Assad Movahed

University of South Carolina School of Medicine - Greenville, Greenville, South Carolina, United States

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Publications (90)185.04 Total impact

  • The American Heart Hospital Journal 01/2009; 7(2):E122-4.
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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;
  • 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: 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;
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    ABSTRACT: The frequent use of transesophageal echocardiogram (TEE) has led to the increased recognition of aortic atheromas. Retrospective and prospective follow-up studies have reported an association between aortic atheromas and stroke in the high-risk patient population, with complex plaques being more likely to embolize than simple plaques. However, TEE-based studies in the low-risk cohorts have failed to show a similar association. There is growing body of evidence suggesting that aortic atheroma is a marker of generalized atherosclerosis. Although magnetic resonance (MR) imaging and computed tomography (CT) scan are emerging as a powerful noninvasive tool for characterization of aortic atheromas, TEE is the imaging modality of choice. Currently, treatment of aortic atheromas is not well defined, and mixed outcomes have been reported for anticoagulation therapy with warfarin. Statins appear promising based on their plaque stabilization properties. However, there are no randomized control trials to establish the role of both anticoagulation and statins in patients with aortic atheromas, and are warranted in the future.
    Echocardiography 03/2008; 25(2):198-207. · 1.26 Impact Factor
  • Firas A Ghanem, Assad Movahed
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    ABSTRACT: The decision to treat elevated arterial pressure in pregnancy depends on the risk and benefits imposed on the mother and the fetus. Treatment for mild-to-moderate hypertension during pregnancy may not reduce maternal or fetal risk. Severe hypertension, on the other hand, should be treated to decrease maternal risk. Methyldopa and beta-adrenoceptor antagonists have been used most extensively. In acute severe hypertension, intravenous labetalol or oral nifedipine are reasonable choices.
    Cardiovascular Therapeutics 02/2008; 26(1):38-49. · 2.85 Impact Factor
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    ABSTRACT: Diastolic heart failure is a common form of congestive heart failure that is responsible for significant morbidity and mortality. In contrast to heart failure caused by systolic left ventricular dysfunction, diastolic heart failure is harder to diagnose and less likely to be accepted as a diagnosis. In addition, treatment strategies are much less defined than those for heart failure caused by systolic dysfunction.
    International journal of cardiology 03/2007; 115(3):284-92. · 7.08 Impact Factor
  • Firas A Ghanem, Assad Movahed
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    ABSTRACT: Hypertension is one of the most important contributors to atherosclerosis. A possible link between inflammation and elevated blood pressure has been suggested by several cross-sectional and longitudinal studies. Possible mechanisms include an imbalance between vasoconstrictors and vasodilators, amplified thrombogenesis and platelet activation, and perhaps a direct effect of inflammatory mediators. C-reactive protein (CRP), an inflammatory cytokine, may play an essential role in vascular inflammation and can directly decrease the production of nitric oxide, a vasocodilator. Angiotensin II (Ang II) up-regulates several inflammatory cytokines, leukocyte adhesion molecules, and chemokines through the activation of the nuclear factor-kappa B leading to a decrease in the bioavailability of vasodilators. The increase in oxidative stress and endothelin-1 production through Ang II may further contribute to vasoconstriction. Adipose tissue can add to the production of CRP and creates a prothrombotic state. The presence of low-grade inflammation, especially elevations of CRP, can help predict the risk of future cardiovascular events and is associated with target organ damage in hypertensive individuals. Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-adrenoreceptor antagonists, and, to a lesser degree calcium channel antagonists, have shown efficacy in reducing CRP. Lifestyle changes such as exercise, weight loss, and tobacco cessation have also shown a similar efficacy. Whether targeting inflammation in the treatment of uncomplicated hypertension can alter the natural history of the disease or lead to improved outcome has yet to be determined.
    Journal of the American Society of Hypertension 01/2007; 1(2):113-9. · 2.84 Impact Factor
  • Matthew Cummings, Jaffar Raza, Assad Movahed
    Journal of Nuclear Cardiology 08/2006; 13(4):576-81. · 2.85 Impact Factor
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    ABSTRACT: Spontaneous coronary artery dissection (SCAD) should be considered as a cause of the acute coronary syndrome in young patients with few apparent risk factors for coronary artery disease, in females in the peripartum period, and in patients who are at a higher risk for this condition. SCAD can also present as sudden death and cardiogenic shock. Several mechanisms have been described in the pathophysiology of this condition. Urgent coronary angiography is indicated if SCAD is suspected. Percutaneous coronary artery stenting and coronary artery bypass grafting are the main treatment strategies.
