Common Cardiac Cause Research Articles

Risk factors for early mortality following transcatheter edge-to-edge repair of mitral regurgitation

BackgroundWhile transcatheter edge-to-edge repair (TEER) with MitraClip is increasingly used, data on the risk stratification for assessing early mortality after this procedure are scarce. ObjectiveThis study aimed to assess early mortality and analyze the risk factors of early mortality among patients who underwent TEER. MethodsUsing the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who had TEER between January 2017 and November 2020. We categorized the cohort into two groups depending on the occurrence of early mortality (death within 30 days after the procedure). Based on the ICD-10, we identified the trend of early mortality after TEER and further analyzed the risk factors associated with early mortality. ResultsA total of 15,931 patients who had TEER were included; 292 (1.8 %) with early mortality and 15,639 (98.2 %) without. There was a decreasing trend in early mortality from 2.8 % in the first quarter of 2017 to 1.2 % in the fourth quarter of 2020, but it was not statistically significant (p = 0.18). In multivariable analysis, the independent risk factors for early mortality were chronic kidney disease not requiring dialysis (adjusted odds ratio [aOR]: 1.57; 95 % confidence interval [CI]: 1.11–2.22, p = 0.01), end-stage renal disease (aOR: 2.34; CI: 1.44–3.79, p < 0.01), chronic liver disease (aOR: 4.90; CI: 3.29–7.29, p < 0.01), coagulation disorder (aOR: 3.42; CI: 2.35–5.03, p < 0.01), systolic heart failure (aOR: 2.81; CI: 1.34–5.90, p < 0.01), diastolic heart failure (aOR: 2.69; CI: 1.24–5.84, p = 0.01) and unspecified heart failure (aOR: 3.23; CI: 1.49–7.01, p < 0.01). Among those who died during 30-day readmission following TEER, the most common cardiac cause and non-cardiac-cause of readmission were heart failure (18.2 %) and infection (26.6 %), respectively. ConclusionThe early mortality following TEER was low at 1.8 %. The independent risk factors associated with early mortality were chronic kidney disease (including end-stage renal disease), chronic liver disease, coagulation disorder, and heart failure (both systolic and diastolic).

#2776 Monoclonal gammopathies and amyloidosis unit (UGAM-A): importance of the nephrologist in the multidisciplinary approach

Abstract Background and Aims The Monoclonal Gammopathies and Amyloidosis Unit (UGAM-A) is a multidisciplinary hospital subcommittee that discusses complex cases in relation to the diagnosis and treatment of patients with blood dyscrasia and amyloidosis. Method Retrospective observational study of the cohort of patients presented at UGAM-A The data were extracted from the minutes of the UGAM-A for the period Jan/18-Dec/22. Results 81 patients were assessed with a median age of 69 years, 52 men (64.2%). HT 58 (71.6%), DM 22 (27.2%), cardiovascular disease 14 (17.3%), Neoplasm 12 (14.8%). 56 patients (69.1%) had renal damage at the time of assessment, 54 with CKD criteria, with a mean creatinine of 1.7 ± 1.0 mg/dl and proteinuria of 1.3 ± 1.7 g/mg. Cardiac involvement was found in 19 patients. There were 37 (45.7%) diagnostic changes after assessment by the UGAM. A total of 22 (27.2%) therapeutic modifications, initiation or change were made. 17 (77.3%) occurred in patients with renal involvement. There were 10 (12.3%) treatment changes, with 22.7% of them improving renal function vs. 7% in the group with no change in treatment (p = 0.04). 8 (9.9%) patients required SDB, with a median time to onset of 452d. A total of 25 (30.9%) patients died, with a median time of 370d, with 12 being the most common cardiac cause, followed by infectious 8. Conclusion Nephrologists should be involved in the complex clinical cases that accompany hematologic diagnoses. In our study, almost 80% of patients had renal involvement concomitant with haematological pathology. The role of the nephrologist is fundamental in clarifying mechanisms of kidney damage and enhancing the initiation of treatment even when they do not meet criteria from the haematological point of view, so that more than 77% of the therapeutic actions took place in patients with renal involvement.

