Inestroza, Karla

Abstract Background Effusive-constrictive pericarditis (ECP) is a condition where acute pericarditis causes a pericardial effusion and stiffening of the pericardium, which can result in haemodynamic instability due to compression of right-sided cardiac chambers. Here, we present a patient with cardiac tamponade followed by ECP complicating treatment of acute myocardial infarction/cardiogenic shock supported with a percutaneous left ventricular assist device (PVAD). Case summary A 65-year-old male presented with an anterior ST-elevation myocardial infarction and cardiogenic shock. The left anterior descending artery was stented, and a PVAD was placed. The patient was haemodynamically unstable, and the PVAD had frequent suction alarms at higher flow rates. Pulsus paradoxus was noted on the arterial line tracing. Echocardiography showed a large pericardial effusion, which was drained with improvement in cardiac output. However, the patient soon worsened again with continued PVAD suction alarms, and this time echocardiography demonstrated constrictive physiology. The patient was treated with anti-inflammatory medications with improvement in haemodynamics. The PVAD was able to be weaned, and the patient was discharged in stable condition. Discussion Effusive-constrictive pericarditis is a syndrome exhibiting the physiology of both cardiac tamponade and constrictive pericarditis. Effusive-constrictive pericarditis should be considered in patients whose haemodynamics do not improve after pericardiocentesis. This patient had a PVAD placed, which relies on left ventricular preload to increase cardiac output. The numerous suction alarms encountered during this patient’s intensive care unit course were likely due to ECP decreasing preload.

Patients with psoriasis (PsO) and psoriatic arthritis (PsA) are at significantly increased risk for cardiovascular (CV) disease, attributed to chronic systemic inflammation and a high burden of cardiometabolic comorbidities. Despite this, CV risk factors in this population are frequently underdiagnosed and undertreated. This consensus document, developed by the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN), provides practical recommendations for dermatologists, rheumatologists, and primary care physicians to improve CV risk assessment and management in PsO and PsA. Key recommendations include conducting baseline CV risk assessments at diagnosis—particularly for patients with moderate-to-severe PsO, PsA, or those requiring biologic therapy—and routine screening for hypertension, diabetes, dyslipidemia, smoking, obesity, and metabolic syndrome. The use of biomarkers such as high-sensitivity C-reactive protein and lipoprotein(a) may help refine risk stratification. Patients at elevated risk should be referred to their primary care provider or a cardiologist for further evaluation and may require additional imaging, including coronary artery calcium scoring. Lifestyle counseling on diet, exercise, weight management, and smoking cessation is essential. Pharmacologic strategies, such as earlier initiation of statins and consideration of glucagon-like peptide-1 (GLP-1) receptor agonists, are encouraged when clinically appropriate. Systemic inflammation should be reduced using anti-inflammatory therapies, although outcome data remain mixed. Clinicians must carefully assess the risks and benefits of NSAIDs, corticosteroids, and Janus kinase (JAK) inhibitors. This document aims to bridge existing gaps in interdisciplinary care and facilitate earlier, more aggressive CV risk management in psoriatic disease, aligning with current cardiology and dermatology guidelines to reduce morbidity and mortality.

Cardiovascular disease (CVD) is a significant health concern influenced by various determinants. Stigma and resilience have emerged as factors in CVD development and management. Women with HIV (WWH) have higher CVD rates than women without HIV. To improve cardiovascular health for WWH, a comprehensive understanding of how these factors interact, the understanding about individual awareness and willingness to engage in risk-reduction interventions are needed. Methods: As part of a study examining CVD risk among WWH aged >35 years old, 90-min focus groups were conducted (May 2022) in the English language. Focus groups aimed to elicit participants’ CVD risk knowledge and potential prevention strategies. Transcripts underwent a qualitative analysis. Results: Nineteen WWH participated in three focus groups. Participants experienced the following: (a) enacted stigma related to their HIV diagnosis (e.g., family, church member, healthcare staff); (b) a recent event (e.g., hospitalization of self/family, death in family, chest pain) triggered both heart health-promoting lifestyle changes and suboptimal health behaviors (e.g., COVID-19 pandemic: unhealthy snacking). Participants wanted to obtain more knowledge (“on a mission”) about CVD risk. In total, 100% expressed willingness to take medication or embark on other lifestyle changes to prevent future CVD events. Although participants identified preventative heart health behaviors (e.g., eating healthy foods; exercising; limiting stress, substances, and smoking), misconceptions were also identified (e.g., “catching” heart disease). Conclusions: Understanding the interplay of the different factors related to heart health is needed both at the provider and the patient level to inform interventions that reduce CVD risk amongst racial/ethnic minoritized women with HIV, living in the Southern region of the US.

Abstract Objective People living with HIV have an increased risk of heart failure (HF). There are different subtypes of HF. Knowledge about the factors differentiating HF subtypes in people with HIV is limited but necessary to guide preventive measures and treatment. Methods A retrospective review of medical records was undertaken in people with HIV aged ≥18 years who received care at the University of Miami/Jackson Memorial HIV Clinic between January 2017 and November 2019 ( N = 1166). Patients with an echocardiogram available for review ( n = 305) were included. HF was defined as a documented diagnosis of any HF subtype ( n = 52). We stratified those with HF by their ejection fraction (EF) into HF with preserved EF (HFpEF), HF with borderline EF, or HF with reduced EF (HFrEF). Results The prevalence of HF was 4.5%. The cohort included 46.2% females and 75% self‐identified African Americans. Those with HF had a higher prevalence of hypertension, prior myocardial infarction, angina, coronary artery disease, percutaneous coronary intervention, coronary artery bypass grafting, diastolic dysfunction, and left ventricle hypertrophy. People with HIV with HF with borderline EF exhibited more coronary artery disease than those with HFpEF. Conclusions We characterize HF in people with HIV in South Florida and report the prevalence of HF and HF subtypes. Only a small percentage of patients had echocardiograms performed, suggesting an ongoing need for recognition of the increased risk of HF in people living with HIV, and raising the concern about lack of awareness contributing to underdiagnosis and missed treatment opportunities in this population.