Cardiology/Vascular

Acute Aortic Dissection Presenting Exclusively as Lower Extremity Paresthesias

Ryan Gibney, BS^*, Jonathan Patane, MD^* and Steven Bunch, MD^*

DOI: https://doi.org/10.21980/J8NK57 Issue 2:2 No ratings yet.

Chest x-ray and CT angiogram was performed to evaluate his thoracic and abdominal vasculature. Chest x-ray did not show any significant widening of the mediastinum. The CT angiogram demonstrated an intimal tear along the aortic arch separating a true and false aortic lumen, consistent with an acute aortic dissection. The true lumen (highlighted in blue in images 1-5) can be identified by continuity with an undissected part of the aorta. While the false lumen (highlighted in red in images 1-5) can be identified by its crescent shape and larger cross-sectional area.

Cardiology/Vascular Visual EM

Acute, massive pulmonary embolism with right heart strain and hypoxia requiring emergent tissue plasminogen activator (TPA) infusion

Jonathan Patane, MD^* and Wirachin Hoonpongsimanont, MD^*

DOI: https://doi.org/10.21980/J84K5K Issue 2:2 No ratings yet.

CT angiogram showed multiple large acute pulmonary emboli, most significantly in the distal right main pulmonary artery (image 1 and 2). Additional pulmonary emboli were noted in the bilateral lobar, segmental, and subsegmental levels of all lobes. There was a peripheral, wedge-shaped consolidation surrounded by groundglass changes in the posterolateral basal right lower lobe that was consistent with a small lung infarction (image 3).

Cardiology/Vascular Respiratory Visual EM

Wellens’ Sign (Wellens’ Syndrome)

Jonathan Patane, MD^* and Kim Sokol, MD^*

DOI: https://doi.org/10.21980/J8W30P Issue 2:2 No ratings yet.

This EKG shows deep, inverted T waves that are most pronounced in V2-V4, and are associated with continued T wave inversions in V5 and V6 and ST segment changes in V1-V3.

Cardiology/Vascular Visual EM

ST Elevation in aVR with Coexistent Multilead ST Depression

Benjamin Cooper, MD^*

DOI: https://doi.org/10.21980/J8KS3XIssue 2:1 No ratings yet.

The ECG shows ST-segment depressions in precordial leads V3 through V6, and limb leads I, II, and aVL, and 1 mm of ST-segment elevation in aVR. The initial troponin I was elevated at 1.37 ng/mL (upper limit of normal 0.40). Cardiology decided to delay catheterization until the next day when diffuse coronary disease was discovered (including 90% of the left circumflex stenosis, 60% proximal and 75% mid-left anterior descending stenosis, 75% third diagonal branch stenosis, and 90% posterior descending artery stenosis). The following day, the patient went to the operating room for coronary artery bypass grafting (CABG).

Cardiology/Vascular Visual EM

Bedside Echocardiography for Rapid Diagnosis of Malignant Cardiac Tamponade

Alaina Brinley, MD, PhD*, Maili Alvarado, MD* and J Christian Fox, MD*

DOI: https://doi.org/10.21980/J82S38Issue 2:1 No ratings yet.

The video shows a subxiphoid view of the heart with evidence of a large pericardial effusion with tamponade – note the anechoic stripe in the pericardial sac (see red arrow). This video demonstrates paradoxical right ventricular collapse during diastole and right atrial collapse during systole which is indicative of tamponade.1,2 Figure 1 is from the same patient and shows sonographic pulsus paradoxus. This is an apical 4 chamber view of the heart with the sampling gate of the pulsed wave doppler placed over the mitral valve. The Vpeak max and Vpeak min are indicated. If there is more than a 25% difference with inspiration between these 2 values, this is highly suggestive of tamponade.1 In this case, there is a 32.4% difference between the Vpeak max 69.55 cm/s and Vpeak min 46.99 cm/s.

Cardiology/Vascular Hematology/Oncology Ultrasound Visual EM

Takotsubo (Stress) Cardiomyopathy

Justin J Hourmozdi, MD^*, Julian P Suszanski, MD^*and Jacqueline M Pflaum, MD^{*^}

DOI: https://doi.org/10.21980/J8Z309Issue 2:1 No ratings yet.

Bedside echocardiography showed the findings consistent with Takotsubo cardiomyopathy. Echocardiographic images are shown in subxiphoid (A) and apical four chamber (B) views. Note the apical ballooning appearance (asterisk) of the left ventricle (LV).

Cardiology/Vascular Visual EM

Hyperkalemia on ECG

Bryson Hicks, MD^*

DOI: https://doi.org/10.21980/J8K017Issue 1:2 No ratings yet.

Initial ECG shows tall, peaked T waves, most prominently in V3 and V4, as well as QRS widening. These findings are consistent with hyperkalemia, which was promptly treated. Follow-up ECG post-treatment shows narrowing of the QRS complexes and normalization of peaked T waves.

Cardiology/Vascular Visual EM

Traumatic Aortic Injury

Brianna Miner^*, Megan Boysen Osborn, MD, MHPE^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J85P4JIssue 1:2 No ratings yet.

The initial chest x-ray showed an abnormal superior mediastinal contour (blue line), suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows) compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow). There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows).

Trauma Cardiology/Vascular Visual EM

Wolff-Parkinson-White Syndrome: Electrocardiogram

Brianna Miner^*, Jonathan Patane, MD^*, and Carrie Chandwani, MD^*

DOI: https://doi.org/10.21980/J8201KIssue 1:2 No ratings yet.

The initial EKG showed wide complex, irregular tachycardia > 200 bpm (EKG 1). Given the possibility of Wolff-Parkinson-White (WPW), procainamide was given to the patient. The patient’s heart rate responded and decreased to 120-140 bpm with narrowing of the QRS complex. A repeat EKG showed narrow complex tachycardia without P waves approximately 120 bpm (EKG 2). Once the procainamide infusion was complete, the patient had converted to sinus rhythm with a delta wave now apparent, consistent with WPW (EKG 3).

Cardiology/Vascular Visual EM

Atrial Myxoma

Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J87P45Issue 1:1 No ratings yet.

Bedside ultrasound revealed the presence of a left atrial mass that appeared to be tethered to the mitral valve. The mass was best viewed on ultrasound in the apical four-chamber window with the phased array probe placed over the patients’ point of maximal impact (PMI), with the patient in left lateral decubitus position.

Ultrasound Cardiology/Vascular Visual EM