospective study was conducted in a tertiary care center in Lahore, Pakistan, to find out coronary abnormalities in TOF. Patients selected were 9 months to 16 years of age and catheterization was conducted before surgical repair. Non-selective aortic root angiograms were done, which were standard 45 left anterior oblique (LAO) and 20 cranial and 30 right anterior oblique views (RAO). Total of 662 patients with TOF underwent catheterization. 65.4% were male while 34.6% were female. 94.4% of patients with TOF had normal coronary anatomy while 5.6% of patients with TOF had abnormal anatomy. Most commonly detected abnormality was single origin of coronary artery found in 2.9% of cases (1.8% of patients had common origin from left sinus and 1.1% of patients had common origin from right sinus). Apart from the abnormality with single origin of coronary artery, 2.6% of patients had abnormal coronary with a conal branch crossing right ventricular outflow track (RVOT) anteriorly and 0.2% of patients with abnormal coronaries had conal branch crossing RVOT posteriorly. Coronary abnormalities in TOF were detected in 5.6% of the cases. Single origin coronary artery was the most common abnormality.

Innocent Chima Nwaogu obtained his DVM degree from the Kishinev Agricultural Institute USSR, MSc and PhD from the University of Nigeria, Nsukka. He is a fellow of the College of Veterinary Surgeons, Nigeria. He is currently the Head, Department of Veterinary Anatomy, University of Nigeria, Nsukka. He has published several scientific articles in peers review local and international journals. He is a member of Nigeria Veterinary Medical Association, Anatomical Society of Nigeria and Editorial Board Member, Nigerian Veterinary Journal (NVJ).

The morphology and histomorphometry of the aorta and its branches in Grasscutter were studied using gross and light microscopic methods. The grasscutters were obtained from Demaco Farms in Akor-Nike in Enugu State, Nigeria and brought to the Department of Veterinary Anatomy, University of Nigeria , Nsukka for anatomic studies. They were humanely sacrificed, carefully dissected and patterns of arteries that originated from their aortic arch and descending aorta were examined. Segments of the aorta and its major branches were fixed in Bouin’s fluid and routinely processed for histology. The brachiocephalic trunk and left subclavian artery originated separately from the aortic arch. The brachiocephalic trunk gave off right subclavian and continued as a common trunk for the right and left common carotid arteries. Bronchoesophageal and dorsal intercostal arteries originated from the thoracic aorta. The abdominal aorta gave off the celiac, cranial and caudal mesenteric, renal, lumbar arteries and terminated into paired external and internal iliac and median sacral arteries. Microscopically, the aorta and its branches were elastic type of arteries though celiac and external iliac had characteristic features of both elastic and muscular arteries. The mean wall thickness and and luminal diameter were 580.38±2.07, 3442.78±68.05; 376.64±4.06, 3026.18±82.89 and 334.74±8.17, 2663.38±55.85μm for aortic arch, thoracic and abdominal aortae, respectively. The mean wall thickness and luminal diameter were 388.94±2.00, 2236.72±55.15; 236.16±30.00, 1598.68±95.22; 294.36±7.78, 1507.90±239.95 and 235.78±22.74, 1391.54±251.61μm for brachiocephalic trunk, left subclavian, celiac and external iliac arteries, respectively.

Mohd. Ayan has completed his medical school at Tripoli University. He did internal Medicine residency at Tripoli University Affiliated hospitals and Master of Public Health at Benedictine University, Lisle IL. He is currently a third year internal medicine resident at Creighton University Medical Center, and is very interested in Cardiology and research, he has also applied for cardiology fellowship this year. He is a member in Committee on Scientific Research (CoSR) Resident and Fellow section American Medical Association. He has more than 20 peer reviewed journal/abstract published. Furthermore, and serving as per reviewer for SGIM and ACP annual meeting.

