Shaffi Kanjwal | Central Michigan University (original) (raw)

Papers by Shaffi Kanjwal

Chest, Oct 1, 2011

PURPOSE: Periodic limb movement disorder is characterized by rhythmic movements of lower extremit... more PURPOSE: Periodic limb movement disorder is characterized by rhythmic movements of lower extremity and results in complaints of insomnia and excessive day time sleepiness.Our main objective was to compare periodic limb movements in right handed patients versus those in left handed patients. we would like to investigate hemispheric dominance Vs limb involment in periodic leg movement disorder to direct us to further investigations focusing on spinal reflex arcs versus cortical/upper motor neuronal processes. METHODS: This was a retrospective analysis of 100 patients of periodic limb movement disorder. These patients were categorized into left handed and right handed patients. These two groups of patients (Left vs. Right handed) were compared for various clinical and polysomnography characteristics. Continuous data is presented as mean± SD and categorical as percentages. RESULTS: Eighty four patients were right handed and 16 left handed. Sixty nine percent of right handed patients had bilateral limb movements compared to 94 % of left handed patients(p= 0.04). Age, sex, race and predominant left sided movement was not significantly different in the two groups. CONCLUSIONS: Left handed people have significantly higher chances of having bilateral limb movements compared to right handed people. CLINICAL IMPLICATIONS: To date , no one has investigates if handedness (left or right) affects the side(s) involved in periodic leg movement disorder, it would be of value to know whether right or left hemisphere motor dominanace affects PLMD because this would lead studies to focus on cortical irritants stimulating the movement disorder.

D51. STRANGE RANGERS IN THE ICU: SELECTED CASE REPORTS, 2010

/ Thematic Poster Session / Wednesday, May 19/8:15 AM-4:00 ... D51 STRANGE RANGERS IN THE ICU: SE... more / Thematic Poster Session / Wednesday, May 19/8:15 AM-4:00 ... D51 STRANGE RANGERS IN THE ICU: SELECTED CASE REPORTS ... PM / Area H, Hall G (First Level), Morial Convention Center ... , Z. Mattar , J. Taji , S. Avasthi , MS Kanjwal , M. Niazi , N. Torok , R. Assaly R. ...

D43. INTERESTING CASES OF TUMORS AND MORE, 2010

University of Toledo Medical Center, Toledo, OH, United States of America, UTMC, Toledo, OH, Unit... more University of Toledo Medical Center, Toledo, OH, United States of America, UTMC, Toledo, OH, United States of America, Toledo, OH, 1 ... Corresponding author's email: rajan.goyal@utoledo.edu ... Introduction : We present here a case of primary lung ...

C75. OTHER SLEEP ISSUES, 2011

C49. RECENT DEVELOPMENTS ON HYPERSENSITIVITY PNEUMONITIS, 2010

... Toledo, OH, 1 2 3 United States of America Corresponding author's email:rajan.goyal@utol... more ... Toledo, OH, 1 2 3 United States of America Corresponding author's email:rajan.goyal@utoledo.edu 30 Year Old female. Gradually worsening SOB in the last year.Respiratory distress with severe hypoxemia. No cough, fever ...

D51. STRANGE RANGERS IN THE ICU: SELECTED CASE REPORTS, 2010

We discuss the case of a 63 years old female who required repeated intubation due to recurrent pu... more We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition. Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation. Key Words: hypertrophic cardiomyopathy; pulmonary edema; dual chamber pacemaker Background Hypertrophic cardiomyopathy has been reported as a cause of failure to wean from mechanical ventilator 1.We report a case of hypertrophic cardiomyopathy with recurrent failures to wean from a mechanical ventilator. Patient underwent dual chamber pacemaker implantation and AV node modification, with improvement in left ventricular outflow tract (LVOT) gradient. Patient was subsequently successfully extubated. Case 63-year-old Caucasian female, with past med...

Indian Pacing and Electrophysiology Journal, Nov 1, 2008

We discuss the case of a 63 years old female who required repeated intubation due to recurrent pu... more We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition. Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation.

Indian Pacing and Electrophysiology Journal, 2008

We discuss the case of a 63 years old female who required repeated intubation due to recurrent pu... more We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition. Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation.