    Acute Cardiac Care 02/2006; 8(3):162-71.
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    ABSTRACT: An increased lung to heart ratio (LHR) on thallium-201 (Tl-201) stress myocardial perfusion imaging (MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease (CAD). The implications of increased LHR in patients undergoing stress technetium-99m (tc-99m) sestamibi are developing. Our aim is to evaluate the relationship between increased LHR and extent of CAD in patients undergoing tc-99m sestamibi MPI. We reviewed the records and images of 530 consecutive subjects who underwent exercise or adenosine tc-99 m sestamibi MPI. One hundred thirty-two had transient or partially reversible myocardial perfusion defects and 79 (exercise=34, adenosine=45, male=43, female=36, mean age=61 years) of these underwent coronary angiography (study population). The average LHR of these 79 subjects was compared to 79 patients (control population) with normal scans (exercise=50, adenosine=29, male=34, female=45, mean age=60 years). The mean LHR (+/-SE) in subjects with normal scans was 0.30+/-0.01. The mean LHR for those with abnormal scans and single vessel CAD who underwent exercise was 0.32+/-0.01 and pharmacological stress was 0.31+/-0.01. There was no statistically significant difference between the LHR of those with a normal scan and those with single vessel disease and an abnormal scan. However, there was a statistically significant association between the elevated LHR and multi-vessel CAD. The mean LHR for subjects with multi-vessel CAD with exercise was 0.39+/-0.01 (p=0.000) and for adenosine was 0.39+/-0.02 (p=0.000). An elevated LHR in patients undergoing exercise or pharmacological tc-99m MPI correlates with multi-vessel CAD.
    International Journal of Cardiology 06/2005; 101(2):219-22. · 5.51 Impact Factor
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    ABSTRACT: Acute left main coronary artery occlusion is a catastrophic and mostly fatal event. Patients may present with sudden death or cardiogenic shock. Intra-aortic balloon pump support and emergency revascularization is indicated to preserve the left ventricular function. We describe a case of left main thrombus in a health 24-year-old young male with no risk factors for coronary atherosclerosis.
    International Journal of Angiology 04/2005; 14(2):94-96.
  • Firas A Ghanem, Assad Movahed
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    ABSTRACT: Angiotensin-converting enzyme (ACE) inhibitors have been the cornerstone of treatment of heart failure. Angiotensin receptor blockers (ARBs) remain an attractive alternative in heart failure patients intolerant of ACE inhibitors. The addition of ARBs to ACE inhibitors in the context of stable heart failure may lead to additional clinical benefits. This is in contrast to heart failure complicating acute myocardial infarction, in which it does not offer any therapeutic advantage.
    Reviews in cardiovascular medicine 02/2005; 6(4):206-13. · 0.58 Impact Factor
  • Nazim Uddin Azam Khan, Assad Movahed
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    ABSTRACT: Pulmonary embolism (PE) is often associated with chest pain, electrocardiographic changes, and right ventricular (RV) dysfunction on echocardiogram. There have been reports of elevated troponin levels with PE. RV dysfunction and elevated troponin levels have prognostic implications in acute PE. The purpose of this retrospective analysis was to determine whether PE was associated with elevated cardiac enzymes and whether there was any difference among patients who presented with or without chest pain. Records of 93 consecutive patients with high-probability ventilation/perfusion lung scan results for PE were analyzed for the presence or absence of chest pain on presentation, abnormalities in cardiac enzymes, and evidence of RV dysfunction on echocardiogram. A total of 56 of 93 patients had cardiac enzymes evaluated; 24 of these 56 patients had chest pains, and 32 did not. Only 1 patient of the 56 had abnormal cardiac enzymes. This patient had a known history of coronary artery disease (CAD) and had experienced an acute anterior myocardial infarction. Echocardiograms were performed in 36 of 93 patients. Evidence of RV dysfunction on echocardiograms was found in 22 of these patients. No significant relationship was found between RV dysfunction and chest pains (P > .10). We found no significant relationship between high-probability ventilation/perfusion scan results and abnormalities in cardiac enzymes irrespective of the presence or absence of chest pain. Patients with a history of CAD or RV dysfunction did not have a higher incidence of chest pain when compared with those with no known history of CAD or RV dysfunction.
    Heart and Lung The Journal of Acute and Critical Care 01/2005; 34(2):142-6. · 1.40 Impact Factor
  • Jaafer A Golzar, Assad Movahed