Background: Primary cardiac tumors are extremely rare with an incidence of less than 0.1%. Cardiac papillary fibroelastomas are the second most common primary cardiac tumors, after myxomas. The demographics, site, size, clinical characteristics, treatment, and prognosis of CPF are examined. Methods: We searched Pubmed, Cochrane library and Embase database for cases, case series and related articles on the subject in English languages. They are retrospectively analyzed. Only cases with histologically proven diagnosis were included. Results Sixty seven cases of CPF complicated by ischemic stroke were identified (52.2% females, 47.8% male, mean age 50.88 ± 15.9 years). The valvular surface was the predominant site of the tumor. The most commonly involved valve was Mitral valve 49.3% followed by Aortic valve 22.4%. Anterior mitral valve leaflet on the atrial side was the most reported mitral valve site. The left ventricle was the predominant non-valvular site involved in 14.9 % followed by left atrium 2 %. Size of the tumor varied from 0.2 cm to 5 cm, mean size 1.27 ± 0.8 cm. Tumor numbers various from 1 to 4 with 86.6% of cases have only one tumor, 7.5% of cases have 2 tumors, 1.5% of case have 3 tumors, 3% of case have 4 tumors. Tumor mobility was reported in 53.7% of cases. Transthoracic echocardiogram was positive in 92.9% of cases, whereas Transesophageal echocardiogram was positive in 98% of cases. Right middle cerebral artery territory was the most common brain site involved in 50% of reported cases, followed by left middle cerebral artery involved in 43%. Three percent of patients who presented with acute ischemic stroke received thrombolytic with good response. Surgical removal of the tumor is curative with excellent long term result. The recurrence after surgical resection was not reported average follow up of 1 year after surgery Conclusions: CPF complicated by ischemic stroke affected mainly middle aged people with almost equal female to male ratio. Left sided heart valves were the predominant site of the tumor. TEE was better than TTE in terms of tumor detection. Surgical removal of the tumor is curative with excellent long term complication. Thrombolytic therapy for ischemic stroke secondary to fibroelastomas has very good outcome.

Mohd. Ayan has completed his medical school at Tripoli University. He did internal Medicine residency at Tripoli University Affiliated hospitals and Master of Public Health at Benedictine University, Lisle IL. He is currently a third year internal medicine resident at Creighton University Medical Center, and is very interested in Cardiology and research, he has also applied for cardiology fellowship this year. He is a member in Committee on Scientific Research (CoSR) Resident and Fellow section American Medical Association. He has more than 20 peer reviewed journal/abstract published. Furthermore, and serving as per reviewer for SGIM and ACP annual meeting.

Background: In-stent restenosis of bare metal stent (BMS) is one of the major drawback of primary coronary intervention (PCI). Currently there is no ideal treatment for BMS restenosis. We aimed to perform meta-analysis for randomized controlled trials assessing the long-term safety and efficacy of stenting versus balloon angioplasty for patient with BMS in-stent restenosis. Method: We conducted a comprehensive search for randomized controlled trials (RCT) using special search criteria. Five prospective randomized controlled trials were identified. Relative Risk (RR) and 95% confidence intervals (CI) computed using the Mantel-Haenszel method. Random-effect model was used in analysis of all the variables. Result: A total of 5 RCT were included in the meta-analysis, a total of 1486 patients were enrolled. At one year follow up compared to balloon angioplasty using stenting in treatment of BMS in-stent restenosis reduced the rate of target vessel revascularization (RR -2.1; 95% CI, -2.6 to -1.6, P = 0.000). However, there were no significant differences in the rate of mortality (RR -2.1; 95% CI, -2.6 to -1.6, P = 0.000) and myocardial infarction (RR -2.1; 95% CI, -2.6 to -1.6, P = 0.000). Conclusions: In patients with BMS in-stent restenosis, the outcome of using stenting was superior to balloon angioplasty alone in reducing the rate of target vessel revascularization, however; there were no statistically significant difference in the rate of mortality and myocardial infarction.

Abdalla Hassan is an Internal Medicine first year resident at Advocate Illinois Masonic Medical Center, Chicago, IL. Dr. Abdalla Hassan graduated and earned his medical degree from the University of Khartoum, Faculty of Medicine, Sudan in 2012 with the highest degree of honor at the top of his class. Dr. Abdalla Hassan was awarded with more than nine national and international prizes and awards (in Microbiology, Pathology, Forensic Pathology, Community medicine, Internal Medicine, and Psychiatry) during his medical school. Dr. Hassan has the privilege of being an author in multiple ongoing papers, abstracts and case reports, as well as a presenter in many national conferences. Dr. Hassan pursued Internal medicine because it fulfills his passion about helping people and solving multi-systemic complex problems that are very intellectually stimulating, and he is hoping to pursue a career in cardiovascular diseases.