Abstract 13786: Early Mortality Following Transcatheter Edge-to-Edge Repair of Mitral Regurgitation

Background: While transcatheter edge-to-edge repair (TEER) is increasingly used, data on risk stratification for predicting early mortality after TEER are scarce. Objective: This study aimed to assess early mortality and analyze the predicting factor of early mortality among patients who underwent TEER. Methods: Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who had TEER between January 2017 and November 2020. We categorized the cohort into two groups depending on the occurrence of early mortality (death within 30 days after the procedure). Based on the ICD-10, we identified the trend of early mortality after TEER and further analyzed the predictors of early mortality. Results: 15,931 patients who had TEER were included in this study; 292 (1.8%) with early mortality and 15,639 (98.2%) without. There was a decreasing trend in early mortality from 1.9% in 2017 to 1.7% in 2020, but it was insignificant (p=0.18). In multivariable analysis, the independent predictors for early mortality were chronic kidney disease not requiring dialysis (adjusted odds ratio [aOR]: 1.57; 95% confidence interval [CI]: 1.11-2.22, p=0.01), end-stage renal disease (aOR: 2.34; CI: 1.44-3.79, p&lt;0.01), chronic liver disease (aOR: 4.90; CI: 3.29-7.29, p&lt;0.01), coagulation disorder (aOR: 3.42; CI: 2.32-5.03, p&lt;0.01) and heart failure (aOR: 2.90; CI: 1.39-6.03, p=0.01). Among those who died during 30-day readmission following TEER, the most common cardiac cause and non-cardiac-cause of readmission were heart failure (18.2%) and infection (26.6%), respectively. Conclusion: The early mortality following TEER was low at 1.8%. The independent predictors of early mortality were chronic kidney disease (including end-stage renal disease), chronic liver disease, coagulation disorder, and heart failure. Figure Hazard Curves for Early Mortality after TEER Stratified by Clinical Predictors of Early Mortality.

Clinico-Epidemiological Profile of Patients Presenting With Acute Chest Discomfort in Emergency Medicine Department of a Tertiary Care Hospital in Uttarakhand, India: A Prospective Observational Study.

Background Acute chest discomfort is a common presenting complaint in the emergency department. There is apaucity of studies related to clinico-epidemiological profile of patients with acute chest discomfort in the emergency department (ED). Hence, we intended to conduct the study to address the dearth of research in this field. Aims and objectives The primary objective of this study was to study the clinico-epidemiological profile of patients with acute chest discomfort presenting to the ED. The secondary objectives were to assess the prevalence of premature acute coronary syndrome (ACS), to study the ED disposition and final hospital discharge diagnosis, and to assess the predictors of 24-hour mortality in such patients. Methods A prospective observational study of patients presenting with acute chest discomfort was conducted in the emergency medicine department of a tertiary care hospital. We included adults above the age of 18 years from December 2021 to December 2022 and excluded trauma patients. A standardized form was used to document patient demographic patterns, comorbidities, chest discomfort description, physical findings, investigations, consultations, ED management, and disposition. Variables having p-value ≤ 0.05 were considered to be significant. Results A total of 200 patients were included. The most common cause of chest discomfort in the EDwas cardiac, accounting for 48.5% (n = 97) of patients. The most common cardiac cause of acute chest discomfort was ST-elevation myocardial infarction (STEMI) ~ 21% (n = 42). Cardiac diagnosis was associated with the maximum number of admissions (≈80%; n = 78). The prevalence of premature ACS was 13.9% (n = 10). A 24-hour mortality was significantly associated with male gender, ambulance transport, history of coronary artery disease, and hypoxia and hypotension at the initial presentation. Conclusions ACS followed by respiratory causes are the predominant etiologies of acute chest discomfort in the ED.Knowledge of the differential diagnosis of acute chest discomfort in the ED can aid in prompt diagnosis and delivery of lifesaving treatment to these patients.

Epidemiology of pediatric out-of-hospital cardiac arrest compared with adults

Out-of-hospital cardiac arrest (OHCA) is associated with approximately 90% mortality rate. In the pediatric population, this would equate to a large number of years of life lost, posing a heavy medical and economic burden to society. Outline characteristics and causes of pediatric OHCA (pOHCA) and associations with survival until discharge in patients enrolled in the End Unexplained Cardiac Death (EndUCD) registry. A prospective state-wide multi-source registry identified all pOHCA in patients aged 1-18 years old in Victoria, Australia (population 6.5 million), from April 2019 to April 2021. Cases were adjudicated using ambulance, hospital and forensic records, clinic assessments and interviews of survivors and family members. The analysis included 106 cases after adjudication (58.5% male), 45 (42.5%) of which were cardiac causes of OHCA, with unascertained (n = 33, 31.1%) being the most common cardiac cause reported. Respiratory events (n = 28, 26.4%) were the most common non-cardiac cause of pOHCA. Non-cardiac causes were more likely to present with asystole or pulseless electrical activity (p=0.007). The overall survival to hospital discharge rate was 11.3% and associated with increasing age, witnessed cardiac arrest and initial ventricular arrhythmias (p<0.05). The incidence of pOHCA in the study population was 3.69 per 100 000 child-years. In contrast to young adults with OHCA, the most common aetiology was non-cardiac. Prognostic factors associated with survival to discharge included increasing age, witnessed arrest and initial ventricular arrhythmias. Rates of cardiopulmonary resuscitation and defibrillation were sub-optimal.

