Cardiovascular Medicine Clinic Chief
- Cardiovascular Disease
- Valvular Heart Disease
- pericardial disease
- Cardiovascular disease in Pregnancy
- women's heart health
- Stanford South Asian Translational Heart Initiative
Clinical Associate Professor, Medicine - Cardiovascular Medicine
Boards, Advisory Committees, Professional Organizations
Task Force Member, CMQCC-Cardiovascular Disease in Pregnancy (2013 - Present)
Reviewer, American Journal of Cardiology (2009 - Present)
Mentor, Association for Women in Science (2013 - Present)
Volunteer, American Heart Association (2009 - Present)
Fellow, American College of Cardiology (2009 - Present)
Residency: Rush University Medical Center (2008) IL
Internship: Rush University Medical Center (2006) IL
Medical Education: The Ohio University College of Medicine on Public Health (2005) OH
Fellowship: Rush University Medical Center (2001) IL
Board Certification, Certification Board of Nuclear Cardiology, Nuclear Cardiology (2011)
Board Certification: American Board of Internal Medicine, Cardiovascular Disease (2012)
Board Certification: National Board of Echocardiography, Echocardiography (2011)
BA, Case Western Reserve University (2000)
MS, Case Western Reserve University, MIS (2001)
MD, The Ohio State University College of Medicine (2005)
Current Research and Scholarly Interests
Cardiovascular disease in Pregnancy
Valvular Heart Disease
Heart Disease in South Asians
Women's Cardiovascular Disease
Early MRI Detection of Myocardial Deterioration as a Preventive, Disease Staging, and Prognostic Biomarker in Insulin Resistance
The purpose of this study is to evaluate the relationship between insulin resistance (IR) and myocardial tissue abnormalities. The study will focus on a patient population, South Asians, with a high prevalence of IR.
Effect of ranolazine on symptom and quality of life in patients with angina in the absence of obstructive coronary artery disease: A case control study.
International journal of cardiology
BACKGROUND: More than 20% of patients presenting to the catheterization lab have no significant obstructive coronary artery disease (CAD) despite having angina. Several occult coronary abnormalities, including endothelial dysfunction, microvascular dysfunction (MVD), and/or a myocardial bridge (MB), may explain their symptoms. We studied the effect of ranolazine on symptoms and quality of life (QOL) in these patients.METHODS: We retrospectively studied 53 patients prescribed with ranolazine, matched on sex and age, with 106 patients on standard of care who underwent comprehensive invasive testing. Endothelial dysfunction was defined as a decrease in luminal diameter of >20% after intracoronary acetylcholine, MVD as an index of microvascular resistance ≥25, and a MB as an echolucent half-moon sign and/or ≥10% systolic compression on intravascular ultrasound. A Seattle Angina Questionnaire (SAQ) and SF-12 questionnaire were completed at baseline and follow-up.RESULTS: Median follow-up was 1.9 (1.7-2.2) years. Endothelial dysfunction was present in 109 (69%), MVD in 36 (23%), and an MB in 86 (54%). Both groups had significant improvement in all dimensions of the SF-12 and SAQ with the exception of treatment satisfaction. We found no significant difference in change in SAQ and SF-12 scores between the groups, although the ranolazine group had significantly lower baseline SAQ scores.CONCLUSION: In patients with angina and no obstructive CAD, ranolazine is no different than standard of care in symptomatic and QOL improvement. Further randomized trials are warrented to confirm our findings and identify novel medical therapies in this patient population.
View details for DOI 10.1016/j.ijcard.2020.02.014
View details for PubMedID 32220488
Takayasu's Arteritis and Pregnancy
CARDIAC PROBLEMS IN PREGNANCY, 4TH EDITION
View details for Web of Science ID 000509558000022
- Psychological Distress Among Female Cardiac Patients Presenting to a Women's Heart Health Clinic AMERICAN JOURNAL OF CARDIOLOGY 2019; 123 (12): 2026–30
- Efficacy of a Telehealth Preventive Cardiology Lifestyle Intervention Program to Treat High-Risk South Asians AMER DIABETES ASSOC. 2019
Psychological Distress Among Female Cardiac Patients Presenting to a Women's Heart Health Clinic.
