Broken Heart Syndrome
Tihomir Stefanec
<p>I am interested in Internal Medicine, Critical Care Medicine and Pulmonary Medicine. My current interest is Critical Care Medicine. </p>
Multidisciplinary Critical Care Medicine (Medical, Surgical, Neurologic, Cardiothoracic).<quillbot-extension-portal></quillbot-extension-portal>
Role of the endothelium and its progenitors in the pathogenesis of disease.<quillbot-extension-portal></quillbot-extension-portal>
<p>Tihomir Stefanec, MD, is Attending Physician, Critical Care Medicine, Assistant Professor, Medicine and Neurology at Montefiore Einstein. His clinical focus is multidisciplinary critical care medicine including medical, surgical, neurologic and cardiothoracic critical care.</p><p>After earning his Doctor of Medicine from the University of Zagreb Medical School in Zagreb, Croatia in 1992, Dr. Stefanec completed an internal medicine internship and residency at Long Island College Hospital in 1997. He then completed a critical care medicine fellowship at Saint Vincent’s Hospital and Medical Center in 1999. Following this, Dr. Stefanec completed a pulmonary medicine fellowship at Memorial Sloan Kettering Cancer Center in 2001.</p><p>Dr. Stefanec’s past research focuses on the role of the endothelium and its progenitors in the pathogenesis of disease. His work has been published in peer-reviewed original publications, reviews, editorials and abstracts, and he has presented nationally.</p><p>Dr. Stefanec is board certified in Internal Medicine, Critical Care Medicine and Pulmonary Medicine by the American Board of Internal Medicine, as well as in Neurocritical Care by the United Council for Neurologic Subspecialties. He has been a Fellow of the American College of Chest Physicians since 2003, and is a member of the American Thoracic Society, the American College of Chest Physicians and the European Respiratory Society.</p>
Brian D. Spund
Nicholas E.S. Sibinga
<p>Vascular disease, the greatest single cause of morbidity and mortality in developed societies, results from interactions between circulating inflammatory cells, the endothelium that lines the vasculature, underlying vascular smooth muscle cells (VSMCs) that comprise most of the arterial wall, and stem/progenitor cells found in the surrounding adventitia. The underlying pathogenesis is complex: factors that impinge on these cell types include reactivated developmental pathways, innate and acquired immune responses, and changes in cell function that result from physical stresses, perturbed blood flow, and biochemical stimuli. Our general approach is to characterize these responses at the molecular level, in cultured cells, and in mouse models that reflect specific types of vascular injury, including atherosclerosis, mechanical trauma, and transplant-associated arteriosclerosis.</p>
<p>Fat proteins are important regulators of cell growth and planar cell polarity. We have linked the atypical cadherin adhesion molecule Fat1 to significant effects on mammalian vascular remodeling. Our studies in VSMCs show that Fat1 interacts with beta-catenin to limit canonical Wnt signaling, a core developmental pathway that regulates many aspects of metazoan embryogenesis, and with Atrophin proteins to control VSMC directional migration. Recent findings suggest that Fat1 is an important regulator of VSMC growth and differentiation in injured vessels, and ongoing studies aim to understand the intracellular and extracellular signals that emanate from Fat1 in cis- and trans-signaling modes. Direct studies of beta-catenin indicate that its expression in VSMCs is required for vascular formation in development and important in adult arterial injury response. Efforts to understand beta-catenin’s essential function in these settings are underway.</p>
