Assad Movahed

East Carolina University, North Carolina, United States

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Publications (112)251.13 Total impact

  • Tin Nguyen · Charles Phillips · Assad Movahed
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    ABSTRACT: Calcification of the pericardium is a relatively rare finding and often has an uncertain etiology. Incidental findings of pericardial calcification may increase due to widespread application of cardiac computed tomography for the assessment of coronary atherosclerosis in the appropriate clinical setting using coronary artery calcium scoring and/or coronary angiography. Pericardial calcification alone is asymptomatic and is neither necessary nor sufficient for the diagnosis of pericardial constriction. Its presence may suggest of diffused pericardial scarring and consequently, its pathological involvement with pericardial constriction. Calcification of the pericardium must be evaluated with full clinical knowledge to facilitate an accurate diagnosis and an appropriate therapy when required. Our objective is to present a case of asymptomatic pericardial calcification and to discuss the importance of its clinical implications.
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    Tin Nguyen · Long Cao · Assad Movahed
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    ABSTRACT: Assessment of right ventricular (RV) function is important in the management of various forms of cardiovascular disease. Accurately assessing RV volume and systolic function is a challenge in day-to-day clinical practice due to its complex geometry. Tricuspid annular plane systolic excursion (TAPSE) and systolic excursion velocity (S') have been reviewed to further assess their suitability and objectivity in evaluating RV function. Multiple studies have validated their diagnostic and prognostic values in numerous pathologic conditions. Diminished longitudinal contraction after cardiothoracic surgery is a well-known phenomenon, but it is not well validated. Despite significant reduction in RV performance along the long-axis assessed by TAPSE and S' after cardiac surgery, RV ejection fractions did not change as well as the left ventricular parameters and exercise capacity. RV contractile patterns were markedly altered with decreased longitudinal shortening and increased transverse shortening, which are likely resulted from the septal damage during cardiac surgery. The septum is essential for RV performance due to its oblique fiber orientation. This allows ventricular twisting, which is a vital mechanism against increased pulmonary vascular resistance. The septum function along with TAPSE and S' should be adequately assessed during cardiac surgery, and evidence of septal dysfunction should lead to reevaluation of myocardial protection methods.
    Echocardiography 06/2014; 31(9). DOI:10.1111/echo.12657 · 1.25 Impact Factor
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    ABSTRACT: Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present, is usually extensive, often encompassing multiple cardiac chambers and valves. We present an unusual case of dystrophic left atrial calcification in the setting of end stage renal disease on hemodialysis diagnosed by echocardiography and computed tomography. Significant calcium deposition is confined within the walls of the left atrium with no involvement of the mitral valve, and no hemodynamic effects.
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    ABSTRACT: Left ventricular (LV) pseudoaneurysm is a rare complication that is reported in less than 0.1% of all patients with myocardial infarction. It is the result of cardiac rupture contained by the pericardium and is characterized by the absence of myocardial tissue in its wall unlike true aneurysm which involves full thickness of the cardiac wall. The clinical presentation of these patients is nonspecific, making the diagnosis challenging. Transthoracic echocardiogram and cardiac magnetic resonance imaging are the noninvasive modalities whereas coronary arteriography and left ventriculography are invasive modalities used for the diagnosis. As this condition is lethal, prompt diagnosis and timely management is vital.
    04/2014; 2(4):90-3. DOI:10.12998/wjcc.v2.i4.90
  • Tin Nguyen · Long-Bao Cao · Minh Tran · Assad Movahed
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    ABSTRACT: Pulsus alternans is characterized by regular rhythm with beat-to-beat alternation of systolic pressures. Left ventricular alternans is usually found in severe left ventricular dysfunction due to cardiomyopathy, coronary artery disease, systemic hypertension, and aortic stenosis. Right ventricular alternans is usually associated with left ventricular alternans, right ventricular dysfunction, pulmonary embolism, and pulmonary hypertension. Biventricular alternans is rare and associated with severe left ventricular dysfunction and left anterior descending coronary artery disease. The exact mechanism of pulsus alternans has not been clearly delineated, and it has been remained a subject of investigation and conjecture since the nineteenth century. Two fundamental mechanisms have been proposed to explain ventricular alteration. The first, based on the Frank-Starling mechanism, proposes beat-to-beat alteration in end-diastolic volume accounted for the alternating contractile force. The second proposed mechanism which explains the physiology of pulsus alternans involves the abnormal calcium handling by cardiac myocytes. To the best of our knowledge, biventricular alternans in pulmonary embolism has not been previously reported in the medical literature. We present and discuss the mechanisms of pulsus alternans and its clinical implications.