The American journal of cardiology
Female cardiac patients are at greater risk for mental health disorders than their male counterparts, and these mental health disorders have been associated with increased cardiac morbidity and mortality. However, few studies have closely examined the mental health disorders found among the female cardiac population. The primary aim of this study was to examine the prevalence of psychological distress in a sample of female cardiac outpatients at an academic medical center. A secondary aim was to determine whether different demographic variables, cardiac risk factors, or cardiac diagnoses were associated with different levels of emotional distress. A survey, including demographic information, medical status, and standardized symptom measures was completed by 117 female patients scheduled for medical visits at an outpatient women's heart health clinic over a 4-month period. Using standardized self-report questionnaires, 38% scored in the moderate-to-severe range for at least 1 mental disorder and 50% endorsed current insomnia. Symptoms of clinical depression (20%) and anxiety (42)% were endorsed at higher rates than predominantly male or mixed comparison samples. Although there was no apparent relation between the severity of cardiac problems and the degree of psychological distress, women with diagnoses of hyperlipidemia, prediabetes, and diabetes reported greater psychological distress than those without these problems. Women with lower income also reported more psychological distress. In conclusion, our findings suggest an unmet need for integrated mental health services for female cardiac patients.
View details for PubMedID 31006484
Maternal Outcomes in Planned and Unplanned Pregnancies in Women with Cardiac Disease.
SAGE PUBLICATIONS INC. 2019: 323A
View details for Web of Science ID 000459610400771
A Multidisciplinary Approach to Care of Pregnant Patients with History of Open Heart Surgery.
SAGE PUBLICATIONS INC. 2019: 323A–324A
View details for Web of Science ID 000459610400772
- CardioClick an Innovative Telehealth Approach to Lifestyle Intervention in High Risk South Asians LIPPINCOTT WILLIAMS & WILKINS. 2019
- Care of the pregnant cardiac patient e the importance of a multidisciplinary approach MOSBY-ELSEVIER. 2019: S536
- EFFECT OF RANOLAZINE ON SYMPTOMS AND QUALITY OF LIFE IN PATIENTS WITH ANGINA IN THE ABSENCE OF OBSTRUCTIVE CORONARY ARTERY DISEASE: A RETROSPECTIVE COHORT STUDY ELSEVIER SCIENCE INC. 2018: 161
Hypertensive Disorders of Pregnancy.
Current atherosclerosis reports
2017; 19 (3): 15-?
Although pregnancy-related deaths are rare in the USA, they are on the rise and have more than doubled in the last 20 years. A substantial portion of these deaths are related to cardiovascular disease, specifically hypertensive disorders of pregnancy (HDP). In this review, we will discuss the definitions and proposed pathophysiology of HDP as well as its potential role in cardiovascular morbidity and mortality.Placental hypoperfusion may lead to an imbalance in proangiogenic and antiangiogenic factors, notably an increase in soluble fms-like tyrosine kinsase-1 (sFlt-1), thereby leading to endothelial dysfunction. Progress has been made in terms of determining the factors which lead to preeclampsia. Potential novel biomarkers for predicting preeclampsia risk have been identified through this research. Preeclampsia not only has important implications for the health during pregnancy but also for future cardiovascular risk. However, the exact mechanism by which it increases cardiovascular risk and the degree of risk it portends are yet to be elucidated.