<p>Diabetes and obesity are important risk factors for cardiovascular disease. We are investigating how allograft inflammatory factor-1 (Aif-1), a 17 kD Ca2+-binding protein contributes to these conditions. Specific Aif-1 isoform-dependent functions that underlie effects on macrophage migration, phagocytosis, survival, and inflammatory signaling are subjects of ongoing studies. Finally, in collaboration with Richard Stanley, we have characterized a role for colony stimulating factor-1 (CSF-1), the main regulator of macrophage survival, proliferation, and differentiation, in control of transplant-associated arteriosclerosis, the major barrier to long-term success of organ transplants. Surprisingly, this effect appears to involve VSMC-associated CSF-1 in an autocrine/juxtacrine mechanism that is largely independent of macrophages.</p>
<p>Ongoing work in these areas involves defining the molecular bases for these observations. By identifying such novel mechanisms, we hope to find new targets for therapeutic intervention to improve vascular disease prevention and treatment.</p>
<p class="MsoListParagraph" style="margin: 0in 13.7pt 6pt 0.75in; font-size: 12pt; font-family: 'Times New Roman', serif; text-indent: -0.25in;"><span style="font-family: Times;">1.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span>Riascos-Bernal D, Chinnasamy P, Cao L, Dunaway CM, Valenta T, Basler K, Sibinga, NES. β-Catenin C-terminal signals suppress p53 and are essential for artery formation. <em>Nature Communications, </em>2016 Aug 8;7:12389. PMID: 27499244</p>
<p class="MsoListParagraph" style="margin: 0in 13.7pt 6pt 0.75in; font-size: 12pt; font-family: 'Times New Roman', serif; text-indent: -0.25in;"><span style="font-family: Times;">2.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span>Cao L, Riascos-Bernal D, Chinnasamy P, Dunaway C, Pujato M, Fiser A, Sibinga NES. Control of mitochondrial function and cell growth by the atypical cadherin Fat1.<em> Nature</em>, 2016 Nov 9;539(7630):575-578. PMID: 27828948.</p>
<p class="MsoListParagraph" style="margin: 0in 13.7pt 6pt 0.75in; font-size: 12pt; font-family: 'Times New Roman', serif; text-indent: -0.25in;"><span style="font-family: Times;">3.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span>Riascos-Bernal DF, Chinnasamy P, Gross JN, Almonte V, Egaña-Gorroño L, Parikh D, Jayakumar S, Guo L, Sibinga NES. Inhibition of smooth muscle β-catenin hinders neointima formation after vascular injury. <em>Arterioscler Thromb Vasc Biol, </em><span style="font-family: Times;">2017 May;37(5):879-888. PMID: 28302627.</span></p>
<p class="MsoListParagraph" style="margin: 0in 13.7pt 6pt 0.75in; font-size: 12pt; font-family: 'Times New Roman', serif; text-indent: -0.25in;"><span style="font-family: Times;">4.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><span style="font-family: Times;">Egaña-Gorroño L, Chinnasamy P, Casimiro I, Almonte VM, Parikh D, Oliveira-Paula<sup> </sup>GH, Jayakumar S, Law C, Riascos-Bernal DF, Sibinga NES. Allograft Inflammatory Factor-1 Supports Macrophage Survival and Efferocytosis and Limits Necrosis in Atherosclerotic Plaques. <em>Atherosclerosis</em>, 2019 Oct;289:184-194. PMID: 31439353.</span></p>
<p class="MsoListParagraph" style="margin: 0in 13.7pt 6pt 0.75in; font-size: 12pt; font-family: 'Times New Roman', serif; text-indent: -0.25in;"><span style="font-family: Times;">5.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><span style="font-family: Times;">Becher T, Riascos-Bernal DF, Kramer DJ, Almonte VM, Chi J, Tong T, Oliveira-Paula GH, Koleilat I, Chen W, Cohen P, Sibinga NES. Three-Dimensional Imaging Provides Detailed Atherosclerotic Plaque Morphology and Reveals Angiogenesis after Carotid Artery Ligation. Circ Res. 2020 Feb 28;126(5):619-632. PMID: 31914850. PMCID: PMC7047629.</span></p>
<p class="MsoNormal" style="margin: 0in 4.3pt 6pt 0.75in; font-size: 12pt; font-family: Calibri, sans-serif; text-indent: -0.25in;"><span style="font-family: 'Times New Roman', serif;">6.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><span style="font-family: 'Times New Roman', serif;">Parikh D, Riascos-Bernal DF, Egaña-Gorroño L, Jayakumar S, Almonte V, Chinnasamy P, Sibinga NES. Allograft inflammatory factor-1-like is not essential for age dependent weight gain or HFD-induced obesity and glucose insensitivity. <em>Sci Rep.</em> 2020 Feb 27;10(1):3594. PMID: 32107417. PMCID: PMC7046694.</span></p>