    08/2013; 1(5):162-165. DOI:10.12998/wjcc.v1.i5.162
  • Adeel M Siddiqui · Long-Bao Cao · Assad Movahed
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    ABSTRACT: Persistent left superior vena cava, usually an incidental finding, is the most common thoracic vein anatomical variation draining into the coronary sinus. Central venous catheter procedures may be complicated secondary to the presence of a persistent left superior vena cava, leading to life-threatening complications such as arrhythmias, cardiogenic shock, and cardiac arrest. We present a case of persistent superior vena cava diagnosed on transthoracic echocardiogram (TTE) in a patient with congestive heart failure. A dilated coronary sinus was identified on TTE, followed by injection of agitated saline into the left antecubital vein resulting in filling of the coronary sinus prior to the right atrium-an indication of persistent left superior vena-cava. This also was confirmed on cardiac computed tomography. Such a diagnosis is critical in patients who may undergo central venous catheter procedures such as our patient's potential requirement for an implantable cardiovertor defibrillator due to severe global left ventricular systolic dysfunction. The presence of a persistent left superior vena cava should always be suspected when the guidewire takes a left-sided downward course towards the right atrium at the level of the coronary sinus. Therefore, special attention should be paid to the imaging work-up prior to central venous catheter procedures.
    08/2013; 1(5):159-161. DOI:10.12998/wjcc.v1.i5.159
  • Long-Bao Cao · David Hannon · Assad Movahed
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    ABSTRACT: Ruptured sinus of Valsalva is very uncommon, and is < 1% of all congenital defects. The incidence ranges from 0.1%-3.5%. There is a male to female predominance of 4:1, with the highest incidence in the Asian population. Higher incidence is also seen in patients with Marfan's syndrome and Ehlers Danlos syndrome. There is a higher association of ruptured sinus of Valsalva with ventricular septal defect (VSD), aortic stenosis, and bicuspid valve defect. While most patients with VSD often have rupture of their right coronary sinus of Valsalva into the right ventricle due to poor structural integrity, we present a rare case of a patient with VSD who had rupture of his noncoronary sinus of Valsalva into the right atrium.
    07/2013; 1(4):146-148. DOI:10.12998/wjcc.v1.i4.146
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    ABSTRACT: An unknown aberrant flow in the right atrium observed on doppler with transesophageal echocardiogram (TEE) in a patient with prior coronary bypass. TEE revealed normal size left ventricle with severely dilated left atrium. There was moderate aortic regurgitation and moderate aortic stenosis noted. Patient was incidentally found to have an abnormal vascular communication noted to the right atrium. To further evaluate this finding, the patient underwent cardiac magnetic resonance angiography which revealed that the tubular structure noted on TEE was actually a graft that was abutting onto the coronary sinus, and the flow anomaly was really the graft coming up and running adjacent to the coronary sinus.
    04/2013; 1(1):28-30. DOI:10.12998/wjcc.v1.i1.28
  • Long Bao Cao · Christopher Jones · Assad Movahed
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    ABSTRACT: Thrombotic thrombocytopenia purpura (TTP) was first described in 1924 as a "pathologic alteration of the microvasculature, with detachment or swelling of the endothelium, amorphous material in the sub-endothelial space, and luminal platelet aggregation leading to compromise of the microcirculation". Ticlopidine induced TTP has been highly associated with autoimmune induced reduction in ADAMTS-13 activity. These findings, to a lesser extent, have also been found in clopidogrel induced TTP. We report a case of clopidogrel associated TTP in a patient that presented with acute stroke, renal failure, and non-ST elevation myocardial infarction.
