INTRODUCTION:Myocarditis is a known adverse event associated with COVID-19 vaccination.We report the index case of cardiac arrest secondary to myocarditis following the first dose of Pfizer-BioNTech mRNA COVID-19 vaccination. CASE PRESENTATION:A 23-year-old male with no significant medical history presented after a resuscitated cardiac arrest secondary to ventricular fibrillation.He had received the first dose of COVID-19 vaccine (Pfizer-BioNTech mRNA vaccine) 3 weeks before.He had no known COVID-19 exposure and SARS-CoV-2 PCR was negative on nasopharyngeal swab testing on admission.EKG showed normal sinus rhythm and troponin I was elevated at 0.5 ng/ml (reference range 0.0-0.04ng/ml).Echocardiogram showed normal ejection fraction with no other abnormalities.Cardiac MRI showed subepicardial enhancement along the lateral wall of left ventricular consistent with focal myocarditis.Electrophysiological study was negative for inducible ventricular arrhythmias.Testing for drug-induced and infectious causes of myocarditis yielded negative results.No arrhythmias or recurrence of symptoms were observed during the hospital stay and the patient was discharged in a stable condition with advice to refrain from second dose of vaccine.DISCUSSION: A diagnosis of focal myocarditis temporally associated with the vaccine was established.Clinical course was mild, and he continued to do well at follow-up without additional clinical sequelae.Recent literature shows an association of myocarditis with mRNA-COVID-19 vaccination, with a prevalence of 0.03%.It is mostly seen in young healthy males after the second dose.Cardiac arrest secondary to COVID vaccine-induced myocarditis is an unusual presentation and no similar cases have been reported to date.Such presentation after the first vaccine dose is also rare in the reported cases. CONCLUSIONS:A high clinical suspicion of COVID-19 vaccine-associated myocarditis should be maintained in young healthy males with a mild disease course.Cardiac arrest is a possible catastrophic presentation of such vaccine-induced myocarditis.

Therapeutic Area: ASCD/CVD in Women Background: We aimed to determine ethnic and gender discrepancies in coronary artery disease (CAD) burden and clinical outcomes in patients admitted with first acute myocardial infarction (AMI). Methods: We conducted retrospective analysis of middle-aged (35-60 years) patients admitted with AMI from 2017-2020. Ethnicity, gender, body mass index (BMI) and cardiovascular (CV) risk factors (history of smoking, diabetes mellitus, hypertension, hyperlipidemia, peripheral arterial disease, and chronic kidney disease) were analyzed. CAD burden was classified into single vessel disease (SVD), 2 vessel disease (2VD) and >2 or multiple vessel disease (MVD). Clinical outcomes were defined as type of intervention (PCI or CABG) and in-hospital mortality. Data was analyzed in STATA 16 and multinomial logistic regression was used to calculate adjusted (for age and CV risk factors) relative risk ratios (aRRR) for CAD burden and outcomes. Results: 434 patients (39.4% females) were divided into the following ethnicities: 61% Caucasians, 33% African Americans (AA), and 6% Hispanics. Mean age was 55+/-14 and mean BMI was 29 +/- 5.5 kg/m2. Analysis revealed higher occurrence of 2VD (aRRR 4.81, [2.64-7.22], p<0.001) and MVD (aRRR 8.23, [6.56-9.09], p<0.001) in AA vs. Caucasians (Figure 1). Hispanics showed increased incidence of 2VD (aRRR 2.21, [2.61-7.23], p<0.001) when compared to Caucasians. AA also had an increased rate of CABG (aRRR 4.11, [3.63-5.31], p<0.001) and in-hospital death (aRRR 3.61, [2.66-6.16], p<0.001). In contrast, Hispanics had similar rate of CABG and mortality compared to Caucasians. Subgroup analysis stratified by gender revealed an increased incidence of MVD (aRRR 3.21, [2.02-4.01], p<0.001) in AA females compared with other subgroups (Figure 2). Hispanic patients did not show a difference in CAD burden or clinical outcomes when stratified by gender. Conclusion: African American and Hispanic patients have increased incidence of 2VD and MVD during first AMI. AA females have the highest incidence of MVD when compared to other subgroups necessitating stricter optimization of cardiovascular health for this subset.

