Harry uman Medical Center

Columbia, MO, United States

Harry uman Medical Center

Columbia, MO, United States
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Chockalingam A.,University of Missouri | Chockalingam A.,Harry uman Medical Center | Xie G.-Y.,University of Missouri | Dellsperger K.C.,University of Missouri
International Journal of Cardiovascular Imaging | Year: 2010

Widespread use of echocardiography has contributed to more frequent recognition of takotsubo stress cardiomyopathy. Initial presentation is similar to acute coronary syndrome and the acute course can be complicated by heart failure, arrhythmias, dynamic left ventricular outflow tract obstruction, hypotension and death. We briefly review the clinical presentation and propose a unified diagnostic algorithm for cardiologists acutely managing this cardiac emergency. We highlight the central role of echocardiography and emphasize the nuances of this peculiar acute cardiomyopathy from an echocardiographers' perspective. © Springer Science+Business Media, B.V. 2010.


Jadhav A.,University of Missouri | Ingole A.,MGMs Medical College and Hospital | Chockalingam A.,University of Missouri | Chockalingam A.,Harry uman Medical Center
American Journal of the Medical Sciences | Year: 2012

Ventricular ectopic beats are commonly seen in daily clinical practice. Majority of them being asymptomatic, some can cause symptoms. In a normal heart, their occurrence is of no clinical significance. However, in the presence of an underlying heart disease, they signify a susceptibility toward more sinister arrhythmias. In some patients, they are triggered by the same mechanism as ventricular tachycardia and these can be cured by catheter ablation. Recent reports on the use of catheter ablation in cases where focal ventricular ectopics are found to trigger ventricular fibrillation. Clinical evaluation and investigations are important in assessing patients with ventricular ectopic beats so that appropriate treatment can be targeted when necessary. This article discusses the current knowledge and practice in this commonly encountered clinical problem. © Southern Society for Clinical Investigation.


Sidhu M.,Harry uman Medical Center | Sidhu M.,University of Missouri | Bhalla M.,Harry uman Medical Center | Bhalla M.,University of Missouri | And 4 more authors.
Angiology | Year: 2010

Aim: Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the elderly population. Atypical presentation, reduced activity levels, and comorbidity often confound the diagnosis. We studied the use of stress myocardial perfusion imaging (MPI) in octogenarians. Methods: We retrospectively reviewed the medical records of all patients with both MPI and coronary angiogram within 6 months from 1998 to 2008. Sixty veterans under the age of 60 years who underwent both cardiac procedures served as controls. Results: We evaluated 53 patients, predominantly men, with mean age of 85 ± 2.5 yrs. Chest pain (68%) was the most common reason for requesting the stress test. Risk factors included diabetes 44%, hypertension 93%, smoking 48%, hyperlipidemia 93%, and peripheral vascular disease 40%. All patients had an abnormal myocardial perfusion scan. Reversible defects were present in 91% with the following distribution: mild 26%, moderate 39%, severe 15% and multiple defects 11%. Fixed defects were present in 44% of the patients. Analysis of both studies in the 53 patients revealed complete (43), partial (7) and no correlation (3) between the MPI defects and culprit lesions identified on the coronary angiogram. Positive predictive value and accuracy of the myocardial perfusion scan in detection of the disease was 98%. Follow up ranged from 1 to 10 years during which 19 patients died, and 7 deaths were cardiac. Conclusion: Myocardial perfusion imaging in octogenarians is as accurate in diagnosing CAD as it is in younger people.


Jhawar M.B.,University of Missouri | Jhawar M.B.,Harry uman Medical Center | Balla S.,University of Missouri | Balla S.,Harry uman Medical Center | And 4 more authors.
European Journal of Echocardiography | Year: 2011

Left ventricular (LV) outflow tract obstruction (LVOTO) occurs in up to 20 of patients undergoing dobutamine stress echocardiography (DSE). Mid-cavity LV obstruction occurs less commonly during DSE. LV regional wall motion abnormalities during DSE may occur despite normal coronaries due to hypertensive blood pressure response and takotsubo stress cardiomyopathy. We describe herein two cases of LVOTO and one case of mid-cavity LV obstruction during DSE associated with transient apical hypokinesis. © 2010 The Author.


Yang Y.,Yunnan Province 2nd Hospital | Yang Y.,University of Missouri | Andresen B.T.,University of Missouri | Andresen B.T.,Harry uman Medical Center | And 4 more authors.
Experimental Biology and Medicine | Year: 2010

Genetic factors are important in the pathogenesis of diabetic retinopathy (DR); there is a clear association of increased expression of vascular endothelial growth factor (VEGF) with DR as well as numerous VEGF polymorphisms that are linked to increased VEGF levels and DR. In this study, the relationships between the VEGF promoter polymorphism -634C/G, plasma VEGF levels and DR were examined in the Han Chinese. Ninety-six healthy subjects and 285 subjects with type 2 diabetes were enrolled in this study. The diabetic subjects were divided into three groups depending on the degree of DR as determined by fundus photography and fluorescent angiography. Along with standard clinical characteristics, the -634C/G polymorphism was examined using TaqMan allelic discrimination, and plasma VEGF levels were analyzed by enzyme-linked immunosorbent assay. The distribution of the polymorphism differed significantly between patients with and without retinopathy; this was most pronounced between the no DR and proliferative DR groups. Significantly greater plasma VEGF levels were present in those with the -634CC genotype, and only the proliferative DR group had elevated plasma VEGF levels. Logistic regression revealed that the -634C/G polymorphism is strongly associated with DR. This study suggests that diabetic Han Chinese carrying the -634CC VEGF promoter polymorphism have a genetic risk of DR, and this polymorphism may be a major factor influencing plasma VEGF levels. Therefore, this polymorphism may be used as a biomarker at the onset of diabetes in the Han Chinese to predict the risk of DR, allowing for clinicians to treat these patients more aggressively. Copyright © 2010 by the Society for Experimental Biology and Medicine.


