Journal of Cardiology Research Reviews & Reports
Editor-in-Chief Tai An Chiang Professor Department of Medical Laboratory Science and Biotechnology Taiwan Journal of Cardiology Research Reviews & Reports is an open-access, peer-reviewed journal dedicated to research and developments in cardiology, cardiovascular medicine, cardiac sciences, and related interdisciplinary fields. The journal provides a platform for researchers, academicians, cardiologists, physicians, clinicians, healthcare professionals, and biomedical scientists to share innovative research, clinical findings, therapeutic approaches, and emerging trends in cardiovascular medicine. The journal welcomes submissions in the form of Letter-to-Editor, Conference Proceedings, Research, Review, Case Reports, E-Books, Editorials, Opinions, Short Communications, Mini-Reviews, Book Reviews, Video Articles, and PowerPoint Presentations (PPTs). Call for Papers: Special Issue on Next-Generation Cardiology: Innovations Shaping the Future of Cardiovascular Medicine Journal of Cardiology Research Reviews & Reports invites researchers, scientists, academics, cardiologists, physicians, clinicians, healthcare professionals, and experts from related disciplines to contribute original and high-quality manuscripts to our upcoming Special Issue on “Next-Generation Cardiology: Innovations Shaping the Future of Cardiovascular Medicine.” This Special Issue focuses on emerging advances and innovations transforming cardiovascular medicine, diagnosis, prevention, treatment, and patient care. Contributions addressing precision cardiology, artificial intelligence, digital health, advanced cardiovascular imaging, minimally invasive interventions, novel therapeutics, regenerative approaches, wearable technologies, remote monitoring, personalized treatment, cardiovascular biomarkers, and innovative approaches to improving cardiovascular outcomes are particularly encouraged. Articles can be submitted through online https://srcpublishers.com/cardiology-research-reviews/user/register or can send through an e-mail with attachment for: cardiologysciences@onlinescientificresearch.info 1.5 Impact Factor 84.5% Citations 65% Acceptance
Ultrasound Estimation of Right Atrial Pressure Predicts Readmission in Patients with Heart Failure
Background: Acute decompensated heart failure (ADHF) is a leading cause of hospital readmissions, resulting in high healthcare costs and poor outcomes. Non-invasive risk stratification tools are needed to reduce 30-day readmission rates. This study evaluated whether a point-of-care ultrasound (POCUS)-measured distensibility index (DI) of the right internal jugular vein (RIJV) predicts 30-day readmission risk in ADHF patients. Methods: A prospective, observational cohort study was conducted in 288 ADHF patients at a tertiary academic center and an affiliated urban community hospital. DI was calculated as the percentage change in RIJV cross-sectional area during the Valsalva maneuver. Patients with DI≥66% were classified as having normal right atrial pressure (RAP), and those with DI<66% as having elevated RAP. The outcome was 30-day readmission due to ADHF, determined from patient charts and verified through follow-up phone calls. Multivariable logistic regression assessed the association between DI and 30-day readmission. Results: Thirty-day readmission occurred in 52 (18%) patients. Patients discharged with DI<66% had a higher readmission risk (odds ratio (OR): 5.29, 95% confidence interval (CI): 2.77-10.60, p<0.001). After adjustment for age, sex, chronic kidney disease, and HFpEF, DI<66% remained independently associated with readmission (adjusted OR: 15.24; 95% CI, 3.79-61.29; p<0.001). DI<66% at discharge had a NPV of 92%. Stratified analyses demonstrated a consistent direction of association across hospital settings. Conclusions: POCUS-derived DI is a reliable and non-invasive method for RAP assessment and predicting 30-day readmissions in ADHF patients. This rapid, non-invasive assessment may enhance discharge risk stratification and support physiologic evaluation of residual congestion.
Copyright (c) 2026 Journal of Cardiology Research Reviews & Reports
Anesthetic Concerns and Management in Parturient with Cardiac Disease: Congenital, Non-Congenital, and Structural Pathologies
Maternal cardiovascular disease remains a leading cause of indirect maternal mortality in modern obstetrics. The complex interactions between the normal physiological adaptations of pregnancy and underlying structural, valvular, or ischemic cardiac defects present a significant management challenge. This article evaluates the anesthetic concerns and clinical management strategies for parturients with congenital and non-congenital cardiac diseases. We trace the hemodynamic changes across the peripartum period, examining the physiological stress points of labor and the immediate postpartum window. The pathophysiology of congenital heart disease is analyzed across three distinct categories of cardiac shunts: left-to-right, right-to-left, and complex bidirectional flows (Eisenmenger syndrome). Furthermore, we compare the risks and benefits of general anaesthesia versus regional blocks, focusing on the specific hemodynamic effects of each approach. Clinical decision-making is structured around the Modified World Health Organization (mWHO) risk classification framework, which guides the management of high-risk cases, including the choice between termination of pregnancy (TOP) and carrying to term. Finally, we establish a robust multi-disciplinary protocol governing elective versus emergent lower segment cesarean sections (LSCS) and assisted spontaneous vaginal deliveries (SVD).
Post-Cardiac Arrest Vasoplegia following Percutaneous CoronaryIntervention in a Case with Left Main Ostial Stenosis
Post-cardiac arrest vasoplegia is a rare but potentially fatal complication that can occur following percutaneous coronary intervention (PCI). We presented a case of a 38-year-old female with sinus venosus atrial septal defect (SV-ASD) and left main ostial stenosis who developed refractory cardiogenic shock due to post-cardiac arrest vasoplegia immediately following coronary angiogram (CAG) and PCI of the left main coronary artery (LMCA). Despite aggressive resuscitative efforts, the patient succumbed to the complication 12 hours after the initial event. This report discusses the pathophysiology, management options, and challenges associated with post-CA vasoplegia in patients with underlying cardiac pathologies such as ASD and left main ostial stenosis.