Coronary vasospasm is an episodic, augmented, contractile response of coronary smooth muscles to ... more Coronary vasospasm is an episodic, augmented, contractile response of coronary smooth muscles to variety of stimuli in the setting of established endothelial dysfunction. Various physiological including cold, stress and pathological factors like smoking, and ethanol have been well known to precipitate vasospasm. Despite these omnipresent factors, coronary vasospasm has become infrequent, in particular due to judicious use of medication including calcium channel blockers, statins and aspirin. We present a case of severe coronary vasospasm resulting in haemodynamic instability, in a patient with hypoxic respiratory failure. Recurrent symptomatic episodes required coronary angiography for the diagnosis and patient was successfully treated with calcium channel blockers.

The Internet Journal of Pulmonary Medicine

Introduction: Pulmonary involvement in classical polyarteritis nodosa is very uncommon. A 65 year... more Introduction: Pulmonary involvement in classical polyarteritis nodosa is very uncommon. A 65 year old woman with well documented, classical polyarteritis nodosa was found to have pulmonary capillaritis presenting as alveolar hemorrhage. Patient responded well to the treatment for alveolar hemorrhage.Methods: We report a case of polyarteritis nodosa with diffuse alveolar hemorrhage due to pulmonary capillaritis.Discussion: We describe a case of Polyarteritis nodosa who presented with pulmonary hemorrhage due to pulmonary capillaritis and hence might represent an overlap of polyarteritis nodosa with Microscopic Polyangiitis (MPA) or other unclassified collagen vascular disease.Conclusion: We conclude that pulmonary capillaritis can coexist with "classical" polyarteritis nodosa.

Respiratory failure in right ventricular infarction can occur due to right to left shunt often at... more Respiratory failure in right ventricular infarction can occur due to right to left shunt often at inter atrial level. We discuss a patient of inferior wall myocardial infarction with right ventricular extension who developed hypoxia and acute respiratory failure refractory to high concentrations of oxygen. She required mechanical ventilation. Echocardiography with bubble contrast showed a right to left shunt at interatrial level. She was treated with nitric oxide enriched oxygen therapy which improved her pulmonary arterial and right heart pressures and her hypoxia improved. She was weaned off the ventilator and successfully extubated.

The Internet Journal of Cardiovascular Research, 2007

Left ventricular noncompaction (LVNC) is known by different names like noncompaction of ventricul... more Left ventricular noncompaction (LVNC) is known by different names like noncompaction of ventricular myocardium, and ventricular trabeculation(1) .WHO classifies LVNC as unclassified cardiomyopathy(1 , 2 , 3 , 4 , 5) ETIOPATHOGENESIS LVNC is a rare type of cardiomyopathy characterized by spongy myocardium and results from arrest in endomyocardial morphogenesis. In the early embryonic period human heart consists of spongy meshwork of interwoven muscle fibers and trabeculae. These communicate through recesses with the ventricular cavity. The blood is supplied to the myocardium through these trabeculae resembling the circulation of nonmammalian vertebrates(6 , 7). During sixth to eighth week of intrauterine life human heart undergoes compaction of this loose and honeycomb structure. The process of compaction proceeds from epicardium to the endocardium and from base to the apex. Arrest of compaction results in persistence of trabeculation and deep recesses(7). Noncompaction is usually isolated but rarely occurs in association with anomalous left coronary artery from pulmonary artery (ALCAPA), complex cyanotic heart diseases, right ventricular outflow tract and left ventricular outflow tract obstruction and Eibsteins anomaly(8 , 9 , 10 , 11 , 12). It may be associated with Beckers and mitochondrial myopathy (13 , 14 , 15 , 16 , 17 , 18 , 19).

The Internet Journal of Cardiovascular Research, 2007

We discuss a 48 year old female of takotsubo cardiomyopathy, who presented with chest pain, T wav... more We discuss a 48 year old female of takotsubo cardiomyopathy, who presented with chest pain, T wave inversion on electrocardiogram (EKG) and elevated cardiac enzymes following an episode of emotional stress. In emergency room she had an episode of sustained ventricular tachycardia. She was taken to cardiac catheterization laboratory, which revealed normal epicardial coronary arteries. Her left ventriculogram revealed a balloon shaped apex.