View details for DOI 10.1007/s11883-017-0648-z
View details for PubMedID 28229431
External validation of a novel transthoracic echocardiographic tool in predicting left atrial appendage thrombus formation in patients with nonvalvular atrial fibrillation
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
2013; 14 (9): 876-881
A recent study demonstrated that in patients with nonvalvular atrial fibrillation (AF), a ratio of left ventricular ejection fraction (LVEF) to the left atrial volume index (LAVI) of <1.5 has 100% sensitivity for detecting left atrial appendage (LAA) thrombus. We sought to validate this prediction tool in an external cohort.We conducted a cohort study of consecutive AF patients who underwent transoesophageal echocardiogram (TEE) to 'rule-out' LAA thrombus and had a prior transthoracic echocardiogram (TTE). The LAVI and LVEF were measured to calculate LVEF/LAVI ratio. The sensitivity and specificity of LVEF/LAVI <1.5 were calculated.Among 215 subjects, 19 (8.8%) had LAA thrombus and also had a higher mean CHADS2 score (2.5 vs. 1.9, P = 0.04), lower mean LVEF (24 vs. 44%, P < 0.001), higher mean LAVI (44 mL/m2 vs. 30 mL/m2, P < 0.001), and higher prevalence of cardiac failure (79 vs. 52%, P = 0.02). The LVEF and LAVI were found to be independent predictors of LAA thrombus (P < 0.05). The LVEF/LAVI ratio diagnosed LAA thrombus with an area under the curve = 0.83 by the receiver operator characteristics curve analysis (P < 0.001). All 19 (100%) subjects with LAA thrombus had LVEF/LAVI <1.5 vs. 87 (44%) among those without LAA thrombus (P < 0.001). The sensitivity and specificity of LVEF/LAVI <1.5 were 100 and 55.6%, respectively.This investigation validates a simple TTE prediction rule to exclude the diagnosis of LAA thrombus, which may obviate the need for pre-cardioversion TEE in selected patients with nonvalvular AF.
View details for DOI 10.1093/ehjci/jes313
View details for Web of Science ID 000322953100008
View details for PubMedID 23291395
- Local Fibrinolysis for Massive Pulmonary Embolism: Teaching an Old Catheter New Tricks SOUTHERN MEDICAL JOURNAL 2010; 103 (5): 396-397
Recurrent Events Following Patent Foramen Ovale Closure in Patients Above 55 Years of Age With Presumed Paradoxical Embolism
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
2008; 72 (7): 966-970
The aim of this article is to summarize our experience of patent foramen ovale (PFO) closure in patients above the age of 55 years.PFO is associated with cryptogenic thromboembolic events (TEs) in patients younger than 55 years. Little is known about the recurrence rate of TE in patients above the age of 55 years undergoing PFO closure for presumed paradoxical embolism.PFO closure was performed in 1,055 patients, 423 of whom were above 55 years of age. Implantation of the device was guided by fluoroscopy and transesophageal or intracardiac echocardiography.A PFO occluding device was implanted successfully in all patients. Residual shunt was documented in 10% of patients above 55 years of age and in 8.4% of patients aged 55 years or younger (P = 0.325). During a median follow-up period of 18 months (range, 0-162 months) the annual incidence of recurrent TE in patients above 55 years was 1.8% while patients aged 55 or below had an annual incidence of recurrent TE of 1.3%. TE-free survival was similar in patients above 55 years of age compared with those aged 55 years and below.PFO closure in older patients is as efficient and seems comparable to those under the age of 55. Although traditional cardiovascular risk factors may be more frequent in the older age group compared with those younger than 55 years, PFO closure should not be withheld as a possible therapeutic option in this age group.
View details for DOI 10.1002/ccd.21737
View details for Web of Science ID 000261602000014
View details for PubMedID 18942060
Percutaneous Mechanical Thrombectomy for Massive Pulmonary Embolism Using a Conservative Treatment Strategy
JOURNAL OF INTERVENTIONAL CARDIOLOGY
2008; 21 (6): 566-571
Percutaneous mechanical thrombectomy (PMT) for treatment of massive pulmonary embolism (PE) has been shown to be technically feasible, although the complication rate of the procedure appears relatively high. Whether a conservative treatment approach defined by an early termination of the PMT procedure once hemodynamic and clinical parameters of the patient have improved is associated with lower complication rates is unknown. We report our experience of PMT in patients with massive PE using the Angiojet system following a conservative treatment strategy.From April 2003 until November 2007, 13 patients underwent PMT with the Angiojet system. Indications for PMT were massive PE and either failed thrombolysis or contraindications to thrombolytic therapy. All patients were deemed high risk for surgical thrombectomy.Technical success was achieved in 12 patients (92%). Mean systemic arterial pressure increased from 87 to 106 mmHg following PMT (P = 0.011), while the heart rate decreased from 119 to 97 beats per minute (P = 0.041). In-hospital mortality was 15% (2 of 13 patients). No complications occurred which were attributable to the PMT procedure. Right ventricular size and function improved in the majority of patients following the PMT procedure.Using a conservative treatment approach of PMT for the treatment of massive PE carries a low periprocedural complication rate. The low morbidity was achieved without compromising clinical outcome, documented by an in-hospital mortality of 15%. PMT using a conservative treatment approach may result in comparable mortality, but lower morbidity than PMT using more aggressive, angiographically guided treatment strategies.