The Mechanism Causing Arterial Hypertension is Different in this New Global Immunodeficiency
The definition of arterial hypertension is when the systolic blood pressure of 130 mmHg and diastolic blood pressure of more than 80 mmHg.
The Influence of Stroke Subtype, Antihypertensive and ThrombolyticTherapy on Hospital Length of Stay for Stroke Patients in aResource-Limited Setting: A Retrospective Cohort Study
Background: Age is a well-established risk factor for stroke, yet its distribution across different stroke subtypes remains underexplored, particularly in African populations. Understanding these variations may enhance diagnostic precision and inform early management strategies. Objective: To investigate whether age at stroke onset differs significantly according to stroke subtype in a clinical cohort of African patients. Methods: We conducted a cross-sectional analysis of patients diagnosed with ischemic stroke, cerebral hemorrhagic stroke, cerebellar stroke, or transient ischemic attack (TIA). Age differences across groups were assessed using one-way ANOVA, followed by Tukey’s HSD post-hoc tests. Results: 72 patients with cerebral ischemic stroke (CIS) stayed less than a week; 33 stayed between 1–3 weeks; only 1 stayed more than 3 weeks. Secondly,43 patients with cerebral hemorrhagic stroke (CHS) stayed less than a week, 22 stayed between 1–3 weeks, and 6 stayed more than 3 weeks. On the other hand, patients with cerebellar stroke (CS) are rare, and all had short stays (<1 week) 95 patients using blood pressure-lowering drugs stayed <1 week; 51 stayed 1–3 weeks; 7 stayed >3 weeks. No antihypertensive group had 32, 4, and 0 in the same durations, respectively. Most patients received antihypertensives, suggesting hypertension was a dominant comorbidity.Only 1 patient receiving thrombolytic therapy stayed more than 3 weeks, while the rest (188) did not receive it and were mostly discharged within 1 to 3 weeks. The low thrombolytic use shows limited access to advanced stroke care in this study Conclusion: Age at stroke onset varies significantly by subtype. Cerebral haemorrhagic stroke is more likely to occur at an older age, supporting its association with vascular fragility and long-standing hypertension. In contrast, ischemic stroke spans a broader age spectrum, underscoring the need for vigilance across all adult age groups. These findings reinforce the clinical value of considering patient age in the early differentiation of stroke subtype, particularly in high-burden settings.
Does Dyspnea in A Patient With Mitral Stenosis Mean that the Dyspnea is Caused by the Valvular Alteration in this New Global Immunodeficiency?
In my clinical practice, I have seen several cases of patients who go to the cardiologist due to shortness of breath during physical exercise, and when they are evaluated through radiological and echocardiographic exams, a valvular abnormality is discovered.
What do People Experiencing Myocardial Infarction have in Common that Medicine is Still Unable to Recognize or Treat?
Nowadays, whenever I open my phone and read news about another famous person who has suddenly passed away, I wish I could share with the world what I am trying to explain in this article.
The Mechanism by which Myocardial Infarction Develops is not the Same Today
In this article, the author will describe what has happened in the last decade with regard to the development of myocardial infarction
Supported but Septic: Risk Factors and Comorbidity Burden in Mechanical Circulatory Support
Patients receiving mechanical circulatory support (MCS) are at a significant risk of developing sepsis, a serious complication that can affect outcomes. This study evaluated 199 patients who underwent 244 MCS therapies between January 2017 and October 2023 to identify factors associated with sepsis. Using machine learning and decision-tree analysis, the overall incidence of sepsis was found to be 20%. Patients with a history of congestive heart failure or previous cardiac surgery showed a higher risk of developing sepsis during MCS therapy. Notably, patients without chronic cardiovascular disease but with prior cardiac surgery had the highest risk, with a 60.3% incidence of sepsis. These findings suggest that underlying inflammatory conditions related to heart failure and prior cardiac surgery may increase susceptibility to sepsis in MCS patients, highlighting the need for further research and improved preventive strategies.
Sudden Cardiac Arrest with Ventricular Fibrillation in a Patient with Epilepsy and a Vagus Nerve Stimulator(2025)
Sudden Unexpected Death in Epilepsy (SUDEP) is a major cause of mortality in patients with refractory epilepsy and is thought to involve peri-ictal autonomic dysfunction and malignant arrhythmias. The cardiac effects of Vagus Nerve Stimulator (VNS) therapy remain incompletely understood. A 36-year-old woman with drug-resistant epilepsy managed with VNS experienced a generalized tonic–clonic seizure followed by sudden collapse. Emergency services documented ventricular fibrillation, and she was successfully resuscitated with defibrillation. Comprehensive cardiac evaluation, including electrocardiography, echocardiography, and coronary angiography, revealed no structural or ischemic heart disease. In view of unexplained ventricular fibrillation, the patient underwent implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) for secondary prevention. Multidisciplinary follow-up was arranged involving neurology and cardiology teams. This case highlights the potential for seizure-related malignant arrhythmias in structurally normal hearts and underscores a possible mechanistic link between epilepsy, autonomic dysfunction, and cardiac instability. Increased awareness and consideration of cardiac evaluation in high-risk epilepsy patients may help mitigate the risk of SUDEP.