Introduction Aortic dissection is uncommon with high mortality rate if untreated. Around one third of patients ultimately diagnosed with acute aortic dissection are first thought to have another diagnosis. We report a very challenging case of long segment aortic dissection in which the dissection type was very difficult to identify due to limitations of the available imaging studies. Case presentation A 66-year-old male presented to us with 3 days history of chest pain and difficulty breathing. He is known to be hypertensive. In the emergency room, patient has systolic blood pressure >190. Chest X-ray showed widening of mediastinum. CT angiography of chest and abdomen showed an acute dissection of the thoracic aorta extending from the mid ascending aorta to the infra-renal aorta suggestive of Stanford type A aortic dissection. Transthoracic echocardiography revealed a calcified intimal flap just beyond the distal arch. Moreover, large partially calcified intimal flap was present in the abdominal aorta with no proximal clear cut extension. Normal ejection fraction was reported with dilated aortic root, dilated aortic arch, and large pericardial effusion with no evidence of cardiac tamponade. Trans-esophageal echocardiography was done later, and it revealed a partially calcified intimal flap in the distal portion of the arch and in the descending thoracic aorta in concordance with the trans-thoracic echocardiogram findings and no abnormalities were reported in the ascending aorta. These findings were significantly consistent with Stanford type B aortic dissection. Due to the discrepancy of these tests, imaging studies were reviewed, and repeated CT chest with contrast was obtained and surprisingly confirmed that he had Stanford type B aortic dissection, with the dissection starting distal to the left subclavian artery and intact ascending aorta. Medical treatment started, and repeated CT angiography was obtained and it confirmed type B aortic dissection. One week after discharge, patient was readmitted with severe neck pain and difficulty breathing. CT chest without contrast showed grossly stable appearance of type A dissection consistent with the first CT angiography. Cardiothoracic surgery immediately reevaluated the situation and recommended surgical intervention. Discussion Aortic dissection is readily diagnosed using CT scanning. Conventional CT scanners without spiral acquisition have less satisfactory results. In CT with contrast, the intimal flap is seen in less than 75% of cases and the site of entry is rarely identified. These side effects may lead to serious delay in the diagnosis of the correct type of dissection leading to significant delay in management, and our patient was a fair example of these drawbacks. In conclusion, we believe that Spiral/ multi-slice CT can improve the accuracy of diagnosis substantially.

Abdalla Hassan graduated and earned his medical degree from the University of Khartoum, Faculty of Medicine, Sudan in 2012 with the highest degree of honor at the top of his class. Dr. Abdalla Hassan was awarded with more than nine national and international prizes and awards (in Microbiology, Pathology, Forensic Pathology, Community medicine, Internal Medicine, and Psychiatry). Dr. Hassan has the privilege of being an author in multiple ongoing papers, abstracts and case reports, as well as a presenter in many national conferences. Dr. Hassan pursued Internal medicine because it fulfills his passion about helping people and solving multi-systemic complex problems that are very intellectually stimulating, and he is hoping to pursue a career in cardiovascular diseases.

Background The prognostic significance of coronary artery disease (CAD) in heart failure with preserved ejection fraction (HFpEF) is controversial. Despite the common concept that CAD patients have a worse prognosis, the effect of CAD on HFpEF is not completely understood. We aimed to analyze the prognostic impact of CAD in HFpEF patients. Methods In this prospective cohort, we queried our institutional heart failure data base and identified 106 consecutive patients with HFpEF hospitalized for the first time for heart failure during 2006 and followed for 9 years. Poor outcome was identified as two or more re-admissions for heart failure, cardiovascular death, and all-cause mortality. Results: Women constituted 55.7% of our patient population, while men represented the remaining (44.3%). Mean age was 73.5 ± 12.6 years. History of CAD was documented in 56.6% of patients. Overall, CAD was not predictive of poor outcome and cardiovascular death. Poor outcome was observed in more than half of HFpEF patients with history of CAD and in only about one third of those without CAD, 56.1% and 38.6%, respectively (P=0.1). Moreover, the number of the diseased coronary artery vessels on angiogram was not a significant predictor of poor outcome (P=0.17). Conclusion Despite the apparent higher percentage of morbidity and mortality in HFpEF patients with CAD, the prognostic impact of CAD in HFpEF patient remains to be statistically insignificant. Large scale prospective studies should be done to revoke or confirm this hypothesis.