Introduction: Coronary artery aneurysm (CAA) is a vessel dilation exceeding 1.5 times adjacent normal segments. We present a case of massive right coronary artery (RCA) aneurysm complicated by ST elevation (STE) myocardial infarction. Case Summary: An 87-year-old female with no significant medical history presented with chest pain. Vitals signs and physical exam were normal. A 12 lead EKG demonstrated STE in inferior leads. Coronary angiography revealed a large aneurysm of the RCA throughout its course (max diameter 20 mm) with TIMI I flow. In the mid RCA, there was a long filling defect with irregular borders consistent with a congealed, organized layered thrombus causing 90% stenosis. Percutaneous coronary intervention (PCI) was not pursued due severe aneurysmal dilation and risk for embolization. The proximal to mid left anterior descending artery (LAD) and abdominal aorta were also aneurysmal. The patient was deemed not to be a surgical candidate after a heart team discussion (STS risk of morbidity or mortality = 12.6%). Left ventricular ejection fraction was 60%. Chest pain resolved and patient was discharged on indefinite anticoagulation and antiplatelet therapy. Discussion: Giant CAAs are rare, with an incidence of 0.02%. Causes include atherosclerosis, Takayasu arteritis, Kawasaki disease, or congenital defects. Although mostly incidental, CAA can be complicated by thrombosis, embolization, fistulation, rupture, arrhythmia, or sudden death. Our patient had an acute RCA thrombus due to stasis and turbulent blood flow in the aneurysm. Localized CAA are treated with surgery or percutaneous coiling or stenting. However, PCI was not feasible in our patient due to risk of embolization and difficultly with stent apposition in the setting of a diffuse, giant-sized aneurysm. Conclusion: CAAs are rare but may cause grave complications. A heart team discussion is essential to guide appropriate medical, percutaneous, or surgical treatment based on vessel anatomy.

