Nikhil Nalluri

Staten Island University Hospital · Department of cardiology

Needle embolisms in the heart are quite rare, and their management is largely based on clinical experience. We describe a patient with chest pain and shortness of breath, whose electrocardiogram revealed subtle inferolateral ST segment elevations. The patient was found to have a bloody pericardial effusion causing tamponade from a long-ago injected...

Objective: Carotid revascularization procedures, carotid artery stenting (CAS) and carotid endarterectomy (CEA), are among the most common vascular interventions performed in the United States, with significant resource utilization. Whereas multiple studies have reported outcomes after these procedures, data regarding 30-day readmission rates afte...

Coronary artery anomalies (CAA) are anatomical aberrations in the origin, structure, and course of the epicardial arteries. Literature has detailed common anomalies or fistulas formed because of coronary artery bypass grafting (CABG) manipulation of intrathoracic vessels. Despite the commonality of the CABG procedure, there are a few CAA and fistul...

Endovascular aneurysm intervention (EVAI) is one of the most commonly performed vascular interventions for abdominal aortic aneurysm (AAA). Data regarding 30-day readmission rates after EVAI are poorly reported in the literature. We used the United States Nationwide Readmission Database from 2010 to 2014 to identify all patients ≥18 years who were...

Background: Percutaneous coronary intervention (PCI) with drug eluting stents (DES) has been increasingly used for revascularization of saphenous vein graft (SVG) stenosis without strong clinical evidence favoring their use. Randomized control trials (RCTs) comparing DES vs BMS in SVG-PCI have been inconclusive. Methods: We performed a comprehens...

A left main coronary artery (LMCA) iatrogenic dissection is a rare but potentially life-threatening complication of coronary angioplasty. It can range from a simple tear in the artery wall to a severe dissection, causing complete blood flow obstruction. We report the case of a 63-year-old male patient who was presented to our catheterization labora...

Percutaneous ventricular assist devices (PVAD) have been used at an increasing rate in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). Recent evidence has demonstrated that use of invasive hemodynamic monitoring with right-sided heart catheterization (RHC) was associated with improved survival in recipients of P...

Background The incidence of patients with previous history of coronary artery bypass grafting (CABG) presenting for aortic valvular replacement has been consistently on the rise. Repeat sternotomy for surgical aortic valve replacement (SAVR) carries an inherent risk of morbidity and mortality when compared to Transcatheter aortic valve replacement...

Since the inception of transcatheter aortic valve replacement (TAVR), there have been significant reductions in complications due to improvements of transcatheter heart valve (THV) designs and technologies. Given expanding TAVR applications, reducing complications further and better understanding THV durability has become a focus within the structu...

Background Bioprosthetic (BP) valves have been increasingly used for aortic valve replacement over the last decade. Due to their limited durability, patients presenting with failed BP valves are rising. Valve in Valve − Transcatheter Aortic Valve Implantation (ViV‐TAVI) emerged as an alternative to the gold standard redo‐Surgical Aortic Valve Repla...

Reverse takotsubo cardiomyopathy is an uncommon cardiomyopathy characterized by reversible regional wall motion abnormalities in the basilar segment of the left ventricle. This happens in the absence of any coronary artery pathology. Although it shares some pathogenic mechanisms with its more common variant, takotsubo cardiomyopathy, differences ex...

Left anterior oblique view of the right coronary artery showing no evidence of disease. A JR4 catheter is used to engage and inject dye into the right coronary artery.

Initial apical four-chamber view displays significant hypokinesis of the apical, apical lateral, and apical septal walls with a hyperdynamic basal inferoseptal and anterolateral walls. The systolic anterior motion of mitral valve causing a dynamic LVOTO along with an enlarged left atrium and significant mitral annular calcification are also seen.

Turbulence of blood flow through the LVOT associated with posteriorly directed mitral regurgitation due to LVOTO from systolic anterior motion of the mitral valve.

A left anterior oblique view of LCA.

Apical five-chamber view showing severe hypokinesis of the apical, apical septal, and apical lateral walls along with basal asymmetric hypertrophy and the LVOTO caused by systolic anterior motion of the mitral leaflet.

Follow-up echocardiogram in the four-chamber view shows the recovery of the apical hypokinesis.

Right anterior oblique view of LCA. A JL3.5 catheter is used to engage and inject dye into the LCA, which showed no evidence of blockages in left circumflex artery and left anterior descending artery.

Follow-up echocardiogram in the five-chamber view shows decreased turbulence in the LVOT and a decreased mitral regurgitation jet.

Highlights • Echocardiography is used to diagnose hypertrophic obstructive cardiomyopathy (HOCM) and Takotsubo cardiomyopathy (TCM). • Hypotension in a patient with TCM should be evaluated for left ventricular outflow tract obstruction (LVOTO). • Management of TCM is challenging in patients with HOCM with severe LVOTO. • Hypotension in LVOTO may pa...

Introduction: Catheter ablation is widely accepted intervention for atrial fibrillation (AF), but data is limited on contemporary trends in major complications and mortality due to the procedure. Methods: HCUP’s Nationwide inpatient sample (NIS) database was utilized from 2011-14 to identify the AF patients treated with Catheter Ablation using ICD-...

Introduction: The influence of previous cardiac surgery (CABG, Valve Replacement or both) on In-hospital clinical outcomes in patients(pts) undergoing Transcatheter Aortic Valve Implantation (TAVI) has not been well established. Methods: We analyzed the clinical characteristics and periprocedural in-hospital outcomes among pts undergoing TAVI using...