Comparing High- Versus Low-Dose Entresto in Heart Failure Patients: A 2025 Meta-Analysis
Entresto (sacubitril/valsartan) is widely used for the treatment of heart failure with reduced ejection fraction (HFrEF) due to its ability to enhance natriuretic peptide activity and inhibit the renin-angiotensin-aldosterone system (RAAS). However, its effects on various cardiovascular outcomes require further evaluation. Therefore, a meta-analysis of existing clinical studies was conducted to compare the effectiveness of high-dose vs. low-dose Entresto in treating chronic heart failure. A systematic search was performed using three databases: PubMed, Clinical Trials, and Cochrane. The meta-analysis included nine randomized controlled trials comprising 4,011 patients with HFrEF. The inclusion criteria were: studies that evaluated patients (>18 years of age) with heart failure (these doses were generally divided into high (97/103 mg) and low (24/26 mg), with four studies using different dosing ranges relative to these categories); studies with relevant primary outcome; and studies written in English. The primary outcomes include: heart failure hospitalization, all-cause mortality, left ventricular ejection fraction (LVEF), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, New York Heart Association (NYHA) functional class, and systolic blood pressure over a minimum follow-up period of three months. We excluded studies with no quantitative outcome data, follow-up period (of at least three months), and dose-group comparisons. Additionally, studies were excluded if they were: case reports; meta-analyses; systematic reviews; conference abstracts; non-human studies or publications in any other language than English. The risk of bias (RoB) was assessed using the Robvis tool and classified into low, moderate, serious, and critical risk of bias categories. The results of this assessment were illustrated via a traffic light plot. A random effects statistical model was used in this study. Heterogeneity for LVEF was found to be substantial (I2 of 93.1%). Subgroup analysis found the source of this to be the dosing groups used in these studies, by excluding studies with less than or equal to 200 mg as their high-dose group. Heterogeneity for NT-proBNP was also substantial (I2 of 98%). Subgroup analysis could not localize a source of this heterogeneity, particularly when applied to dosing groups (high-dose groups with less than or equal to 200 mg of sacubitril/ valsartan). The analysis revealed there was no statistically significant difference between LVEF improvement between low- and high-dose groups (1.95 (95% confidence interval (CI): -1.32 to 5.22); p=0.242). A meta-analysis of these studies showed a statistically significant reduction in NT-proBNP with Entresto. The pooled effect size was -667.24 (95% CI: -1312.69 to -21.8; p=0.04), indicating a significant decline in NT-proBNP levels in patients receiving a higher dose of Entresto. These findings suggest that while higher doses of Entresto do not significantly improve LVEF compared to lower doses, they are associated with a greater reduction in NT-proBNP levels, indicating improved cardiac stress and function. This supports the potential dose-dependent benefits of Entresto in managing heart failure with reduced ejection fraction. Further large-scale studies are warranted to explore the long-term impact of high-dose Entresto on clinical outcomes to optimize dosing strategies for HFrEF patients.
Study of Serum Electrolytes and Troponin I in COVID-19 Patients
SARS CoV was the causal agent for first outbreak of acute respiratory distress syndrome in the year 2002 and 2003 in Guangdong province, China. MERS CoV was the causal agent in the second outbreak of Middle East respiratory syndrome in the year 2012, Middle East. Both of these are zoonotic in origin and sometimes associated with fatal illness. Given its genetic diversity and genetic recombination of their genomes, their increasing activities human-animal interface, corona virus is expected to emerge periodically in human population. The clinical spectrum of SARS-CoV-2 infection appeared to be wide, ranging from asymptomatic infection, mild upper respiratory tract illness to severe or even fatal in some cases. The gold standard for the laboratory diagnosis of COVID-19 is the reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) assay, which searches for SARS-CoV-2 target genes in nasopharyngeal/oropharyngeal (NP/OP) samples, and its performance depends on the quantity and quality of the RNA input. The angiotensin-converting enzyme 2 receptor (ACE2) is expressed in epithelial cells of many tissues including the kidney, and has been identified to interact with human pathogenic coronaviruses, including SARS-CoV-2. Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19 infection, two recent studies demonstrate that kidney impairment in hospitalized COVID-19 patients is common, and that kidney involvement is associated with high risk of in-hospital death. It has been proposed that low sodium balance may lead to more severe COVID-19. Indeed, studies on electrolyte disturbances during COVID-19 have shown significantly lower sodium concentrations in patients with severe COVID-19 infection. Besides focusing on the severe condition of pneumonia, the novel coronavirus may attack many important organs and cause multiple organ failure with cytokine storm. The heart is one of the most important organs and it is highly suspicious that viral myocarditis and myocardial injury could be also involved and may even be considered as one of the leading causes for the death of COVID-19 patients. Myocarditis and myocardial injury were suspected and may even be considered as one of the leading causes for death of COVID-19 patients. Acute respiratory infections as well as sepsis are often associated with an increase in troponin, which can be used as a marker of disease severity and predicts future cardiovascular events. Elevated troponin levels are frequent in patients with COVID-19 and significantly associated with fatal outcomes. This study is conducted to provide an overview on the current status of electrolytes and troponin-I levels in a small subset of people living in Manipur who are Covid-19 infected and non-infected healthy individuals with a special focus on the potential implications for COVID-19 pandemic.
Dr. Rajkumari Vidyabati Devi Vidyabati Devi
Prosthesis Selection in Heart Valve Surgery: Is Intraoperative Valve Size the Missing Factor?
