Zeid Nesheiwat

Background: Cor triatriatum sinistrum is a type of congenital heart defect that occurs due to the left atrium being divided into two chambers by a fibromuscular septum. An even rarer subsection of this is cor triatriatum dextrum, in which the fibromuscular septum fully divides the right atrium. Case presentation: We present a patient with intermittent palpitations, chest pressure, and lightheadedness without syncope related to her cor triatriatum dextrum exacerbated by her pregnancy status. Without any prior history of congenital heart defects or pertinent family history, this seemingly health female prior to her pregnancy likely revealed and exacerbated her symptoms and lead to the diagnosis. Conclusions: Treatment in the setting of an asymptomatic presentation of a pregnant patient with history of cor triatriatum remains unclear. Many physicians elect close follow up to monitor for development of symptoms. In symptomatic cases, rate control, thromboembolic prophylaxis, and hemodynamic stabilization are mainstays of treatment. This unique presentation in a rare patient population furthers literature and gives a perspective on pregnancy and structural heart disease like cor triatriatum.

Background: Membranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults worldwide. A growing body of evidence indicates a pathogenic and autoimmune correlation betweenHelicobacter pyloriinfection, MN, and autoimmune liver disease.Case presentation: A 47-year-old African American woman presented to our institution with epigastric pain and vomiting. In-patient hospital workup included a thorough abdominal evaluation including esophagogastroduodenoscopy and liver biopsy, which revealed activeH. pyloriinfection and autoimmune hepatitis. The patient was incidentally also found to have nephrotic-range proteinuria. Renal workup including kidney biopsy established the diagnosis of MN. Proteinuria improved after initiation of triple therapy forH. pyloriinfection.Conclusion: This case adds to the growing evidence of a correlation betweenH. pyloriinfection, MN, and autoimmune liver disease. This report demonstrates a unique case of a patient with MN, autoimmune hepatitis (AIH)/primary biliary cholangitis (PBC), and HP who underwent triple-eradication antibiotic treatment that resulted in an ultimate resolution of all these conditions.

Background There is limited data on the clinical characteristics and predictors of mortality of coronavirus disease-2019 (COVID-19) in North West Ohio. We performed a retrospective review of patients hospitalized with COVID-19 in the ProMedica Health System in Northwest Ohio from March 25 to June 16, 2020. The study aims to identify epidemiological, clinical characteristics, and predictors of Mortality of COVID-19 patients in Northwest Ohio. Methods This study was conducted on 217 COVID-19 patients admitted to ProMedica Health System Hospitals in Northwest Ohio from March 25 to June 16, 2020. We collected data, including clinical signs, symptoms, and outcomes of the COVID-19 patients. We compared clinical signs and symptoms along with comorbidities of survivors and non-survivors. Results Of the 217 patients included in the study, the mean age of the population was 63.13 (SD 17.8), of which 194 (89.4%, mean age 61.7 years) survived while 23 (10.6%, mean age 74.6 years) died. Among them, 53% were females and 47% male. Common presenting symptoms were chest pain (91.71%), shortness of breath (79.7%), cough (71%), and fever (64%). Mortality was associated with age greater than 63 (p-value 0.0052) and hypertension (p-value: 0.0058) with marginal significance with gender (p-value: 0.0642), chest pain (pvalue: 0.0944), and history of cancer (p-value: 0.0944). Conclusions Advanced age and hypertension (HTN) are independent predictors for increased mortality. History of cancer and chest pain are associated with increased mortality with marginal significance. Awareness among physicians about predictors of mortality is essential in dealing with COVID-19 patients. It is essential to educate the public about preventative strategies such as wearing masks to decrease mortality and morbidity from this pandemic.

Infective endocarditis (IE) carries a high mortality rate. Consequently, the prognosis is poorer in patients with multiple valve involvement. Due to poor prognosis of patients with endocarditis, early diagnosis and management of these patients can be challenging in the clinical setting. We describe a case of a 45-year-old man who came in with bacteremia secondary to a diabetic foot ulcer. Electrocardiogram (EKG) showed complete third-degree heart block which rose suspicion for possible valvular abscess formation. Transthoracic echocardiogram (TTE) was performed and revealed vegetations on the aortic and mitral valve. A follow-up transesophageal echocardiogram (TEE) showed an abscess on the aortic valve along with vegetations on the mitral and tricuspid valve, the latter which was missed on TTE. The prompt utilization of TEE in detecting early and late mechanical complications of endocarditis is imperative in facilitating rapid clinical decision-making and early intervention. Patients with multi-valve endocarditis are at extremely high risk of complications and should be evaluated for surgical intervention immediately.

The risk of permanent pacemaker implantation (PPM) following Transcatheter Aortic Valve Replacement (TAVR) remains high. Valve implantation depth is an independent predictor of PPM. This study aims...

Postural orthostatic tachycardia syndrome (POTS) is estimated to impact millions of people each year. However, there is no established gold standard for its treatment. Bupropion is a norepinephrine and a dopamine reuptake inhibitor and has been implicated as a potential treatment for POTS. We performed a non-randomized retrospective chart review on 47 patients with POTS with statistical analysis evaluating for significant findings including reduced orthostasis and improvement of symptoms with the use of bupropion. Bupropion was not associated with a statistically significant improvement in orthostatic vitals but there was an overall reduction in reported syncope. While the use of bupropion does not show a statistically significant impact on orthostatic vitals in patients with POTS, it did show a degree of improvement in syncope and as such might be useful in patients with syncope-predominant POTS.

Background: Anomalous coronary arteries occur in less than 1% of the population and have been implicated in sudden cardiac and exercise-related death. The most common variant involves the left circumflex artery arising from a separate ostium than the left coronary artery. This case demonstrates a rare variation in which all three coronary arteries arise from a shared, single, ostium originating from the right coronary cusp. Case presentation: We report the case of a 63-year-old Caucasian man with a history of myocardial infarction, congestive heart failure, and atrial fibrillation who presented for syncope. Inpatient ischemic workup, including coronary angiography, demonstrated a rare coronary anomaly which included all three coronary arteries arising from a shared, single, ostium originating from the right coronary cusp. Our patient was treated conservatively with an option for coronary bypass if symptomatic. Conclusion: Surgical management is indicated in high-risk patients, but the optimal management for a nonmalignant, shared origin for all three coronary arteries has not been explored in detail.