Characteristics and outcomes of patients presenting with out of hospital cardiac arrest to a regional hospital

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Out of hospital cardiac arrest (OHCA) carries a high rate of mortality and can be due to cardiac or non-cardiac causes. We reviewed consecutive patients presenting with OHCA to the emergency department of a regional hospital in Australia, between January 2019 and March 2022. Medical records were reviewed to assess presenting rhythm, final diagnosis, risk factors known at time of presentation, results of cardiac investigations and survival to hospital discharge. Results Over the study period, 107 patients presented with cardiac arrest, with an average age of 67 years (range 29 to 95 years). Most patients were male (70, 67%), although in those with a non-cardiac cause identified only 53% were male. An underlying cardiac cause was identified in 50 (47%), a non-cardiac cause was identified in 18 (17%), and 39 (36%) had no identifiable cause. The most common cardiac causes were ST-elevation myocardial infarction (18, 36%), followed by non-ischaemic cardiomyopathy (9, 18%) and scar-related arrhythmia (7, 14%). Overall, ischaemic heart disease was responsible for 31 (62%) cases. Coronary angiography was performed in 36 (72%) of cardiac cases. Those who were diagnosed with ST-elevation myocardial infarction had an average time from presentation to coronary angiography of 61 minutes while the average was 38 hours for all patients presenting with OHCA. The most common presenting rhythm was ventricular fibrillation (39, 38%). The overall mortality rate was 61% for all OHCA. Among those with a cardiac cause, a non-cardiac cause or no cause identified for the OHCA, the mortality rates were 32%, 87% and 87% respectively. Data published by the regional Ambulance Service show that the survival to discharge from hospital of 39% in our regional hospital is comparable with state-wide outcomes. Discussion These data reflect the significant mortality and wide spectrum of disease underlying OHCA, and thus the challenge of managing patients presenting with OHCA. Cardiac disease accounts for almost half of all cases of OHCA, and also encompasses a wide spectrum of disease. However, the mortality in patients with OHCA due to an underlying cardiac cause, while still significant, is better than those patients in whom no cardiac cause is identified.

One-year unplanned readmission after percutaneous coronary intervention in ST-elevation myocardial infarction: rates, causes and predictors

Abstract Introduction and aim Unplanned readmission after percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has a significant impact on the healthcare system. Nevertheless, most of the previous literature evaluated readmission within one month only post PCI without assessing the long-term readmission rates and predictors post-PCI. Therefore, we conducted a retrospective observational study to determine the rates, causes, and predictors of readmission post PCI among patients with STEMI over 1-year follow-up. Methods We conducted a single-center retrospective observation cohort study. Study population included all patients who were admitted to the hospital with diagnosis of STEMI and underwent PCI during the same admission (index admission) and discharged alive in the period between Jan 1st, 2016 and Sep 30th, 2018. Patients were divided into two groups: those who had one or more unplanned readmission within one year after PCI and those who were not readmitted. Rates and causes of readmission within one year following PCI were reported. Predictors of readmission post-PCI were assessed using multivariate logistic regression and reported as odds ratio (OR) with p&amp;lt;0.05 indicating statistical significance. Results A total of 1257 patients were included in our retrospective analysis. Most of the patients were male (95.9%). The mean age of the study population was 51±10. The most frequent culprit vessel was left anterior descending artery (LAD) in 56.3%. The median troponin T upon presentation was 47 ng/L [interquartile range: 171], with 25th percentile of 17 ng/L and 75th percentile of 2197 ng/L. Although around 70% of patients had reduced ejection fraction during the index admission, only 13.4% of the study population had clinical heart failure (HF). The unplanned readmission rate within one year post PCI was 11.5%, with 8.2% due to cardiac readmission while the remaining 3.3% due to non-cardiac causes. The most common cardiac causes for readmission were acute coronary syndrome and HF as shown in Table 1. As demonstrated in Table 2, positive predictors for all-cause readmission within one year after PCI among patients with STEMI were female gender (aOR= 4.14, 95% CI 2.10–8.18; p-value&amp;lt;0.001), chronic kidney disease (aOR= 2.76, 95% CI 1.07–7.08; p-value= 0.035), PCI using more than one stent (aOR= 1.66, 95% CI 1.09–2.55; p-value= 0.019) and clinical HF during index admission (aOR= 2.36, 95% CI 1.49–3.74; p-value&amp;lt;0.001). Conclusion The rate of one-year unplanned readmissions after PCI among patients with STEMI was 11.5%, with acute coronary syndrome and HF as most common causes of cardiac readmission. We found that female gender, chronic kidney disease, PCI with more than one stent and clinical HF were associated with a significantly increased likelihood of readmission after PCI among patients with STEMI which may warrant close and frequent follow-up for these populations. Funding Acknowledgement Type of funding sources: None.