Objectives: To assess the effects of ferulic acid and ascorbic acid and combination of both on ECG variables, serum cardiac enzymes (AST, ALT, LDH, CK-MB), myocardial oxidative stress markers (MDA,SOD and GSH) and connexin 43 expression in isoproterenol induced myocardial infarction. Methods: 50 male rats subdivided into equal 5 groups, a) normal group, ISO group (rats received isoproterenol 150 mg/Kg i.p. for 2 consecutive days at 24 hrs intervals), c) FA group (rats received ISO + ferulic acid 20 mg/kg/day p.o for 6 days), d) AA group (rats received ISO + ascorbic acid 80 mg/kg/day p.o for 6 days) and e) combined group (rats received ISO + AA+ FA in the same previous doses).Results: ISO group showed significant elevation in serum cardiac enzymes (AST, CK-MB, LDH), myocardial MDA (marker of lipid peroxidation) and myocardial histopathological damage score with significant decrease in myocardial antioxidants (SOD and GSH) and expression of connexin 43 compared to normal group (p< 0.05). Also, rats of ISO group showed ECG changes such as ST segment elevation, prolonged QT interval, short RR interval and heart rate. Pretreatment with a combination of FA and AA caused more significant improvement in all studied parameters than did each agent alone. Moreover, ECG changes were improved significantly improved in combined group only. Conclusion: we concluded that a combination of FA and AA has a synergistic protective effect against ISO induced myocardial infarction. This might be due to their antioxidant effects as well as their effects on connexin 43 expression in myocardium.

Lea Arceli G. Porciuncula is at the age of 30 years from St. Luke’s Medical Center, E. Rodriguez Avenue, Quezon City, Philippines. She is currently training as a 2nd year clinical fellow in cardiology in the HB Calleja Heart and Vascular Institute.

OBJECTIVES: To determine the efficacy and safety of tenecteplase with anticoagulation versus anticoagulation alone in patients with intermediate-risk pulmonary embolism (PE) in reducing all-cause mortality, respiratory distress requiring mechanical ventilation (MV), recurrence of PE and major bleeding episodes. DESIGN: Meta-analysis including three RCTs. SETTING: Studies included were performed in Italian, German, and American medical centers. PARTICIPANTS: Inclusion criteria: adult patients diagnosed with PE with RV dysfunction on echocardiogram or CT scan with stable hemodynamic status. Exclusion criteria: hemodynamic instability, history of bleeding, and contraindication to anticoagulants INTERVENTIONS: Weight-based tenecteplase with anticoagulation versus anticoagulation alone MAIN OUTCOME MEASURES: Efficacy outcome measures: reduction in all-cause mortality, respiratory distress requiring MV and recurrence of PE; Safety outcome parameter: major bleeding episodes RESULTS: There is no statistically significant difference for death from any cause (Z=0.89, pvalue0.37), however, there is a trend favoring tenecteplase group (OR0.65, CI0.26-1.66). There is also no statistically significant difference for reduction in respiratory distress requiring MV and recurrence of PE, but there is a trend favoring tenecteplase group. In terms of major bleeding, there is a statistically significant difference, favoring placebo (OR4.91, CI2.68-8.97). CONCLUSION: There is a trend favoring tenecteplase in intermediate-risk PE in terms of all-cause mortality, respiratory distress requiring mechanical ventilation and recurrence of PE, however, with increased rate of major bleeding.

Francis Carl L. Catalan MD is presently an Adult Interventional fellow at Cardinal Santos Medical Center. He had his premedical major in Bachelor of Science in Physical Therapy. Following a completion of his Internal Medicine residency at the East Avenue Medical Center and Adult Cardiology training in Philippine Heart Center. To further augment his acquired clinical expertise and skills, he worked and acquainted himself in various hospital settings for 3 years. His competence as a doctor is not only existent in a clinical setting. But holistically, he exhibited competency in research and scientific presentations. He is duly recognized by various renowned research committee in Hong Kong, and Dubai. He is also interested in interventional and experimental cardiology. He is very much excited to be part of this conference where he can learn from future innovations and practices.