<p class="MsoNormal" style="margin: 0in 4.3pt 6pt 0.75in; font-size: 12pt; font-family: Calibri, sans-serif; text-indent: -0.25in;"><span style="font-family: 'Times New Roman', serif;">7.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><span style="font-family: 'Times New Roman', serif;">Chen W, Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Riascos-Bernal DF, Wu TT, Qiu Y, Kurland IJ, Dubin RF, Chen Y, Parekh RS, Bushinsky DA, Sibinga NES. Identification of Novel Biomarkers and Pathways for Coronary Artery Calcification in Nondiabetic Patients on Hemodialysis Using Metabolomic Profiling. Kidney360. 2021 February;2(2):279-289. PubMed PMID: 34723191; PubMed Central PMCID: PMC8553022; DOI: 10.34067/kid.0004422020.</span></p>
<p class="MsoListParagraph" style="margin: 0in 13.7pt 6pt 0.75in; font-size: 12pt; font-family: 'Times New Roman', serif; text-indent: -0.25in;"><span style="font-family: Times;">8.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span>Almonte VM, Uriyanghai U, Egaña-Gorroño L, Parikh D, Oliveira-Paula GH, Zhang J, Jayakumar S, Riascos-Bernal DF, Sibinga NES. PLX3397, a CSF1 receptor inhibitor, limits allotransplantation-induced vascular remodeling. <em>Cardiovasc Res.</em> 2021 Sep 3:cvab289. doi: 10.1093/cvr/cvab289. Online ahead of print. PMID: 34478521.</p>
<p class="MsoListParagraph" style="margin: 0in 13.7pt 6pt 0.75in; font-size: 12pt; font-family: 'Times New Roman', serif; text-indent: -0.25in;"><span style="font-family: Times;">9.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span>Lituma PJ, Woo E, O’Hara BF, Castillo PE, Sibinga NES, Nandi S. Altered synaptic connectivity and brain function in mice lacking microglial adapter protein Iba1. <em>Proc Nat Acad Sci U S A. 2021</em>, Nov 16;118(46):e2115539118. doi: 10.1073/pnas.2115539118. PMID: 34764226. PMCID: PMC8609554.</p>
<p class="MsoListParagraph" style="margin: 0in 13.7pt 6pt 0.75in; font-size: 12pt; font-family: 'Times New Roman', serif; text-indent: -0.25in;"><span style="font-family: Times;">10.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span>Riascos-Bernal DF, Maira A, Sibinga NES. The Atypical Cadherin FAT1 Limits Mitochondrial Respiration and Proliferation of Vascular Smooth Muscle Cells. <em>Front Cardiovasc Med.</em> 2022 May 11;9:905717. doi: 10.3389/fcvm.2022.905717. PMID: 35647082</p>
<p class="MsoListParagraph" style="margin: 0in 13.7pt 6pt 0.75in; font-size: 12pt; font-family: 'Times New Roman', serif; text-indent: -0.25in;"><span style="font-family: Times;">11.<span style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><span style="font-family: Times;">Parikh D, Jayakumar S, Oliveira-Paula GH, Almonte V, Riascos-Bernal DF, Sibinga NES. Allograft inflammatory factor-1-like is a situational regulator of leptin levels, hyperphagia, and obesity. <em>iScience</em>. 2022 Sep 3;25(10):105058. doi: 10.1016/j.isci.2022.105058. eCollection 2022 Oct 21. PMID: 36134334 </span></p>
Adarsha Selvachandran
Donald S. Miller
Rishi Malhotra
<span style="caret-color:#000000;font-family:Calibri, Arial, Helvetica, sans-serif;font-size:16px;text-size-adjust:auto;background-color:#ffffff;">Subarachnoid hemorrhage, Intracerebral Hemorrhage, Ischemic Stroke, Status Epilepticus, Neuromuscular Respiratory Failure, CNS Infections</span>
<span style="caret-color:#000000;font-family:Calibri, Arial, Helvetica, sans-serif;font-size:16px;text-size-adjust:auto;background-color:#ffffff;">Intracerebral Hemorrhage</span>