Background: The choice between mechanical or biological heart valve prosthesis has traditionally been guided by patient age, comorbidities, and need for lifelong anticoagulation. However, the expansion of transcatheter therapies, particularly valve-in-valve (ViV) and sequential ViV procedures, has introduced new considerations for prosthesis selection. These techniques offer less invasive alternatives but may be limited by patient–prosthesis mismatch (PPM), especially in small annuli. This study discusses whether prosthesis size at the time of the first implantation should also influence the selection of heart valve prosthesis type. Methods: Evidence from recent clinical literature and an in-vitro hydrodynamic study evaluating sequential ViV implantation using a Brazilian conventional bioprosthesis and transcatheter valve was analyzed. Was assessed the feasibility and hydrodynamic performance of different prosthesis size combinations in ViV and sequential ViV configurations, focusing on effective orifice area and oversizing limits. On the other hand, a recent cohort study demonstrated safety of mechanical heart valves for elderly patients. Results: Hydrodynamic testing demonstrated that feasibility of sequential ViV procedures strongly depends on the size of the initially implanted surgical prosthesis. Larger initial prosthesis sizes therefore increase the potential for multiple transcatheter interventions during a patient’s lifetime. Conversely, small annuli may restrict future transcatheter strategies and may favor mechanical prostheses. As a clinical counterpoint, findings were compared with a large cohort study demonstrating that mechanical mitral valves were associated with lower all-cause mortality than biological valves in patients up to 70 years of age, while the survival advantage of mechanical prostheses in the aortic position disappeared after 55 years of age. Notably, this study did not account for transcatheter treatment of degenerated bioprosthesis. Conclusions: With the growing role of transcatheter therapies for degenerated bioprostheses, prosthesis size at the time of initial surgical implantation may represent an additional determinant in choosing between mechanical and biological valves. Larger annuli may favor biological prostheses due to the feasibility of ViV strategies, whereas smaller annuli may support the use of mechanical valves. Importantly, conventional reoperations for degenerated bioprostheses may increase operative mortality by up to 8%, reinforcing the importance of long-term procedural planning at the time of the first valve replacement.
Hypertrophic or dilatational cardiomyopathies are common manifestations of long-standing hypertension. The condition is dreaded due to its complications like valvular disorders like mitral prolapse or mitral regurgitation. It can also lead to untimely heart failure with poor prognosis. It would be outstanding accomplishment by cardiologists to bring about reversal of this condition through early diagnosis and holistic preventive care. ACEI/ARBs are known to cause this reversal with positive remodeling of the enlarged heart when prescribed to hypertensive patients. Still, it seldom works unless the hypertensive patients are additionally cured by hormonal changes, nutrition, salt sensitivity, physical activity and environmental changes like stress management. Each of these factors will be explored and discussed comprehensively during the presentation.
Keeping People in Rhythm Electronically - An Overview of Cardiac Rhythm Management Devices
Use of Outside Energy to Stimulate the Heart - For Pacing and Defibrillation. The history of cardiac rhythm devices reflects a remarkable evolution in cardiovascular medicine, driven by technological innovation and a deepening understanding of electrophysiology. The journey began in the 1950s with the invention of the first implantable pacemaker, a groundbreaking solution for bradyarrhythmia’s. Over the decades, cardiac rhythm management (CRM) devices have expanded to include implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT) devices, and leadless pacemakers. These advancements have been fuelled by improvements in battery life, miniaturization, telemetry, and device programming. Modern devices not only correct life-threatening arrhythmias but also provide real-time diagnostics and remote monitoring capabilities. This overview traces the historical milestones and technological advancements that have shaped cardiac rhythm devices, highlighting their growing role in improving patient outcomes and quality of life in those with heart rhythm disorders.
Strengthening Cardiovascular Care in Ghana: Early Detection, Equity and Evidence-based Practice- A Case Study at Presbyterian Hospital, Agogo
Background Cardiovascular diseases (CVDs) are the leading cause of morbidity, hospitalization, and death in Ghana. Ghana has put up NCD policies and national programs to improve CVD care. Yet, CVD cases continue to rise with majority of cases showing up in their late-stage. This study analyses outpatient department (OPD) trends in hypertension, diabetes mellitus, and heart failure at the Presbyterian Hospital, Agogo between 2015 and 2025, to assess the need for early detection and policy alignment to strengthen cardiovascular care. Methods A retrospective descriptive analysis was conducted using OPD attendances data on hypertension, diabetes, and heart failure collected between 2015 and 2025 extracted from the Presbyterian Hospital, Agogo health information system. Extracted data was visually inspected and annualized totals compiled and summarized graphically. Results Total CVD OPD attendances rose by 17.7% from 2015 to 26,098 in 2025, with a 385 peak in 2024. Hypertension cases were 204,293 (73.0%) of CVD OPD attendances while 25.8% were diabetes, and 1.2% heart failure attendances. The CVDs especially diabetes showed oscillating patterns with a progressive increase over time creating an unexplained anomaly. Cases of heart 4 failure were noted to increase significantly by 169% by 2025 from the baseline indicating poor upstream management. Conclusions The growing CVD OPD cases at the Presbyterian Hospital, Agogo reflect the growing disease burden and pressure on the district and national health systems. The oscillations in case attendances further indicate a concern in health-seeking behaviors, gaps in access to continuous care and early detection at the community levels highlighting a wider national challenge. The findings call
The Importance of Early Endovascular Intervention and Guideline-Based Cardiac Rehabilitation in Managing Type-B Aortic Dissection
Background Type-B aortic dissection (TBAD) is traditionally managed with optimal medical therapy; however, contemporary data show a survival benefit from early thoracic endovascular aortic repair (TEVAR) and emerging—but still fragmented—guidance on post-dissection exercise prescription. Case Synopsis We report a 76-year-old woman with extensive TBAD extending to the distal left iliac artery. She was deemed a poor surgical candidate and treated medically. On hospital day 5, she suffered sudden cardiac arrest shortly after a low-intensity cardiac rehabilitation (CR) session. Autopsy suggested retrograde flap propagation triggered by exertional haemodynamic stress. Key Messages Need for Early Endovascular Intervention Registry analyses demonstrate that, even in “uncomplicated” TBAD, TEVAR confers a 32% relative reduction in long-term mortality compared with medical therapy alone. Our case underscores that anatomical complexity and frailty do not always preclude intervention; a proactive, multidisciplinary evaluation may identify candidates for hybrid or limited-landing-zone techniques before catastrophic extension. Guideline-Based (Not Generic) Rehabilitation Existing CR literature in aortic-dissection survivors documents favourable functional gains with meticulous blood-pressure monitoring and workloads ≤3–5 METs, but highlights major evidence gaps regarding timing, progression, and surveillance imaging. We propose a stepped protocol: • Confirm aortic stability on repeat CTA or TEE. • Initiate supervised ambulation at <20 bpm above resting heart rate and systolic BP <140 mmHg. • Escalate workload by ≤0.5 MET per session, with weekly imaging or sooner if symptoms occur. Conclusions Early TEVAR should be actively reconsidered—even in borderline surgical candidates—to forestall haemodynamic-triggered propagation. When CR is indicated, programmes must be tailored to TBAD-specific haemodynamic thresholds with imaging-guided checkpoints. Bridging current evidence gaps will require prospective trials integrating vascular, cardiac-rehabilitation, and imaging expertise.