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    ABSTRACT: Pre-operative cardiac assessment is important in the evaluation of patients undergoing major vascular surgery. Our study aims to evaluate the value of absence of a transient myocardial perfusion defect during radionuclide myocardial perfusion study for prediction of cardiac events (myocardial infarction, sudden cardiac death, unstable angina, coronary artery revascularization and congestive heart failure) in patients undergoing major vascular surgery. We studied 63 consecutive patients (ages 35-83 [avg. 64], male 39, female 24) with radiographically proven, abdominal aortic aneurysm or severe aortofemoral occlusive disease who underwent major vascular surgery (abdominal aortic aneurysm repair [38] or aortofemoral bypass [25]). The subjects all had multiple coronary artery risk factors (hypertension 48, diabetes 10, hyperlipidemia 23, tobacco use 39, family history of coronary artery disease 10), but a negative pre-operative stress myocardial perfusion study for myocardial ischemia. Of these 63 patients, 17 patients were able to exercise and achieve their adequate 85% maximal predicted heart rate. Thirty-eight patients received adenosine infusion of 140 microg/kg/min for 6 min. Six patients received dipyridamole infusion of 0.56 mg/kg over 4 min. Two patients received dobutamine infusion at 5, 10, 20, 30, and 40 mg/kg/min. Of the 63 patients, 60 received 3-4 mCi of thallium-201 ((201)Tl) and 3 patients received 8-9 mCi of technetium-99m (99mTc) at rest and 25-30 mCi 99mTc during stress. The subjects all underwent major vascular surgery and were followed up to one year for any cardiac events. Of the 63, who underwent pre-operative cardiac assessment with myocardial perfusion testing, 25 had a fixed myocardial perfusion defect (scar) and none had evidence of transient myocardial perfusion defect (ischemia). One subject had coronary artery bypass grafting 11 months after aortofemoral bypass surgery. One died from a stroke one month after aortofemoral bypass surgery. Of the remaining 61 patients, none had any cardiac events up to one year after major vascular surgery.
    The International Journal of Cardiovascular Imaging 01/2005; 21(2-3):267-70. · 2.65 Impact Factor
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    ABSTRACT: AIDS has resulted in a significant increase in the incidence of both primary and secondary cardiac lymphomas. Prognosis of HIV associate cardiac non-Hodgkin's lymphoma is poor with very limited survival. Many cases of cardiac involvement in lymphoma remain undetected secondary to non-specific symptoms. Chemotherapy may produce remission in some cases. We report two cases of cardiac involvement with B-cell lymphoma. The first patient had a history of AIDS while the second had no evidence of HIV infection.
    The International Journal of Cardiovascular Imaging 01/2005; 20(6):477-81. · 2.65 Impact Factor
  • Jaffar Ali Raza, Joseph D Babb, Assad Movahed
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    ABSTRACT: Cardiovascular disease (CVD) in the developed countries continues to grow at an epidemic proportion. There are a significant number of young adults with no clinical evidence of CVD, but who have two or more risk factors that predispose them to CV events and death. Many of these risk factors are modifiable, and by controlling these factors, the CVD burden can be decreased significantly. Recent statistics have shown that, if all major forms of CVD were eliminated, the life expectancy would rise by almost 7 years. Hence it is imperative that primary prevention efforts should be initiated at a young age to avert decades of unattended risk factors. Hyperlipidemia has been linked to CVD almost a century ago. Since then various clinical trials have not only supported this link, but have also shown the CV benefits in aggressively treating patients with hyperlipidemia. In this generation, we have various therapeutic agents that are capable of reducing the elevated lipid levels. With drugs like statins, we are able to reduce the risk of CVD by about 30% and avoid major adverse events. Newer drugs are being researched and introduced in the treatment of hyperlipidemia in humans. These can be used in combination therapy resulting in optimal levels of lipids. The new National Cholesterol Education Program (NCEP)/Adult Treatment Panel III (ATP III) guidelines have come as a wake-up call to clinicians about primary prevention of CVD through strict lipid management and multifaceted risk management approach in the prevention of CVD.
    International Journal of Cardiology 01/2005; 97(3):355-66. · 5.51 Impact Factor