    04/2013; 1(1):31-33. DOI:10.12998/wjcc.v1.i1.31
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    Hutton P Brantley · Brian R Cabarrus · Assad Movahed
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    ABSTRACT: Spontaneous coronary artery dissection and vertebral artery dissection are rare, life-threatening conditions. The pathophysiology of spontaneous coronary artery dissection during the peripartum period is poorly understood. We present a case of spontaneous multivessel dissection in a 32-year-old postpartum woman who presented with neck and chest pain. The patient's coronary and vertebral artery dissections were diagnosed with use of multiple imaging methods, and dissection of the internal mammary artery was discovered during surgery. The patient underwent successful coronary artery bypass grafting and remained asymptomatic 2 years later. To our knowledge, this is the first report of simultaneous coronary, vertebral, and internal mammary artery dissection in a postpartum woman. Early recognition and treatment is crucial, given the high mortality rate associated with spontaneous dissection.
    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2012; 39(5):683-6. · 0.63 Impact Factor
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    Sanjay Mehra · Hossein Movahed · Assad Movahed
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    ABSTRACT: The role of statins in reducing the risk of coronary artery disease is well established. The use of statins in patients at high risk for cardiovascular disease has reduced the incidence of major clinical events by 25% to 40%. However, despite aggressive statin therapy and the achievement of target low-density lipoprotein cholesterol levels, the residual risk of cardiovascular events remains high. This review investigates emerging therapies to target the residual risk of cardiovascular events with concurrent statin therapy.
    Reviews in cardiovascular medicine 01/2012; 13(1):e24-31. · 1.18 Impact Factor
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    Sanjay Mehra · Hossein Movahed · Assad Movahed
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    ABSTRACT: Numerous clinical studies have shown that coronary artery calcium scoring provides substantial incremental risk prediction beyond conventional coronary risk factors for coronary heart disease events. About half of all patients with coronary artery disease (CAD) present initially with unexpected myocardial infarction or sudden death. Early identification of this subgroup of patients is vital for institution of intensive, early preventive measures to decrease morbidity and mortality due to CAD.
    Reviews in cardiovascular medicine 01/2011; 12(2):e94-e103. · 1.18 Impact Factor
  • Anil George · Assad Movahed
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    ABSTRACT: Multislice computed tomography (CT) is rapidly emerging as a novel technique for the evaluation of coronary artery disease. It is anticipated that with increasing acceptance of this imaging technique, CT for calcium scores and CT angiography will be performed in ever greater numbers. Thus, it is all but inevitable that clinicians will stumble upon incidental findings given the sheer number of vital organs and blood vessels that are imaged in the field of view. This article reviews the literature on incidental findings on cardiac CT with a focus on pulmonary nodules, ethical aspects of following up such findings, and cost implications.
    Reviews in cardiovascular medicine 01/2010; 11(2):84-91. · 1.18 Impact Factor
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    Sanjay Mehra · Assad Movahed
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    ABSTRACT: Numerous modifiable and unmodifiable risk factors have been identified that contribute to increased cardiovascular risk in renal transplant recipients. We reviewed several clinical studies and journal articles to identify these risk factors in an attempt to risk stratify chronic kidney disease patients who are candidates for renal transplantation. Cardiovascular disease has been identified as the leading cause of death with graft function among renal transplant recipients. No single test or diagnostic modality has been found to provide complete diagnostic and prognostic information. Hence, a combination of clinical, biochemical, and radiographic data is essential to risk stratify renal transplantation candidates.
    Reviews in cardiovascular medicine 01/2010; 11(3):e130-40. · 1.18 Impact Factor
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    ABSTRACT: Apart from their existence as medical curiosities, anatomic variants also double as diagnostic dilemmas. In the heart, more than in any other location in the body, misinterpretation of normal anatomic variants as pathologic entities can have a profound impact on treatment decisions and clinical consequences. Echocardiography is an easily accessible tool these days and is used routinely in most cardiac evaluations. Thus it becomes imperative for the echocardiographer to be cognizant of normal anatomic variants. Furthermore, echocardiographic findings should always be evaluated in their proper clinical context and diagnoses should never be entertained in a clinical vacuum. The literature is replete with numerous case reports and vignettes on these fascinating structures but is lacking in a formal review of normal anatomic variants. In this article, we have attempted a systemic review of normal variants, their embryologic origins, echocardiographic characteristics, and common pitfalls encountered in their evaluation.