Internet Journal of Cardiovascular Research, 2007

Carotid sinus hypersensivity syndrome also known as Bishop's syndrome is an uncommon cause of syn... more Carotid sinus hypersensivity syndrome also known as Bishop's syndrome is an uncommon cause of syncope. Carotid sinus hypersensitivity may be an important cause of syncope even in patients thought to have other causes of syncope. We report a patient who presented with syncope and had supraventricular tachycardia documented on Holter monitor. Patient subsequently underwent diagnostic EP study and was inducible for two different types of tachycardias that obviously were not the cause of syncope. He finally had long hemodynamically significant pauses on carotid sinus massage.

Journal of Innovations in Cardiac Rhythm Management

We discuss the case of a 22-year-old female who presented to the clinic experiencing recurrent pa... more We discuss the case of a 22-year-old female who presented to the clinic experiencing recurrent palpitations. She was also found to have intermittent preexcitation on her electrocardiogram (ECG). Her palpitations were attributed to stress. Previously, she had gone to the emergency department a few times and was diagnosed with sinus tachycardia. Her ECG revealed a right-sided accessory pathway. Given her atypical finding of orthodromic reciprocating tachycardia, a 30-day event monitor was implanted, which revealed that one episode was correlated with sinus tachycardia, with a heart rate of 120 bpm. She mentioned experiencing other episodes that were severe, but she did not activate the monitor manually at the time of these incidents. After a long discussion with the patient about available management options for her symptoms, it was decided to proceed with longterm monitoring with an implantable loop recorder to gather better symptom-rhythm correlation data. At six months after surgery, the patient experienced multiple manually triggered transmissions from her device, which were all consistent with sinus tachycardia. She had no episode suggestive of any supraventricular tachycardia and is thus being treated for inappropriate sinus tachycardia. This case highlights the importance of gathering adequate symptom-rhythm correlation data before pursuing more invasive treatment options for an arrhythmic etiology in low-risk patients.

C75. OTHER SLEEP ISSUES, 2011

American Journal of Therapeutics

Indian pacing and electrophysiology journal, 2008

We discuss the case of a 63 years old female who required repeated intubation due to recurrent pu... more We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition. Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation.

Chest, Oct 1, 2011

PURPOSE: Periodic limb movement disorder is characterized by rhythmic movements of lower extremit... more PURPOSE: Periodic limb movement disorder is characterized by rhythmic movements of lower extremity and results in complaints of insomnia and excessive day time sleepiness.Our main objective was to compare periodic limb movements in right handed patients versus those in left handed patients. we would like to investigate hemispheric dominance Vs limb involment in periodic leg movement disorder to direct us to further investigations focusing on spinal reflex arcs versus cortical/upper motor neuronal processes. METHODS: This was a retrospective analysis of 100 patients of periodic limb movement disorder. These patients were categorized into left handed and right handed patients. These two groups of patients (Left vs. Right handed) were compared for various clinical and polysomnography characteristics. Continuous data is presented as mean± SD and categorical as percentages. RESULTS: Eighty four patients were right handed and 16 left handed. Sixty nine percent of right handed patients had bilateral limb movements compared to 94 % of left handed patients(p= 0.04). Age, sex, race and predominant left sided movement was not significantly different in the two groups. CONCLUSIONS: Left handed people have significantly higher chances of having bilateral limb movements compared to right handed people. CLINICAL IMPLICATIONS: To date , no one has investigates if handedness (left or right) affects the side(s) involved in periodic leg movement disorder, it would be of value to know whether right or left hemisphere motor dominanace affects PLMD because this would lead studies to focus on cortical irritants stimulating the movement disorder.

D51. STRANGE RANGERS IN THE ICU: SELECTED CASE REPORTS, 2010

/ Thematic Poster Session / Wednesday, May 19/8:15 AM-4:00 ... D51 STRANGE RANGERS IN THE ICU: SE... more / Thematic Poster Session / Wednesday, May 19/8:15 AM-4:00 ... D51 STRANGE RANGERS IN THE ICU: SELECTED CASE REPORTS ... PM / Area H, Hall G (First Level), Morial Convention Center ... , Z. Mattar , J. Taji , S. Avasthi , MS Kanjwal , M. Niazi , N. Torok , R. Assaly R. ...