Prevalence and Etiologies of Dyspnea in Adults at the General Hospital of Douala, Cameroon

Introduction: Dyspnea is a subjective feeling of discomfort. It can be acute or chronic onset. Our objective was to determine the frequency and etiologies of dyspnea in adults at the medical and surgical emergencies of the Douala General Hospital. Methods: This was a retrospective study conducted from January 1, 2018 to February 28, 2020. Patients over the age of 18 who came to consult for dyspnea were enrolled. Sociodemographic and clinical data were collected and analyzed using SPSS version 25 software. Results: Of the 565 files collected, 55.93% were women. The mean age was 47.66 ± 17.87 years. The frequency of dyspnea was 4.18%. Married people represented 53.63% of the workforce. History of high blood pressure (39.14%), chronic kidney disease (26.70%) and HIV infection (12.21%) were the most common. Acute dyspnea accounted for 89.56% of cases. The etiologies were dominated by: cardiovascular conditions (24.43%), non-tumor bronchopulmonary and pleural pathologies (20.88%), tumoral conditions (10.27%). The most common cardiac and pulmonary causes were acute pulmonary edema (78.26%), lower respiratory infections (52.54%) and exacerbations of asthma (23.73%). Conclusion: Dyspnea represents 4.18% of admissions to the medicosurgical emergency department of the Douala General Hospital. Etiologies are dominated by cardiac and lower respiratory causes.

Assessment of Cardiovascular Surgery Requirements in Children and Adolescents Admitted With Chest Pain To A Pediatric Emergency Clinic.

Chest pain in children and adolescents is an important symptom in the pediatric emergency clinic. The aim of this study is to assess the characteristics of chest pain and cardiovascular surgery in the pediatric population. There were 352 children who presented with chest pain to the pediatric emergency department between December 2007 and February 2017. These children were included in this study, which is a retrospective observational study. Among the 352 patients, six patients (1.7%) underwent cardiovascular surgery. Forty-eight patients (13.6%) were diagnosed with cardiac disease, and the most common cardiac causes were myocarditis and pericarditis. Only six patients (1.7%) who were admitted to the emergency department with chest pain needed cardiovascular surgery. The chest pain in children required less surgery, and mortality and morbidity were lower compared with adult cardiac chest pain.

Long term mortality and readmissions after transcatheter aortic valve replacement.

Readmissions following transcatheter aortic valve replacement (TAVR) are common but detailed analysis of cardiac and non-cardiac inpatient readmissions beyond thirty days to different levels of care are limited. Our study population was 1,037 consecutive patients who underwent TAVR between 2011-2017 within a multi-hospital quaternary health system. A retrospective chart review was performed and readmissions were adjudicated and classified based on primary readmission diagnosis (cardiac versus noncardiac) and level of care [intensive care unit (ICU) admission vs. non-ICU admission]. Incidence, causes, and outcomes of readmissions to up to three years post procedure were evaluated. Of the 1,017 patients who survived their index hospitalization, there were readmissions due to noncardiac causes in 350 (34.4%) and cardiac causes in 208 (20.5%) during a mean 1.96 years of follow-up. The most common non-cardiac causes of readmission were sepsis/infection (14.3%), gastrointestinal (8.3%), and respiratory (4.8%), whereas heart failure (14.0%) and arrhythmias (4.6%) were the most common cardiac causes of readmission. A total of 191 (18.8%) patients were readmitted to the ICU and 372 patients (36.6%) were non-ICU readmissions. The risk of a noncardiac readmission was highest in the period immediately following TAVR (~4.5% per month) with an early high hazard phase that gradually declined over months. However, the risk of cardiac readmission remained stable at ~1% per month throughout. TAVR patients that were readmitted for any cause had markedly increased mortality; this was especially true for patients readmitted to an ICU. In TAVR patients who survived their index hospitalization, non-cardiac readmissions were more prevalent than cardiac. The risk of readmission and subsequent mortality was highest immediately post-procedure and declined thereafter. Readmission to ICU portends the highest risk of subsequent death in this cohort. Patient baseline co-morbidities are an important consideration for TAVR patients and play a significant role in readmissions and outcomes.

