Title: A Proposed Approach for the Management of Diastolic Dysfunction: Optimization of the E and A Wave Measurement, Morphology and Timing
Much focus over the past few decades has been on the systolic phase of the cardiac cycle, yet it is becoming evident that more advanced therapies are warranted for the clinical management of heart failure, specifically diastolic dysfunction. A novel optimized approach in evaluating and managing diastolic dysfunction/ heart failure is required to evaluate and treat cardiac dysfunction. The proposed measures include the evaluation of the baseline functionality of the cardiac conduction system, Baseline E and A wave Measurement and Morphology (BEAMM) and STRess-induced E and A wave Measurement and Morphology (STREAMM) with timing and variability taking into consideration of both macro and micro diastolic myocardial processes. Implementation of a management plan that includes echocardiographic optimization (ECHO-Op) and pharmaceutical optimization (PharmOp) into the current guideline recommendations for the evaluation and management of diastolic dysfunction/ heart failure is an additional goal. Clinical adoption of the proposed approach may lead to earlier identification of patients at risk of diastolic dysfunction/ heart failure as well as other associated cardiac symptoms and downstream pathological processes.
John R. Dylewski, MD, FHRS, FACPAS is a cardiac electro physiologist and professor of medicine in active clinical practice for the last 20+ years with an extensive and diversified background in materials engineering and medical applications of artificial intelligence to improve healthcare delivery. With the abundance of valuable data generated for patient care and the continuous production of scientific knowledge, Dr. Dylewski found it significantly challenging to deliver accurate, up-to-date and expeditious care to his tens of thousands of patients resulting in the development of the Complaint2Care model for a novel healthcare delivery platform, LifeSaver, powered by Apollo Artificial Intelligence.
Title: Pharmaceutical Atrial-Ventricular Optimization in Diastolic Dysfunction: A Clinical Concept Application of Materials Engineering to Myocardial Pathophysiology
Benjamin Cooper is currently a medical resident at Aventura Hospital and Medical Center in Aventura, FL. Prior to starting medical school, He was a full-time Firefighter/Paramedic in Des Moines, Iowa. In addition, he worked at Iowa Heart Center as a Testing Paramedic for CT, Nuclear, and Ultrasound departments. He has been an American Heart Association Basic Life Support Instructor since 2007. Ben received his Doctor Osteopathic Medicine degree and Masters of Medical Science degree from Lake Erie College of Osteopathic Medicine.
Title: Pasteurella Multocida: A Case Report on the Presentation and Challenges of Cellulitis, Osteomyelitis and Myocarditis
Pooja Patel completed her medical school in Mumbai, India and is currently pursuing her Internal Medicine residency at Larkin Community Hospital in South Miami, Florida. She is currently a PGY2 resident, who aspires to specialize in cardiology and critical care. She is from the Midwest, not fearing living in the oh-so-cold winters. Patel enjoys learning and improving her skills, in every aspect available. She believes ‘teaching others is the easy way to learning’. Patel also completed and received her Master’s in Biomedical Sciences. She has volunteered her time at a non-profit organization since 2017, at Waukesha Free Clinic in Waukesha, Wisconsin (former St. Joseph’s Medical Clinic), and still continues to do so whenever possible. Patel was awarded the Director’s Coin during her rotation at the VA Medical Center in Grand Junction, Colorado for the care provided to our veterans, and for volunteering to help the community in times of the COVID surge in the late 2021. As a physician, she prides herself on serving those who have served our country.
Title: Conduction abnormalities after TAVI
Transcatheter aortic valve implantation is a procedure that allows the aortic valve replacement via minimally invasive technique. We can distinguish several access methods: transfemoral, transapical, subclavian, direct aortic as well as transcaval. Patients who underwent TAVI have a lower mortality rate in comparison with those who have non-operated severe aortic stenosis. Although advantages prevail over disadvantages, the procedure may entail conduction abnormalities. The most common are: left bundle branch block and high-grade atrioventricular block. The proximity of the aortic valve to the conduction pathways (possible injury as a result from interventional equipment interactions) as well as the anatomical variants of AV nodes may predispose patients who underwent TAVI to higher risk of conduction abnormalities. We can distinguish several factors that have the evident impact on previously described complications, such as: pre-existing RBBB, type of the transcatheter valve, annular size, depth of the implantation and the degree of mitral and aortic valve calcifications. The electrocardiographic recordings that are the cause of concern are narrow QRS complexes (especially before TAVI) as well as fluctuating changes in PR interval.
Among risk factors for LBBB development we can underline the self-expandable prostheses (in comparison with balloon-expandable ones) and larger implant depth. The behavior of heart blocks has been noticed to change dynamically during and after aortic valve replacement.
Patients who presented conduction abnormalities before TAVI, were in the higher risk group. Majority of the heart blocks are reversible. The management of conduction abnormalities after transcatheter aortic valve implantation is based on the clinical status of our patient and ECG monitoring. Temporary pacemakers and PPM are being implanted if needed.
Stefania Czapp has graduated from Medical University of Gdańsk in 2021 and now she is doing her postgraduation internship in Szpital Morski im. PCK in Gdynia (Poland). She has the big interest in Cardiosurgery and is planning to do her PhD in this field of science in Poland.
Title: Opening pulmonary valve in patients of heart failure
Pulmonary valve is the most dangerous _ the first killer in the world ,and the heart of 3 valves is better than that of 4 valves. Opening it by a stent or by a sond, gives great benefit for 2 types of patients ; TYPE 1;congestive heart failure[DCM]& TYPE II; Systemic arterial hypertension [HTN] Opening it by a stent or by a sond, gives indirect benefit for other types of patients. The new procedure is a new sond like PM sond designed to leave the PV always opened, it is a reversible procedure [if there is deterioration in the RV function , the sond is easily withdraw]. Scientific facts are we have to accept that pulmonary insufficiency[PI] is goodly tolerated for many decades , in pure congenital pulmonary stenosis,the best approach is balloon percutaneous intervention with excellent results,[that means PI is symptomatic],and no need in future for pulmonary val replacement[PVR].the only need for PVR is post Tetralogy of Fallot in only 10% after 20years,knowing that there is hypoplasic in RV outlet and pulmonary arteries and sometimes the need to do blalock[central shunt ],and to put a patch to widen the outlet ,and almost all the operations of PVR are done for pts of patchs, and those with preserved annulus and valvectomy do not need PVR ,that means the cause of right heart failure is iatrogenic and I think the operation PVR is not valid and malevaluated,I think it is avery particular case, and I shell exclude it
Notice; it is impossible for the lone PI to cause right heart failure.
The idea of the protocol is the Heart failure is the pathophysiology state in which the heart is unable to pump blood at a rate commensurate with the requirement of the metabolizing tissues,