SESSION TITLE: Cardiovascular Disease Case Report Posters 6 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: The severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) can cause multiple respiratory and systemic complications. Although the lungs are the main organ involved in COVID-19, a wide range of cardiovascular manifestations have also been reported in patients infected with SARS-CoV-2. On rare occasions, pericardial effusion has also been documented in association with COVID-19, which is mostly non-hemorrhagic. We present a rare case of spontaneous hemorrhagic pericardial effusion complicated by cardiac tamponade in a patient after a recent COVID-19 infection [1,2]. CASE PRESENTATION: A 75-year-old man with a past medical history of diabetes, severe aortic stenosis status post-TAVR, and hypertension presented to the clinic with the complaint of progressive dyspnea. The patient reported a recent COVID-19 infection one month. He was found to have volume overload and EKG revealed atrial flutter with a rapid ventricular response. The patient was sent to our hospital for further management. Initial vitals showed blood pressure of 116/96 mmHg, heart rate of 137 bpm, and oxygen saturation of 93% on room air. Physical examination was significant for marked peripheral edema and irregularly irregular heartbeat. Repeat EKG demonstrated atrial flutter with variable A-V block and low voltage QRS (Figure 1). Chest X-ray showed cardiomegaly with moderate bilateral pleural effusions and a left basilar opacity. Echocardiogram revealed a large circumferential pericardial effusion (Figure 2). Initial labs showed normal high-sensitivity troponin and BNP. CBC was significant for an elevated WBC count of 11.8x 10*3/UL and hemoglobin of 12.5 g/dL. The patient was found to be SARS-CoV-2 positive on PCR. Treatment was initiated with aggressive diuresis and beta-blocker for atrial flutter. However, the patient continued to deteriorate. A repeat echocardiogram revealed an interval increase in pericardial effusion, now with tamponade physiology. He underwent an emergent subxiphoid pericardial window with 1L of hemorrhagic fluid drainage. Limited follow-up echo showed marked improvement of the pericardial effusion. His hospital course was complicated by recurrent atrial fibrillation which was treated with a higher dose of beta-blocker; Apixaban was initiated. The patient's clinical status gradually improved and he was discharged with cardiology follow-up as an outpatient. DISCUSSION: Most COVID-19-related pericardial effusion (PE) reports have been non-hemorrhagic, with only a few hemorrhagic cases reported in the literature. This makes COVID-19 only the second viral infection that can lead to hemorrhagic PE, in addition to Coxsackievirus. There are currently no specific blood biomarkers for the diagnosis of PE; however, it is often associated with elevated inflammatory markers like ESR, CRP, and d-dimer. If PE is suspected, an echocardiogram can be used to confirm the diagnosis. There is no standard management approach regarding PE related to COVID-19. Medications are usually ineffective in the case of a giant or hemorrhagic PE; hence, both require drainage for resolution [1,3]. CONCLUSIONS: In conclusion, hemorrhagic pericardial effusion with subsequent cardiac tamponade must be considered as a potentially lethal late manifestation of COVID-19 infection, which can be treated with drainage if diagnosed early. REFERENCE #1: 1. Kermani-Alghoraishi, M., Pouramini, A., Kafi, F., & Khosravi, A. (2022). Coronavirus Disease 2019 (COVID-19) and Severe Pericardial Effusion: From Pathogenesis to Management: A Case Report Based Systematic Review. Current problems in cardiology, 47(2), 100933. https://doi.org/10.1016/j.cpcardiol.2021.100933 REFERENCE #2: 2. Brogi, E., Marino, F., Bertini, P., Tavazzi, G., Corradi, F., & Forfori, F. (2022). Cardiac complications in patients with COVID-19: a systematic review. Journal of Anesthesia, Analgesia and Critical Care, 2(1), 18. https://doi.org/10.1186/s44158-022-00046-7 REFERENCE #3: 3. Long, B., Brady, W. J., Koyfman, A., & Gottlieb, M. (2020). Cardiovascular complications in COVID-19. The American journal of emergency medicine, 38(7), 1504–1507. https://doi.org/10.1016/j.ajem.2020.04.048 DISCLOSURES: No relevant relationships by William Bachman No relevant relationships by Moiz Ehtesham No relevant relationships by Marium Faiz No relevant relationships by Larabe Farrukh No relevant relationships by Issam Halasa No relevant relationships by Sumbal Wajid No relevant relationships by Hafiza Hareem Waqar