Hospital Readmission in Patients With Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) can present with various clinical symptoms, including chest pain, syncope, and sudden cardiac death, particularly in those without atherosclerotic risk factors. In this contemporary analysis, we aimed to identify the causes and predictors of 30-day hospital readmission in SCAD patients. We utilized the latest Nationwide Readmissions Database from 2016 - 2017 to identify patients with a primary discharge diagnosis of SCAD. The primary outcome was 30-day readmission. Among 795 patients admitted with a principal discharge diagnosis of SCAD, 85 (11.3%) were readmitted within 30 days of discharge from index admission (69.8% women, mean age of 54.3 ± 0.8). More than half of the readmissions (57%) were cardiac-related readmissions. Common cardiac causes for 30-day hospital readmission were acute coronary syndrome (27.3%), chest pain/unspecified angina (24.6%), heart failure (17.5%), and recurrent SCAD (8.3%). In conclusion, we found that following hospitalization for SCAD, almost one-tenth of patients were readmitted within 30 days, largely due to cardiac cause . Risk stratifying patients with SCAD, identifying high-risk features or atypical phenotypes of SCAD, and using appropriate management strategies may prevent hospital readmissions and reduce healthcare-related costs. Further studies are warranted to confirm these causes of readmission in SCAD patients.

Syncope and electrocardiogram.

Suspected transient loss of consciousness and syncope are common causes of hospitalization in older patients. Arrhythmias are the most common cardiac causes of syncope. Although a number of instrumental diagnostic procedures are usually routinely performed in patients with suspected syncope, a 12-lead electrocardiogram (ECG) is the only instrumental test recommended for the initial evaluation of these patients. In this paper current literature on this topic will be reviewed, including ECG diagnostic criteria and findings suggestive of cardiac syncope. The ECG may disclose an arrhythmia associated with a high likelihood of syncope, avoiding further evaluations and permitting institution of specific treatment in 7% of patients referred to emergency department. When the cause of syncope remains uncertain after initial evaluation the next step is to assess the risk of major cardiovascular events or sudden cardiac death. An abnormal ECG selected patients with high probability of cardiac syncope. ECG diagnostic criteria and ECG findings suggesting arrhythmic syncope are presented. Indications and potential clinical implications of ECG monitoring will be discussed too. A careful, well-conducted medical history focused on the suspected syncopal event is crucial for the diagnosis. In this setting, the ECG is a mandatory diagnostic tool which, although normal in the majority of patients of syncope, has the potential to identify patients with high likelihood of cardiac syncope due to arrhythmic or cardiopulmonary disorder.

Diffuse Alveolar Hemorrhage in Cardiac Diseases.

Diffuse alveolar hemorrhage (DAH) is a rare condition with reported mortality ranging between 20 and 100%. There are many etiologies of DAH. Cardiac diseases are likely underreported causes of DAH. Heart failure and mitral valve diseases are the most common cardiac causes of DAH. The DAH results from pulmonary venous hypertension leading to stress failure of the pulmonary capillaries. There is also a contribution of the bronchial circulation. The Alveolar-capillary membrane or blood-gas barrier is an extremely thin structure that allows rapid and passive diffusion of oxygen from the inhaled air to the pulmonary capillaries while preventing pulmonary edema and DAH with chronic elevation of the transmural hydrostatic pressure. The purpose of this manuscript is to inform the clinician about this rare cause of DAH, which may be overlooked unless specifically sought after. We also discuss the pathophysiologic aspects of DAH and the safety mechanisms in place to prevent such occurrences.

Hospital readmissions after catheter ablation for atrial fibrillation among patients with heart failure in the United States