View details for DOI 10.1111/j.1540-8183.2008.00405.x
View details for Web of Science ID 000261065100014
View details for PubMedID 18973510
Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults
AMERICAN JOURNAL OF CARDIOLOGY
2008; 102 (7): 902-906
Transcatheter closure of secundum atrial septal defect (ASD) and patent foramen ovale (PFO) has become a routine procedure. Little is known about the effect of atrial septal device implantation on the occurrence of atrial fibrillation (AF). We evaluated the frequency of AF occurring after transcatheter PFO and ASD closure in a large population. From 1994 until 2007 a total of 1,062 patients underwent transcatheter closure of an interatrial communication. New-onset AF was defined by 12-lead electrocardiogram or Holter monitoring in patients without a history of AF at baseline. Of the 1,062 patients, 822 had a PFO and 240 had an ASD. During a median follow up of 20 months, new-onset AF was documented in 8% of patients. New-onset AF occurred in 7% of patients after PFO closure and in 12% of patients with underlying ASD. The annual incidence of new-onset AF was 2.5% and 4.1% in patients with PFO and ASD, respectively. Generally, patients with new-onset AF were older than those without AF. Device type or size did not influence the occurrence of AF. In the group of patients with PFO, residual shunt was more common in patients with AF compared with the non-AF group. In conclusion, AF is more common after PFO and ASD closure compared with the general population; although device type or size did not impact the occurrence of AF, residual shunt may influence the occurrence of AF after intervention in patients with underlying PFO.
View details for DOI 10.1016/j.amjcard.2008.05.045
View details for Web of Science ID 000259616100020
View details for PubMedID 18805119
Idiopathic hemophagocytic syndrome with a fulminant clinical course.
Clinical advances in hematology & oncology : H&O
2008; 6 (8): 587-590
View details for PubMedID 18820601
Patent Foramen Ovale and the Risk of First Ischemic Stroke
Expert Review of Cardiovascular Therapy
2007; 5 (5): 821-824
View details for DOI 10.1586/14779072.5.5.821
The Clinical Picture - A young woman with an eroded plaque on the hand
CLEVELAND CLINIC JOURNAL OF MEDICINE
2006; 73 (4): 369-371
View details for Web of Science ID 000236650600013
Subclinical chronic lymphocytic leukaemia associated with a 13q deletion presenting initially in the skin: apropos of a case
JOURNAL OF CUTANEOUS PATHOLOGY
2006; 33 (3): 256-259
B-cell chronic lymphocytic leukaemia (B-CLL) represents a low-grade B-cell lymphoproliferative disease that is the most common leukaemia in adults. The neoplastic cell is an autoreactive CD5 CD23 B lymphocyte. B-CLL may involve the skin, typically in the context of known disease. We present a case of subclinical B-CLL presenting initially in the skin.A 73-year-old male developed a lesion on his right cheek in April 2003 compatible with basal cell carcinoma. The re-excision specimen contained a well-differentiated atypical lymphocytic infiltrate consistent with B-CLL along with residual carcinoma. Subsequent laboratory studies revealed peripheral blood lymphocytosis with smudge cells. A diagnosis was made of Rai stage 0 CLL. Chromosomal studies on peripheral blood showed a deletion at 13q14.3. Excision of a second primary skin carcinoma revealed a squamous cell carcinoma in association with B-CLL that was identical to his previously diagnosed skin involvement.This case identifies a cutaneous presentation of subclinical B-CLL. There are two prior reports describing B-CLL presenting initially in the skin. In one case, the infiltrates were incidental on a re-excision specimen. The second report suggests 16% of B-CLL patients have cutaneous manifestations as the first sign of disease.
View details for Web of Science ID 000235210500011
View details for PubMedID 16466516