Cardiology/Vascular

Ventricular Tachycardia

Rohit Menon, MD^*, Geremiha Emerson, MD^* and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J8KD2R Issue 8:4 No ratings yet.

At the conclusion of the simulation session, learners will be able to: 1) identify the different etiologies of VT, including structural heart disease, acute ischemia, and acquired or congenital QT syndrome; 2) describe confounding factors of VT, such as electrolyte abnormalities and sympathetic surge; 3) describe how to troubleshoot an unsuccessful synchronized cardioversion, including checking equipment connections, increasing delivered energy, and changing pad placement; 4) compare and contrast treatments of VT based on suspected underlying etiology; 5) describe reasons to activate the cardiac catheterization lab other than occlusive myocardial infarction; and 6) identify appropriate disposition of the patient to the cardiac catheterization lab.

Acute Pulmonary Edema and NSTEMI

Ashley Pilgrim, MD^*

DOI: https://doi.org/10.21980/J8CW67 Issue 8:3 No ratings yet.

At the end of this practice oral boards case, the learner will: 1) recognize unstable vital signs (VS) and intervene to stabilize ventilation and oxygenation, 2) demonstrate the ability to obtain a complete medical history including the important characteristics of chest pain, 3) demonstrate an appropriate exam on a patient, 4) order the appropriate evaluation studies for a patient with complaints of dyspnea, 5) interpret the results of diagnostic evaluation and diagnose Non- ST elevation myocardial infarction (NSTEMI) and pulmonary edema, 6) order appropriate management of pulmonary edema and NSTEMI, and 6) demonstrate effective communication with patient and family members.

Cardiology/Vascular Oral Boards

Construction of Soft Prep Cadaver Pericardiocentesis Training Model and Implementation Among Emergency Medicine Residents

Kathryn Oskar, MD^* and Dana Stearns, MD^{^}

DOI: https://doi.org/10.21980/J87930 Issue 8:2 No ratings yet.

By the end of this session, residents will gain increased procedural competence and confidence with pericardiocentesis. Residents will be able to identify necessary supplies for the procedure, identify relevant surface anatomy and ultrasound views, and successfully aspirate fluid from model effusion.

Cardiology/Vascular Innovations Procedures

Peripartum Cardiomyopathy

Victoria L Morris, MD^*, Carolina Mendoza, MD^*, Gowri S Stevens, MD^*, Jessica L Wilson, MD^*and Adeola A Kosoko, MD^*

DOI: https://doi.org/10.21980/J8ZS9M Issue 8:2 No ratings yet.

By the end of this simulation session, learners will be able to: 1) initiate a workup of a pregnant patient who presents with syncope, 2) accurately diagnose peripartum cardiomyopathy, 3) demonstrate care of a gravid patient in respiratory distress due to peripartum cardiomyopathy, 4) appropriately manage cardiogenic shock due to peripartum cardiomyopathy.

Cardiology/Vascular Ob/Gyn Simulation

A Case Report of Subtle EKG Abnormalities in Acute Coronary Syndromes Indicative of Type One Myocardial Infarction

Paige Matijasich, BA^*, Patrick Bruss, MD^{^}, Gregory Reinhold, MD^{^} and Zachary Koppelmann, MD^{^}

DOI: https://doi.org/10.21980/J8W06X Issue 8:2 No ratings yet.

The ECG does show multiple subtle abnormalities that in conjunction with his symptoms and risk factors are concerning for ischemia and/or occlusion of the coronary artery vessel. 1) ST depression in aVL. Although slight, the ST segment is below the TP segment or isoelectric point (blue circles). 2) Focal hyper QT waves. The T-waves in II, III, AVF V2, V3, and V4 are hyper acute, namely peaked and tall in relationship to the QRS. These are best displayed in leads II, III, and AVF where the T-waves are taller than the QRS amplitude (vertical blue lines). 3) Straightening off the ST segment. Multiple leads display a straight ST segment namely aVL, III, AVF, and V2 (red lines). Of note, the length of the straight ST segment is greater than 1/4 the amplitude of the QRS (purple lines). 4) Although subtle, these abnormalities are focal in nature.

Cardiology/Vascular Visual EM

Acute Chest Syndrome

Patrick Meloy, MD^*, Daniel R Rutz, MD^{^} and Amit Bhambri, MD^†

DOI: https://doi.org/10.21980/J80S8J Issue 8:1 No ratings yet.

