Papers by Ahmed El-Medany
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Feb 16, 2022
Abernethy malformation, or congenital extrahepatic portosystemic venous shunt, is a rare anomaly ... more Abernethy malformation, or congenital extrahepatic portosystemic venous shunt, is a rare anomaly involving the portal venous system. Despite its rarity, it is increasingly being reported, and therefore, it is important to diagnose given the potential adverse clinical consequences if left untreated. It has a spectrum of presentations, ranging from complete lack of symptoms, to causing hepatic carcinoma, hepatic encephalopathy, severe pulmonary hypertension, and diffuse pulmonary arteriovenous malformation. We herein describe the case and echocardiographic, computed tomography, and magnetic resonance imaging findings of a transgender individual, with this anomaly detected incidentally during adulthood.
Allied Health Professionals/Nursing/Health Scientists
Conclusion We successfully implemented an SDM meeting into our TAVI pathway. Data collection cont... more Conclusion We successfully implemented an SDM meeting into our TAVI pathway. Data collection continues, however our initial experience in this small number of patients suggests that this approach appears to significantly improve positive decision-making outcomes. These include patient involvement, discussion around treatment options and their risks, the opportunity to ask questions, and a reduction in negative responses when compared to patients who did not have an SDM meeting. SDM collaboration is widely applicable throughout clinical decision-making and has the potential to increase patient engagement in their management.
The symptoms of long COVID, which include fatigue, breathlessness, dysregulated breathing, and ex... more The symptoms of long COVID, which include fatigue, breathlessness, dysregulated breathing, and exercise intolerance, have unknown mechanisms. These symptoms are also observed in heart failure and are partially driven by increased sensitivity of the carotid chemoreflex. As the carotid body has an abundance of ACE2 (the cell entry mechanism for SARS-CoV-2), we investigated whether carotid chemoreflex sensitivity was elevated in participants with long COVID. During cardiopulmonary exercise testing, the VE/VCO2slope (a measure of breathing efficiency) was higher in the long COVID group than in the controls, indicating excessive hyperventilation. The hypoxic ventilatory response, which measures carotid chemoreflex sensitivity, was increased in long COVID participants and correlated with the VE/VCO2slope, suggesting that excessive hyperventilation may be related to carotid body hypersensitivity. Therefore, the carotid chemoreflex is sensitized in long COVID and may explain dysregulated br...
International Journal of Cardiology Congenital Heart Disease
BMJ Case Reports
A woman in her 40s was admitted following syncope. The 12-lead ECG showed atrial fibrillation wit... more A woman in her 40s was admitted following syncope. The 12-lead ECG showed atrial fibrillation with slow ventricular response and suspected complete atrioventricular (AV) block. Cardiac monitoring demonstrated non-sustained monomorphic ventricular tachycardia (VT). Her medical history included surgical repair of an atrial septal defect (ASD) aged 4 years. The patient’s mother died suddenly in her early 50s and also had an ASD. Given the patient’s syncope, background of familial sudden cardiac death (SCD), suspicion of complete AV block and non-sustained VT, she received an implantable cardiac defibrillator (ICD). She underwent genetic testing, revealing a heterozygous NKX2-5 genetic mutation. The signature phenotype in NKX2-5 mutations is ASD with AV conduction disturbance and an increased risk of SCD secondary to ventricular arrhythmias or severe bradycardia. SCD has been described in NKX2-5 mutation carriers despite functioning permanent pacemakers (PPMs). Therefore, we propose imp...
JRSM Open
Summary We present the case of a 67-year-old woman brought into the coronary care unit (CCU) with... more Summary We present the case of a 67-year-old woman brought into the coronary care unit (CCU) with a suspected ST-segment elevation myocardial infarction (STEMI) due to lateral ST-segment elevation on her 12-lead electrocardiogram (ECG) and a significant troponin rise, but no reported chest pain and a fluctuating consciousness level. Whilst in CCU, she deteriorated further with a reduction in consciousness and sluggish pupillary reflexes, warranting urgent computed tomography (CT) of her brain, which confirmed extensive subarachnoid haemorrhage (SAH) with early evidence of hydrocephalus. She was therefore transferred to the local tertiary neurosurgical centre for endovascular coiling. ECG changes alongside a raised troponin are not uncommon findings in SAH and clinicians should exercise vigilance and consider urgent brain imaging in the absence of chest pain and presence of neurological deficit, to prevent adverse events from unnecessary antiplatelet or anticoagulant therapy, and inv...
<p>ICC: intraclass correlation coefficient; CI: confident interval;</p><p>*Two-... more <p>ICC: intraclass correlation coefficient; CI: confident interval;</p><p>*Two-Way Mixed, Consistency Agreement, Average Measure Model</p><p>Note: When both eyes had VAMPIRE measurement, the mean calculated from both eyes was used.</p><p>Analysis of VAMPIRE measures regarding the inter-operator reliability.</p
Scientific poster presentations
<p>SD: standard deviation;</p><p>*from Bland-Altman analysis</p><p>... more <p>SD: standard deviation;</p><p>*from Bland-Altman analysis</p><p>Correlation of VAMPIRE measure between left and right eyes.</p
Current Cardiology Reviews
: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been demonstrated as... more : Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been demonstrated as a major risk factor in inducing coronary stent thrombosis due to its propensity to create a pro-thrombotic state. This review explores the mechanisms that may contribute to the increased thrombosis risk seen in COVID-19. Furthermore, we discuss the patient and haematological factors that predispose to an increased risk of stent thrombosis, as well as the role of certain antiplatelet and anticoagulation therapies, including ticagrelor and enoxaparin, that may reduce the likelihood and severity of in-stent thrombosis, in SARS-CoV-2 infection. To counter the proinflammatory and pro-thrombotic state shown in COVID-19, anti-thrombotic therapy in the future may be optimised using point-of-care platelet inhibition testing and inflammation-modifying therapies. Large-scale randomised trials with long-term follow-up are increasingly necessary to assess the intersection of COVID-19 and stent optimisation as well as the reduction of stent thrombosis after drug-eluting stent (DES) implantation.