Introduction: Kawasaki disease is a form of vasculitis that is self-limiting and usually occurs in children.. Its incidence is high in Japan and in Korea. Several causes have been inflicted as a trigger to Kawasaki but some studies mentioned toxins such as fungal toxin or bacterial superantigen. In children, it is easy to diagnose by using the clinical criteria such as persistent fever of more than 5 days, lymphadenopathy, strawberry tongue, rash and conjunctivitis. However, this criteria has not been widely accepted in adults. In Kawasaki disease, 25% of them may present with coronary artery aneurysm. It is defined as dilatation of more than1.5 times of the patient’s largest coronary. Case: This is a case of a 44-year old male, hypertensive, smoker, physician who came in due to sudden onset of chest pain. The pain was described to be chest heaviness, continuous, not relieve by rest, VAS 7/10. His family had no history of premature coronary artery disease. He had recurrent rhinitis and conjunctivitis during his childhood. On examination, he was stable with the following vital signs: blood pressure of 120/70, heart rate of 70 beats per minute, a respiratory rate of 18 cycles per minute, temperature of 36.8 C. He weighs 90 kg with a BMI of 21. His electrocardiogram revealed an ST segment elevation over the inferior leads (leads II, III and aVF). Initial troponin showed normal result but there was a 20% increment on the repeat troponin determination.Two dimensional echocardiography showed preserved ejection fraction of 75% with adequate wall motion and contractility With the presentation of classic angina and electrocardiogram result, he was brought to the catheterization laboratory for an emergency double set up. Emergency coronary angiography was done and revealed an ectatic right coronary artery with a large aneurysm over the distal segment and thrombus within its lumen. Aspiration thrombectomy was done hoping that the lumen would be free from thrombus but none was aspirated. Intracoronary Tirofiban was also administered. There was regression of the ST elevation. The patient was admitted for 5 days and was maintained on dual antiplatelet and anticoagulation. Currently, he is asymptomatic, on going rehabilitation with stable vital signs. Conclusion: Although atherosclerosis is the most common cause of Acute Coronary Syndrome, we should be mindful to the feasibility of unwonted causes of angina like dissection, inflammatory or autoimmune diseases. As a cardiologist, we should be wary with high index of suspicion of these rare entities as a cause of angina.

Alexander E. Berezin has received PhD in 1994 in the State Medical University of Zaporozhye (Ukraine). He is currently working as a Professor of Medicine in the State Medical University of Zaporozhye (Ukraine). His research goals are fundamental study of biological markers, the development of cardiovascular prevention and rehabilitation. Based on this research and training in heart failure he has received several awards and honors. He has published more than 550 papers in reputed journals, 19 books/chapters and has been serving as an editorial board member of repute.

Background / aim: Chronic heart failure (CHF) remains a leading cause of cardiovascular morbidity and mortality. Although the endothelium is considered an important targeting for traditional risk factors and endothelial dysfunction remained independently associated with mortality from CHF, the innate molecular mechanisms affected forming of endothelial dysfunction is being became not fully clear. The study aim was to evaluate whether circulating micro particles with apoptotic or none-apoptotic phenotypes are useful for risk assessment of three-year cumulative fatal and non-fatal cardiovascular events in CHF patients. Methods: It was studied prospectively the incidence of fatal and non-fatal cardiovascular events, as well as the frequency of occurrence of death from any cause in a cohort of 388 patients with CHF during 3 years of observation. Circulating levels of NT-pro brain natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), endothelial apoptotic micro particles (EMPs) were measured at baseline. Results: Median follow-up was of 2.32 years (IQR=1.8-3.1). During follow-up, 110 cardiovascular events (including 43 fatal cases) were determined. Additionally, 74 subjects were hospitalized repetitively due to worsening CHF and also 16 subjects were readmitted in the hospital due to other cardiovascular reasons. In the univariate logistic regression analysis, the main factors independently related with cumulative end-points were creatinine, fasting glucose, HbA1c, total cholesterol, uric acid various types of EPMs, NT-pro-BNP, hs-CRP, NYHA class, decreased left ventricular ejection fraction (LVEF) less 45%, and type 2 diabetes mellitus. In multivariate model NYHA class, decreased LVEF (less 45%), NT-pro-BNP, hs-CRP, CD144+/CD31+/annexin V+ EMPs, and CD31+/annexin V+ EMPs remained statistically significant for cumulative end-point. Adding of CD144+/CD31+/annexin V+ EMCs and CD31+/annexin V+ EMCs to the standard ABC model may improve the relative IDI for cumulative end-point by 11.4% and 10.5% respectively. These data are very promising, and they are required new investigation with higher statistical power and increased sample size to be overcome the internal limitations of the study. Conclusion: Apoptotic phenotype of circulating micro particles may relate three-year combined clinical outcomes in CHF patients. Finally, identification of the pattern of circulating EMPs may help to determine patients at high risk and reclassify it for possible biomarker-guided therapy of CHF.

