Cardiology/Vascular

Severe Hyperkalemia

Daniel Johnson, DO^* and Dan Wiener, MD^*

DOI: https://doi.org/10.21980/J8KH1D Issue 5:3 No ratings yet.

The initial ECG obtained upon arrival shows what is commonly referred to as a sine wave pattern. This patient does have a biventricular pacemaker which would ordinarily create a wide QRS complex mimicking an intraventricular conduction delay. However, the QRS complex here is exceptionally wide, in excess of 400 milliseconds (normal: less than 120 milliseconds). As the QRS widens, alongside other deflections present on the ECG, it morphologically mimics a mathematical sine wave.

Cardiology/Vascular Visual EM

Caught on CT! The Case of the Hemodynamically Stable Ruptured Abdominal Aortic Aneurysm

Matthew Patrick Weber, MS, BS^* and Megan Stobart-Gallagher, DO^*

DOI: https://doi.org/10.21980/J8B07B Issue 5:3 No ratings yet.

The associated images demonstrate the transverse, sagittal, and coronal views of a 6.8 cm infrarenal ruptured AAA continuous with a 4 cm right common iliac aneurysm (transverse, sagittal and coronal). Active hemorrhage was seen contained within the aortic wall, and retroperitoneal bleeding can be appreciated with asymmetric enlargement of the left psoas muscle (coronal - red arrow).1 Plaque and calcifications with a residual opacified true lumen is also present (transverse – red star, sagittal – red arrow). Known as the tangential calcium sign, this is a common radiologic finding of AAAs.2

Cardiology/Vascular Visual EM

Post-Coital Sudden Cardiac Arrest Due to Non-Traumatic Subarachnoid Hemorrhage—A Case Report

Vinson Vong, MD^*, John Costumbrado, MD, MPH^*, Daniel Ng, MD^*and Brandon Phong^{^}

DOI: https://doi.org/10.21980/J8663N Issue 5:3 No ratings yet.

The electrocardiogram demonstrated sinus tachycardia with ST segment elevation in lead aVR (black arrows) and diffuse ST depressions concerning for possible ST elevation myocardial infarction (STEMI). Given the events reported and the patient’s neurologic exam without sedation, non-contrast CT of the head was ordered; imaging showed evidence of a large subarachnoid hemorrhage, mostly at the level of the Circle of Willis (black arrow) concerning for an aneurysmal bleed as well as mild generalized white matter density suggestive of cerebral edema.

Neurology Cardiology/Vascular Visual EM

Ascending Thoracic Aortic Dissection: A Case Report of Rapid Detection Via Emergency Echocardiography with Suprasternal Notch Views

Brandon Backlund, MD^*, Anastasia Kendrick-Adey, MD^*, Rachel Harper, MD^* and Martin Makela, MD^*

DOI: https://doi.org/10.21980/J8WW6WIssue 5:2 No ratings yet.

Video of parasternal long-axis bedside transthoracic echocardiogram: The initial images showed grossly normal left ventricular function, and no pericardial effusion or evidence of cardiac tamponade. However, the proximal aorta beyond the aortic valve was poorly-visualized in this window.

Cardiology/Vascular Ultrasound Visual EM

Pulseless Electrical Activity Cardiac Arrest

Erik Sembroski, MD^*, Christopher M McDowell, MD^{^} and Matthew M Mannion, BA^{^}

DOI: https://doi.org/10.21980/J8Z055 Issue 5:1 No ratings yet.

After competing this simulation-based session, the learner will be able to: 1) Identify PEA arrest; 2) review the ACLS commonly recognized PEA arrest etiologies via the H &T mnemonic; 3) review and discuss the risks and benefits of tissue plasminogen activator (tPA) for massive PE.

Cardiology/Vascular Respiratory Simulation

Bilateral Common Iliac Artery Aneurysm

Laura Kolster, DO^*, Danielle Biggs, MD^*, Amy Patwa, DO^* and Michael Gerardi, MD^*

DOI: https://doi.org/10.21980/J83S73 Issue 5:1 No ratings yet.

