Cardiology/Vascular

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.

Curriculum Cardiology/Vascular

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/Vascular Visual 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/Vascular Simulation

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/Vascular Simulation

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/Vascular Visual EM

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/Vascular Visual EM

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/Vascular Visual EM

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/Vascular Visual EM

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/Gastroenterology Cardiology/Vascular Visual EM

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.

Respiratory Cardiology/Vascular Visual EM