Internists
10 years of experience

Accepting new patients
Maedgen Area
Texas Tech University
3601 4th St
Lubbock, TX 79430
806-743-3150
Locations and availability (2)

Education ?

Medical School
Univ D`Algiers, Faculte De Medecine, Algiers (2000)

Awards & Distinctions ?

Associations
American Board of Internal Medicine

Affiliations ?

Dr. Krim is affiliated with 1 hospitals.

Hospital Affilations

Score

Rankings

  • University Medical Center - Lubbock
    602 Indiana Ave, Lubbock, TX 79415
    • Currently 2 of 4 crosses
  • Publications & Research

    Dr. Krim has contributed to 8 publications.
    Title A Case of All 3 Coronary to Bronchial Arteries Fistulas.
    Date October 2011
    Journal Journal of the American College of Cardiology
    Title Gigantic Coronary Sinus Associated with Concurrent Persistent Left Superior Vena Cava and Right Ventricular Volume Overload.
    Date January 2011
    Journal Methodist Debakey Cardiovascular Journal
    Excerpt

    A 76-year-old women with known atrial fibrillation and congestive heart failure presented with increasing shortness of breath. A 2-dimensional (2-D) transthoracic echocardiogram was performed to assess left ventricular function. An incidental finding of a very large coronary sinus with a diameter of 4.8 cm was seen, raising a suspicion for the possibility of a persistent left superior vena cava (PLSVC) (Figure 1). Additional pertinent positive findings included a massively dilated right atrium (estimated volume: 538 mL), dilated tricuspid annulus with poor leaflet coaptation, severe tricuspid regurgitation, and pulmonary artery systolic pressure (PASP) of 50 mmHg with an estimated mean right atrial pressure (RAP) of 25 mmHg. After agitated saline administration into the left brachial vein, there was immediate and sequential opacification of the dilated coronary sinus, right atrium, and right ventricle, confirming the presence of a PLSVC (Figure 2). CT angiography provided detailed anatomical and morphological characterization demonstrating drainage of the PLSVC into the gigantic coronary sinus and right-sided cardiac chambers and absence of other vascular or congenital anomaly (Figures 3 and 4).

    Title Multimodality Imaging of Giant Prolapsing Left Atrial Myxoma.
    Date August 2010
    Journal Methodist Debakey Cardiovascular Journal
    Excerpt

    Through a case of a very large left atrial myxoma diagnosed in a 53-year old woman, we feature the complementary value of multimodality imaging. Two-dimensional echocardiography continues to be the principal imaging modality for intracardiac masses due to its accessibility and ability to provide basic information on mass morphology, position, and mobility. Real-time three-dimensional echocardiography offers more precise assessment of tumor size and attachment. Cardiac magnetic resonance allows superior tissue characterization, particularly important in differentiating a myxoma from a thrombus. Appropriate use of these various non-invasive imaging modalities is a safe and comprehensive preoperative diagnostic approach for patients with intracardiac masses.

    Title St Elevation Myocardial Infarction in a Teenager: Case Report and Review of the Literature.
    Date May 2009
    Journal Southern Medical Journal
    Excerpt

    In the presence or absence of atherosclerosis, young adults can experience a myocardial infarction. Notably, young patients are at increased risk to be misdiagnosed since they do not frequently have traditional coronary risk factors. We describe a 19-year-old woman with chest pain and ST elevation on electrocardiogram who was initially suspected to have pericarditis. History revealed hormonal contraception and marked elevation of troponins, which later led to the diagnosis of myocardial infarction. Angiography displayed an occlusion of the right coronary artery that resolved with anticoagulation treatment. She recovered uneventfully. Differential diagnoses of ST elevation and various causes of acute coronary syndromes among young patients are reviewed.

    Title Heart Failure in Hispanics.
    Date May 2009
    Journal Journal of the American College of Cardiology
    Excerpt

    Although large-scale heart failure (HF) studies in Hispanic Americans are lacking, some compelling data indicate that they are a particularly vulnerable population and underscore the need for further research. Hispanics comprise the largest and fastest-growing ethnic group in the U.S., in whom the impact of this burgeoning public health problem may be magnified. Current data show that Hispanics with HF are more likely to be younger and underinsured than non-Hispanic whites. They have higher rates of readmissions but have lower in-hospital and short-term mortality rates. Epidemiologic studies demonstrate that Hispanics have excessive rates of diabetes, obesity, dyslipidemia, and metabolic syndrome. Although hypertension and ischemic heart disease are established risk factors in this ethnic group, it may be considered that insulin resistance plays a significant role in the pathogenesis of HF in Hispanics, accounting for their inordinate cardiometabolic risk burden and the growing evidence of novel metabolic risk factors for HF. Hispanics encounter multiple barriers to health care influenced by socioeconomic, linguistic, and cultural factors that, in turn, have an adverse impact on disease prognosis. Recognition of predominant risk factors and health care disparities in this population is crucial to tailoring appropriate management strategies. This review summarizes epidemiologic and clinical data on Hispanics with HF, details risk factors and health care impediments, and presents an agenda for future investigation.

    Title Digoxin: Current Use and Approach to Toxicity.
    Date December 2008
    Journal The American Journal of the Medical Sciences
    Excerpt

    Heralded as the oldest known cardiovascular drug, digoxin remains widely used today in the face of increasing rates in heart failure and atrial fibrillation despite the emergence of newer medications. Its hemodynamic, neurohormonal and electrophysiologic actions make it a suitable adjunctive, evidence-based therapy for the above conditions. Its narrow therapeutic index and its toxicity, however, have become more relevant as aging, comorbid diseases, and polypharmacy make more patients vulnerable. Because signs and symptoms of digoxin toxicity are mostly nonspecific, a high index of suspicion is crucial for early recognition and appropriate management.

    Title It's a Trap! Clinical Similarities and Subtle Ecg Differences Between Takotsubo Cardiomyopathy and Myocardial Infarction.
    Date
    Journal Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine
    Excerpt

    We describe a 65-year-old woman with a history of hypertension and smoking who presented with an acute episode of chest pain precipitated by severe emotional stress. Her initial electrocardiogram done in the emergency room showed non-specific T wave changes in the lateral leads and her cardiac troponin levels were mildly elevated. Because of her clinical presentation, she was admitted with a presumptive diagnosis of acute myocardial infarction and managed with antiplatelet and anticoagulant therapy. Coronary angiogram did not reveal coronary artery disease and left ventriculography showed findings consistent with apical ballooning syndrome or takotsubo cardiomyopathy. Subsequent electrocardiograms displayed dramatic changes including T wave inversions, QT interval prolongation and U waves. The patient remained asymptomatic and recovered uneventfully. Three weeks post-discharge, an echocardiogram documented resolved left ventricular dysfunction. We describe the clinical features and highlight the electrocardiographic findings that may help differentiate takotsubo cardiomyopathy from myocardial infarction.


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