SESSION TITLE: Cardiovascular Disease Posters 3 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Vascular damage from inflammation in ANCA vasculitis leads to a sustained procoagulant state causing accelerated atherosclerosis. A population-based cohort study found that the risk of cardiovascular disease is more than 3-fold higher in patients with ANCA-associated vasculitis. We hypothesize that those with ANCA vasculitis are more likely to have a major adverse cardiovascular event compared to those in the hypertension control group. Our aim was to determine associations of major adverse cardiovascular events (MACE) in patients with history of ANCA-associated vasculitis compared to that seen in the control group, patients with hypertension without ANCA-associated vasculitis. METHODS: We retrospectively reviewed patients with ANCA vasculitis (n=125) between 2017-2020. Charts were reviewed to assess cardiovascular (CV) risk factors which included history of smoking, hypertension, hyperlipidemia, diabetes mellitus and chronic kidney disease. Incidence of MACE such as myocardial infarction (MI), stroke, heart failure (HF) was calculated retrospectively after the diagnosis of ANCA vasculitis. Chi square and modified Poisson regression were used to calculate the incidence rate ratio (IRR) for MACE. We also retrospectively reviewed patients with hypertension without ANCA-associated vasculitis (n=100) between 2017-2020. The associations of each of the ANCA vasculitis categories and hypertension group with outcomes of MACE were examined by logistic regression. Minitab statistical software was used with significance accepted at p <0.05. RESULTS: Of 125 total ANCA vasculitis patients, 77 (61.6%) had granulomatosis with polyangiitis (GPA), 37 (29.6%) had eosinophilic granulomatosis with polyangiitis (EGPA), and 11 (8.8%) had microscopic polyangiitis (MPA). Females were 68%. Mean age of the cohort was 58 years with a mean BMI of 29.4 kg/m². The unadjusted and adjusted (for age, gender, and CV risk factors) IRR for stroke was significantly lower in patients with EGPA and MPA vs. GPA (p<0.05), while IRR for HF was higher in EGPA vs. GPA (p<0.05). The adjusted IRRs for MI and HF were higher in patients with EGPA and MPA but were not statistically significant. The mean age of the hypertension group was 62 years with a mean BMI of 30.1 kg/m². Females were 48%. The odds of having a stroke were higher amongst EGPA, GPA, and MPA patients than hypertension patients. The odds of having a MI were higher amongst EGPA, GPA, and MPA patients than hypertension patients. The odds of having HF were higher amongst EGPA and GPA patients than hypertension patients. The odds of having HF were higher amongst MPA patients than hypertension patients but were not statistically significant. CONCLUSIONS: Incidence of stroke is higher in GPA patients compared with EGPA and MPA, while EGPA patients are more likely to have heart failure compared to GPA patients. The odds of having a stroke and MI were higher amongst EGPA, GPA, and MPA patients than hypertension patients. The odds of having HF were higher amongst EGPA and GPA patients than hypertension patients. CLINICAL IMPLICATIONS: Patients with ANCA-associated vasculitis are at increased risk of major adverse cardiovascular events. DISCLOSURES: No relevant relationships by Moiz Ehtesham No relevant relationships by Larabe Farrukh No relevant relationships by Shannon Murawski No relevant relationships by Ruben Peredo-Wende No relevant relationships by Lisa Rosenberg

Backgrounds: AngioVac is used for the percutaneous removal of vegetations and for debulking of large vegetations in patients who are not surgical candidates.This study aims to identify the demographics, echocardiographic features, indications, improvement of the tricuspid valve regurgitation, and survival outcomes of patients who have undergone AngioVac vegetectomy reported in the literature. Methods: A systematic review was performed to identify articles reporting suction thromectomy or vegetation removal using the AngioVac system for RSIE (right sided infective endocarditis). Survival on discharge was our primary outcome. Additionally, we evaluated indications for suction thrombectomy and TR improvement. Categorical variables were expressed as percentages and ratios. Results: A total of 49 studies were identified. The most common risk factor was intravenous drug abuse seen in 45% (20/49) and cardiovascular implantable electronic device (CIED) in 45% (20/49). Circulatory shock was seen in 35% of patients. The causative organism was gram positive cocci (86%). Moderate to severe TR was present in 74% of cases with documented echocardiograms. Indications for AngioVac were poor surgical candidacy (81%) or to reduce septic emboli risk (19%). Survival at discharge was 93%. TR improvement was reported only in 16% cases and remained unchanged/worsened in 84%. Conclusion: AngioVac procedure is an alternative treatment for critically ill patients who cannot undergo surgery. To understand the survival, safety and candidacy of patients undergoing this procedure, further randomized control studies and literature reviews are needed. The improvement or worsening of tricuspid regurgitation in patients with TR valve involvement is another factor to be investigated.

Objective: We aimed to uncover gender and racial differences in major adverse cardiovascular events (MACE) in patients with inflammatory bowel disease (IBD). Methods: The National Inpatient Sample was retrospectively studied (1/1/19-12/31/19) for IBD hospitalizations of ages >17 years. The primary outcome was a composite 5 point-MACE: cerebrovascular accident (CVA), myocardial infarction (STEMI and NSTEMI), congestive heart failure (CHF), Hypertension (HTN), and peripheral arterial disease (PAD). Type of coronary revascularization was assessed: percutaneous intervention (PCI) or coronary artery bypass graft (CABG). Data were analyzed in STATA 16.0, and adjusted odds ratios (AOR) were calculated using hierarchal multivariate regression analysis reported with 95% confidence interval (CI) and P-values. Results: The study included 169,355 patients (females=78705). Caucasians were the predominant race ([78%] reference) followed by African Americans (AA) (11%), Hispanics (H) (7%), and others (4%). Analyses revealed decreased association of STEMI (AOR 0.56, [0.35-0.90], P < 0.001), NSTEMI (AOR 0.53, [0.31-0.92], P < 0.001), CABG (AOR 0.12, [0.01-0.90], P < 0.001) and PAD (AOR 0.76, [0.65-0.89], P < 0.001) in AA vs Caucasians. Concurrently, there was an increased association of CHF (AOR 1.63, [1.43 -1.86], P < 0.001) and HTN (AOR 2.1, [1.88-2.24], P < 0.001) in the AA cohort. No significant difference existed between Hispanics and Caucasians for risk of MACE. Subgroup analysis for ulcerative colitis revealed a decreased occurrence of CABG (P < 0.001) and an increased association of HTN, PAD, and CHF in AA cohort (P < 0.001). Subgroup analysis for Crohn's disease revealed an increased association between HTN and CHF in AA vs Caucasians (P < 0.001). Subgroup analysis for females revealed a decreased association of STEMI and NSTEMI in AA cohort (P< 0.001) and an increased association of HTN, PAD, and CHF (P < 0.001) compared to Caucasians. Conclusion: African American patients with IBD are more likely to develop HTN, PAD, and CHF compared to their Caucasian counterparts while the occurrence of STEMI, NSTEMI, and CABG is reduced. There was no statistically significant change noted in outcomes in the Hispanic population.

Sjogren’s syndrome (SS) is a connective tissue disease targeting the exocrine glands with subsequent sicca symptoms mainly in eyes and mouth. Respiratory symptoms may be the most frequent extraglandular manifestation following fatigue and pain. Mucosal dysfunction may affect the upper and lower airways, being the small airways more frequently involved. Parenchymal disease carries most of the morbidity and mortality. Nonspecific interstitial pneumonia (NSIP) is the most common radiographic feature, whereas the fibrotic NSIP type is the most reported finding in biopsies. Pulmonary lymphoma may arise from bronchial-associated lymphoid tissue lesions, and although rare, it is prevalent in SS. Chronic hypertrophic bronchial wall changes may ascribe to the various cystic lesions. Under their presence, possible lymphocytic interstitial pneumonia, amyloidosis, and lymphoma should be explored. Pulmonary arterial hypertension may present as frequently as in lupus, especially in Asian populations. Advanced knowledge in the pathogenesis has helped in understanding the various presentations within the respiratory system, contrasting with the scarce therapeutic options to treat both the airway and parenchymal disease. Anti-fibrotic parenchymal lung therapy offers promising outcomes. The pulmonary involvement in SS may associate with a decline in quality of life and reduced life expectancy. Subsequently, clinicians should know these facts for a timely intervention.

A woman in her 50s with history of recurring myasthenia gravis (MG) exacerbations (three hospitalisations in the past 6 months) presented with complaints of generalised weakness and visual abnormalities for the last 4 days. MG was diagnosed 2 years ago when she presented with similar symptoms

Coronavirus disease 2019 (COVID-19) is primarily known to affect the lungs; however, several studies indicate that it can be a multisystem disease. There is documentation detailing different sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients affected with this virus have been seen to develop a hypercoagulable state leading to systemic thrombosis in some cases or embolism leading to catastrophic outcomes in others. Data regarding anticoagulation in these patients is limited. Further research needs to be carried out for management and prophylaxis for patients with COVID-19 at risk of aortic thrombosis. We present a case of a middle-aged man with multiple comorbidities and remote COVID-19 infection who came to the emergency room with signs and symptoms worrisome for a cerebrovascular accident (CVA). Brain imaging revealed multiple cortical infarcts suggestive of a cardioembolic etiology. During his hospitalization, he underwent a transesophageal echocardiogram (TEE) that showed a 1x1 cm mobile thrombus in the distal descending aorta. Laboratory workup was negative for any hypercoagulable condition; it was thought that this patient might have a hypercoagulable state post-COVID-19 infection. After a thorough risk vs. benefit discussion, patient was started on apixaban. He remains alive and is doing well in a recent follow-up in our clinic.