<p>Rishi Malhotra, MD, is Director of Neurocritical Care, Director of the Neuroscience ICU and Director of the Neurocritical Care Fellowship, as well as Associate Professor of Neurology, Medicine and Neurological Surgery at Montefiore Einstein. Dr. Malhotra’s clinical focus includes the critical care management of subarachnoid hemorrhage, intracerebral hemorrhage, traumatic brain injury, acute spinal cord injury, ischemic stroke, status epilepticus, brain tumors, neuromuscular respiratory failure and central nervous system infections.</p><p>A graduate of the combined BA/MD program at Brooklyn College, Dr. Malhotra completed his Doctor of Medicine with State University of New York - Downstate Medical Center in 2004. After completing his internal medicine internship at St. Luke’s-Roosevelt Hospital in 2005, Dr. Malhotra completed his three-year neurology residency at Columbia University Medical Center in 2008. He then pursued a neurocritical care fellowship at Columbia University Medical Center and Weill Cornell Medical Center, which he completed in 2010.</p><p>Dr. Malhotra’s scholarly interests include intracerebral hemorrhage, hypoxic-ischemic brain injury and status epilepticus. He has shared his work through peer-reviewed journals, books, abstracts and poster presentations.</p><p>Dr. Malhotra is board certified in Neurology and Neurocritical Care. He is a member of the Neurocritical Care Society.</p>
Benjamin T. Galen
<p>Dr. Galen graduated from Brown University with honors in the biological sciences and earned an M.D. from Tufts University School of Medicine. He trained in internal medicine at Yale University where he was elected to the Gold Humanism Honor Society and was the class speaker at residency graduation. He joined Montefiore and Einstein in 2013 as a teaching attending in Hospital Medicine</p>
<p>Dr. Galen is an Associate Program Director in The Einstein/Montefiore Internal Medicine Residency Program, the Director of Firm 3 and the Director of ultrasound and procedure training. In 2015 Dr. Galen received the Sharon R. Silbiger Faculty Teaching Award from the Einstein residents. He has led hundreds of resident teaching conferences and has worked to formalize curricula for point-of-care ultrasound (POCUS) and bedside procedures, such as lumbar puncture and paracentesis. Dr. Galen has taught in the EPHEM, Microbiology, and PDC classes at Einstein. He has led translational research on recurrent meningitis, collaborting with members of Betsy Herold's laboratory. He has co-authored over 20 original research studies. Dr. Galen is passionate about medical case reports and he has mentored residents and junior faculty in the process of publishing cases in a variety of venues. </p>
<p>Dr. Galen is the editor-in-chief of <em>POCUS Journal (</em><a href="https://pocusjournal.com/">https://pocusjournal.com/)</a>, the world's leading peer-reviewed, open-access publication for point-of-care ultrasound. He teaches POCUS nationally at a variety of workshops and conferences. </p>
<ol>
<li>Shankar, N., Kuo, L., Krugliak Cleveland, N., Galen, B., Samel, N. S., Perez-Sanchez, A., Nathanson, R., Coss, E., Echavarria, J., Rubin, D. T., & Soni, N. J. (2025). Point-of-Care Ultrasound in Gastroenterology and Hepatology. <em>Clin Gastroenterol Hepatol</em>. <a href="https://doi.org/10.1016/j.cgh.2024.09.040" target="_blank" rel="noopener noreferrer">https://doi.org/10.1016/j.cgh.2024.09.040</a></li>
<li>Cool, J. A., Galen, B. T., & Dancel, R. (2025). Point-counterpoint: Should hospitalists perform their own bedside procedures? <em>J Hosp Med</em>,<em> 20</em>(1), 89-93. <a href="https://doi.org/10.1002/jhm.13545" target="_blank" rel="noopener noreferrer">https://doi.org/10.1002/jhm.13545</a></li>
<li>Schechter, M. S., Baron, S. W., Gohari, A., Southern, W. N., & Galen, B. T. (2024). Midline Catheter-Associated Thrombosis (MCAT): Does Tip Location in the Axillary Vein Increase Risk? <em>J Infus Nurs</em>,<em> 47</em>(6), 363-368. <a href="https://doi.org/10.1097/nan.0000000000000558" target="_blank" rel="noopener noreferrer">https://doi.org/10.1097/nan.0000000000000558</a></li>
<li>Singh, J., Oliver-Krasinski, J., Tauras, J., & Galen, B. T. (2023). Systemic Amyloidosis: Is It ATTR or AL? <em>Am J Med</em>,<em> 136</em>(7), 652-654. <a href="https://doi.org/10.1016/j.amjmed.2023.03.009" target="_blank" rel="noopener noreferrer">https://doi.org/10.1016/j.amjmed.2023.03.009</a></li>