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    ABSTRACT: The prevalence of ischemic heart disease (IHD) has been increasing among the women in developed countries. The well recognized IHD excess in men has often obscured the fact that IHD is the leading cause of death in women. Women have atypical symptoms of IHD that lead to a delay in the diagnosis and an overall poor prognosis. Women have a delay in the onset of IHD due to the beneficial effects of their sex hormones. Postmenopausal women lose this beneficial effect of estrogen and undergo significant changes in their lipid profile, arterial pressure, glucose tolerance, and vascular reactivity that increase their risk for development of IHD. Recently there has been considerable interest in the sex hormones and their role in IHD in women. The general belief that hormone replacement therapy (HRT) has an overall beneficial effect on cardiovascular disease (CVD) in women and hence decreases CVD mortality and morbidity has not been shown in the recent multicenter prospective studies. With the availability of various types of estrogen and progestins, physicians prescribing these agents should take into consideration their varying effects on the cardiovascular system. Risk factor modifications should include diet, weight loss, regular exercise, smoking cessation and adequate control of hypertension (HTN), diabetes (DM) and hyperlipidemia. In the appropriate setting, treatment with proven beneficial agents like aspirin, beta-blockers, angiotensin converting enzyme (ACE) inhibitors and statins will help decrease the burden of IHD in women.
    International Journal of Cardiology 08/2004; 96(1):7-19. · 5.51 Impact Factor
  • Nazim Uddin Azam Khan, Assad Movahed
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    ABSTRACT: Prolonged overactivation of neurohormonal mechanisms in heart failure produces deleterious effects on the cardiovascular system and leads to poor prognosis. Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers have been shown to interrupt this excessive overactivity and improve survival. Activation of the renin-angiotensin system leads to increased synthesis of aldosterone in heart failure. Some aldosterone production is independent of ACEs; therefore, ACE inhibition does not entirely suppress the excessive formation of aldosterone. An excess of aldosterone in heart failure leads to sodium retention and myocardial fibrosis. The use of aldosterone antagonists, combined with standard therapy for heart failure, improves morbidity and mortality.
    Reviews in cardiovascular medicine 02/2004; 5(2):71-81. · 0.58 Impact Factor
  • Jaafer Golzar, S Jamal Mustafa, Assad Movahed
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    ABSTRACT: Case history. A 52-year-old woman with hypertension treated with hydrochlorothiazide and clonidine presented to East Carolina University Brody School of Medicine (Greenville, NC) with presyncope. Her main complaint on admission was episodes of lightheadedness when standing for several minutes, which were relieved by lying flat. She denied having chest pain, shortness of breath, or syncope. During the course of the patient’s hospitalization, her physician ordered a stress myocardial perfusion scan for evaluation of coronary artery disease. Clonidine was discontinued 4 days before stress testing. The patient was not able to exercise because of her lightheadedness; therefore adenosine pharmacologic stress testing was performed. The patient received adenosine at 140 g·k g 1 · min 1 for 6 minutes. The resting electrocardiogram showed sinus rhythm (Figure 1). Her resting heart rate was 51 beats/min, and her blood pressure was 165/65 mm Hg. Three minutes into the adenosine infusion, 41 mCi technetium 99m sestamibi was injected. She reported no chest pain during adenosine infusion. Six minutes into adenosine infusion, her heart rate was 68 beats/min and her blood pressure was 108/66 mm Hg. There were no significant ST-T changes during adenosine infusion. Three minutes after discontinuation of adenosine infusion, substernal chest pain developed. The electrocardiogram showed 3- to 6-mm ST elevation in electrocardiographic leads II, III, aVF, and V3 to V6 and 2- to 4-mm ST depression in electrocardiographic leads I, aVL, and V2 (Figure 2). The patient was given oxygen, aspirin, and 0.4 mg nitroglycerin sublingually, and 1 to 2 minutes later, ST changes returned to baseline (Figure 3). Sixty minutes later, adenosine myocardial perfusion images were obtained by gated single photon emission computed tomography (SPECT). Five days later, the patient was underwent rest myocardial perfusion imaging. At rest, 40 mCi Tc-99m sestamibi was injected; 1 hour 15 minutes later, rest myocardial perfusion images were obtained by SPECT. SPECT images were acquired with a dual-head gamma camera by use of step-and-shoot detector rotation, with 32 projections being obtained over a 180° arc (45° right anterior oblique to 45° left posterior oblique). The camera was equipped with a low-energy highresolution collimator. Rest and stress images were acquired with a 20% window centered over the 140-keV photopeak. Gated acquisitions were obtained by use of 8 frames per cardiac cycle with a 40% acceptance window. Acquisition times were 40 seconds per projection. The summed projection data sets were filtered with a Butterworth filter (order, 5; cutoff, 0.33). Short-axis and vertical and horizontal long-axis images were evaluated for transient, partially reversible, or fixed perfusion defects. Stress and rest myocardial perfusion images re
    Journal of Nuclear Cardiology 01/2004; 11(6):744-6. · 2.85 Impact Factor

Publication Stats

357 Citations
185.04 Total Impact Points

Institutions

  • 1991–2009
    • University of South Carolina School of Medicine - Greenville
      Greenville, South Carolina, United States
  • 1989–2008
    • East Carolina University
      • • Department of Medicine
      • • Department of Internal Medicine
      Greenville, NC, United States