<p>*p-values from chi-squared test (and, for age, chi-squared test for trend)</p><... more <p>*p-values from chi-squared test (and, for age, chi-squared test for trend)</p><p><sup>†</sup> reference group</p><p>Adjusted ORs from multivariable logistic regression model adjusting simultaneously for sex, age and case/control status were almost identical to unadjusted ORs; p values derived from multivariable logistic regression analyses were similar</p><p>Proportions of participants with at least one image that was <i>processable</i> or <i>analysable</i> by gender, age group and case-control status.</p
<p>*based on the UK Biobank Data Showcase 11.</p><p>Participant characteristics... more <p>*based on the UK Biobank Data Showcase 11.</p><p>Participant characteristics.</p
Echocardiography, 2022
Abernethy malformation, or congenital extrahepatic portosystemic venous shunt, is a rare anomaly ... more Abernethy malformation, or congenital extrahepatic portosystemic venous shunt, is a rare anomaly involving the portal venous system. Despite its rarity, it is increasingly being reported, and therefore, it is important to diagnose given the potential adverse clinical consequences if left untreated. It has a spectrum of presentations, ranging from complete lack of symptoms, to causing hepatic carcinoma, hepatic encephalopathy, severe pulmonary hypertension, and diffuse pulmonary arteriovenous malformation. We herein describe the case and echocardiographic, computed tomography, and magnetic resonance imaging findings of a transgender individual, with this anomaly detected incidentally during adulthood.
Correlations and change in ejection fraction (pre to post surgery). (DOCX 176Â kb)
Systemic inflammatory markers. (DOCX 387Â kb)
☯ These authors contributed equally to this work. ¶ Membership details for the UK Biobank Eye and... more ☯ These authors contributed equally to this work. ¶ Membership details for the UK Biobank Eye and Vision Consortium are provided in the Acknowledgements.
Europace, 2021
Type of funding sources: None. Heart rhythm disorders are an important cause of morbidity and eme... more Type of funding sources: None. Heart rhythm disorders are an important cause of morbidity and emergency hospitalisation in patients with adult congenital heart disease (ACHD), and this is due to a combination of surgical scar, residual haemodynamic lesions, and cardiac chamber dilatation. The most effective available treatment is catheter ablation, although this can be extremely challenging owing to abnormal anatomy and problems accessing intra cardiac sites critical to the arrhythmia mechanism. However, outcomes of catheter ablation and analysis of factors which may predict recurrence of arrhythmia remain poorly defined. Purpose To define the cohort of ACHD patients undergoing catheter ablation for atrial arrhythmia in a large tertiary centre, characterise outcomes, and determine factors associated with arrhythmia recurrence. Retrospective study of all catheter ablations for atrial arrhythmias in ACHD patients between April 13, 2016 and December 16, 2019 at our institution. Pati...
BMJ Case Reports, 2021
We herein report the case of a 53-year-old man who was historically diagnosed with hypertrophic c... more We herein report the case of a 53-year-old man who was historically diagnosed with hypertrophic cardiomyopathy (HCM) and was lost to follow-up, before presenting with end-stage heart failure. This was initially suspected as dilated cardiomyopathy and then ‘burnt-out phase’ of HCM but subsequently the underlying diagnosis was Fabry disease. Fabry disease is an uncommon lysosomal-storage disease due to reduced or absent activity of the alpha-galactosidase A enzyme. Cardiac involvement most frequently comprises left ventricular hypertrophy. Early treatment of the underlying condition with enzyme replacement therapy may prevent the progression to end-stage heart failure. Fabry disease should be considered in all patients presenting with a clinical phenotype of HCM and a historical diagnosis should be re-evaluated in light of new diagnostic tools. Untreated Fabry can progress to a ‘burnt out’ phase, whereby initial hypertrophy undergoes eccentric remodelling to a dilated, severely impair...
European Heart Journal - Case Reports, 2021
Background The Gerbode defect is a rare abnormal communication between the left ventricle (LV) a... more Background The Gerbode defect is a rare abnormal communication between the left ventricle (LV) and right atrium (RA). The lesion is either congenital or acquired. Acquired defects are largely iatrogenic or infective in origin. We present two cases of acquired Gerbode defects with similar clinical presentations but very different outcomes. Case summaries Patient 1 A 64-year-old male presented with features of decompensated cardiac failure and a low-grade temperature. Dehiscence of a recently implanted bioprosthetic aortic valve and high-velocity LV to RA jet (Gerbode defect) was found on echocardiography. Blood cultures grew Staphylococcus warneri and the diagnosis of infective endocarditis was established. The patient was treated with intravenous antibiotics and the aortic valve and Gerbode defect were successfully surgically repaired. Patient 2 An 81-year-old male presented after being found on the floor at home. On admission, he was clinically septic with evidence of decompensate...
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Papers by Ahmed El-Medany