A woman in her 60s with history of hypertension presented with typical left-sided chest pain for 2 hours. The pain radiated to her left jaw and was associated with diaphoresis. On presentation, her vital signs were stable and physical examination was unremarkable. Laboratory evaluation revealed

Introduction: Hypertension (HTN), dyslipidemia (HLD), smoking, obesity, and diabetes (DM), peripheral arterial disease (PAD) are known risk factors for coronary artery disease (CAD). However, it is not clear if one risk factor is related to causing higher plaque burden than others. We attempted to find relationship of these risk factors with number of occluded coronary arteries (>50% stenosis) to assess plaque burden. Methods: Retrospective analysis of patients admitted to a tertiary care center undergoing coronary revascularization (PCI or CABG) for acute myocardial infarction (AMI) from May 2019 - May 2021. Patients were classified based on the number of occluded coronary vessels: single vessel disease (SVD), 2 vessel disease (2VD), and >2 or multivessel disease (MVD). CAD risk factors were analyzed. CAD burden was assessed by number of vessels showing >70% stenosis angiographically. The relationship between CAD risk factors and CAD burden was analyzed via univariate and multivariate analysis. Results: A total of 434 patients were included. Mean age was 56 ± 11 years with 61% Caucasians, 33% African Americans (AA), and 6% Hispanics. Females were 39.4%. Patients with SVD, 2VD, and MVD, were 264 (60.8%), 101 (23.3%) and 69 (16%) respectively. Smoking and diabetes were more prevalent in SVD group, while AA race was associated with higher incidence of MVD (table 1). HTN, HLD, diabetes, obesity, smoking, PAD, CKD were statistically similar with respect to CAD burden. On multivariate analysis, AAs {OR 0.13 [0.07-0.23]} and Hispanics {OR 0.22 [0.09-0.54]} had a lower prevalence of SVD compared to Caucasians. AA had higher odds of MVD {6.2 [2.9-12.9]} shown in table 2. Mortality was higher in MVD group compared to SVD (24.6% vs. 40.6%, p=0.01). Conclusions: African American patients had a higher CAD burden when presenting with AMI. HTN, HLD, diabetes, obesity, PAD, smoking and CKD were statistically similar when compared for CAD burden.

BACKGROUND:The presence of bifascicular block on electrocardiography suggests that otherwise-unexplained syncope may be due to complete heart block. European Society of Cardiology (ESC) recommends investigating it with electrophysiology study (EPS). PPM is indicated if high-degree atrioventricular block is inducible. Long term rhythm monitoring with implantable loop recorder (ILR) is recommended if EPS is negative. We evaluated adherence to these guidelines.METHODS:This is a single-center retrospective audit of adult patients with bifascicular block hospitalized for unexplained syncope between January 2018 and August 2019 under general medicine service. Patients with an alternative explanation for syncope were excluded. Guideline adherence was assessed by formal cardiology consult and whether EPS followed by ILR and/or PPM were offered.RESULTS:65 out of 580 adult patients (11.2%) admitted to general medicine service for syncope had a bifascicular block; 29 (5%) were identified to have bifascicular block and unexplained syncope. Median age was 77 ±10 years; 9 (31%) were female, and 6 (20.7%) patients had at least one prior hospital visit for syncope at our academic medical center. Cardiology was consulted on 17 (58.6%) patients. Two patients were evaluated by EPS (1 refused) followed by ILR. Overall, 3 out of 29 patients (10.3%) received guideline-directed evaluation during the hospitalization based on ESC guidelines. None of the patients received empiric PPM during the index hospitalization.CONCLUSION:Among patients admitted to the general medicine service with unexplained syncope and bifascicular block, a minority (10.3%) underwent guideline-directed evaluation per ESC recommendations. Cardiology was consulted in 58.6% of cases.