Chockalingam A.,Harry uman Medical Center | Chockalingam A.,University of Missouri | Linden M.A.,University of Missouri | Del Rosario M.,University of Missouri | And 3 more authors.
Angiology | Year: 2010

Hypertension, diabetes and obesity cause cardiac diastolic dysfunction (DD) which could reduce exercise capacity. Our aim was to determine if 10% weight loss by exercise at 60% VO 2max five days/week (∼-375 kcal/session) and caloric restriction (∼-600 kcal/d) over 6 months improves exercise capacity and DD in Metabolic syndrome (MetS). Eighteen subjects (40 ± 1y, women = 6, BMI = 33.5 ± 1.0 kg/m 2) successfully completed the study. Maximal treadmill stress echocardiography was performed at baseline and post weight loss to determine VO 2max, resting and stress DD as the ratio of peak early diastolic mitral inflow velocity (E) to tissue Doppler early diastolic annular decent (E'). After weight loss (mean = 9.5 ± 0.2%), all metabolic parameters improved. Resting and stress E/E' values remained normal before and after weight loss. Exercise intolerance is likely due to general deconditioning and not cardiac dysfunction in early MetS as VO 2max increases significantly with lifestyle while cardiac function remains unchanged.


PubMed | Harry uman Medical Center
Type: Journal Article | Journal: Angiology | Year: 2010

Hypertension, diabetes and obesity cause cardiac diastolic dysfunction (DD) which could reduce exercise capacity. Our aim was to determine if 10% weight loss by exercise at 60% VO(2max) five days/week (approximately -375 kcal/session) and caloric restriction (approximately -600 kcal/d) over 6 months improves exercise capacity and DD in Metabolic syndrome (MetS). Eighteen subjects (40 +/- 1y, women = 6, BMI = 33.5 +/- 1.0 kg/m(2)) successfully completed the study. Maximal treadmill stress echocardiography was performed at baseline and post weight loss to determine VO(2max), resting and stress DD as the ratio of peak early diastolic mitral inflow velocity (E) to tissue Doppler early diastolic annular decent (E). After weight loss (mean = 9.5 +/- 0.2%), all metabolic parameters improved. Resting and stress E/E values remained normal before and after weight loss. Exercise intolerance is likely due to general deconditioning and not cardiac dysfunction in early MetS as VO(2max) increases significantly with lifestyle while cardiac function remains unchanged.


PubMed | Harry uman Medical Center
Type: Journal Article | Journal: Expert opinion on investigational drugs | Year: 2010

The renin-angiotensin-aldosterone system (RAAS) is a key regulator of blood pressure (BP), as well as volume and electrolytes, in both hypertensive and normotensive individuals. Inappropriate activation of the RAAS is important in hypertension-induced cardiovascular disease (CVD) and chronic kidney disease (CKD). Renin is the rate-limiting step in the RAAS cascade, which makes direct renin inhibitors (DRIs) an attractive target for RAAS suppression and treatment of hypertension. Current regimens using either angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) result in feedback upregulation of renin and aldosterone breakthrough, which contribute to incomplete suppression of the RAAS. Thereby, aliskiren - alone or in combination - might offer a novel therapeutic intervention to improve suppression of the RAAS, with potential to translate to improved CVD and CKD outcomes.Herein, we present the current state of knowledge of DRIs in the preclinical and clinical realm and their antihypertensive efficacy in relation to cardiovascular and renal risk. Recent clinical trials (2007 - 2009) support the efficacy of aliskiren, and studies suggest the potential for improved CVD and CKD outcomes.An understanding of the mechanism of action of DRIs and a perspective of recent clinical trials.The DRI aliskiren is an effective antihypertensive agent that preliminary data suggests has a beneficial effect in CVD and CKD. Combination of aliskiren with an ACEi or ARB may be better tolerated than the ACEi-ARB combination. Future work is needed to further quantify aliskirens impact on hard CVD and CKD end points.


PubMed | Harry uman Medical Center
Type: Journal Article | Journal: Angiology | Year: 2010

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the elderly population. Atypical presentation, reduced activity levels, and comorbidity often confound the diagnosis. We studied the use of stress myocardial perfusion imaging (MPI) in octogenarians.We retrospectively reviewed the medical records of all patients with both MPI and coronary angiogram within 6 months from 1998 to 2008. Sixty veterans under the age of 60 years who underwent both cardiac procedures served as controls.We evaluated 53 patients, predominantly men, with mean age of 85 +/- 2.5 yrs. Chest pain (68%) was the most common reason for requesting the stress test. Risk factors included diabetes 44%, hypertension 93%, smoking 48%, hyperlipidemia 93%, and peripheral vascular disease 40%. All patients had an abnormal myocardial perfusion scan. Reversible defects were present in 91% with the following distribution: mild 26%, moderate 39%, severe 15% and multiple defects 11%. Fixed defects were present in 44% of the patients. Analysis of both studies in the 53 patients revealed complete (43), partial (7) and no correlation (3) between the MPI defects and culprit lesions identified on the coronary angiogram. Positive predictive value and accuracy of the myocardial perfusion scan in detection of the disease was 98%. Follow up ranged from 1 to 10 years during which 19 patients died, and 7 deaths were cardiac.Myocardial perfusion imaging in octogenarians is as accurate in diagnosing CAD as it is in younger people.

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