At the end of this oral board session, examinees will: 1) demonstrate the ability to obtain a complete medical history; 2) demonstrate the ability to perform a detailed physical examination in a patient with respiratory distress; 3) identify a patient with respiratory distress and hypoxia and manage appropriately (administer oxygen, place patient on monitor); 4) investigate the broad differential diagnoses which include acute chest syndrome, pneumonia, acute coronary syndrome, acute congestive heart failure, acute aortic dissection and acute pulmonary embolism; 5) list the appropriate laboratory and imaging studies to differentiate acute chest syndrome from other diagnoses (complete blood count, comprehensive metabolic panel, brain natriuretic peptide (BNP), lactic acid, procalcitonin, EKG, troponin level, d-dimer, chest radiograph); 6) identify a patient with acute chest syndrome and manage appropriately (administer intravenous pain medications, administer antibiotics after obtaining blood cultures, emergent consultation with hematology) and 7) provide appropriate disposition to the intensive care unit after consultation with hematology.

Cardiology/Vascular Oral Boards

Aortic Dissection Case Report

Chelsea Bunce, DO^*, Christopher Bryczkowski, MD^* and Mary Rometti, MD^*

DOI: https://doi.org/10.21980/J8964Z Issue 8:1 No ratings yet.

In transverse view, point-of-care ultrasound (POCUS) showed an anechoic circular true lumen (blue highlight) and half-circular anechoic false lumen (green highlight), separated by a near hyperechoic dissection flap (orange highlight) that pulsated with blood flow. When viewed in sagittal orientation, the anechoic true lumen (blue highlight) appears longitudinal, separated from the false lumen (green highlight) by a dissection flap (orange highlight). Stills showing the measurements of these dissections are also provided.

Cardiology/Vascular Visual EM

A Novel Module Based Method of Teaching Electrocardiogram Interpretation for Emergency Medicine Residents

Alexandra S Koutsoubis, MD^*, Emily Fishbein, MD^*, Megan Stobart-Gallagher, DO^{^}, Behzad B Pavri, MD^† and Jennifer White, MD^{^}

DOI: https://doi.org/10.21980/J8Z06J Issue 7:4 No ratings yet.

After completion of the module learners should be able to: 1) correctly recognize and identify ECG abnormalities including but not limited to abnormal or absent P waves, widened QRS intervals, ST elevations, abnormal QT intervals, and dysrhythmias that can lead to sudden cardiac death; and 2) synthesize findings into a succinct but accurate interpretation of the ECG findings.

Cardiology/Vascular Small Group Learning

Torsade de Pointes Due to Hypokalemia and Hypomagnesemia

Mary Crista Cabahug^* and Amrita Vempati, MD^*

DOI: https://doi.org/10.21980/J8JP8G Issue 7:4 No ratings yet.

By the end of this simulation session, learners will be able to: 1) formulate appropriate work-up for altered mental status (AMS) 2) recognize hypokalemia and associated findings on ECG 3) address hypomagnesemia in a setting to hypokalemia 4) manage pulseless VT by following advanced cardiac life support (ACLS) 5) recognize and address TdP 6) provide care after return of spontaneous circulation (ROSC) 7) consult intensivist and admit to intensive care unit (ICU).

Cardiology/Vascular Simulation

Inferior STEMI Electrocardiogram in a Young Postpartum Female with Sickle Cell Trait with Chest Pain – A Case Report

Jessica Truong^{*^}, Ryan Perdomo, MD^{^}, Daniel Ng, MD^{*^}, Sassan Ghassemzadeh, MD^{*^}and John Costumbrado, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J8KP95 Issue 7:4 No ratings yet.

ECG shows evidence of ST segment elevation in the inferolateral leads with reciprocal change in a bigeminy pattern. The ECG pattern seen in this patient demonstrates ST elevations in the inferior leads (II, III, and avF) as well as the precordial leads V4-V6. Reciprocal changes can also be seen in leads I and avL. Though this STEMI pattern is typically associated with occlusion of the right coronary artery in 80% of cases, it may also be caused by occlusion of the left circumflex artery. This may explain this patient’s cardiac catheterization findings of vasospasm in the left circumflex coronary artery.

Cardiology/Vascular Visual EM