Abstract Background Catheter ablation for atrial fibrillation may improve quality of life and long-term mortality among patients with heart failure. Purpose The rates of hospital readmission after catheter ablation for atrial fibrillation among patients with an established diagnosis of heart failure are largely unknown. We aimed to assess the rates and causes of 30-day readmission among patients with heart failure undergoing catheter ablation vs. medical therapy for atrial fibrillation in the United States. Methods The 2016 Nationwide Readmissions Database was screened for patients with diagnosis of heart failure and atrial fibrillation using the 10th Revision of International Classification of Diseases codes. Patients undergoing catheter ablation for atrial fibrillation were grouped separately from those treated medically for atrial fibrillation. Thirty-day readmissions were assessed for both groups. Results The analytical cohort included 749,776 (national estimate of 1,421,673) patients with heart failure and atrial fibrillation. This included 2,204 patients that underwent catheter ablation. Patients treated with catheter ablation had lower 30-day readmissions compared to the medical therapy group (16.8% vs 20.1%, p&amp;lt;0.001). Fifty-five percent of all readmissions among the catheter ablation cohort were related to cardiac events. Heart failure exacerbation (40%) and arrhythmia (36%) were the most common cardiac causes for readmission after catheter ablation (Figure). Conclusions In a contemporary nationwide analysis of patients with heart failure and atrial fibrillation, compared to medical therapy those treated with catheter ablation for atrial fibrillation had fewer 30-day readmissions after index hospital discharge. The most common cause for readmission among patients treated with catheter ablation was heart failure exacerbation and arrhythmia. Causes of readmission Funding Acknowledgement Type of funding source: None

PAY ATTENTION! AN UNUSUAL CASE OF DYSPNEA

SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Platypnea-orthodeoxia is an uncommon syndrome characterized by dyspnea and hypoxemia in upright position that improves with recumbent position. It can occur due to intracardiac shunts, pulmonary arteriovenous shunts and ventilation perfusion mismatch. We present a unique and rare cause of platypnea-orthodeoxia syndrome. CASE PRESENTATION: A 68 years old man with history of coronary artery disease and COPD presented with acute onset chest pain and associated difficulty breathing. Patient did have several months’ history of exertional dyspnea which did not improve with rest this time. On presentation, patient was noted to be hypoxic with oxygen saturation of 88% and ABG showed PH 7.41, PaO2 47 mmHg and PaCO2 22.4 mmHg. Oxygen saturation improved to 94% with 3L of supplemental oxygen. EKG and troponin were unremarkable. CT PE was unremarkable for pulmonary embolism as well. IV heparin drip was started for suspected unstable angina and patient underwent cardiac catheterization that revealed non-obstructive coronary artery disease. Echocardiography showed ejection fraction of 55-60% with mild mitral and tricuspid regurgitationDuring the course of hospitalization, patient was noted to have intermittent positional hypoxemia. He had normal resting saturation on 2 L of oxygen which dropped to 88% sitting upright and dropped to 84% on 2 L of oxygen upon raising both arms. Platypnea-orthodeoxia syndrome was strongly suspected with possible intra-cardiac or intrapulmonary shunt. Meanwhile, CT chest was unremarkable for interstitial lung disease. Right heart catheterization revealed normal right atrial RA (68.9%) and pulmonary arterial PA (68.3%) saturation at rest but reduced RA (42.5%) and PA (43.2%) saturation with sitting up. Echocardiography with bubble study showed right-to-left shunting and trans-esophageal echocardiography revealed a small 0.5 cm atrial septal defect (ASD) with bidirectional shunting. Patient was diagnosed with Platypnea-orthodeoxia syndrome secondary to ASD. He was discharged home on supplemental oxygen and outpatient follow-up for ASD closure. DISCUSSION: Platypnea-orthodeoxia is a rare syndrome. Patent foramen ovale is the most common cardiac cause of platypnea-orthodeoxia syndrome followed by ASD. Transesophageal echocardiography is the best test to diagnose atrial septal defect but it is important to rule out pulmonary causes of platypnea-orthodeoxia syndrome as well. ASD is successfully treated with percutaneous closure and prognosis of is good after correction of the defect. CONCLUSIONS: Platypnea-orthodeoxia syndrome is rare syndrome but it can be easily recognized with careful history and physical examination. Reference #1: Henkin S, Negrotto S, Pollak PM, Cullen MW, O'Cochlain DF, Wright RS. Platypnea-Orthodeoxia Syndrome: Diagnostic Challenge and the Importance of Heightened Clinical Suspicion. Tex Heart Inst J. 2015;42(5):498-501. Published 2015 Oct 1. doi:10.14503/THIJ-14-4596 Reference #2: Kazawa S, Enomoto T, Suzuki N, et al. Platypnea-orthodeoxia Syndrome in a Patient with an Atrial Septal Defect: The Diagnosis and Choice of Treatment. Intern Med. 2017;56(2):169-173. doi:10.2169/internalmedicine.56.7728 Reference #3: PLATYPNEA ORTHODEOXIA SYNDROME: A RARE COMPLICATION OF IATROGENIC ATRIAL SEPTAL DEFECT. Bharat Avirneni, Christopher Rosse, Joseph Choo, Kalpan Desai. J Am Coll Cardiol. 2020 Mar, 75 (11 Supplement 1) 2799. DISCLOSURES: No relevant relationships by Muhammad Aamir, source=Web Response No relevant relationships by Muhammad Afzal, source=Web Response No relevant relationships by Saleha Dar, source=Web Response