Keyur Mehta graduated from Grant Medical College in Mumbai at the age of 23 years. He completed his pediatrics training from State University of New York, Downstate Medical Center. Before starting residency, he worked at the National Cancer Center in Singapore. Currently, he is working as a Clinical Assistant Instructor and Chief Resident at SUNY Downstate. He is a member of the Medical Council of India as well as the American Academy of Pediatrics. He is going to begin his Pediatric Cardiology fellowship at Nicklaus Children’s Hospital (formerly Miami Children’s Hospital) in Florida next year.

INTRODUCTION: Heterotaxy Syndrome (HS) is defined as an abnormality of thoraco-abdominal visceral arrangement across the left-right axis of the body leading to either polysplenia or asplenia. Mortality in these patients depends on associated cardiac, pulmonary and abdominal lesions. We evaluate the hypothesis that pulmonary hypertension (PH) increases the mortality of HS in pediatric population. METHODS: After thorough review of electronic databases, patients with HS were classified as polysplenia or asplenia. PH prevalence was determined in each group based on echocardiogram (pulmonary vascular systolic pressure as definitively ≥ 50% systemic) and/or cardiac catheterization (pulmonary vascular resistance > 3WUm2) results. Associated cardiac lesions were categorized as either 1) Simple lesions (e.g., ASD, common AV canal defect); 2) Complex two ventricle palliation (e.g., TGA, DORV); or 3) Single ventricle palliation (e.g., HLHS). Chi square test was used to test differences among groups. Mortality and median survival in each was determined. RESULTS: Of 236 patients initially coded for HS, 56 patients (born between 1954 and 2006) met unequivocal criteria for HS: 21(37.5%) polysplenia and 35 (62.5%) asplenia. Simple cardiac lesions were more common in polysplenia (50% vs 17.9%, p = 0.021). PH was present in 33.9% of patients, predominantly in the polysplenia group (52.4% vs 22.9%, p = 0.023). PH occurred with simple cardiac lesions more frequently than with complex cardiac lesions (64.2% vs 23.8%, p = 0.005). The overall mortality rate for HS was 37.5% without a significant difference between polysplenia vs asplenia (p > 0.05) or between simple vs complex lesions (p > 0.05). However, the association of PH increased mortality to 68.4% (p < 0.001). CONCLUSIONS: PH is present in about one third of cases of HS and in more than half of cases with polysplenia. The simple cardiac lesions seen in polysplenia tend to be at a higher risk of developing PH. Mortality is significantly increased in HS when PH is present, suggesting patients with polysplenia die from PH complications whereas patients with asplenia die from complications of their complex cardiac lesions. Evaluation of this precisely phenotyped historical HS cohort confirms our hypothesis that PH is a potential cause of death in HS. Early diagnosis and treatment of PH may prevent premature mortality, especially in patients with polysplenia.

Imei Tiongco is a 5th year student of BS Pharmacy Major in Clinical Pharmacy in University of Santo Tomas, Manila, Philippines.

Hypertension is a condition in which the arteries have persistently elevated blood pressure. Diuretic based therapy has been proven effective in reducing morbidity and mortality in hypertensive patients. The goal of this study is to determine whether the methanolic extract of Pachyrhizus erosus tubers has diuretic and blood-pressure lowering effect. Pachyrhizus erosus exhibits a variety of pharmacological use including the utilization of its tubers through decoction which is said to be diuretic based on folkloric use. The study utilized 25 male Sprague-Dawley rats divided into five groups with five rats each. Hypertension was induced to all of the test subjects through the subcutaneous injection of Cyclosporin A with a dose of 25 mg/kgBW. Systolic blood pressure (SBP) was measured using a Non-invasive Blood Pressure apparatus utilizing tail cuffs. Then, two groups were set as positive (Hydrochlorothiazide) and negative (water) controls. The other three were given varying doses of the methanolic extract of the tubers of Pachyrhizus erosus: 50 mg/kg, 100 mg/kg, and 200 mg/kg orally. During the whole course of treatment, the SBP of the subjects were consistently monitored. The urine output was also recorded based on schedule, 8 hours a day, using a metabolic cage. Statistical tests were used to determine significant changes. The methanolic extract of the tubers of Pachyrhizus erosus showed potential blood pressure lowering activity at a dose of 200 mg/kg and possibly on higher doses. The diuretic effect was only exhibited at the 50 mg/kg dose and cannot be suggestive of potential therapeutic activity.

