Cardiovascular Fellow Wins Poster Award at National Meeting

Singh’s poster describes a case of coronary subclavian steal syndrome (CSSS) resulting in symptomatic myocardial ischemia.

It scored in the top 5 percent of all submissions.

CSSS is a rare complication in patients who have received a coronary artery bypass graft (CABG) using the left internal mammary artery (LIMA). It occurs when blood is diverted away from the coronary artery through the LIMA as a result of stenosis of the proximal left subclavian artery (LSA).

In the case Singh described, a 61-year-old woman — who’d had a heart attack necessitating CABG a decade prior — arrived at Buffalo General Medical Center complaining of chest pain.

Bloodwork revealed that she was having another heart attack; coronary angiography showed two new, major blockages.

To determine which blockage was causing the patient’s symptoms, physicians administered a vasodilator nuclear stress test. It showed significantly limited blood flow in the front of the heart and no such limitation on the right side, indicating that LSA stenosis was causing the patient’s symptoms by “stealing” blood from the left anterior descending artery.

The patient underwent proximal LSA stenting, which immediately resolved her symptoms.

“Correctly diagnosing CSSS requires a multimodality diagnostic approach,” Singh says.

“This unique case demonstrated that vasodilator nuclear stress testing can accurately detect the regional limitations in coronary blood flow caused by this condition.”

Singh credits her mentor and study co-author —  Saurabh Malhotra, MD, clinical assistant professor of medicine — with inspiring her to pursue her goals with “hard work, sincerity and dedication.”

“Dr. Malhotra is a patient educator who offers me a safe place to test-drive ideas,” Singh says.

“Despite a very busy schedule, he has always been very generous with his time and guidance. I find that his passion kick-starts my own assessment of where I want my professional journey to take me,” she says.

Singh is pleased to be training in the cardiovascular disease fellowship, not only for the thoughtful guidance she receives, but for the “important life lessons” that will carry her throughout her career.

“My training and experience at UB will enable me to spread my wings anywhere I choose to work and practice.”

In addition to Malhotra, Singh’s co-authors on the study were:

• Stanley F. Fernandez, MD, PhD, research assistant professor of medicine
• Abhishek Sawant, MD, MPH, a first-year cardiovascular disease fellow

The title of the study is “Biased Blood Flow: Coronary Subclavian Steal Syndrome, a Rare Cause of Coronary Flow Heterogeneity Demonstrated on Vasodilator Stress Testing.”