Cardiology/Vascular

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 No ratings yet.

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.

Emed-Opoly: Echocardiography

Andrew W Phillips, MD, MEd^*, Michelle Hunter-Behrend, MD^* and Sara Nikravan, MD^{^}

DOI: https://doi.org/10.21980/J8PC77 Issue 2:2 No ratings yet.

By the end of this session, the learner will be able to: 1) Recognize normal and abnormal left heart global function 2) Recognize normal and abnormal right heart global function 3) Recognize pericardial effusions and pericardial tamponade

Cardiology/Vascular Small Group Learning Ultrasound

Left Ventricular Assist Devices

Khuansiri Narajeenron, MD, MSc^{*^}, Wirachin Ying Hoonpongsimanot, MD, MS^{^} and Megan Boysen Osborn, MD, MHPE^{^}

DOI: https://doi.org/10.21980/J8JP4Z Issue 2:2 No ratings yet.

Upon completion of this cTBL module, the learner will be able to: 1) Properly assess LVAD patients’ circulatory status; 2) appropriately resuscitate LVAD patients; 3) identify common LVAD complications; 4) evaluate and appropriately manage patients with LVAD malfunctions.

Cardiology/Vascular Team Based Learning (TBL)

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