    Echocardiography 10/2009; 26(9):1109-17. DOI:10.1111/j.1540-8175.2009.01013.x · 1.25 Impact Factor
  • Anil George · Assad Movahed
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    ABSTRACT: Cardiac computed tomography (CT) has continued to make great strikes in cardiovascular imaging. New advances and refinements in technology have enable CT to render astonishingly detailed images. Cardiac CT depends on a high temporal resolutions to minimize coronary artery movement-related motion artifacts. There is ongoing debate as to the position of CT in the algorithm of diagnostic imaging in the realm of the cardiovascular sciences. There is a definite role for cardiac CT in patients with chest pain who have low or intermediate probability of coronary artery disease; a negative result on cardiac CT angiography could potentially exclude significant coronary artery disease and thus obviate further expensive workup. Further advancements in technique and validation of results will help establish CT on firmer ground. Such developments should proceed in tandem with reimbursement practices that encourage use of this tool in the right clinical context.
    Reviews in cardiovascular medicine 02/2009; 10(2):97-105. · 1.18 Impact Factor
  • The American Heart Hospital Journal 01/2009; 7(2):E122-4. DOI:10.15420/ahhj.2009.7.2.122
  • Firas A. Ghanem · Assad Movahed
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    ABSTRACT: Coronary heart disease (CHD) is a leading cause of death in the USA, and a burden that is estimated to overtake all other causes of mortality worldwide by the year 2020 [1]. Marked advances have been made in recent years to better understand the pathophysiology of CHD and to develop scoring systems that can integrate risk factors to estimate an individual’s risk of future cardiovascular (CV) events. Risk factors for CHD are divided into modifiable (smoking, hypertension, lipid abnormalities, diabetes, sedentary lifestyle) and nonmodifiable (age, male gender, genetic factors, ethnicity). Interventions aimed at prevention can be divided into primary (disease prevention in patients without overt cardiovascular disease) as opposed to secondary, when dealing with those with known cardiovascular disease (CVD). The following is an overview of interventions aimed at prevention of CHD.
    12/2008: pages 419-423;
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    ABSTRACT: Clinical cardiac electrophysiology is a subspecialty of cardiology dealing with the evaluation and management of patients with complex rhythm or conduction abnormalities. In the last four decades, clinical cardiac electrophysiology has evolved into an established discipline credited with improving and saving hundreds of thousands of lives. We briefly review the basic electrophysiologic principles, anatomy of the electric system of the heart, mechanism of arrhythmias, genetical predisposition to arrhythmias, types of arrhythmias, diagnostic electrophysiologic studies, and pharmacologic and device therapies available for the treatment of different types of arrhythmias.
    12/2008: pages 145-154;
  • R. Wayne Kreeger · Jaffar Ali Raza · Assad Movahed
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    ABSTRACT: The goals of antiarrhythmic drug therapy are to control heart rate, abolish tachyarrhythmias, suppress ectopic beats, and to restore and maintain normal sinus rhythm. The selection of appropriate agents is a match between the common antiarrhythmic drugs, the condition and age of the patient, the urgency of treatment, the potential long-term side effects, and especially the drug’s proven efficacy on the arrhythmia in question [1]. This chapter will discuss the pharmacokinetics and pharmacodynamics of the commonly utilized and marketed antiarrhythmic drugs.
    12/2008: pages 453-461;

Publication Stats

597 Citations
251.13 Total Impact Points


  • 1989–2014
    • East Carolina University
      • • Department of Medicine
      • • Department of Internal Medicine
      • • Department of Computer Science
      North Carolina, United States
  • 1990–2009
    • University of South Carolina School of Medicine - Greenville
      Гринвилл, South Carolina, United States
    • Mount Sinai Medical Center
      New York City, New York, United States
  • 1991
    • North Greenville University
      Гринвилл, North Carolina, United States