Introduction: Takotsubo cardiomyopathy (TTC) is diagnosed in 1-2% of the patients presenting with troponin positive suspected acute coronary syndromes(ACS). Rising trends of adverse events in patients with TTC, makes it imperative to explore causes and predictors of readmission in this patient population. Methods: National Readmission Data (NRD) 20...

Introduction: Impella is a catheter-based micro-axial flow pump placed across the aortic valve, and it is currently the only percutaneous left ventricular assist device approved for high-risk percutaneous coronary intervention and cardiogenic shock. Areas Covered: Even though several studies have repeatedly demonstrated the excellent hemodynamic pr...

Study aims The goal of our study was to determine the current trends for inpatient utilization for endoscopic retrograde cholangiopancreatography (ERCP) and its economic impact in the United States between 2002 and 2013. Patients and methods A Nationwide Inpatient Sample from 2002 through 2013 was examined. We identified ERCPs using International C...

Dural prostate metastases (DPM) are a rare manifestation of metastatic prostate cancer seen in approximately one to six percent of cases. Presenting symptoms may include signs of elevated intracranial pressure, headache, altered mental status, or cranial nerve palsies. Hearing loss, sensory changes, dysarthria, and dysphagia are rare symptoms in DP...

IgG4-related disease is?characterized by multi-system inflammation and possible elevation in serum immunoglobulin-G4 level. Treatment regimens include glucocorticoids, disease-modifying anti-rheumatic agents and recently, rituximab infusions have been reported to be effective in treatment-refractory disease. We present a case of a 64-year-old male...

Cardiac sarcomas are extremely rare primary malignant tumors of the heart. In this article, we present the case of a 70-year-old female, who was found to have a left atrial mass during a routine outpatient transthoracic echocardiography. Further investigation with cardiac magnetic resonance imaging confirmed the presence of a bilobulated mass with...

Since the introduction of new antiplatelet and anticoagulant agents in the last decade, large-scale data studying gastrointestinal bleeding (GIB) in patients undergoing percutaneous coronary intervention (PCI) are lacking. Using the Nationwide Inpatient Sample, we identified all hospitalizations from 2006 to 2012 that required PCI. Temporal trends...

Introduction: Atrial fibrillation (AF) is common following cardiac surgery. Reduction of postoperative AF would decrease average length of stay and improve patient outcomes. Ranolazine has been shown to prevent AF by increasing postrepolarization refractoriness in atrial tissue. This study evaluates prophylactic ranolazine on postoperative AF in ca...

Catheter ablation for atrial fibrillation has emerged as a popular procedure. The purpose of this study was to examine whether there exists differences or disparities in ablation utilization across gender, socioeconomic class, insurance or race. Using the Nationwide Inpatient Sample (NIS) (2000-12), we identified adults hospitalized with a principa...

Prior studies have highlighted disparities in cardiac lifesaving procedure utilization, particularly among women and in minorities. Although there has been a significant increase in implantable cardioverter-defibrillator (ICD) insertion, socioeconomic disparities still exist in the trend of ICD utilization. With the use of the Nationwide Inpatient...

Atrial fibrillation (AF) is the most common type of sustained arrhythmia, which is now on course to reach epidemic proportions in the elderly population. AF is a commonly encountered comorbidity in patients with cardiac and major non-cardiac diseases. Morbidity and mortality associated with AF makes it a major healthcare burden. The objective of ou...

Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide and the most common arrhythmia leading to hospitalization. Due to a substantial increase in incidence and prevalence of AF over the past few decades, it attributes to an extensive economic and public health burden. The increasing number of hospitalizations, aging population, antico...

Carditis is one of the manifestations of the Lymes disease which can occur during the early-disseminated phase of the illness. Conduction block at the atrioventricular node level is the most common manifestation of Lyme's carditis. We report three rare cases of multilevel conduction block secondary to lymes carditis with corresponding electrophysio...

Background: Cardiac resynchronization therapy (CRT) trials have not adequately represented the elderly population. However as the population ages these groups of patients are increasingly referred for CRT implantation. The objective of this study was to examine the safety outcomes of CRT implants in octogenarians.

Over the past decade, metabolic syndrome has gained recognition as a significant contributor to cardiovascular mortality. Isolated metabolic syndrome, without diabetes mellitus, plays an increasingly essential role in the pathogenesis of Coronary Artery Disease (CAD). The risk factors for metabolic syndrome act synergistically to promote the develo...

Second generation permanent polymer drug eluting stents (PP-DES) (Everolimus and Zotarolimus) are currently used in USA and is a standard of care. Biodegradable polymer based drug eluting stents (BD-DES) are being studied in Europe and Asia, and the results have been promising. To test the premise, that BD-DES could improve clinical outcomes compar...

Floating right heart thrombus, also known as "emboli in transit" is a potentially fatal condition, which may be attributed to several different etiologies and usually co-exists with massive pulmonary embolism. Although, the mortality rate is as high as 40%, there are no therapeutic guidelines established. A case is presented of 84 year old female w...

Diabetes Insipidus (DI) is either due to deficient secretion of arginine vasopressin (central) or to tubular unresponsiveness (nephrogenic). Drug induced DI is a well-known entity with an extensive list of medications. Polyuria is generally defined as urine output exceeding 3 liters per day in adults. It is crucial to identify the cause of diabetes...