Fibroelastoma to Atrial Flutter: A Patient Journey
It began in 2020 with what seemed to be a swallowing problem. This was combined with a very dry cough usually occurring in the morning. When we began to suspect the possibility of a problem more serious than perhaps an allergy related cough, we made an appointment in March 2021 with our primary care physician. After his examination he suggested an appointment with a gastroenterologist. At this appointment, many other tests were ordered, including the dreadful esophagogram. To our surprise, our gastroenterologist referred me to a cardiologist. After research, I consulted with Dr. James Lee of Associates in Cardiology in the Washington DC area. He immediately ordered an EKG and an Echocardiogram. In the middle of the echocardiogram, the nurse administering the test said there was something she wanted to check with Dr. Lee and left the room. During our follow-on consultation, Dr. Lee suggested a Nuclear Cardiac MRI, which, at the time, was a fairly new technology allowing the doctor to actually view the interior of the heart. The MRI showed what the standard cardiac imaging tests would not show: a fibroelastoma. This is a rare tumor inside the heart. Following the catheterization on June 23, 2021, Dr. Ammar S. Bafi at the Washington Hospital Center successfully removed the tumor by an open-heart surgery. During the intervening years, I’ve been under the care of an oncologist, pulmonologist, and nephrologist. During a routine semi-annual appointment, Dr. Lee suggested that I should see a cardiac surgeon, Dr. Scott Shapiro. My tests showed an irregular heartbeat resulting from Atrial Flutter. My presentation will be the story from a swallowing problem in 2021 which, step by step, led to an Atrial Flutter surgery in 2026, based on the hypothesis that preventive care by cardiologists most likely kept me from having a life-threatening stroke.
Micro RNA-based Regulation of the Sinoatrial Node: A Look into Pacemaking Future?
The sinoatrial node (SAN) constitutes the dominant pacemaker of the heart, generating spontaneous electrical activity that governs cardiac rhythm and ensures effective myocardial contraction. Anatomically, the SAN is composed of a heterogeneous population of specialised pacemaker cells located at the junction of the superior vena cava and the right atrium, supported by a paranodal region that contributes to impulse propagation, rhythm stability, and may serve as a secondary pacemaker during primary pacemaker dysfunction. At the molecular level, SAN automaticity is critically dependent on hyperpolarisation-activated cyclic nucleotide-gated channel 4 (HCN4), which mediates the pacemaker current (If) and regulates the slope of diastolic depolarisation. Increasing evidence implicates microRNAs as pivotal post-transcriptional regulators of cardiac electrophysiology, with emerging roles in both physiological and pathological modulation of heart rate. In particular, microRNA-486-3p has been identified as a regulator of HCN4 mRNA expression, suggesting a novel mechanism for modulating SAN pacemaker activity at the transcriptional level. This review synthesises current knowledge regarding the structural and molecular regulation of the SAN, with emphasis on the functional interaction between HCN4 and miR-486-3p, and critically evaluates the therapeutic potential of microRNA-based strategies for the management of sinus tachycardia. By comparing microRNA-mediated modulation of HCN4 expression with established pharmacological interventions such as ivabradine, which exerts its effects through direct channel blockade, this review explores the translational implications of targeting pacemaker regulation upstream at the gene expression level. Elucidation of these mechanisms may facilitate the development of more selective and potentially safer therapeutic approaches for heart rate control, particularly in clinical contexts where conventional treatments are limited or contraindicated.
