Cardiology/Vascular

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Osborn Waves

James Elliot Karz, DO*, Grant Wei, MD* and Chirag Shah, MD*

DOI: https://doi.org/10.21980/J8G34G Issue 3:2[mrp_rating_result]
The initial ECG shows a junctional rhythm with Osborn waves (or J point elevations/J waves) in the lateral precordial leads, as well as the limb leads (Image 1). The second ECG, 49 minutes later, shows an improving ventricular rate and Osborn wave height decrease of approximately 50% (Image 2). 
Cardiology/VascularVisual EM
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Elderly female with acute abdominal pain presenting with Superior Mesenteric Artery Thrombus

Sassan Ghassemzadeh, MD*

DOI: https://doi.org/10.21980/J82W52 Issue 3:2[mrp_rating_result]
Computed tomography (CT) angiogram of the abdomen and pelvis revealed a superior mesenteric artery (SMA) thrombosis 5 cm from the origin off of the abdominal aorta. As seen in the sagittal view, there does not appear to be any contrast 5 cm past the origin of the SMA. On the axial views, you can trace the SMA until the point that there is no longer any contrast visible which indicates the start of the thrombus.  The SMA does not appear to be reconstituted. There was normal flow to the celiac artery. (See annotated images).
Abdominal/GastroenterologyCardiology/VascularVisual EM
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Tricuspid Annular Plane Systolic Excursion (TAPSE) in a Patient with Pulmonary Emboli

Nicole Zawada, BS*, Ethan Kunstadt, MD* and Maili Alvarado, MD^

DOI: https://doi.org/10.21980/J8M052 Issue 3:1[mrp_rating_result]
Video 1 and Image 1 show a thrombus in the patient’s IVC. Video 2 and Images 2-3 demonstrate a positive TAPSE of less than 17mm (blue arrow length) with a significantly dilated RV, indicating abnormal excursion of the tricuspid annulus and right ventricular dysfunction.  
RespiratoryCardiology/VascularVisual EM
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Management of Wolff-Parkinson-White Tachyarrhythmia Presenting as Syncope with Seizure-like Activity

Samuel Kaplan, BS* and Lindsey Spiegelman, MD*

DOI: https://doi.org/10.21980/J8534P Issue 2:4[mrp_rating_result]
At the end of this simulation session the learner will: 1) Recognize clinical history suggestive of cardiogenic syncope, 2) recognize clinical evidence of Wolff-Parkinson-White syndrome, 3) promptly and appropriately treat unstable WPW tachyarrhythmia.
Cardiology/VascularSimulation
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Asymptomatic Wolff-Parkinson-White Syndrome: Incidental EKG

Samer Assaf, MD* and Christopher Libby, MD, MPH^

DOI: https://doi.org/10.21980/J8T05X Issue 2:3[mrp_rating_result]
The ECG shows slurred up-stroking of the QRS complexes characteristic of a delta wave. The PR interval is normal; however, the QT interval is greater than 110ms.
Cardiology/VascularVisual EM
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Renal Infarction from Type B Aortic Dissection

Marit Tweet, MD* and James Roy Waymack, MD*

DOI: https://doi.org/10.21980/J8HG9G Issue 2:3[mrp_rating_result]
Initial abdominal images demonstrated a dissection flap; therefore, a CTA of the chest was also obtained. These images revealed a Stanford type B aortic dissection beginning just distal to the left subclavian artery and extending to the origin of the inferior mesenteric artery. The right renal artery arose from the true lumen of the dissection while the left renal artery arose from the false lumen. This case is interesting as imaging shows the lack of perfusion to the left kidney, residing in the retroperitoneum, which correlates with her non-descript abdominal and left flank pain.
Cardiology/VascularRenal/ElectrolytesVisual EM
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Ruptured Abdominal Aortic Aneurysm

Jessica Andrusaitis, BS, MS* and Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J8FP6SIssue 2:3[mrp_rating_result]
CTA demonstrated a ruptured 7.4 cm infrarenal abdominal aortic aneurysm with a large left retroperitoneal hematoma.
Cardiology/VascularVisual EM
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Use of Bedside Compression Ultrasonography for Diagnosis of Deep Venous Thrombosis

Mohamad Moussa, MD* and Maher Abdo, BS*

DOI: https://doi.org/10.21980/J81G94 Issue 2:3[mrp_rating_result]
As shown in the still image of the performed ultrasound, a transverse view of the proximal-thigh revealed a visible thrombus (green shading) occluding the lumen of the left common femoral vein (blue ring), which was non-compressible when direct pressure was applied to the probe. Also visible is a patent and compressible branch of the common femoral vein (purple ring) and the femoral artery (red ring), highlighted by its thick vessel wall and pulsatile motion.
UltrasoundCardiology/VascularVisual EM