Objective: Anemia is a common comorbidity during pregnancy and in non-pregnant females of childbearing age. Our goal was to ascertain its association with in-hospital mortality and complications in females with peripartum cardiomyopathy (PPCM). Methods: The national inpatient sample was retrospectively queried from 2011-2017 to identify all women aged 17 to 51 years with the diagnosis of PPCM. We further identified diagnosis of anemia within each admission using ICD-10 codes (D64.9 and D64.89). Primary outcome was inpatient mortality rate while secondary outcomes were in-hospital complications such as acute kidney injury (AKI), pulmonary edema and antepartum hemorrhage. Demographic (age, sex, race) and clinical (history of hypertension, stroke, myocardial infarction, obesity, smoking) data was also noted. Analysis was conducted using STATA 16.0. Adjusted odds ratios (AOR) were calculated with multivariate logistic regression method reported with confidence interval (CI) and a P-value (significance <=0.05). Results: We recorded 211,476 hospitalizations for PPCM, out of which 38% (80,361) had anemia. Average age of the patients was 35 years and 78% of the women were Caucasian. Overall inpatient mortality rate was 3.9% and was higher in PPCM hospitalizations with anemia compared to those without anemia [4.1% vs 3.3%; AOR: 1.24 (1.19 – 1.30, p<0.001)]. Women with PPCM and anemia reported clinically significant history of obesity and smoking (p<0.001). PPCM hospitalizations with anemia also had higher incidence of preeclampsia, AKI, acute pulmonary edema, and antepartum hemorrhage (Table). Conclusion: Our study demonstrates that anemia increases inpatient mortality rate in women with PPCM. Anemia also increases in-hospital incidence of preeclampsia, AKI, acute pulmonary edema, and antepartum hemorrhage in women with PPCM.

Objective: Preeclampsia has been shown to put women at an increased risk of developing hypertension later in life. We aimed to determine racial differences in in-hospital outcomes of hypertensive crisis in women with history of preeclampsia in the United States. Methods: The national inpatient sample was retrospectively studied from 2012-2019 to identify hospitalizations for hypertensive crisis aged >18. We further identified history of preeclampsia within each admission using ICD-10 codes. The primary outcome was hospital length of stay (LOS) and inpatient mortality rate. Secondary outcomes were chosen as a 3-point composite development of stroke, myocardial infarction (MI) or congestive heart failure (CHF). Demographic (age, sex, race) information was also recorded. Caucasian patients were chosen as baseline reference to compare other ethnicities with. Data was analyzed with STATA 16.0, and adjusted odds ratios (AOR) were calculated using multivariate logistic regression. Results: There were 531,432 hospitalizations for hypertensive crisis, out of which 11% (58,457) had history of preeclampsia. 65% of this subset was Caucasian, 21% were African American (AA) and 11% Hispanic. Inpatient mortality rate was higher in Hispanic patients with preeclampsia vs Caucasians [6.2% vs 4.3%; AOR: 1.56 (1.49 – 1.61, p<0.001)]. AA patients had a longer LOS vs Caucasians [5.5 vs 3.2; AOR: 1.21 (1.19 – 1.25, p<0.001)]. There was no significant difference in LOS in Hispanic patients (p=0.08). Hispanic women had increased odds of developing stroke while inpatient compared to their Caucasian counterparts (AOR: 2.31, p<0.001). There was no significant difference in development of MI amongst the races (p=0.09). However, AA women with history of preeclampsia were more likely to develop CHF compared to Caucasians (AOR: 1.92, p<0.001). Conclusion: Hispanic women with history of preeclampsia have higher mortality rate and incidence of stroke when admitted with hypertensive crisis. Similarly, African American women with preeclampsia have longer hospital stay when admitted with hypertensive crisis. Further research is needed to understand and alleviate these cardiovascular burdens in ethnic minorities.