High-Accuracy Non-Invasive ECG Mapping for Ventricular Arrhythmia Localization: First Clinical Experience with the CorLector System
Background: Accurate preprocedural localization of ventricular arrhythmogenic substrates is crucial for successful ablation. However, localization can often be challenging: foci may be ambiguous, substrates complex to map or PVCs suppressed by sedation—factors prolonging procedures and compromising outcomes. Non-invasive cardiac mapping technologies have emerged as valuable tools for identifying arrhythmogenic regions. The CorLector system applies a 12-lead ECG-based inverse algorithm to reconstruct activation maps in real time without additional hardware. This study aimed to evaluate the first clinical experience, spatial accuracy, and reliability of this ECG-based 3D mapping approach in patients with premature ventricular contractions (PVC), ventricular tachycardia (VT), and paced rhythms and compare it to invasive electroanatomical mapping (EAM). Methods: A total of 16 ECG recordings were analyzed at the Munich Heart Center (September–October 2025). Twelve-lead ECGs recorded during arrhythmia episodes were processed using CorLector to reconstruct 3D activation maps. Results were compared in a blinded fashion to invasive EAM reference data (CARTO™ 3). Localization accuracy was scored on a 0–5 ordinal scale (0 = opposite ventricle, 5 = exact anatomical segment). Quantitative metrics included the 3D distance between earliest-activation points and map-agreement scores. Scores ≥3 were considered clinically acceptable, with a predefined acceptance target of ≥80%. Results: All 16/16 cases (100%) met the predefined acceptance threshold, exceeding the 80% target. Exact-segment agreement (score 5) was achieved in 75% of cases, adjacent-segment localization (score 4) in 19%. The mean localization error was 9 ± 4 mm (median 8 mm, IQR 5–11 mm). No cross-ventricular or remote mislocalizations were observed. Accuracy remained consistent across both ventricles for PVCs, VT and pacing conditions. Expert visual comparison confirmed close replication of activation topography between invasive and non-invasive maps. Minor regional displacement (score 4) was observed in three cases, all corresponding to adjacent or overlapping basal–inferoseptal borders indicating physiologically and anatomically acceptable variance. Conclusions: The CorLector non-invasive mapping system demonstrated high spatial fidelity and reproducibility, achieving segment-level precision comparable to invasive EAM and full compliance with predefined clinical acceptance thresholds. A median localization error of 8 mm confirms reliable identification of early-activation sites using standard 12-lead ECG without CT co-registration. These findings support the integration of non-invasive ECG mapping into pre-ablation assessment to optimize therapy and workflows. Future prospective multicenter studies with larger patient populations are warranted to validate these findings.
Strengthening Cardiovascular Care in Ghana: Early Detection, Equity and Evidence-Based Practice- A Case Study at Presbyterian Hospital, Agogo
Background: Cardiovascular diseases (CVDs) are the leading cause of morbidity, hospitalization, and death in Ghana. Ghana has put up NCD policies and national programs to improve CVD care. Yet, CVD cases continue to rise with majority of cases showing up in their late-stage. This study analyzes outpatient department (OPD) trends in hypertension, diabetes mellitus, and heart failure at the Presbyterian Hospital, Agogo between 2015 and 2025, to assess the need for early detection and policy alignment to strengthen cardiovascular care. Methods: A retrospective descriptive analysis was conducted using OPD attendances data on hypertension, diabetes, and heart failure collected between 2015 and 2025 extracted from the Presbyterian Hospital, Agogo health information system. Extracted data was visually inspected and annualized totals compiled and summarized graphically. Results: Total CVD OPD attendances rose by 17.7% from 2015 to 26,098 in 2025, with a 385 peak in 2024. Hypertension cases were 204,293 (73.0%) of CVD OPD attendances while 25.8% were diabetes, and 1.2% heart failure attendances. The CVDs especially diabetes showed oscillating patterns with a progressive increase over time creating an unexplained anomaly. Cases of heart failure were noted to increase significantly by 169% by 2025 from the baseline indicating poor upstream management. Conclusions: The growing CVD OPD cases at the Presbyterian Hospital, Agogo reflect the growing disease burden and pressure on the district and national health systems. The oscillations in case attendances further indicate a concern in health-seeking behaviors, gaps in access to continuous care and early detection at the community levels highlighting a wider national challenge. The findings call for more NCD policy alignments to support early detection and equitable access to evidence-based care.
Etiological Profiles of Acute Dyspnea in The Cardio-Respiratory Diseases Department: A Retrospective Study at Morafeno University Hospital Center, Toamasina, Madagascar
Background: Acute dyspnea represents a subjective experience of respiratory discomfort that constitutes a major handicap for affected patients. In most cases, it represents a diagnostic and therapeutic emergency and must be considered as a sign of severity of the underlying disease, which may have multiple etiologies. Understanding the etiological profile of acute dyspnea in resource-limited settings is essential for optimizing diagnostic and therapeutic strategies. Objective: To determine the most frequent etiologies of acute dyspnea in patients admitted to the Cardio-Respiratory Diseases Department of Morafeno University Hospital Center in Toamasina, Madagascar. Methods: We conducted a single-center retrospective descriptive study over a 63-month period from January 2015 to March 2020. All patients admitted with acute dyspnea during this period were included. Data were collected from medical records and analyzed to determine the distribution of etiological categories and specific diagnoses. Results: A total of 357 patients were included in the study. Cardiovascular causes were the predominant etiology, accounting for 64.15% (n=229) of cases, followed by bronchopulmonary causes at 33.89% (n=121). Other etiologies represented only 2.0% (n=7) of cases. Among cardiovascular causes, decompensated heart failure was the leading diagnosis, representing approximately 89-92% of cardiovascular etiologies. Infectious pneumonia dominated the bronchopulmonary causes. Conclusion: Acute dyspnea is a multifactorial symptom that can be severely disabling. In the Cardio-Respiratory Diseases Department of Morafeno University Hospital Center, decompensated heart failure is the leading cause of acute dyspnea, followed by infectious pneumonia. These findings highlight the need for strengthened cardiovascular and infectious disease management capacity in resource-limited settings.
