Cardiology/Vascular

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Endocarditis

Sara Arastoo, BS* and Sari Lahham, MD, MBA*

DOI: https://doi.org/10.21980/J8JP73Issue 3:4[mrp_rating_result]
Upright frontal radiograph of the chest demonstrated large pleural effusion on the left and moderate pleural effusion on the right as shown by the visible menisci on both sides (red arrows) with diffuse bilateral nodular densities (yellow dotted lines), consistent with septic pulmonary emboli. Computed tomography (CT) of the chest demonstrated multiple scattered lung nodules bilaterally containing internal foci of air cavitation (green dotted lines).
Infectious DiseaseCardiology/VascularVisual EM
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Clinical Evaluation and Management of Pediatric Pericarditis

Sharona Hariri, BA*, Alisa Wray, MD, MAEd^ and Lauren Sylwanowicz, MD^

DOI: https://doi.org/10.21980/J8HP85Issue 3:4[mrp_rating_result]
An electrocardiogram (ECG) was concerning for ST segment elevation in leads II, III, aVF, and V4, with subtle ST elevations in V5 and V6 (see black arrows).  There is also ST segment depression in aVL (see blue arrows).
Cardiology/VascularVisual EM
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An Unusual Case of Hematemesis

Amanda Amen, BA*, Jane Xiao, MD^, Julie Parks-Bortel, MD† and Shanna Jones, MD†

DOI: https://doi.org/10.21980/J84H00Issue 3:4[mrp_rating_result]
The patient’schest X-ray revealed a prominent mediastinum and opacification in the left middle and lower lung fields. The CT showed an aortic aneurysm extending from the thorax to the abdomen with rupture near T7 (blue arrow). It also showed periaortic hemorrhage with active extravasation (green arrow) likely secondary to a penetrating ulcer and bilateral pulmonary opacities concerning for hemothorax (pink arrow).
Cardiology/VascularVisual EM
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Extensive Aortic Dissection with Normal Vital Signs

Meryl Abrams, MD*, Nicole Pagliuso, EMT* and Xiao Chi Zhang, MD, MS*

DOI: https://doi.org/10.21980/J80S6SIssue 3:4[mrp_rating_result]
The patient was found to have a Stanford type A dissection (see yellow arrow) with visible false lumen starting at aortic arch (see green circle). The dissection extended into the descending aorta (see blue circle) as shown by the false lumen (red highlighted area) visible on CT. The radiologist performed a reconstruction of the aorta, which showed that the left kidney was not being perfused, making the kidney not visible on the reconstruction.
Cardiology/VascularVisual EM
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Don’t Forget the Pacemaker – A Rare Complication

Amanda Esposito, MD*, Kenneth Rapp, MD* and Albert Ritter, MD*

DOI: https://doi.org/10.21980/J8GS7HIssue 3:4[mrp_rating_result]
The ECG demonstrated the presence of pacemaker spikes without appropriate capture (green arrows) and a ventricular escape rhythm which can be identified by an absence of P waves prior to the QRS complex (purple arrows). The portable chest X- demonstrated displaced pacemaker leads (red arrows) that were coiled around the pulse generator (blue arrow).   
Cardiology/VascularVisual EM

Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Cardiovascular Emergencies Small Group Module

Michael Barrie, MD*, Erin Wenzel, MD*, Colin Kaide, MD*, Daniel Bachmann, MD*, Daniel Martin, MD, MBA*, Jennifer Mitzman MD*^, Benjamin Ostro, MD*, Beth Bubolz, MD^, Kristin Stukus, MD^, Farhad Aziz, MD*, Cynthia Leung, MD*, Howard Werman, MD*, Alyssa Tyransky* and Andrew King, MD*

DOI: https://doi.org/10.21980/J8X334 Issue 3:3[mrp_rating_result]
We aim to teach the presentation and management of cardiovascular emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents.
CurriculumCardiology/Vascular
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Right Ventricular Dilation in Patient With Submassive Pulmonary Embolism

Adrian Diez, MD* and Christopher Bryczkowski, MD*

DOI: https://doi.org/10.21980/J82P84Issue 3:3[mrp_rating_result]
Bedside echocardiography four chamber view revealed enlarged right ventricular (RV) to left ventricular (LV) ratio (greater than 1) on apical four-chamber view (see red and blue outlines respectively). The right atrium is not clearly delineated in this image and therefore is not outlined. One can also rule out a large pericardial effusion as the cause of her dyspnea, since there is no large hypoechoic collection surrounding the heart on either four- chamber view or parasternal long view.
Cardiology/VascularVisual EM

Fainting Spells

Brittany Guest, DO*, Amir Rouhani, MD* and Steven Lai, MD*

DOI: https://doi.org/10.21980/J8Z91R Issue 3:2[mrp_rating_result]
ABSTRACT: Audience: The target audience for this simulation is 4th year medical students, emergency medicine residents, pediatric residents, and family medicine residents. Introduction: Brugada syndrome is defined as the combination of specific electrocardiogram (ECG) changes and clinical manifestations of a ventricular arrhythmia, including syncope and sudden cardiac arrest.1 Brugada syndrome is caused by a mutation in the phase-0 cardiac sodium channel. This
Cardiology/VascularSimulation