Incidence, Clinical Presentation, and Causes of 30-Day Readmission Following Hospitalization With Spontaneous Coronary Artery Dissection

ObjectivesThe aim of this study was to investigate the impact of spontaneous coronary artery dissection (SCAD) on 30-day readmission rates following hospitalization with acute myocardial infarction (AMI) using a national database. BackgroundAMI in the setting of SCAD represents an uncommon type of myocardial infarction with limited data on short-term outcomes. MethodsAll hospitalizations with primary or index diagnoses of AMI from 2010 to 2015 in the Nationwide Readmissions Database were queried. The primary outcome was overall 30-day readmission rates in both SCAD and non-SCAD cohorts. Propensity score matching (1:2) was conducted. ResultsA total of 2,654,087 patients with AMI were included in the final analysis, of whom 1,386 (0.052%) were diagnosed with SCAD. SCAD was associated with a higher readmission rate in the SCAD cohort (12.3% vs. 9.9%; p = 0.022). The main causes of readmissions in the SCAD cohort were cardiac causes (80.6%), and AMI was the most common cardiac cause (44.8%), followed by chest pain (20.1%) and arrhythmia (12.7%). Among the SCAD readmissions, 50.6% patients were readmitted in the first week post-discharge, with 54.5% of AMI readmissions occurring in the first 2 days post-discharge. ConclusionsThe incidence of 30-day readmission following AMI and SCAD is nontrivial and occurs early post-discharge. Most readmissions are due to cardiac causes, especially AMI. Targeted management approaches are needed to diminish the high rates of readmission and early recurrent AMI.

Prevalence and major cardiac causes of cardio-embolic stroke and in-hospital mortality in Eastern Nepal

Background: Cardioembolism accounts for 15%–30% of all ischemic strokes. The study aims to assess conventional and major cardiac causes of cardio-embolic stroke, its prevalence, lesions associated with the side of weakness, and in-hospital mortality. Materials and Methods: Patients with cardio-embolic stroke over 18 months were included in the study. Groups were compared using Chi-square test and Student's t-test. Results: In 384 patients with ischemic stroke, 168 (44%) had a cardio-embolic stroke. Among these 168 cardio-embolic patients, 56% were male and 44% female with a mean age of 69 ± 1 year. Dyslipidemia (72%), hypertension (69%), smoking (34%), and diabetes (33%) were the most prevalent conventional cardiovascular risk factors in these patients. Atrial fibrillation (AF) (71%) was the most common specific cardiac cause for cardio-embolic stroke. Hypertension was present in more than 76%, while dyslipidemia in 66% of patients with AF. Seventeen patients (10%) had in-hospital mortality, while nine (5%) left the hospital against medical advice. The in-hospital mortality rates were not different in AF patients as compared to those with sinus rhythm (59% vs. 41%,P = 0.225). However, patients with left ventricular ejection fraction ≤50% had a higher rate of mortality when compared to patients with normal ejection fraction (P < 0.001). Patients with AF had a higher incidence of left-sided weakness when compared to sinus rhythm (P = 0.049). Conclusion: Hypertension and dyslipidemia were the most prevalent conventional risk factors, while AF was the most common cardiac cause of cardio-embolic stroke. Reduced left ventricular ejection fraction less than 50% was significant predictor of in-hospital mortality in cardio-embolic stroke patients.

To assess the effectiveness of simulation teaching of defibrillation on the knowledge and skill of nurses working in the critical care unit of a Tertiary Care Teaching Institute: Prospective, randomised study

Rapid defibrillation is a life-saving treatment for pulseless ventricular tachycardia and ventricular fibrillation which are the most common cardiac cause of sudden death. Simulation teaching has been shown as an effective teaching method for nurses. The present study was conducted to assess the effectiveness of planned simulation teaching regarding defibrillation on the knowledge and skill of nurses working in the critical care unit and emergency department of a tertiary care hospital. A randomised control design was used in which 100 nurses from the emergency department and critical care unit were randomly assigned to the experimental and control group. Baseline knowledge and skill were assessed using an investigator developed defibrillation knowledge assessment questionnaire and defibrillation skill assessment checklist, respectively. Simulation teaching was given in the experimental group. The simulation teaching was provided in the clinical area in a group of 3–4 nurses. Post-test 1 was taken immediately after the simulation teaching in the experimental group. Post-test 2 was taken after 1 month of enrolment in the study in both the groups with the same tool. A significant improvement in knowledge and skill was observed in the experimental group. A significant association of pre-test knowledge with gender, age, educational qualification, education program attended, experience with defibrillation and of the post-test knowledge with gender, nature of work, experience with defibrillation, educational qualification and age were found. A significant association of pre-test skill with nature of work and post-test skill with gender and nature of work was also found. A significant moderate positive correlation (r = 0.42) was found between the knowledge and skill on nurses. Simulation teaching is an effective method for increasing knowledge and skill among nurses. The present study has further opened up new avenues into nurse-led defibrillation initiatives in India.