D43. INTERESTING CASES OF TUMORS AND MORE, 2010

University of Toledo Medical Center, Toledo, OH, United States of America, UTMC, Toledo, OH, Unit... more University of Toledo Medical Center, Toledo, OH, United States of America, UTMC, Toledo, OH, United States of America, Toledo, OH, 1 ... Corresponding author's email: rajan.goyal@utoledo.edu ... Introduction : We present here a case of primary lung ...

C75. OTHER SLEEP ISSUES, 2011

C49. RECENT DEVELOPMENTS ON HYPERSENSITIVITY PNEUMONITIS, 2010

... Toledo, OH, 1 2 3 United States of America Corresponding author's email:rajan.goyal@utol... more ... Toledo, OH, 1 2 3 United States of America Corresponding author's email:rajan.goyal@utoledo.edu 30 Year Old female. Gradually worsening SOB in the last year.Respiratory distress with severe hypoxemia. No cough, fever ...

D51. STRANGE RANGERS IN THE ICU: SELECTED CASE REPORTS, 2010

We discuss the case of a 63 years old female who required repeated intubation due to recurrent pu... more We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition. Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation. Key Words: hypertrophic cardiomyopathy; pulmonary edema; dual chamber pacemaker Background Hypertrophic cardiomyopathy has been reported as a cause of failure to wean from mechanical ventilator 1.We report a case of hypertrophic cardiomyopathy with recurrent failures to wean from a mechanical ventilator. Patient underwent dual chamber pacemaker implantation and AV node modification, with improvement in left ventricular outflow tract (LVOT) gradient. Patient was subsequently successfully extubated. Case 63-year-old Caucasian female, with past med...

Indian Pacing and Electrophysiology Journal, Nov 1, 2008

We discuss the case of a 63 years old female who required repeated intubation due to recurrent pu... more We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition. Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation.

Indian Pacing and Electrophysiology Journal, 2008

We discuss the case of a 63 years old female who required repeated intubation due to recurrent pu... more We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition. Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation.

Coronary vasospasm is an episodic, augmented, contractile response of coronary smooth muscles to ... more Coronary vasospasm is an episodic, augmented, contractile response of coronary smooth muscles to variety of stimuli in the setting of established endothelial dysfunction. Various physiological including cold, stress and pathological factors like smoking, and ethanol have been well known to precipitate vasospasm. Despite these omnipresent factors, coronary vasospasm has become infrequent, in particular due to judicious use of medication including calcium channel blockers, statins and aspirin. We present a case of severe coronary vasospasm resulting in haemodynamic instability, in a patient with hypoxic respiratory failure. Recurrent symptomatic episodes required coronary angiography for the diagnosis and patient was successfully treated with calcium channel blockers.

The Internet Journal of Pulmonary Medicine

Introduction: Pulmonary involvement in classical polyarteritis nodosa is very uncommon. A 65 year... more Introduction: Pulmonary involvement in classical polyarteritis nodosa is very uncommon. A 65 year old woman with well documented, classical polyarteritis nodosa was found to have pulmonary capillaritis presenting as alveolar hemorrhage. Patient responded well to the treatment for alveolar hemorrhage.Methods: We report a case of polyarteritis nodosa with diffuse alveolar hemorrhage due to pulmonary capillaritis.Discussion: We describe a case of Polyarteritis nodosa who presented with pulmonary hemorrhage due to pulmonary capillaritis and hence might represent an overlap of polyarteritis nodosa with Microscopic Polyangiitis (MPA) or other unclassified collagen vascular disease.Conclusion: We conclude that pulmonary capillaritis can coexist with "classical" polyarteritis nodosa.

Respiratory failure in right ventricular infarction can occur due to right to left shunt often at... more Respiratory failure in right ventricular infarction can occur due to right to left shunt often at inter atrial level. We discuss a patient of inferior wall myocardial infarction with right ventricular extension who developed hypoxia and acute respiratory failure refractory to high concentrations of oxygen. She required mechanical ventilation. Echocardiography with bubble contrast showed a right to left shunt at interatrial level. She was treated with nitric oxide enriched oxygen therapy which improved her pulmonary arterial and right heart pressures and her hypoxia improved. She was weaned off the ventilator and successfully extubated.

