Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. Mental health disorders are associated with the onset and progression of cardiac disease. The adverse sequelae of this association include worsened quality of life, adverse cardiovascular outcomes, and heightened mortality. The increased prevalence of CVD is partly explained by increased rates of traditional cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking, but mental illness is an independent risk factor for CVD and mortality. Given the association between mental health disorders and poor cardiovascular health, it is vital to have an early and accurate identification and treatment of these disorders. Our review article shares the current literature on the adverse cardiovascular events associated with psychiatric disorders. We present a review on depression, anxiety, bipolar disorder, schizophrenia, type A and D personality disorders, obsessive-compulsive disorder, and stress.

Bereavement due to loss of a partner is one of the most stressful life events, often leading to adverse physiological responses. Spousal loss has been associated with an increased morbidity and mortality, particularly from cardiovascular disease. Use of aspirin and/or beta adrenergic blockers have previously been suggested to play a role in cardiovascular risk associated with early bereavement. However, the available literature regarding this topic is limited. In this review article, we explore the potential beneficial role of aspirin and beta blockers in early bereavement. Our systematic review suggests that most studies have found aspirin and beta blockers to be beneficial in preventing adverse cardiovascular outcomes associated with early bereavement. Further randomized controlled long-term studies are warranted with adequate sample size to clearly establish the role of these medications on cardiovascular disease in late bereavement.

Omega-3-fatty-acids are now increasingly being used for potential beneficial anti-inflammatory effect in the treatment and management of cardiovascular disease. Eicosapentaenoic acid and Docosahexaenoic acid are 2 essential omega-3 fatty acids found predominately in fish and fish oil supplements. Despite the increased use of fish oil products for both primary and secondary prevention of cardiovascular morbidity and mortality, the available literature evidence are controversial. We searched through PubMed for studies that have investigated the impact of omega-3 fatty acids on coronary heart disease and mortality. Our systemic review suggests that most studies, which are mostly observational, have found there to be a potential benefit of omega-3 fatty acids on coronary heart disease whereas some other studies have found conflicting results. More randomized controlled studies are warranted with adequate sample size to clearly establish the risk and benefits of omega-3 fatty acids on cardiovascular disease.

Targeted temperature management, also known as therapeutic hypothermia (TH), is recommended for out-of-hospital cardiac arrest (OHCA). Both internal or external methods of cooling can be applied. Individuals resuscitated from OHCA frequently develop postarrest myocardial dysfunction resulting in decreased cardiac output and left ventricular systolic function. This dysfunction is usually transient and improves with spontaneous recovery over time. Echocardiogram (ECHO) can be a vital tool for the assessment and management of these patients. This manuscript reviewed methods available for TH after OHCA and reviews role of ECHO in the diagnosis and prognosis in this setting.

Modern pacemakers can sense and pace multiple chambers of the heart. These pacemakers have different modes and features to optimize atrioventricular synchrony and promote intrinsic conduction. Despite recent advancements, current pacemakers have several drawbacks that limit their feasibility. In this review article, we discuss several of these limitations and detail several emerging technologies in cardiac pacing aimed to solve some of these limitations. We present several technological advancements in cardiac pacing, including the use of leadless pacemakers, physiologic pacing, battery improvements, and bioartificial pacemakers. More research still needs to be done in testing the safety and efficacy of these new developments.

Cardiac pathology can be congenital or acquired with underlying genetic predispositions. In this era of medicine there is a concern that the comprehensive physical examination doctors prided themselves on is becoming a lost art. Research studies have also revealed a decline in physical examination skills. The full clinical cardiovascular examination is indeed quite complex and does take significant time to master. It is critical that physicians be competent in the physical exam. Not identifying subtle clinical findings leading to missed or delayed diagnosis which can lead to significant morbidity and mortality. In this paper we intend to highlight the clinical cardiovascular findings that may be detected on patients even before initiating the physical exam. The head and neck visual examination may be quite revealing.

Cardiac pathology can be congenital or acquired with underlying genetic predispositions. In this era of medicine there is a concern that the comprehensive physical examination doctors prided themselves on is becoming a lost art. Research studies have also revealed a decline in physical examination skills. The full clinical cardiovascular examination is indeed quite complex and does take significant time to master. It is critical that physicians be competent in the physical exam. Not identifying subtle clinical findings leading to missed or delayed diagnosis which can lead to significant morbidity and mortality. In this paper we intend to highlight the clinical cardiovascular findings that may be detected on patients even before initiating the physical exam. The head and neck visual examination may be quite revealing.

Chronic systemic skin disease and cardiovascular disease are multisystem disorders which have been associated with each other for centuries. Recent research has strengthened this association, particularly in systemic inflammatory disease. Here we explore the current literature on psoriasis, hidradenitis suppurativa, lupus erythematosus, acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. Psoriasis is a chronic inflammatory disorder that has been labeled as a risk-modifier for hyperlipidemia and coronary artery disease by the American College of Cardiology ACC lipid guidelines. Cardiovascular disease is also found at a significantly higher rate in patients with hidradenitis suppurativa and lupus erythematosus. Some associations have even been noted between cardiovascular disease and acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. While many of these associations have been attributed to a shared underlying disease process such as chronic systemic inflammation and shared underlying risk factors, these dermatologic manifestations can help to identify patients at higher risk for cardiovascular disease.

Background: Immune checkpoint inhibitors (ICIs) are increasingly being used for cancer therapy. Cardiotoxicity from ICIs has largely been underestimated since cardiovascular monitoring is not routinely performed after initiating immunotherapy. Cardiotoxic side effects are uncommon but are serious complications of ICIs with a high morbidity and mortality. Aims and Objectives: To determine gender differences in the risk of CVEs in cancer patients that receive immunotherapy. To determine the risk of CVEs in males and females who received different number of ICI injections. To study other possible risk factors for adverse CVEs in patients who received immunotherapy with ICIs. Materials and Methods: In this observational, retrospective, pharmacovigilance study, we used MarketScan Databases to compare cardiovascular adverse events reported in patients who received ICIs. The data used in this study was fully integrated and de-identified data. The study included 16,574 patients who had cancer and underwent ICI therapy between January 1, 2011, and December 31, 2018. ICI drugs in this study included nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab, and ipilimumab. The time to an event and the end of follow-up was counted from the time of first ICI injection. Our primary exposure variable was gender. Results: This study demonstrated that time to adverse CVE in cancer patients that receive ICI therapy is affected by the gender. The hazard time to CVEs between the male and female gender varied by age. There was no difference in CVEs between males and females at a younger age. The hazard time to CVEs increased with age above 60 years in males when compared to females. The hazard of time to CVE in males was 1.18 times the hazard in females at the mean study age of 60.5 years. Adjusted Kaplan–Meier survival curves for males and females stratified by ICI injection categories showed that those with fewer number of ICI injections had a shorter time to CVE. Conclusions: The number of ICI injections and the gender both impact adverse cardiovascular events in cancer patients. Managing and reducing cardiotoxicity is vital for safe delivery of this effective therapy. Future studies should assess whether late onset chronic cardiotoxicity can occur with ICI therapy.

SESSION TITLE: Medical Student/Resident Pulmonary Vascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Cardiac myxomas are noncancerous primary tumors of the heart and majority of cardiac myxomas are found in left atrium and arise in interatrial septum. Right atrial myxomas tend to be more solid and sessile and have wider attachment to interatrial septum. Myxomas can lead to multiple complications resulting in obstruction, embolization, and constitutional symptoms. Right atrial myxomas are rare and usually. We report first case of a massive round right atrial myxoma removed in a young male presenting with acute heart failure and embolism to pulmonary vasculature. CASE PRESENTATION: 49-year old male presented with severe dyspnea on excretion and worsening pedal edema over a two week period. His past medical history was significant for coronary artery disease with a coronary stent placed in the first diagonal artery of the left anterior descending artery. Recent cardiac catheterization confirmed patency of the first diagonal stent, with minimal luminal irregularities involving the dominant right coronary artery and left circumflex artery. Transesophageal echocardiogram demonstrated a 6 x 4 cm large mobile mass in the right atrium arising from the interatrial septum (Image 1). Thorax radiography revealed cardiomegaly and a right lower lobe infiltrate and effusion. Electrocardiogram showed normal sinus rhythm with diffuse low voltage. Laboratory testing showed ALT 34 U/liter; D-Dimer 4.06 μg/ml; NT-proBNP 758 Ñ€g/ml; Troponin I 0.05 ng/ml. CT angiogram of the chest demonstrated small pulmonary emboli in the right middle lobe, right lower lobe, and left lower lobe. It also indicated a 6.4 x 4.5 x 4.6 cm filling defect in the right ventricle and right atrium. The patient was subsequently anti-coagulated. No venous thrombosis was detected. Given the possibility of myxomatous emboli, the patient was transferred to a tertiary care hospital for further treatment. He underwent surgical excision of the right atrial myxoma by median sternotomy under circulatory arrest. He was found to have a large distinct foci of right atrial tumor (Image 2). The right ventricle, left atrium, and left ventricle did not have any additional foci upon careful inspection. A 6 x 4 cm surgical specimen was excised (Image 3). Pathologic evaluation was consistent with the diagnosis of cardiac myxoma. DISCUSSION: Primary tumors of the heart are extremely rare. Right atrial myxomas are uncommon and not previously reported to present with pulmonary embolism and congestive heart failure. In order to avoid complications from atrial myxoma, early diagnosis and surgical intervention is necessary. Clinicians should consider right atrial myxoma in their differential diagnosis of a patient presenting with pulmonary embolism and acute congestive heart failure. CONCLUSIONS: Clinicians should be aware that right atrial myxomas are rare but can be infrequently associated with pulmonary embolism and acute congestive heart failure. Reference #1: 1.Thyagarajan B, Kumar MP, Patel S, Agrawal A. Extracardiac manifestations of atrial myxomas. Journal of the Saudi Heart Association. 2017;29(1):37-43. doi:10.1016/j.jsha.2016.07.003. Reference #2: 3.Sahitya V, Anandam G, Shastry S. Right atrial myxoma in a 65-year-old female: A rare presentation. Medical Journal of Dr DY Patil University. 2018;11(6):551-553. doi:10.4103/mjdrdypu.mjdrdypu_66_18. Reference #3: 4.Kalçık M, Bayam E, Güner A, et al. Evaluation of the potential predictors of embolism in patients with left atrial myxoma. Echocardiography. 2019;36(5):837-843. doi:10.1111/echo.14331. DISCLOSURES: No relevant relationships by Sheharyar Minhas, source=Web Response

Digoxin is an antiarrhythmic medication that has been used to manage chronic heart failure. Despite more than 200 years of research, the role of digoxin in patients with heart failure and sinus rhythm remains controversial. Recent studies have shown digoxin to reduce heart failure associated morbidity without having any effect on mortality. The purpose of our study was to study the impact of digoxin on mortality in heart failure patients in sinus rhythm. Objective • Effect of digoxin on mortality in heart failure patients in sinus rhythm • Study impact of covariates such as age, gender, race, previous MI, and NYHA class Methods: Heart failure patients with LVEF ≤0.45 were randomly assigned to digoxin group (n=3392) or placebo group (n=3401) and were followed on average for 38.4 months. Patients were enrolled at multiple clinical centers in the United States and Canada. Results: In the study, mortality was unaffected. There were 1180 deaths in the digoxin group (34.77%) and 1194 deaths in the placebo group (35.09%). The adjusted hazard ratio (AHR) for the digoxin group compared with placebo group was 0.981 (p=0.6425) which was not statistically significant. The unadjusted median survival time for the placebo group was 58.37 months. The median survival time for the treatment group could was not reported because the group did not reach 50% survival probability during the study. Conclusions: After controlling for age, gender, race, previous MI, and NYHA functional class, we found no difference in the hazard of death between those receiving digoxin and those receiving placebo. Our study demonstrated that digoxin did not reduce the overall mortality and has no survival benefit in the management of chronic heart failure.

Cardiac pathology can be congenital or acquired with underlying genetic predispositions. In this era of medicine there is a concern that the comprehensive physical examination doctors prided themselves on is becoming a lost art. Research studies have also revealed a decline in physical examination skills. The full clinical cardiovascular examination is indeed quite complex and does take significant time to master. It is critical that physicians be competent in the physical exam. Not identifying subtle clinical findings leading to missed or delayed diagnosis which can lead to significant morbidity and mortality. In this paper we intend to highlight the clinical cardiovascular findings that may be detected on patients even before initiating the physical exam. The head and neck visual examination may be quite revealing.

Pregnancy is associated with major structural and hemodynamic changes in the cardiovascular system that predispose women to an increased risk of atrial fibrillation. While these changes generally resolve after parturition, the impact of subsequent pregnancies on the risk of atrial fibrillation is unknown. We searched through PubMed for studies that have investigated the impact of multiparity on the risk of atrial fibrillation. The following Medical Subject Headings terms were used: ([repeated pregnancies] OR parity) AND ([Atrial fibrillation] OR AF). Studies with complete data were included in the current study. Out of 135 studies identified through the prespecified criteria, we selected 2 studies with relevant data. Increasing number of pregnancies was associated with an increased risk of atrial fibrillation in a dose-response relationship. Our systematic review suggests that multiparity is associated with an increased risk of atrial fibrillation. More studies are warranted to elucidate the association between repeated pregnancies and atrial fibrillation.

