Cardiology/Vascular

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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

Chest Pain with Acute Coronary Syndrome

Alisa Wray, MD*

DOI: https://doi.org/10.21980/J8K04C Issue 3:2[mrp_rating_result]
At the end of this case learners should be able to prepare a differential for patients with chest pain, provide appropriate medications for a patient with chest pain, recognize an ST segment elevation MI, and appropriately disposition a patient with acute myocardial infarction (AMI).
Cardiology/VascularSimulation
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Osborn Waves in a Severely Hypothermic Patient

Jon Van Heukelom, MD*

DOI: https://doi.org/10.21980/J8H34SIssue 3:2[mrp_rating_result]
The initial EKG shows marked elevation of the J-point (point where the QRS segment joins the ST segment), otherwise known as an “Osborn Wave” (see black arrows).  A subsequent EKG obtained after active rewarming, showed resolution of the Osborn waves.
Cardiology/VascularVisual EM
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Torsades de Pointes

Richard J Chen, MD*, Grant Wei, MD* and Chirag Shah, MD*

DOI: https://doi.org/10.21980/J87K91 Issue 3:2[mrp_rating_result]
The patient was found to be in a polymorphic ventricular tachycardia; he was alert, awake and asymptomatic. A rhythm strip showed a wide complex tachycardia with the QRS complex varying in amplitude around the isoelectric line consistent with Torsades de Pointes.
Cardiology/VascularVisual EM
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Type 1 Brugada Syndrome

Sha Yan, DO*, Grant Wei, MD* and Chirag Shah, MD*

DOI: https://doi.org/10.21980/J8V91T Issue 3:2[mrp_rating_result]
ECG shows an incomplete right bundle branch block (blue arrow) with coved ST segment elevation and an inverted T wave in V1 (red arrow) and ST segment elevation in V2 (black arrow).
Cardiology/VascularVisual EM