<li>Johri, A. M., Glass, C., Hill, B., Jensen, T., Puentes, W., Olusanya, O., Capizzano, J. N., Dancel, R., Reierson, K., Reisinger, N., Liblik, K., & Galen, B. T. (2023). The Evolution of Cardiovascular Ultrasound: A Review of Cardiac Point-of-Care Ultrasound (POCUS) Across Specialties. <em>Am J Med</em>,<em> 136</em>(7), 621-628. <a href="https://doi.org/10.1016/j.amjmed.2023.02.020" target="_blank" rel="noopener noreferrer">https://doi.org/10.1016/j.amjmed.2023.02.020</a></li>
<li>Eman, G., Synn, S., Galen, B., Shah, R., Nauka, P., Hope, A. A., Congdon, S., & Islam, M. (2023). Thoracic Ultrasound in COVID-19: Use of Lung and Diaphragm Ultrasound in Evaluating Dyspnea in Survivors of Acute Respiratory Distress Syndrome from COVID-19 Pneumonia in a Post-ICU Clinic. <em>Lung</em>,<em> 201</em>(2), 149-157. <a href="https://doi.org/10.1007/s00408-023-00614-w" target="_blank" rel="noopener noreferrer">https://doi.org/10.1007/s00408-023-00614-w</a></li>
<li>Nauka, P. C., LeFrancois, D., & Galen, B. T. (2022). An Introductory Curriculum for Internal Medicine Interns in Point-of-Care Ultrasound to Detect Lower Extremity Deep Vein Thrombosis. <em>Pocus j</em>,<em> 7</em>(2), 185-186. <a href="https://doi.org/10.24908/pocus.v7i2.15937" target="_blank" rel="noopener noreferrer">https://doi.org/10.24908/pocus.v7i2.15937</a></li>
<li>Varrias, D., Palaiodimos, L., Balasubramanian, P., Barrera, C. A., Nauka, P., Melainis, A. A., Zamora, C., Zavras, P., Napolitano, M., Gulani, P., Ntaios, G., Faillace, R. T., & Galen, B. (2021). The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis. <em>J Clin Med</em>,<em> 10</em>(17). <a href="https://doi.org/10.3390/jcm10173903" target="_blank" rel="noopener noreferrer">https://doi.org/10.3390/jcm10173903</a></li>
<li>Shah, R., Zhang, L., & Galen, B. T. (2021). A 73-Year-Old Woman With Pulseless Electrical Activity Arrest. <em>Chest</em>,<em> 160</em>(6), e665-e667. <a href="https://doi.org/10.1016/j.chest.2021.03.075" target="_blank" rel="noopener noreferrer">https://doi.org/10.1016/j.chest.2021.03.075</a></li>
<li>Koleilat, I., Galen, B., Choinski, K., Hatch, A. N., Jones, D. B., Billett, H., Indes, J., & Lipsitz, E. (2021). Clinical characteristics of acute lower extremity deep venous thrombosis diagnosed by duplex in patients hospitalized for coronavirus disease 2019. <em>J Vasc Surg Venous Lymphat Disord</em>,<em> 9</em>(1), 36-46. <a href="https://doi.org/10.1016/j.jvsv.2020.06.012" target="_blank" rel="noopener noreferrer">https://doi.org/10.1016/j.jvsv.2020.06.012</a></li>
<li>Nauka, P. C., & Galen, B. T. (2020). The Focused Assessment with Sonography in Cancer (FASC) Examination. <em>Pocus j</em>,<em> 5</em>(2), 42-45. <a href="https://doi.org/10.24908/pocus.v5i2.14428" target="_blank" rel="noopener noreferrer">https://doi.org/10.24908/pocus.v5i2.14428</a></li>
<li>Merkin, R., Kruger, A., Bhardwaj, G., Kajita, G. R., Shapiro, L., & Galen, B. T. (2020). Internal Medicine Resident Work Absence During the COVID-19 Pandemic at a Large Academic Medical Center in New York City. <em>J Grad Med Educ</em>,<em> 12</em>(6), 682-685. <a href="https://doi.org/10.4300/jgme-d-20-00657.1" target="_blank" rel="noopener noreferrer">https://doi.org/10.4300/jgme-d-20-00657.1</a></li>
</ol>
Jessica R. Cristallo
Kujtim Balidemaj
<p>Endothelial dysfunction and congestive heart failure.</p>
Specialization in general and preventive cardiology, congestive heart failure, hypertension, lipid metabolism, coronary artery disease, valvular disease, noninvasive imaging, and the care of patients undergoing surgery.
Kujtim Balidemaj, MD?a graduate of University of Zagreb, Croatia?completed a medical internship and residency at Einstein, Jacobi Medical Center (he served as chief medical resident), and a fellowship in Cardiovascular Diseases at Montefiore (he served as chief fellow). Dr. Balidemaj is also a fellow of the American College of Cardiology, and board certified in cardiovascular diseases and internal medicine.