Surgical Repair of a Radial Artery Aneurysm Following Elective Percutaneous Coronary Intervention: A Case Report
Background: Transradial approach for percutaneous coronary intervention (PCI) is frequently preferred because it has lower complication rates than femoral access. However, unusual vascular complications, such as radial artery pseudoaneurysms, might arise, requiring diagnostic and treatment challenges. Case Summary: We present a case of a 68-year-old man who underwent an elective right radial percutaneous coronary intervention (PCI) with a 6 Fr sheath. Following the procedure, he experienced the development of a non-painful, progressively growing pulsatile mass at the site of access ten days later. A duplex ultrasound revealed a saccular pseudoaneurysm measuring 22 × 18 mm, characterized by a 2.5 mm neck and to-and-fro flow patterns. A CT angiography confirmed the presence of a localized pseudoaneurysm without any signs of distal embolization. After a discussion among specialists, Surgical intervention was decided, while maintaining the patency of the radial artery and avoiding any distal ischemia. The patient was discharged the next day and remained asymptomatic with duplex-confirmed thrombosis after 1 and 6 months. Conclusion: A delayed pulsatile swelling following transradial procedures should lead to the use of duplex imaging. For anatomically appropriate radial pseudoaneurysms, ultrasound-guided thrombin injection is an efficient and minimally invasive treatment option for small sized pseudoaneurysms. For large, symptotic pseudoaneurysm, Surgical removal is the treatment of choice.
Radial Artery, Pseudo Pseudoaneurysm, Percutaneous Coronary Intervention, Transradial Access, Access-Site Complication
Time in the Therapeutic Range for Patients with Atrial Fibrillation and Taking Warfarin in Gaza (TTR- AF Gaza)
ABSTRACT Background: Anticoagulation control with warfarin, as assessed by the international normalized ratio (INR), Poor quality of warfarin control by low INR or low time in therapeutic range (TTR) can lead to increased risk of adverse events. The objective of this study was to examine the overall quality of (INR) control and the association of TTR among patients in Gaza Strip. Method: A prospective study was conducted among patients on warfarin for NVAF who attended the Cardiology Outpatient Clinic of Alshifa Hospital between June 2021 to October 2022. Patients’ TTR was calculated by using Traditional method Results: A total of 231 patients were included with mean age 59.15±12.6 years. The mean TTR score was 50.93±16.37%, the total 1155 INR measurements were calculated. Of the sample patients, 47.6 % were in the good control category (TTR ≥ 60%), and 52.4% were in the poor control category (TTR<60%) Conclusion: Our study demonstrates more than half of patients have poor anticoagulation control and we urgent need to improve oral anticoagulation care for most patient segments in the Gaza Strip.
Copyright (c) 2025 Journal of Cardiology Research Reviews & Reports
Hypertension, often known as high blood pressure, is a prevalent and serious global health problem. It is a chronic disorder characterized by chronically high blood pressure levels, which can lead to serious problems such as cardiovascular disease, stroke, and renal failure. The purpose of this review article is to offer a full overview of hypertension, including epidemiology, etiology, pathophysiology, diagnosis, therapy, and preventative strategies. Furthermore, the study delves into the most recent advances in hypertension research, developing therapy options, and the significance of lifestyle changes in controlling this illness. A solid knowledge of hypertension is essential for healthcare practitioners and researchers in developing effective therapies to control and avoid its negative effects.
Copyright (c) 2024 Journal of Cardiology Research Reviews & Reports
Acid-Sensing Ion Channels in Panic Disorder
Spontaneous, recurring panic attacks are characteristic of Panic Disorder (PD) which are coupled by fear and multiple physical and cognitive symptoms of anxiety. A panic attack (PA) is a sudden and intense fear reaction triggered by a perceived threat, which may involve external stimuli (such as predators), internal bodily signals (like a racing heart), painful stimuli (such as nociceptive events), or threats from others (like rivals) [1]. The pathophysiology of panic disorder (PD) is not clearly understood despite years of scientific research [2]. Numerous studies involving clinical, provocation, neuroimaging, and psychophysiological studies of PD have enabled biological, cognitive and behavioral theories to emerge that involve distinct neuroanatomical structures and areas [2-7]. Neuroimaging studies on patients with PD have shown that homeostatic pH disturbances play a key role in panic physiology[8]. The nervous system functions to adapt and produce flexible behavioral responses to a changing environment. The brain’s highly adaptive defensive system reacts to threatening stimuli (e.g., predator, aversive stimulus) by generating rapid autonomic and behavioral response [9]. These behaviors are essential to survival and include securing food, shelter, water, and most importantly, defending against immediate and perceived threats [9].
Lysine and Tryptophan have the Protection Basis against Lysosomal Dysfunction and both PKU and CVD including Mitochondrial Disorder Mediated by Activating Lysosomes and OPA1
The phenylketonuria “PKU” due to sever decreasing in lysine “AAG” and in Lys/ phosphorylation (which necessary for lysosomal digestive function), and associated with sever decreasing in Trp “TGG”, followed by mitochondrial dysfunction and lysosomal dysfunction, that followed by sever decreasing in phe /hydroxylase and in Tyr/ hydroxylase, and followed by decreasing in lysine acylation and in SFACs productiin which followed by decreasing in RA productive pathway and associated with increasing in both of TNFa and cholesterol accumulation which activate increasing in in both of TNFa and NLRP3 pathogenic pathway which reflect decreasing in estrogen synthesis and in dopamine production, that followed by increasing in the risk of ischemic damage pulmonary disease and diabetes. And we can conclude that both of Lys “AAG” and Trp “TGG” are so necessary for activating mitochondrial oxidative functions and necessary for promoting transport system where Mitochondria is so necessary to activate antioxidant function and promoting all of Phe hydroxylase, Tyr hydroxylase, and Lys acylation production which necessary for dopamine and RA synthesis respectively, where the PKU characterized by sever decreasing in antioxidant function, and sever decreasing in both Phe/ hydroxylase & Trp/ hydroxylase production, followed by decreasing in dopamine production and decreasing in retinoic acid production (which due to the reduction in SFACs synthesis).And I concluded that PKU characterized by sever decreasing in Phe /hydroxylase and Tyr /hydroxylase, followed by reduction in dopamine production, and reduction in alpha amylase, that associated with increasing in TNFa and in NLRP3 pathogenic pathway, and associated with increasing in the pulmonary disease and CVD risk.Retionic acid “RA” is regulated by lysine acylation and is regulated by lysine acylation mediated by short fatty acid synthesis, which regulate aminoacyl-tRNAs production regulated by mitochondrial enzymes and regulate mRNA production by E coli (regulated by phenylalanine) that necessary to run antioxidant functions and cellular biosynthesis.The antihypertensive pathway mechanism is: the Lysine →activate ATPase and both lysosomes and Mitochondrial oxidative functions which activate lysine acylation →activate short fatty acid synthesis →stimulate retinoic acid “RA” synthesis - →where both Lys and Trp activate GTPase which promote mitochondria repair and oxidative functions, which activate, Phe/ hydroxylase, and activate Tyr/ hydroxylase which activate dopamine, followed by activating NR4As pathway which responsible for activating GC-beta and both of Oxytocin and Nrf2, followed by Ang2-AT2 and VEGF-A productive functions and heme oxygenase production (notice dopamine regulate heme oxygenase mediated by dopamine beta-hydroxylase which regulated by Mitochondrial oxidative functions) followed by activating anti-inflammatory growth and processes. Lysine Methylation has important role to enhance and adopt hypertension through activating RA and pervious Antihypertensive pathway mediated by Phe/hydroxylase synthesis and Tyr /hydroxylase production followed by activating both of dopamine and NR4As pathway.
Lysine, Phenylalanine, Tyrosine, Phe/Hydroxylase, Tyr/Hydroxylase, Lysine Acetylation, ATPase and GTPase, Dopamine, Mitochondrial Membranes, Nrf2, Oxytocin, VEGF-A, Angiotensin-2 (Ang2-AT2), Phenylketonuria Causes, Diabetic Tissues, LV Hypertrophy, Lysosomes, E Coli, Aminoacyl tRNAs, Cardiomyopathy-TNFa, NLRP3 Inflammasome, Retinoic acid and Short Fatty Acid, Dopamine and Hydroxylase, Theme Oxygenases
Keeping People in Rhythm Electronically – An Overview of CardiacRhythm Management Devices
In 1956, Dr. Leatham duplicated Dr. Zoll’s work and developed the concept of automatic onset and termination of stimulations to pace the heart. By1957, only transcutaneous pacemakers were available, but even those required steel surgical sutures. In 1958, transvenous pacemakers were introduced. The first patient had the electrode placed in the myocardium, but it exited the chest wall to be connected to the outside generator. There were case reports of rechargeable batteries pacemakers as well, however those did not last long at all. Following which, there are reports of a 12 V battery being used. The lead was implanted via a left thoracotomy and brought out the chest wall. The first bipolar electrode was implanted in 1959 and a first completely transvenous system was implanted in 1962. The initaldevices had limited or no programing capabilities. In 1957, external dials were used to set programming options.1963-63, the pacemakers had needle driven potentiometer. 1961-1973 is when magnetic switches were used. Finally, radiofrequencyenergy was introduced to set programming options for these devices since 1973
Two Arrhythmias, One Diagnosis, All from Surface ECGs
A 48-year-old male with known supraventricular tachycardia presented with wide complex tachycardia and he was cardioverted. The patient was initially diagnosed with both ventricular tachycardia and supraventricular tachycardia. After reviewing electrocardiograms, a correct diagnosis of orthodromic atrioventricular reciprocating tachycardia with left-sided accessory pathway was made which was confirmed and successfully ablated in subsequent electrophysiological study. Not all wide complex tachycardias are ventricular tachycardia. If the rate of narrow complex supraventricular tachycardia becomes slower with the development of a bundle branch block, it is diagnostic for the presence and participation of the ipsilateral accessory pathway, which is called Coumel’s law
Tachycardia, AVRT, Accessory Pathway, Orthodromic Reciprocating Tachycardia, Left Bundle Branch Block, Supraventricular Tachycardia, Ventricular Tachycardia, Coumel’s Law
Effect of an Early Mobilization Program on Functional Capacityafter Coronary Artery Bypass Surgery a Systemic Review
Cardiac surgery has worldwide excellent results for improving of patients’ functions. Coronary artery bypass surgery is an effective treatment of ischemic heart disease. Approximately 90% ofpatients will have relief of symptoms of angina without requiring ongoing medications. The procedure itself is considered relatively safe with a mortality less than 1% if the patient has normal heart function. CABG is performed to improve the coronary artery blood flow and reduce the symptoms of myocardial ischemia, improve the ventricular function and to prevent the progression of the acute myocardial infarction and reduce the mortality [1,2]. In the CABG surgery, sections of saphenous vein, internal mammaryartery, radial artery, subscapular artery, and right gastroepigloticarteries are used. CABG surgeries were performed via a mediansternotomy.