The CABG may lead to severe bleeding that the most common cause of bleeding in cardiac surgical patients is the fibrinolysis and platelet inhibition by Cardiopulmonary Pump (CBP).Therefore, researchers with use of drugs such as tranexamic acid, looking to reduce this side effect. Nowadays A lot of research on the effects of this drug on postoperative bleeding and blood factors is done. Because of Platelets play a key role in hemostasis and one of the primary causes of uncontrolled bleeding is loss of platelets and little research has examined the effect of tranexamic acid on the platelets level, this study examine the effect of intravenously administered tranexamic acid on platelet level in patients under CABG. Patients 50-70 years with ASA class 2 & 3, scheduled for CABG, were included in this randomized clinical trial study in Ahwaz Golestan Hospital on 2011. They were allocated to 7 blocks. They randomly treated whit a combination of fast or slow tranexamic acid infusion technique and dose (10, 15 & 20Mg/Kg) but control group not given drug. Finally the platelet levels and some other factors were measured. There was no significant difference in platelets level between the control and other groups (p=0.49). Also Comparison of pre-and postoperative platelet level average shows no significant difference in 7 blocks (p=0.173 vs p=0.175).Tranexamic acid it can be used as a safe drug without changing the balance of the blood platelets; of course, this finding need more research by researchers.

Amreeta Sharma graduated from Wilfrid Laurier University, Kitchener Ontario with a HBSc in Health Sciences. Prior to entering medical school, she worked at CRICH (Centre for Research on Inner City Health) in Toronto, Ontario performing research on epidemiological factors pertaining to public health access. Amreeta is now a third year medical school student at St. George’s University, and is currently completing her core clerkship rotation in Internal Medicine at St. John Hospital and Medical Center.

A 44 year-old Caucasian male presented with substernal chest pain that began minutes after suffering a fall on the chest during a hockey game. The patient initially thought the pain was a result of the fall itself and proceeded to rest for a few minutes. He quickly realized that his condition was not improving, but was in fact worsening. The patient has a history of hypertension controlled with 50 mg daily of Lisinopril and hyperlipidemia medicated with Fenofibrate 200 mg daily. His family history is significant for CAD as his brother and grandfather died at 42 and 50 years of age, respectively, as a result of an myocardial infarction. When his pain became unbearable, the patient drove himself to an urgent care centre where a 12- lead EKG showed a STEMI on inferior leads, he was transferred to our hospital where an emergent coronary angiogram showed a hyperdominant right circulation with a fresh clot completely obstructing mid RCA, for which throbectomy trials have failed. He was immediately transferred to the OR where an emergent CABG was done; the thrombus was removed, and a dissection was visualized. Following the procedure, he was admitted to the coronary care unit for observation. The patient’s hospital course was complicated by right ventricular failure (EF=40%), atrial fibrillation and hypotension. Eventually, the patient was stabilized and discharged on post operative day 11. Trauma induced myocardial infarction is a rare clinical entity. Both diagnosis and management are delayed in many instances, contributing to suboptimal outcomes in many cases. Every effort should be made to avoid such delays, and this condition should be kept in mind, even in the light of polytrauma.

After completing his medical school from St. George’s University in 2011, he went to SUNY downstate Medical School for Internal Medicine Residency which he completed last year. He is currently a Chief resident at West Suburban Medical Center and he will be starting a Fellowship in Advanced Cardiac imaging next month at St. Francis Medical Center. He want to practice Clinical Cardiology and continue work in an Academic institution.

Myopericarditis is an inflammation of both the pericardial sac and the myocardium. In clinical practice they usually co-exist. The clinical presentation is variable and depends on the area of myocardium involved. Symptoms range from mild to no chest pain to fulminant heart failure, syncope or sudden cardiac death. About 50% of the cases are idiopathic and the rest can be divided into infectious, neoplastic, autoimmune, metabolic, trauma, and drugs. The most likely etiology involves a viral infection –commonly Coxsackie B. 27 year old AAM with no past medical history came to the ED with abdominal pain. CT of the abdomen showed widespread pneumatosis, consistent with perforated viscus favoring a ruptured appendix. Patient was unstable and was emergently taken to the OR. During surgery, large amount of purulent material was found in the peritoneal cavity, after which patient was transferred to the ICU. At this time patient troponin level was undetectable. Echo showed EF of 70% with no Wall motion abnormality (WMA). Despite being on appropriate antibiotics for two days, WBC was elevated with worsening LFT’s, and creatinine. On day 3, new ST elevation were noted on telemetry mainly in leads II, III, avF and V5 with a troponin level of 57. Patient was started on ASA, and a heparin drip, though the suspicion for atherosclerotic disease was low (young age and no risk factors). Patient maintained his EF on the repeat echo and still did not have any WMA. Repeat CT of the abdomen showed multiple areas of loculated fluid, one of which was along the liver margin, directly underneath the right ventricle. The Next day, the patient was taken back to the OR for an abdominal washout. Subsequently, patient had resolution of ST elevations, heparin was discontinued, and troponins had normalized within 2 days. Myopericarditis can be diagnosed when there is an elevation of cardiac biomarkers in the presence or absence of chest pain or if there is myocardial inflammation seen on the cardiac MR or acute heart failure with reduced EF. Other common findings are ventricular arrhythmias, new bundle branch blocks and IVCD. It’s very unique to have myocardial damage through a localized infectious source such as an abscess as in this case and present with STEMI. It’s important to acknowledge the etiology because management of myopericarditis induced STEMI is very different from when there is an occlusive Coronary artery disease. This patient was managed medically with ASA, blockers and Lisinopril as tolerated without activating the CATH lab. Understanding the pathophysiology can help with decision making when caring for patients with an unusual presentation.