Objective: Arrhythmias are a significant clinical challenge and can complicate hospital course for mechanically ventilated patients. We aimed to determine the burden of arrhythmias and their effect on inpatient outcomes in mechanically ventilated patients in the US. Methods: The national inpatient sample was retrospectively studied (2015-2019) to identify all mechanically ventilated patients aged >17. We further identified the following arrhythmias within each admission: atrial fibrillation (AF), non-sustained ventricular tachycardia (NSVT), supra-ventricular tachycardia (SVT), atrioventricular block (AVB) and ventricular fibrillation (VF). Primary outcomes were inpatient mortality rate, hospital length of stay (LOS) and total cost for each type of arrythmia. Demographic (age, sex, race) and clinical information (history of hypertension, stroke, myocardial infarction, obesity) was recorded. Data was studied in STATA 15 and multivariate logistic regression was used to estimate adjusted odds ratios (AOR) reported with p-value (significance=<0.05). Results: Our analysis included 1,745,867 weighted discharges of mechanically ventilated patients. Mean age was 65 years (56% male, 69% Caucasian). Most frequent arrythmia was AF (63% of all patients) and least common was AVB (11%). AF, VF, and SVT were associated with an increase in mortality (AOR: 3.52, 2.78, 1.45 respectively, p < 0.001). NSVT, AF, and SVT were associated with an increase in hospital LOS of 4.5, 3.2, and 2.8 days respectively (AOR 3.31, 2.94, 1.75 respectively, p<0.001). The adjusted inpatient cost was highest in patients with NSVT ($21,567, p<0.05). AVB and NSVT were not associated with an increase in mortality (p<0.05). On gender and race stratification, African American males had the highest mortality rate secondary to AF and VF (AOR: 3.54 and 4.21 respectively, p<0.001). Conclusion: We demonstrate that atrial fibrillation, ventricular fibrillation, and SVT are independently associated with increased mortality in mechanically ventilated patients. We also show that NSVT is associated with increase in hospital LOS in these patients. African American mechanically ventilated males had the highest mortality rates secondary to atrial and ventricular fibrillation.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) refers to acute myocardial infarction with normal or near-normal coronary arteries. The MINOCA is a heterogeneous group of conditions, and possible etiologies are coronary artery spasm, spontaneous coronary artery dissection, coronary thromboembolism, coronary plaque disruption, coronary microvascular dysfunction, supply and demand mismatch. It is more common in young adults, with women having a higher chance of getting MINOCA than men. Considering MINOCA as a clinically dynamic working diagnostic that needs further investigation rather than a "true" diagnosis is proposed. Optical coherence tomography (OCT), intravenous ultrasound (IVUS), cardiac MRI may be required to stratify the underlying mechanism. Due to the lack of evidence-based literature and prospective randomized controlled studies, therapeutic management is limited. Consequently, the strategy is patient-specific. The prognosis of MINOCA patients remains unclear and depends upon the underlying etiology. This article aims to review the literature about various aspects of MINOCA, including pathophysiology, diagnosis, prognosis, and treatment.

Tricuspid valve endocarditis with recurrent septic pulmonary emboli is an indication for surgery. In this report, we present a case of right-sided infective endocarditis (RSIE) in a female patient with a history of intravenous drug use (IVDU). The patient was admitted with multiple chief complaints of fatigue, chills, fever, cough, chest pain, and shortness of breath. She was found to have a large 1.8 cm (W) x 2.4 cm (L) mobile tricuspid valve vegetation on transthoracic echocardiogram (TTE). Despite being on appropriate antibiotics, the patient failed to improve clinically. Cardiothoracic surgery (CTS) evaluated the patient for surgical management of infective endocarditis (IE) given the size of vegetation, persistent bacteremia, and clinical deterioration. However, the risk/benefit ratio for open-heart surgery was high, given the history of active IVDU and hemodynamic instability. The patient underwent percutaneous extraction of the vegetation using suction filtration and veno-venous bypass and her condition significantly improved clinically afterward. We discuss the importance of suction filtration and veno-venous bypass in managing tricuspid valve endocarditis as an alternative in patients who are not ideal candidates for surgery and the need for more evidence regarding its effectiveness compared to surgery.