Cardiology/Vascular

Arteriovenous Graft Pseudoaneurysm

Erik Madsen, MD^*, Lauren Sylwanowicz, MD^{^} and Alisa Wray, MD, MAEd^{^}

DOI: https://doi.org/10.21980/J8B06ZIssue 4:1[mrp_rating_result]

A bedside ultrasound of the mass demonstrated a large compressible hypoechoic structure (see purple outline) above the arteriovenous graft (see red outline). The contents demonstrated movement of fluid within the structure. This was confirmed with Doppler mode, which allowed for visualization of flow communicating between the structure and the underlying vessel, which is diagnostic for a pseudoaneurysm.

Visual EM Cardiology/Vascular

Guilty as Charged: Jailed Coronary Vessel Presenting as Wellens’ Syndrome Type B

Aderonke Susan Akapo, DO^*, Ryan Fashempour^*, Mohamad Moussa, MD^* and Patrick Bruss, MD^{^}

DOI: https://doi.org/10.21980/J8DS6H Issue 4:1[mrp_rating_result]

Evolving changes to electrocardiograph (ECG) were noted during serial ECG monitoring involving leads V2 and V3, along with some T-wave inversion in V4 and V5 that were concerning for a Wellens’ syndrome type B on second ECG. She was admitted and subsequently taken to cardiac catheterization suite where it was revealed that the previously placed stent in the left anterior descending (LAD) artery was patent. Unfortunately, the stent blocked off an adjacent side branch vessel off the LAD in proximal two-third region of the stent (as seen in the cartoon).

Visual EM Cardiology/Vascular

Intramural Hematoma with Type B Aortic Dissection

Ronald Goubert, BS^*, Robert Rowe, MD^* and Alisa Wray, MD, MAEd^*

DOI: https://doi.org/10.21980/J81M03Issue 4:1[mrp_rating_result]

Computed tomography angiography of the chest and abdomen revealed a 9.5 cm thoracoabdominal aneurysm (red outline) with intramural hematoma (yellow shading) and large left pleural effusion versus hemothorax with old blood (blue shading).

Cardiology/Vascular Visual EM

Cocaine-induced Myocardial Infarction and Pulmonary Edema

Dae-won Lee, MD* and Timothy J Koboldt, MD*

DOI: https://doi.org/10.21980/J8ZS87Issue 3:4[mrp_rating_result]

By the end of this simulation session, the learners will be able to:1) Determine appropriate diagnostics in a patient with likely cocaine toxicity. 2) Identify and manage respiratory failure. 3) Identify and manage a ST-elevation myocardial infarction (STEMI) and pulmonary edema. 4) Identify and manage cocaine toxicity with benzodiazepines. 5) Determine appropriate disposition of the patient to the cardiac catheterization lab and an intensive care unit (ICU). 6) Demonstrate effective communication and teamwork during resuscitation of a critically ill patient.

Cardiology/Vascular Simulation Toxicology

Prehospital Cardiac Arrest Management Simulation

Nicklaus P Ashburn, MD^*, Bryan P Beaver, MD^*, Robert D Nelson, MD^*, Michael T Fitch, MD, PhD^* and Jason P Stopyra, MD^*

DOI: https://doi.org/10.21980/J8V057 Issue 3:4[mrp_rating_result]

At the end of this simulation learners will be able to: 1) Perform team-focused CPR using effective leadership and communication skills during prehospital resuscitation. 2) Employ high-quality CPR with an emphasis on compressions and early defibrillation. 3) Demonstrate appropriate airway management utilizing an oropharyngeal airway and bag-valve-mask, blind-insertion airway device, and/or endotracheal intubation during cardiac arrest. 4) Recognize and appropriately defibrillate pulseless ventricular tachycardia and ventricular fibrillation. 5) Formulate an appropriate differential diagnosis for pulseless electrical activity.

EMS Cardiology/Vascular Simulation

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 Disease Cardiology/Vascular Visual EM

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/Vascular Visual EM

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/Vascular Visual EM

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/Vascular Visual EM

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/Vascular Visual EM