Background Recent epidemiologic data has indicated coronavirus to be highly contagious with high risk of person-to-person transmission. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. With the increasing number of confirmed cases and the accumulating clinical data, the cardiac manifestations induced by COVID-19 have generated great concern. COVID-19 was also associated with cardiac arrest, acute-onset heart failure, and myocarditis. COVID-19 has not been reported as the cause of abnormalities of cardiac conduction system. Case Presentation Our patient was transferred from a long-term care facility with history of new onset bradycardia and fall. Patient had no classical symptoms of viral infection, including fever, dyspnea or any classical radiological finding like bilateral ground glass opacities. Initial EKG was noted for 3rd degree AV and heart rate 30 BPM. He was taken to cardiac catheterization lab for an emergent temporary transvenous pacemaker. Patient subsequently had permanent pacemaker implanted electively. Discussion and Conclusions This case represents cardiac conduction abnormality requiring therapeutic pacing as a presenting symptom of SARS-CoV-2 Health care professionals need to be vigilant about atypical, noval presentation of this disease in patients belonging to risk groups such as over 60 years age, immunocompromised, residents of long-term facilities, and with medical conditions such as heart disease, lung disease, diabetes, stroke, renal disease, cirrhosis, and diabetes. Currently there is no proven treatment for this infection and individuals in these at-risk groups are susceptible to higher morbidity and mortality.

Introduction: Immune checkpoint inhibitors (ICIs) are increasingly being used for cancer therapy. Cardiotoxicity from ICIs has largely been underestimated since cardiovascular monitoring is not routinely performed after initiating immunotherapy. Cardiotoxic side effects are uncommon but are serious complications of ICIs with a high morbidity and mortality. Hypothesis: Adverse cardiovascular events in cancer patients are associated with the number of immune checkpoint inhibitor injections and the gender. Methods: In this observational, retrospective, pharmacovigilance study, we used MarketScan Databases to compare cardiovascular adverse events reported in patients who received ICIs. The data used in this study was fully integrated and de-identified data. The study included 9,583 male and 6,991 female patients who had cancer and underwent ICI therapy between Jan 1, 2011 and Dec 31, 2018. ICI drugs in this study included nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab, and ipilimumab. The time to an event and the end of follow-up was counted from the time of first ICI injection. Our primary exposure variable was gender. Results: At least one cardiovascular IRAE was reported in 3,804 (23%) of 16,574 patients enrolled in the study. The hazard time to cardiovascular events (CVEs) between the male and female gender varied by age. There was no difference in CVEs between males and females at a younger age. The hazard time to CVEs increased with age above 60 years in males when compared to females. The hazard of time to CVE in males was 1.18 times the hazard in females at the mean study age of 60.5 years. Adjusted Kaplan-Meier survival curves for males and females stratified by ICI injection categories showed that those with fewer number of ICI injections had a shorter time to CVE. Conclusions: The number of ICI injections and the gender both impact adverse cardiovascular events in cancer patients. Managing and reducing cardiotoxicity is vital for safe delivery of this effective therapy. There needs to be multidisciplinary approach between primary care physicians, cardiologists, oncologists, and immunologists for better understanding and management of ICI associated cardiotoxicity.

A total of 366,000 people died from coronary artery disease (CAD) in 2015. Coronary artery calcification (CAC) can be used as a direct measure of CAD. CAC is a robust and independent predictor of cardiovascular events and all-cause mortality. The standard methodology for scoring the amount of CAC

Utilization of direct oral anticoagulants (DOAC) have steadily increased since their approval and are now recommended over warfarin for both stroke prevention in nonvalvular atrial fibrillation and treatment of venous thromboembolism (VTE). With increased DOAC use, the number of major bleeding events requiring medical intervention will continue to rise. Until 2015, warfarin maintained an advantage as the only oral anticoagulant with a specific reversal agent. Since then, idarucizumab has been approved for dabigatran reversal and recently, andexanet alfa was granted approval for the reversal of apixaban or rivaroxaban in patients with life-threatening or uncontrolled bleeding events. Due to the manufacturing practices required to yield these reversal therapies, they are available at high cost to hospital systems and as a result, have been met with resistance. Data exists describing both prothrombin complex concentrates (PCC) and andexanet alfa for DOAC reversal, however, without head-to-head comparison. Until future studies are available, current literature must be critically evaluated to aid in the clinical decision-making process of how to treat patients with life-threatening DOAC-related bleeding.