A bedside ultrasound of the aorta was performed. The proximal, middle, and distal aorta appeared normal in caliber, as demonstrated by the images; however there seemed to be some enlargement at the bifurcation. The bifurcation into the iliac arteries, as highlighted by the yellow arrow, demonstrates a slightly enlarged iliac artery on the left. The aorta was followed below the bifurcation as it divided into the iliac arteries, as shown in the video clip. The ultrasound demonstrated a left iliac artery aneurysm measuring 5.99 cm, as highlighted by the orange circle. There were aneurysms to the bilateral common and internal iliac arteries.

Cardiology/Vascular Abdominal/Gastroenterology Visual EM

A Low-Cost, Reusable Ultrasound Pericardiocentesis Simulation Model

Jonathan dela Cruz, MD^*, Tyler Fulks, MD^*, Mark Baker, MD^*, Jason Kegg, MD^*, Richard Austin, MD^*, Jimmy Jain, MD^*, Michael Boehler, MS^*, Sharon Kim, PhD^{^}, and Cassie Jaeger, PhD^{^}

DOI: https://doi.org/10.21980/J8TD1J Issue 4:4 No ratings yet.

Through the use of this model and skill session, learners will be able to: 1) discuss the indications, contraindications, and complications associated with ultrasound guided pericardiocentesis; 2) demonstrate an ability to obtain subxiphoid and parasternal long views of the heart; 3) demonstrate an ability to identify pericardial fluid in these two views; and 4) demonstrate proper probe and needle placement to successfully perform an ultrasound guided pericardiocentesis in these two views.

Procedures Cardiology/Vascular Innovations

Henoch-Schönlein Purpura in the Adult

Ivan Virovets, DO^* and Danielle Biggs, MD^*

DOI: https://doi.org/10.21980/J8QH08 Issue 5:1 No ratings yet.

The images show a raised, palpable, purpuric rash on the lower extremities, surrounded by a mild, 1+ non-pitting edema. Several of the lesions are exfoliated with serous discharge. There is no surrounding erythema, fluctuance, or lymphangitis to suggest cellulitis. There was no tenderness to palpation; however, pruritus was exacerbated on palpation.

Dermatology Cardiology/Vascular Visual EM

ECG Stampede

Benjamin L Cooper, MD^*, Jonathan A Giordano, DO^*, Catherine E Reynolds, MD^*, and Tom T Fadial, MD^*

DOI: https://doi.org/10.21980/J8PP93 Issue 4:4 No ratings yet.

ECG Stampede is a unique educational program comprised of a comprehensive, video-based curriculum with accompanying student and instructor guides. ECG Stampede also features an engaging game accessible via modern browsers and dedicated mobile applications for iOS and Android devices. The gamified model presents learners with a batch of ECGs for which they must assign one of four triage acuities.

Cardiology/Vascular Innovations

Atypical Presentation of Abdominal Aortic Aneurysm

Michael Rohinton Mirza, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J82W6F Issue 4:4 No ratings yet.

Bedside ultrasound revealed an abdominal aortic aneurysm (AAA) with concern for dissection vs thrombus/hematoma due to an area of echogenicity within the lumen of the vessel, since normal blood vessels (including the aorta) have lumens that are uniformly anechoic. An intimal flap concerning for dissection appears as a hyperechoic stripe within the lumen of the vessel on ultrasound, often with a hypoechoic and/or anechoic area appreciated underneath the flap, indicating a separate area of blood flow. If this visualized area is of significant size, color doppler can be used to confirm blood flow on both sides of the flap. Given his bedside ultrasound findings, the patient underwent emergent computed tomography scan and was found to have an enlarged infrarenal abdominal aortic aneurysm, with acute intramural hematoma, extending into bilateral common iliac arteries.

Cardiology/Vascular Visual EM