Chaturvedi has done his MBBS in year 2005 from Rajasthan university of Health Science, jaipur, Rajasthan India. Thereafter he has completed Post Graduation Diploma in Clinical Cardiology from Indira Gandhi national Open University ,India. He is a member of ACC and has been elected for Fellow of American College of Cardiology (FACC) in August 2015. He is Head Non Invasive Cardiology at EHCC & RI jaipur.

Background and objective: Lipid control to target is essential in patients with established coronary heart disease (CHD). To determine prevalence of target oriented LDL cholesterol in patients with diabetes and CHD we performed a study. Methods: Successive new patients presenting to cardiac out-patient department were enrolled in the study. The patients were classified into Group I- non-cardiac/non-diabetic, Group II- CHD without diabetes, and Group III- CHD with diabetes. Groups II and III were further stratified into those taking or not taking statins for at least 3 months. Descriptive statistics are presented. Results: We enrolled 1032 patients, 123 (15.8%) in Group I, 403 (37.2%) in Group II and 506 (46.8%) in Group III. There were 40% females and 64% subjects were in age-group 35-50 years. In Group I, II and III respectively, mean total cholesterol was 176.8, 229.7 and 238.6 mg/dl, LDL cholesterol was 92.2, 132.4 and 159.0 mg/dl and HDL cholesterol was 56.8, 34.6 and 36.8 mg/dl (ANOVA p<0.01). In combined Groups II and III among patients on statins vs. not on statins only 26.4 vs. 6.1% had total cholesterol <200 mg/dl and 8.4 vs. 1.1% had LDL cholesterol <100 mg/dl (p<0.05). Revised target of LDL cholesterol <70 mg/dl was not achieved in any case. Conclusions: There is dismal control of lipid levels in free-living patients with CHD in India.

Background: Pulmonary arterial hypertension (PAH) is a progressive and life-threatening disease associated with high morbidity and mortality rates. However, the exact regulatory mechanism of PAH is unknown. Although mitochondrial coupling factor 6 (CF6) is known to function as a repressor, its role in PAH has not been explored. Objective: We investigated the involvement of endogenous CF6 in the development of PAH. Methods and Results: PAH was induced with monocrotaline (MCT), as demonstrated by significant increases in pulmonary artery pressure and vessel wall thickness (p<0.01). CF6 upregulation was confirmed by quantitative RT-PCR and ELISA. Immunohistochemistry analysis revealed a large amount of CF6 localized to all three layers of the vascular wall and the surrounding tissues in the PAH rats; however, it was barely detectable in endothelial cells (ECs). A total of 2×1010 gp of adeno-associated virus (AAV) was used for transduction of CF6 short hairpin RNA (shRNA) or a control vector, which was intratracheally transfected into the rats before or after MCT injection. The CF6 shRNA effectively reduced the CF6 mRNA and protein levels in the PAH rats and also reversing the 6-keto-PGF1a levels in circulation and in lung tissue (p<0.05). Finally, we found that CF6 shRNA reduced inflammatory infiltration, reversed endothelial dysfunction and vascular remodeling and ameliorated the severity of pulmonary hypertension and right ventricular dysfunction (p<0.05) at 4 weeks when it was used as both a pretreatment and rescue intervention. Conclusions: CF6 contributes to the pathogenesis of PAH, and it may function in association with prostacyclin. The blockage of CF6 could reverse the progression of PAH; thus, it might be applied as a novel therapeutic approach.