Sex differences in rates and causes of 30-day readmissions after cardiac electronic device implantations: insights from the Nationwide Readmissions Database

BackgroundWomen undergoing cardiac implantable electronic device (CIED) implantation are at a higher risk of procedure-related complications. The present study examined sex differences in rates and causes of 30-day readmissions following CIED implantation. MethodsUsing the United States Nationwide Readmissions Database (NRD), all adults who had undergone CIED implantation (cardiac resynchronization therapy (CRT), permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD)) between January 2010 and September 2015 were included. We compared rates, trends and causes of 30-day readmissions between sexes, and examined associations between sex and outcomes (adjusted odds ratios (aOR) and 95% confidence intervals (CI)). ResultsOut of 1,155,992 index hospitalizations for CIED implantation, 43.1% of the patients were women. All-cause 30-day readmissions were persistently higher in women than men but declined in both sexes over the study period, more so in women (women vs. men; 2010: 15.0% vs. 14.1%; 2015: 13.7% vs.13.4%). Women were at higher odds of readmission due to cardiac (aOR 1.22, 95%CI 1.20–1.24) and device-related complications (aOR 1.18, 95%CI 1.15–1.20) compared to men, but no difference odds of all-cause readmission were found between sexes (women: aOR 0.998, 95%CI 0.997–1.008). The most common cardiac and non-cardiac causes of readmission were heart failure and infection, respectively, and these were similar in both sexes (men vs. women: 17.8% vs. 17.6% and 10.7% vs. 10.8%, respectively). ConclusionWomen are persistently at higher risk of readmission due to cardiac causes and device-related complications compared to men over a six-year period, but no difference in all-cause readmissions was found between sexes.

3204 Abdominal Pain From the Sahara: An Atypical Source for a Common Complaint

INTRODUCTION: Chest and abdominal pain are staple symptoms that plague the emergency room and the differential that it poses is vast and can sometimes be misleading. The more common cardiac and gastrointestinal causes are well known and can easily be discerned but every once in a while, an unlikely source emerges and urges clinicians to think outside the box. CASE DESCRIPTION/METHODS: This case looks at the story of a 61-year-old recently immigrated Ethiopian male with a history of diabetes mellitus and hypertension who presented with a twenty one day history of intermittent chest and abdominal pain. His initial troponins were negative and his electrocardiography showed no ischemia. Due to his historical risk factors, he was admitted and an echocardiogram and stress test were done but no ischemic changes were noted. Although troponins and images were negative, labs showed eosinophilia and due to recent travel to Ethiopia, additional stool workup was initiated after he started to complain with concurrent symptoms of nausea. Gastroenterology weighed in by performing an endoscopy that showed mild erosive gastropathy but benign biopsies. Lab results came back positive for the strongyloides antibody and the ova and parasite culture showed some strongyloides larvae. Infectious disease advised two doses of ivermectin and patient reported improvement through his hospital course and was eventually discharged. DISCUSSION: Strongyloides is a helminthic parasite that is usually shed in human feces and the larvae in the stool find their way through the skin of another host and eventually deposit themselves in the small bowel until they are ready to shed their new larvae into the feces; thereby restarting the cycle. Though the disease may be more common in third world areas, it only affects a fraction of patients in the United States. Per the Center for Disease Control, small studies showed that it affected 0 to 6.1% of people tested in the United States. Most patients present with cutaneous, gastrointestinal, or pulmonary findings but cardiac complaints are rare. His eosinophilia helped prompt further investigation and eventually brought forth a formal diagnosis. However common or mundane a symptom may be, every clinical picture is unique and should be evaluated thoroughly with a wide differential. Had his disease been misdiagnosed, it could have lead to a hyperinfection syndrome and may have caused sepsis and even death. Thus, whether a patient is in suburbia or the Sahara, it is vital to keep a broad differential.