The Internet Journal of Cardiovascular Research, 2007

Left ventricular noncompaction (LVNC) is known by different names like noncompaction of ventricul... more Left ventricular noncompaction (LVNC) is known by different names like noncompaction of ventricular myocardium, and ventricular trabeculation(1) .WHO classifies LVNC as unclassified cardiomyopathy(1 , 2 , 3 , 4 , 5) ETIOPATHOGENESIS LVNC is a rare type of cardiomyopathy characterized by spongy myocardium and results from arrest in endomyocardial morphogenesis. In the early embryonic period human heart consists of spongy meshwork of interwoven muscle fibers and trabeculae. These communicate through recesses with the ventricular cavity. The blood is supplied to the myocardium through these trabeculae resembling the circulation of nonmammalian vertebrates(6 , 7). During sixth to eighth week of intrauterine life human heart undergoes compaction of this loose and honeycomb structure. The process of compaction proceeds from epicardium to the endocardium and from base to the apex. Arrest of compaction results in persistence of trabeculation and deep recesses(7). Noncompaction is usually isolated but rarely occurs in association with anomalous left coronary artery from pulmonary artery (ALCAPA), complex cyanotic heart diseases, right ventricular outflow tract and left ventricular outflow tract obstruction and Eibsteins anomaly(8 , 9 , 10 , 11 , 12). It may be associated with Beckers and mitochondrial myopathy (13 , 14 , 15 , 16 , 17 , 18 , 19).

The Internet Journal of Cardiovascular Research, 2007

We discuss a 48 year old female of takotsubo cardiomyopathy, who presented with chest pain, T wav... more We discuss a 48 year old female of takotsubo cardiomyopathy, who presented with chest pain, T wave inversion on electrocardiogram (EKG) and elevated cardiac enzymes following an episode of emotional stress. In emergency room she had an episode of sustained ventricular tachycardia. She was taken to cardiac catheterization laboratory, which revealed normal epicardial coronary arteries. Her left ventriculogram revealed a balloon shaped apex.

Internet Journal of Cardiovascular Research, 2007

Carotid sinus hypersensivity syndrome also known as Bishop's syndrome is an uncommon cause of syn... more Carotid sinus hypersensivity syndrome also known as Bishop's syndrome is an uncommon cause of syncope. Carotid sinus hypersensitivity may be an important cause of syncope even in patients thought to have other causes of syncope. We report a patient who presented with syncope and had supraventricular tachycardia documented on Holter monitor. Patient subsequently underwent diagnostic EP study and was inducible for two different types of tachycardias that obviously were not the cause of syncope. He finally had long hemodynamically significant pauses on carotid sinus massage.

Journal of Innovations in Cardiac Rhythm Management

We discuss the case of a 22-year-old female who presented to the clinic experiencing recurrent pa... more We discuss the case of a 22-year-old female who presented to the clinic experiencing recurrent palpitations. She was also found to have intermittent preexcitation on her electrocardiogram (ECG). Her palpitations were attributed to stress. Previously, she had gone to the emergency department a few times and was diagnosed with sinus tachycardia. Her ECG revealed a right-sided accessory pathway. Given her atypical finding of orthodromic reciprocating tachycardia, a 30-day event monitor was implanted, which revealed that one episode was correlated with sinus tachycardia, with a heart rate of 120 bpm. She mentioned experiencing other episodes that were severe, but she did not activate the monitor manually at the time of these incidents. After a long discussion with the patient about available management options for her symptoms, it was decided to proceed with longterm monitoring with an implantable loop recorder to gather better symptom-rhythm correlation data. At six months after surgery, the patient experienced multiple manually triggered transmissions from her device, which were all consistent with sinus tachycardia. She had no episode suggestive of any supraventricular tachycardia and is thus being treated for inappropriate sinus tachycardia. This case highlights the importance of gathering adequate symptom-rhythm correlation data before pursuing more invasive treatment options for an arrhythmic etiology in low-risk patients.

C75. OTHER SLEEP ISSUES, 2011

American Journal of Therapeutics

Indian pacing and electrophysiology journal, 2008

We discuss the case of a 63 years old female who required repeated intubation due to recurrent pu... more We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition. Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation.