POPULARITY
102 episodes with case reports
223 episodes with case reports
92 episodes with case reports
14 episodes with case reports
7 episodes with case reports
7 episodes with case reports
10 episodes with case reports
8 episodes with case reports
7 episodes with case reports
5 episodes with case reports
5 episodes with case reports
80 episodes with case reports
3 episodes with case reports
4 episodes with case reports
3 episodes with case reports
2 episodes with case reports
5 episodes with case reports
2 episodes with case reports
Send us a text⚠️ Quick note: Sorry for the audio quality in this episode — we've been having tremendous recording issues! Thanks for sticking with us.
CardioNerds (Dr. Rick Ferraro and Dr. Dan Ambinder) join Dr. Sahar Samimi and Dr. Lorraine Mascarenhas from Baylor College of Medicine, Houston, Texas, at the Houston Rodeo for some tasty Texas BBQ and a tour of the lively rodeo grounds to discuss an interesting case full of clinical pearls involving a patient with nonbacterial thrombotic endocarditis (NBTE). Expert commentary is provided by Dr. Basant Arya. Episode audio was edited by CardioNerds Intern Dr. Bhavya Shah. (Photo by Xu Jianmei/Xinhua via Getty Images)Xinhua News Agency via Getty Images We discuss a case of a 38-year-old woman with advanced endometrial cancer who presents with acute abdominal pain, found to have splenic and renal infarcts, severe aortic regurgitation, and persistently negative blood cultures, ultimately diagnosed with nonbacterial thrombotic endocarditis (NBTE). We review the definition and pathophysiology of NBTE in the context of malignancy and hypercoagulability, discuss initial evaluation and echocardiographic findings, and highlight important management considerations. Emphasis is placed on the complexities of anticoagulation choice, the role of valvular surveillance, and the need for coordinated, multidisciplinary care. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls- Nonbacterial Thrombotic Endocarditis Eliminate the Usual Suspects. NBTE is a diagnosis of exclusion! Always rule out infective endocarditis (IE) first with serial blood cultures and serologic tests. More than Meets the Echo. Distinguishing NBTE from culture-negative endocarditis can be tricky. Look beyond the echo—focus on clinical context (underlying malignancy, autoimmune issues) and lab findings to clinch the diagnosis. TEE for the Win... Mostly. While TEE is more sensitive than TTE, NBTE vegetations can be sneaky and may embolize quickly. Don't hesitate to use advanced imaging (i.e., cardiac MRI, CTA) or repeat imaging if you still suspect NBTE. Choose your champion. In cancer-associated NBTE, guideline recommendations for anticoagulation choice are lacking. Consider DOACs and LMWH as agents of choice, but ultimately use shared decision-making to guide management. No obvious trigger? Go hunting for hidden malignancies or autoimmune disorders. A thorough workup is essential to uncover the driving force behind NBTE. Check out this state-of-the-art review for a comprehensive, one-stop summary of NBTE: European Heart Journal, 46(3), 236–245. Please note that the figures and tables referenced in the following notes are adapted from this review. notes- Nonbacterial Thrombotic Endocarditis Notes were drafted by Dr. Sahar Samimi. What is nonbacterial thrombotic endocarditis (NBTE)? NBTE, previously known as marantic endocarditis, is a rare condition in which sterile vegetations form on heart valves.1 It occurs most commonly in association with malignancies and autoimmune conditions (i.e, antiphospholipid antibody syndrome or systemic lupus erythematosus).1 In addition, NBTE has been reported in association with COVID-19 infection, burns, sepsis, and indwelling catheters.2 Precise mechanisms remain unclear, but an interplay of endothelial injury, hypercoagulability, hypoxia, and immune complex deposition contributes to the formation of these sterile vegetations. 1 How do we diagnose NBTE? Physicians should have a high level of suspicion for NBTE in at-risk patients (e.g., with active malignancy) who present with recent or recurrent embolic events (i.e., stroke, splenic, renal, or mesenteric infarct, and acute coronary syndrome).1
Today, after a brief discussion on the recent deaths of Ozzy Osbourne and Malcolm Jamal-Warner, Asif and Ali discuss the career and complicated life of Hulk Hogan (7:15). They guys start off by discussing when they first heard of Hogan. They then go over his meteoric rise to become the most famous professional wrestler of all time. They then discuss his controversies including videos of Hogan using racist language and the Gawker trial, and the ongoing repercussions of these events. Hogan had a history of anabolic steroid use and died of cardiac arrest and so in the second half of the episode, Ali asks Asif about the heart complications of anabolic steroid use (34:30). He talks about how these steroids “build up” tissues and muscles and result in masculine-like effects (androgenization). He discusses how common anabolic steroid use is and how it has been linked to heart disease and heart failure in particular. Asif goes over the common symptoms that this type of heart failure would present with. He then goes over the testing that should be done as well as the treatment (mainly stopping steroid use). Music courtesy of Wataboi and 8er41 from PixabayContact us at doctorvcomedian@gmail.comFollow us on Social media:Twitter: @doctorvcomedianInstagram: doctorvcomedianShow Notes: Can You Mourn Hulk Hogan the Wrestler, But Not the Man? https://www.rollingstone.com/culture/culture-features/hulk-hogan-legacy-remembrance-1235393582/The Mortal Hulk Hogan: https://www.theringer.com/2025/07/24/wwe/hulk-hogan-obituary-wrestling-legacyWhat Hulk Hogan Left Behind: https://www.nytimes.com/2025/07/26/opinion/hulk-hogan-gawker.htmlHulk Hogan's son arrested on DUI charge in Florida city where he was involved in a car crash 16 years ago: https://www.nbcnews.com/news/us-news/hulk-hogans-son-arrested-dui-florida-city-was-involved-car-crash-16-ye-rcna125905Nobody Speak: Trials of the Free Press review – Hulk v Gawker in portrait of wealthy arrogance: https://www.theguardian.com/film/2017/jun/22/nobody-speak-trials-of-a-free-press-review-hulk-hogan-gawker-netflixAnabolic androgenic steroids and cardiomyopathy: an update https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1214374/full#B11Steroid-Induced Cardiomyopathy: Insights From a Systematic Literature Review and a Case Report https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.70171Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use https://www.ahajournals.org/doi/10.1161/circulationaha.116.026945 Hosted on Acast. See acast.com/privacy for more information.
BUFFALO, NY – July 24, 2025 – A new #casereport was #published in Volume 16 of Oncotarget on July 23, 2025, titled “Extracorporeal blood filtration leading to tumor growth arrest and reduced analgesic requirements in Stage IV poorly differentiated pancreatic adenocarcinoma: A case report.” In this report, Susanna Ulahannan from the University of Oklahoma Health Sciences Center and colleagues describe the use of extracorporeal blood filtration in a patient with metastatic pancreatic cancer. The patient experienced clinical improvement, reduced pain, and no signs of new tumor growth over 12 months of follow-up. Metastatic pancreatic cancer is difficult to treat and is often diagnosed at an advanced stage. In this case, a 51-year-old woman with stage IV poorly differentiated adenocarcinoma chose not to undergo standard chemotherapy. Instead, she received extracorporeal blood filtration with the Seraph® 100 device, which is designed to remove circulating tumor cells (CTCs) from the bloodstream. CTCs are thought to contribute to the spread of cancer to other organs. “Circulating tumor cells (CTC's) are tumor cells that are shed from the primary tumor and travel via blood or lymphatic system to form micro metastases in distant organs under a suitable environment.“ The patient received between nine and twelve treatments over the course of a year. These treatments were performed both abroad, where the device is approved for this use, and under a clinical protocol in the United States. Medical imaging showed that her disease remained stable, with no new metastases detected. She also reported improvements in appetite, energy levels, and pain control. Her opioid use was reduced by 90%. Blood samples confirmed a drop in CTC levels after treatment. This observation supports the idea that removing CTCs might help limit cancer progression in some patients. However, given that this is a single case report, larger clinical studies are needed to evaluate the effectiveness of this approach. The mechanism behind the patient's pain relief is not fully understood. Authors suggest that it may be related to the reduction of tumor cells or inflammatory molecules in the blood. Researchers noted that pro-inflammatory cytokines, known to influence pain, could also have been affected by the filtration process. This is the first documented case of stable disease and reduced symptoms following CTC filtration in advanced pancreatic cancer. While these findings should not be generalized, they highlight an approach outside standard protocols that should be further explored in clinical research. Future studies will be needed to determine whether this method can contribute to symptom management or disease control in other patients with metastatic pancreatic cancer. DOI - https://doi.org/10.18632/oncotarget.28756 Correspondence to - Susanna Ulahannan - susanna-ulahannan@ouhsc.edu Video short - https://www.youtube.com/watch?v=dro6iUGDrVQ Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28756 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, extracorporeal blood filtration, circulating tumor cells, metastatic pancreatic cancer, seraph 100, OncoBind To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Spotify - https://open.spotify.com/show/0gRwT6BqYWJzxzmjPJwtVh MEDIA@IMPACTJOURNALS.COM
A 46-year old man is admitted to hospital following a first time presentation of psychosis that involved barricading himself inside a neighbour's home. At admission he appears disorganised with slow movements and speech. His rambling reveals bizarre delusional beliefs of a paranoid and persecutory nature. At moments he shows aggression towards staff but when examines reports occasional dizziness and an intolerance of cold. Physical examination reveals cool peripheries, sparse axillary and pubic hair, and soft adult-sized testicles. The investigating team suspect hypothyroidism and a complex series of investigations and therapies follows.Guests Dr Peak Man Mah FRACP (Lyell McEwin Hospital, University of Adelaide) Dr Malcolm Borg (Royal Adelaide Hospital) HostsAssociate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide)Mic Cavazzini DPhilProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physician Simeon Wong and medical student Cindy Shi. Key Reference (Spoiler Alert)* * * * *Panhypopituitarism and psychosis in a male patient [Aust N Z J Psychiatry. 2010] Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox or any podcasting app.
CardioNerds (Dr. Claire Cambron and Dr. Rawan Amir) join Dr. Ayan Purkayastha, Dr. David Song, and Dr. Justin Wang from NewYork-Presbyterian Queens for an afternoon of hot pot in downtown Flushing. They discuss a case of congenital heart disease presenting in adulthood. Expert commentary is provided by Dr. Su Yuan, and audio editing for this episode was performed by CardioNerds Intern, Julia Marques Fernandes. A 53-year-old woman with a past medical history of hypertension visiting from Guyana presented with 2 days of chest pain. EKG showed dominant R wave in V1 with precordial T wave inversions. Troponin levels were normal, however she was started on therapeutic heparin with plan for left heart catheterization. Her chest X-ray revealed dextrocardia and echocardiogram was suspicious for the systemic ventricle being the morphologic right ventricle with reduced systolic function and the pulmonic ventricle being the morphologic left ventricle. Patient underwent coronary CT angiography which confirmed diagnosis of congenitally corrected transposition of the great arteries (CCTGA) as well as minimal non-obstructive coronary artery disease. Her chest pain spontaneously improved and catheterization was deferred. Patient opted to follow with a congenital specialist back in her home country upon discharge. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls- A Case of Congenital Heart Disease Presenting in Adulthood Congenitally Corrected Transposition of the Great Arteries (CCTGA) is a rare and unique structural heart disease which presents as an isolated combination of atrioventricular and ventriculoarterial discordance resulting in physiologically corrected blood flow. CCTGA occurs due to L looping of the embryologic heart tube. As a result, the morphologic right ventricle outflows into the systemic circulation, and the morphologic left ventricle outflows into the pulmonary circulation. CCTGA is frequently associated with ventricular septal defects, pulmonic stenosis, tricuspid valve abnormalities and dextrocardia. CCTGA is often asymptomatic in childhood and can present later in adulthood with symptoms of morphologic right ventricular failure, tricuspid regurgitation, or cardiac arrhythmias. Systemic atrioventricular valve (SAVV) intervention can be a valuable option for treating right ventricular failure and degeneration of the morphologic tricuspid valve. notes- A Case of Congenital Heart Disease Presenting in Adulthood Notes were drafted by Ayan Purkayastha. What is the pathogenesis of Congenitally Corrected Transposition of the Great Arteries? Occurs due to disorders in the development of the primary cardiac tube Bulboventricular part of the primary heart forms a left-sided loop instead of right-sided loop, leading to the normally located atria being connected to morphologically incompatible ventricles This is accompanied by abnormal torsion of the aortopulmonary septum (transposition of the great vessels) As a result, there is ‘physiologic correction' of blood flow. Non-oxygenated blood flows into the right atrium and through the mitral valve into the morphologic left ventricle, which pumps blood into the pulmonary artery. Oxygenated blood from the pulmonary veins flows into the left atrium and through the tricuspid valve to the morphologic right ventricle, which pumps blood to the aorta. Compared with standard anatomy, the flow of blood is appropriate, but it is going through the incorrect ventricle on both sides. Frequent conditions associated with CCTGA include VSD, pulmonic stenosis and dextrocardia
Carolyn McMakin, MA, DC - contact-at-frequencyspecific.com Kim Pittis, LCSP, (PHYS), MT - info-at-fsmsports365.com 00:35 Patient Gratitude and Nerve Pain 01:27 Tennis Players and Shoulder Treatment 04:05 Importance of Posterior Chain in Sports 10:42 Youth and Neuroplastic Connections 16:57 Listening to Patients and Diagnostic Challenges 26:56 Knee Pain and Treatment Insights 30:50 Q&A Session 31:05 Understanding Insulin Resistance 31:52 Reducing Insulin Resistance: Protocols and Exercise 33:33 The Role of Culture and Habits in Obesity 34:43 Upcoming Events and Lectures 36:21 Case Reports and Research Insights 38:43 Addressing Specific Medical Questions 49:46 The Importance of the Vagus Nerve 54:53 Upcoming Courses and Final Thoughts Introduction to Frequency Specific Microcurrent FSM is a modality designed to aid medical practitioners in treating patients who present challenging conditions unresponsive to conventional care methods. This approach focuses on utilizing specific frequencies to influence bodily tissues and functions, thereby enhancing treatment outcomes. Key Areas of Focus in FSM 1. Shoulder and Rotator Cuff Treatment: - The shoulder, being a complex structure, relies on proprioception and muscle balance for stability. - Treatment often involves focusing on co-contraction and stabilization, emphasizing the critical role of the posterior muscles. - Practitioners are encouraged to utilize slow, controlled movements to reinforce proprioceptive feedback and muscle memory. 2. Tendinopathy and Connective Tissue: - Tendinopathy is a common issue addressed in FSM therapy, particularly in cases involving athletes and individuals with repetitive strain injuries. - Treatments include addressing both superficial and deep tissue concerns, acknowledging that muscle tightness can contribute significantly to nerve irritation. 3. Insulin Resistance and Inflammation: - FSM targets inflammation and toxicity in adipose tissue, which can play a role in insulin resistance. - There is a strong emphasis on the integration of exercise and lifestyle changes alongside FSM treatment to reduce insulin resistance effectively. 4. Neuromuscular and Proprioceptive Training: - A foundational element of FSM therapy is retraining the neuromuscular system to achieve stability and strength. - Techniques involve engaging and strengthening deep tissue structures, particularly in sports-related treatments. 5. Cranial Nerve and Vestibular Disorders: - FSM provides protocols to potentially aid in recovery from cranial nerve palsies, focusing on targeted frequency applications. - Specific attention is given to understanding vestibular and cranial nerve pathways, exploring how viral infections or other non-traumatic factors may influence conditions. 6. Role of the Vagus Nerve: - The vagus nerve plays a crucial role in maintaining equilibrium within the body. - FSM treatments often start with stimulating the vagus nerve to provide a foundation for various other therapeutic interventions. Practical Considerations Healthcare practitioners engaging in FSM training are encouraged to apply these concepts in diverse clinical scenarios. The interplay between inflammation, nerve conductance, and muscle balance forms the basis of effective treatment planning. Moreover, integrating FSM with other therapeutic exercises and lifestyle modifications can enhance patient outcomes.
Gastric sleeve surgery is the key feature of a pair of recent cases from the journal, which start this episode (1:17). Both cases feature 25-yo women with presentations in common: paraesthesia and limb weakness, along with disordered eye movement. Their symptoms arose soon after the gastrectomy operation. https://pn.bmj.com/content/25/3/268 The second report is a "true grey case" (22:14), with a myriad of presenting symptoms in a 27-yo man: fevers, weight loss, lethargy, light sensitivity, and skin plaques around the nose and mouth. Steroid treatment was started with a suspicion of a connective tissue disease, but was halted when his condition soon worsened. Some feathered friends of the podcast shine a light on the diagnosis. https://pn.bmj.com/content/25/3/253 The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the June 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Amy Ross Russell and Brian O'Toole, editing by Brian O'Toole. Thank you for listening.
Send us a textFeeling stuck, overwhelmed, or tempted to start over (again) on your case report? Before you completely trash your case report, you'll want to listen to this
Send us a textFeeling overwhelmed by your case report? Thinking about using PTO just to finish writing? You're not alone — and you definitely don't have to do that.With the July 1 early bird deadline for the ABPTS Oncology application fast approaching, now's the time to create a case report game plan that fits your real life (you know, the one with patients, laundry, and maybe even sleep).Whether you're applying for the July 1 or September 30 deadline, this episode will help you stay focused, avoid perfection paralysis, and write a case report you're proud of — without sacrificing your sanity.
Part 2 of a 2-part series recapping the 2025 POSNA Annual Meeting in Las Vegas. In this episode, we sit down with the 2025 Program Committee — Drs. Julie Samora, Tony Riccio, John Vorhies, and Christine Ho — to hear what's new and what makes this year's meeting stand out. Drs. Lindsay Andras, Apurva Shah, Firoz Miyanji, and Christine Ho highlight some standout presentations from the Awards Papers session. Drs. Stu Weinstein and John Birch share their thoughts on memorable Case Reports and how this new format adds a unique dimension to the meeting. We also chat with Dr. Jon Schoenecker, winner of the Best Basic Science Paper, and Dr. Dan Sucato, winner of the Best Clinical Paper, to learn more about their award-winning research. Hosted by Tyler McDonald (University of South Alabama) and Will Morris (Scottish Rite for Children). Music by A. A. Aalto.
Send us a text✅ Write your case report.✅ Earn CEUs.✅ Make real progress on your ABPTS Oncology application.In this quick bonus episode, I'm sharing the major updates to Case Report Writing Workshop — including 18 contact hours for PT CEUs, new module upgrades, and a streamlined path to finishing your case report (without the burnout).
ST elevation is clearly a worrying finding that can herald life-threatening conditions, such as ST elevation myocardial infarction. But not all ST-elevations are created equal, and Trainees would benefit from considering a broader number of causes for this presentation. In today's podcast the team will discuss a case of ST elevation observed in a 65-year-old female during the routine elective procedure of atrial fibrillation ablation. A range of pathophysiologies is discussed that can help listeners work though the differentials in a systematic way. Guests Assoc Prof Pramesh Kovoor FRACP FACC PhD (Westmead Hospital; the University of Sydney) Dr Neil Warwick FANZCA (Westmead Hospital) HostsAssociate Professor Stephen Bacchi FRACP (University of Adelaide)Dr Joshua Kovoor (Ballarat Base Hospital)ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Game show music courtesy of Waderman. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan, Aafreen Khalid, Hugh Murray and medical student Nivida Dixit.Key Reference (Spoiler Alert)* * * * *Metaraminol-induced coronary vasospasm masquerading as ST-elevation myocardial infarction during general anaesthesia [Br J Anaesth. 2024] Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.
CardioNerds Critical Care Cardiology Council members Dr. Gurleen Kaur and Dr. Katie Vanchiere meet with Dr. Yash Patel, Dr. Akanksha, and Dr. Mohammed El Nayir from Trinity Health Ann Arbor. They discuss a case of pulmonary air embolism, RV failure, and cardiac arrest secondary to an ocular venous air embolism. Expert insights provided by Dr. Tanmay Swadia. Audio editing by CardioNerds Academy intern, Grace Qiu. A 36-year-old man with a history of multiple ocular surgeries, including a complex retinal detachment repair, suffered a post-vitrectomy collapse at home. He was found hypoxic, tachycardic, and hypotensive, later diagnosed with a pulmonary embolism from ocular venous air embolism leading to severe right heart failure. Despite a mild embolic burden, the cardiovascular response was profound, requiring advanced hemodynamic support, including an Impella RP device (Abiomed, Inc.). Multidisciplinary management, including fluid optimization, vasopressors and mechanical support to facilitate recovery. This case underscores the need for early recognition and individualized intervention in cases of ocular venous air embolism. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls- Clear Vision, Clouded Heart: Ocular Venous Air Embolism with Pulmonary Air Embolism, RV Failure, and Cardiac Arrest Hypoxia, hypotension and tachycardia in a patient following ocular instrumentation are classic findings suggestive of pulmonary embolism from possible air embolism. The diagnosis of RV failure is based on clinical presentation, echocardiographic findings (such as McConnell's sign), and invasive hemodynamic assessment via right heart catheterization. Mechanical circulatory support can be considered as a temporary measure for patients with refractory RV failure. Central Figure: Approach to Pulmonary Embolism with Acute RV Failure Notes - Clear Vision, Clouded Heart: Ocular Venous Air Embolism with Pulmonary Air Embolism, RV Failure, and Cardiac Arrest 1. What is an Ocular Venous Air Embolism (VAE), and how can it be managed in critically ill patients? An Ocular Venous Air Embolism is defined as the entry of air into the systemic venous circulation through the ocular venous circulation, often during vitrectomy procedures. Early diagnosis is key to preventing cardiovascular collapse in cases of Ocular Venous Air Embolism (VAE). The goal is to stop further air entry. This can be done by covering the surgical site with saline-soaked dressings and checking for air entry points. Adjusting the operating table can help, especially with a reverse Trendelenburg position for lower-body procedures. The moment VAE is suspected, discontinue nitrous oxide and switch to 100% oxygen. This helps with oxygenation, speeds up nitrogen elimination, and shrinks air bubbles. Hyperbaric Oxygen Therapy can reduce bubble size and improve oxygenation, especially in cases of cerebral air embolism, when administered within 6 hours of the incident. Though delayed hyperbaric oxygen therapy can still offer benefits, the evidence is mixed. VAE increases right heart strain, so inotropic agents like dobutamine can help boost cardiac output, while norepinephrine supports ventricular function and systemic vascular resistance, but this may also worsen pulmonary resistance. Aspiration of air via multi-orifice or Swan-Ganz catheters has limited success, with success rates ranging from 6% to 16%. In contrast, the Bunegin-Albin catheter has shown more promise, with a 30-60% success rate. Catheterization for acute VAE-induced hemodynamic compromise is controversial, and there's insufficient evidence to support its ...
Send us a textThinking about board certification in oncologic physical therapy but feeling stuck on where to start — or whether you can even do it? This episode is your roadmap and your pep talk in one. Theresa Walchner, PT, shares exactly how writing her case report and earning her Oncology Specialist Certification transformed her clinical confidence and sharpened her patient care. And more importantly, she shows how you can do the same.By listening, you'll learn how to:Approach your case report with less overwhelm and more clarityAvoid common pitfalls and plan your writing timeline wiselyUse peer feedback to make both your report and your clinical reasoning strongerBuild the confidence and validation that comes with reflecting deeply on your practiceTheresa's candid advice and hard-won lessons will help you skip the guesswork and start your own board certification journey with a clear plan and new motivation. If you're serious about specializing and want to make a bigger impact in oncology rehab, this conversation is packed with the tools and mindset shifts to help you get there.Listen now!Follow TheOncoPT on Instagram.Follow TheOncoPT on LinkedIn.
Two wide open cases from the latest issue of the journal. Starting with a case from Italy (1:18), of a 63-yo man having a history of behavioural and cognitive problems since retiring. His many changes included low mood, significant weight loss, and problems with sleep and temperature regulation. He had a background of type 2 diabetes. Initial treatment was on a suspicion of Alzheimer's, but there was no clinical improvement. https://pn.bmj.com/content/25/2/159 A case from the United States is next (17:36), featuring a 66-yo lady experiencing 10 days of generalised weakness, with episodes of forgetfulness and a series of falls. She had previously been treated for left-sided ophthalmic herpes zoster. Neurological examination showed mild right arm and leg weakness. https://pn.bmj.com/content/25/2/164 The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the February 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening.
Welcome to Episode 45 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 45 of “The 2 View” – All things toxicology: the intoxicated patient, propranolol overdose and suicide, snake bites, and a special guest. Segment 1 – The intoxicated patient Kaufman J, Fitzpatrick P, Tosif S, et al. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ. The BMJ. Published April 7, 2017. https://www.bmj.com/content/357/bmj.j1341 Kraaijvanger N, Raven W, van Dijken T, Gresnigt F. The PIRATE mnemonic: providing a structured approach in the care for intoxicated patients at the emergency department. Int J Emerg Med. Educational Advances in Emergency Medicine. BMC: Part of Springer Nature. Published March 1, 2024 https://intjem.biomedcentral.com/articles/10.1186/s12245-024-00606-4 Thiessen P. A simple new technique for collecting urine in infants. Thischangedmypractice.com. The University of British Columbia. Faculty of Medicine: This Changed My Practice (TCMP) by UBC CPD. Published November 18, 2015. https://thischangedmypractice.com/new-technique-for-collecting-urine-in-infants/ Van Oyen A, Barney N, Grabinski Z, et al. Urine Toxicology Test for Children With Altered Mental Status. Aap.org. Pediatrics. Case Reports. American Academy of Pediatrics: Dedicated to the Health of All Children. Published October 6, 2023. https://publications.aap.org/pediatrics/article/152/5/e2022060861/194346/Urine-Toxicology-Test-for-Children-With-Altered?autologincheck=redirected Segment 2 – Propranolol overdose and suicide Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. In: StatPearls. StatPearls Publishing. NIH: National Library of Medicine – National Center for Biotechnology Information. Published July 28, 2023. https://www.ncbi.nlm.nih.gov/books/NBK448097/ Srettabunjong S. Fatal Self-Poisoning With Massive Propranolol Ingestion in a Young Male Physician. Am J Forensic Med Pathol. PubMed®. NIH: National Library of Medicine – National Center for Biotechnology Information. Published September 2017. https://pubmed.ncbi.nlm.nih.gov/28691951/ Segment 3 – Snake bites Rohl S, Meredith M, Anderson, T, et al. Comparing the Use of Crotaline-Polyvalent Immune Fab (Ovine) Versus Observation in Children. Pediatric Emergency Care: Dedicated to the Care of the Ill or Injured Child. Lww.com. Published November 2024. https://journals.lww.com/pec-online/abstract/2024/11000/comparingtheuseofcrotalinepolyvalentimmune.19.aspx Snake bites. Wikem.org. WikiEM. Last edited March 17, 2021. https://wikem.org/wiki/Snake_bites Toxicology resources Goldfrank LR, Flomenbaum NE, Howland MA, et al. Goldfrank's Toxicologic Emergencies. 8th ed. McGraw-Hill Medical; 2006. Katz K, O'Connor A, Amaducci AM. EMRA and ACMT Medical Toxicology Guide: 2nd Edition.; 2022. National Poison Data System. Poisoncenters.org. America's Poison Centers: Treatment, Education, Prevention. Accessed April 9, 2025. https://poisoncenters.org/national-poison-data-system Poison Control: National Capital Poison Center. Poison.org. Accessed April 9, 2025. https://www.poison.org/ Segment 4 – Special guest: Nancy Denke, DNP, ACNP-BC, FNP-BC, FAEN, CEN, CCRN, of Arizona Linkedin.com. Accessed April 9, 2025. https://www.linkedin.com/in/nancy-denke-dnp-acnp-bc-fnp-bc-faen-a62851 Nancy Denke, DNP, ACNP-BC, FNP-BC, FAEN, CEN, CCRN, of Arizona. ENA Hall of Honor. Published July 26, 2024. Accessed April 9, 2025. https://hall-of-honor.org/nancy-denke PodBean Development. Talking Toxicology: A Recipe for Disaster (Nancy Denke). BCEN & Friends Podcast. PodBean. Published March 7, 2023. https://bcenandfriends.podbean.com/e/talking-toxicology-a-recipe-for-disaster-nancy-denke/ *Recurring Sources * Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!
Watch Here : https://www.youtube.com/watch?v=g-pKdoQ-ycw Website: https://vigoroussteve.com/ Consultations: https://vigoroussteve.com/consultations/ eBooks: https://vigoroussteve.com/shop/ YouTube Channel: http://www.youtube.com/user/VigorousSteve/ Workout Clips Channel: https://www.youtube.com/channel/UCWi2zZJwmQ6Mqg92FW2JbiA Instagram: https://instagram.com/vigoroussteve/ TikTok: https://www.tiktok.com/@vigoroussteve Reddit: https://www.reddit.com/r/VigorousSteve/ PodBean: https://vigoroussteve.podbean.com/ Spotify: https://open.spotify.com/show/2wR0XWY00qLq9K7tlvJ000 Patreon: https://www.patreon.com/vigoroussteve
Send us a text“One day you will tell your story of how you overcame what you went through, and it will be someone else's survival guide.” – Brené BrownYour case report is exactly that—a survival guide for future OncoPTs.When you share your clinical reasoning, decision-making, and outcomes, you're not just fulfilling an application requirement. You're shaping how oncology physical therapy is practiced in the future.In this episode of TheOncoPT Podcast, we're diving deep into what makes a strong case report for your ABPTS Oncology Specialty application, how to start writing it (without getting stuck), and why your voice and experience truly matter in advancing our field.Listen now!Follow TheOncoPT on Instagram.Follow TheOncoPT on LinkedIn.
In this episode we hear about an emergency presentation to a South Australian hospital, of a 74-year-old male with shortness of breath. The curve ball is that he had undergone ablation for drug-refractory atrial fibrillation less than two weeks prior. This discussion gives an overview of developing technologies for AF treatment and developing knowledge about the possible complications. We also have some multiple choice questions to test your understanding.Guest Dr Shaun Evans, FRACP (Royal Adelaide Hospital; University of Adelaide) HostsAssociate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)Jasmine Le (University of Adelaide) ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Hugh Murray, Aidan Tan, Aafreen Khalid, Sebastiaan Lambooy, Amy Hughes and Lauren Gomes. Key Reference (Spoiler Alert)*****Delayed cardiac tamponade from pericarditis following pulmonary vein cryo-balloon ablation [IMJ. 2020] Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.
In this episode, we get into the world of reverse logistics in the cold chain. Our guest, Dan Spitale Vice President, Global Sales At Ups Capital sheds some light on common errors shippers are making in reverse logistics and where to find improvements. For more information subscribe to Running on Ice the newsletter or podcast. Follow the Running on Ice Podcast Other FreightWaves Shows Learn more about your ad choices. Visit megaphone.fm/adchoices
CardioNerds (Drs. Daniel Ambinder and Eunice Dugan) join Dr. Namrita Ashokprabhu, Dr. Yulith Roca Alvarez, and Dr. Mehmet Yildiz from The Christ Hospital. Expert commentary by Dr. Odayme Quesada. Audio editing by CardioNerds intern, Christiana Dangas. This episode highlights the pivotal role of cardiac MRI and functional testing in uncovering coronary vasospasm as an underlying cause of MINOCA. Cardiac MRI is crucial in evaluating myocardial infarction with nonobstructive coronary arteries (MINOCA) and diagnosing myocarditis, but findings must be interpreted within clinical context. A 58-year-old man with hypertension, hyperlipidemia, diabetes, a family history of cardiovascular disease, and smoking history presented with sudden chest pain, non-ST-elevation on EKG, and elevated troponin I (0.64 µg/L). Cardiac angiography revealed nonobstructive coronary disease, including a 40% stenosis in the LAD, consistent with MINOCA. Eight weeks later, another event (troponin I 1.18 µg/L) led to cardiac MRI findings suggesting myocarditis. Further history revealed episodic chest pain and coronary vasospasm, confirmed by coronary functional angiography showing severe vasoconstriction, resolved with nitroglycerin. Management included calcium channel blockers and long-acting nitrates, reducing symptoms. Coronary vasospasm is a frequent MINOCA cause and can mimic myocarditis on CMRI. Invasive coronary functional testing, including acetylcholine provocation testing, is indicated in suspicious cases. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Notes - Coronary Vasospasm What are the potential underlying causes of MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries)? Plaque Rupture: Plaque disruption, which includes plaque rupture, erosion, and calcified nodules, occurs as lipids accumulate in coronary arteries, leading to inflammation, necrosis, fibrosis, and calcification. Plaque rupture exposes the plaque to the lumen, causing thrombosis and thromboembolism, while plaque erosion results from thrombus formation without rupture and is more common in women and smokers. Intravascular imaging, such as IVUS and OCT, can detect plaque rupture and erosion, with studies showing plaque disruption as a frequent cause of MINOCA, particularly in women, though the true prevalence may be underestimated due to limited imaging coverage. Coronary Vasospasm: Coronary vasospasm is characterized by nitrate-responsive chest pain, transient ischemic EKG changes, and >90% vasoconstriction during provocative testing with acetylcholine or ergonovine, due to hyper-reactivity in vascular smooth muscle. It is a common cause of MINOCA, with approximately half of MINOCA patients testing positive in provocative tests, and Asians are at a significantly higher risk than Whites. Smoking is a known risk factor for vasospasm. In contrast, traditional risk factors like sex, hypertension, and diabetes do not increase the risk, and vasospasm is associated with a 2.5–13% long-term risk of major adverse cardiovascular events (MACE). Spontaneous Coronary Artery Dissection: Spontaneous coronary artery dissection (SCAD) involves the formation of a false lumen in epicardial coronary arteries without atherosclerosis, caused by either an inside-out tear or outside-in intramural hemorrhage. SCAD is classified into four types based on angiographic features, with coronary angiography being the primary diagnostic tool. However, in uncertain cases, advanced imaging like IVUS or OCT may be used cautiously. While the true prevalence is unclear due to missed diagnoses, SCAD is more common in women and is considered a cause of MINOCA when i...
In today's episode Nat Beuse, chief safety officer at Aurora joins us to talk about the recent release of an Informational Report on the final steps required to deploy driverless trucks safely. Follow the Truck Tech Podcast Other FreightWaves Shows Learn more about your ad choices. Visit megaphone.fm/adchoices
Sandra M. Oliver-McNeil, DNP, ACNP-BC, FACC, JACC: Case Reports Associate Editor, is joined by author Victor A. Ferrari, MD, FACC discussing this study from Ravindra et al presented at ACC.25 and published in JACC: Case Reports. This clinical vignette highlights the case of a 62-year-old male who presented with worsening dyspnea and was ultimately found to have constrictive pericarditis secondary to primary pericardial mesothelioma. The use of multimodality imaging can facilitate early diagnosis of this rare condition, helping to initiate treatment options for an otherwise high-mortality disease.
Andrea Scotti, MD, JACC: Case Reports Deputy Editor, is joined by authors Richard Carrick, MD, PhD and Drew Bidmead, BS discussing this study from Carrick et al presented at ACC.25 and published in JACC: Case Reports. Left atrial dissection is a rare, but potentially serious, complication that most commonly arises following mitral valve surgeries. In this report, we describe an unusual case of left atrial dissection that occurred after multi-valve surgical replacement in a patient with hypertrophic cardiomyopathy. While permanent pacemaker placement was required due to recurrent episodes of complete heart block, the patient was otherwise managed safely using a conservative approach without surgical re-intervention.
Mary Norine Walsh, MD, MACC, JACC: Case Reports Deputy Editor, is joined by author Alexander C Sacher, DO, discussing this study from Sacher et al presented at ACC.25 and published in JACC: Case Reports. Antiphospholipid syndrome (APS) is known for thrombotic events and pregnancy complications, but its association with myocarditis is rare and poorly understood. In this case, a 44-year-old female presented with acute chest tightness, elevated cardiac biomarkers, and severe anemia. Diagnostic workup revealed ST-segment changes on ECG, preserved left ventricular function on echocardiography, and myocardial inflammation on cardiac MRI, suggestive of acute myocarditis. Positive antiphospholipid antibodies confirmed APS. She was managed with close multidisciplinary follow up. This case highlights the role of cardiac MRI in diagnosing myocarditis early, guiding management strategies, and the need for heightened clinical suspicion in APS patients presenting with cardiac symptoms.
Miho Fukui, MD, JACC: Case Reports Associate Editor, is joined by author Ree Lu, MD, discussing this study from Cho et al presented at ACC.25 and published in JACC: Case Reports. Intravenous leiomyomatosis (IVL) is a rare benign uterine growth that extends into the venous system. This case describes a 48-year-old female who presented with 1 month of chest pain and dyspnea on exertion. She was found to have a right atrial mass that transiently crossed into the right ventricle with associated moderate tricuspid regurgitation. Computed tomography revealed a uterine mass with contiguous intravascular extension through the inferior vena cava terminating in the right atrium. This case of symptomatic tricuspid valve obstruction due to IVL illustrates the importance of maintaining preload. Chest and abdominal imaging may be necessary to identify the source of the mass and ensure appropriate surgical planning.
Maurice Enriquez-Sarano, MD, FACC JACC: Case Reports Associate Editor, is joined by author Emmanuel Daniel, MD, discussing this study from Daniel et al presented at ACC.25 and published in JACC: Case Reports. Large lead-associated vegetations carry a significant risk of pulmonary embolism with hemodynamic instability when transvenous lead extraction is attempted. In this case, a 54-year-old male came to the hospital with fever and dyspnea. He was found to have MSSA bacteremia and a large RV lead vegetation on echo. He had multiple co-morbidities and was a high-risk surgical candidate. He underwent successful vegetation aspiration using the Flowtriever system, followed by endovascular lead extraction.
CardioNerds co-founders Dr. Daniel Ambinder and Dr. Amit Goyal are joined by Dr. Spencer Weintraub, Chief Resident of Internal Medicine at Northwell Health, Dr. Michael Albosta, third-year Internal Medicine resident at the University of Miami, and Anna Biggins, Registered Dietitian Nutritionist at the Georgia Heart Institute. Expert commentary is provided by Dr. Zahid Ahmad, Associate Professor in the Division of Endocrinology at the University of Texas Southwestern. Together, they discuss a fascinating case involving a patient with a new diagnosis of hypertriglyceridemia. Episode audio was edited by CardioNerds Intern Student Dr. Pacey Wetstein. A woman in her 30s with type 2 diabetes, HIV, and polycystic ovarian syndrome presented with one day of sharp epigastric pain, non-bloody vomiting, and a new lower extremity rash. She was diagnosed with hypertriglyceridemia-induced pancreatitis, necessitating insulin infusion and plasmapheresis. The CardioNerds discuss the pathophysiology of hypertriglyceridemia-induced pancreatitis, potential organic and iatrogenic causes, and the cardiovascular implications of triglyceride disorders. We explore differential diagnoses for cardiac and non-cardiac causes of epigastric pain, review acute and long-term management of hypertriglyceridemia, and discuss strategies for the management of the chylomicronemia syndrome, focusing on lifestyle changes and pharmacotherapy. This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Hypertriglyceridemia Cardiac sarcoidosis can present with a variety of symptoms, including arrhythmias, heart block, heart failure, or sudden cardiac death. The acute management of hypertriglyceridemia-induced pancreatitis involves prompt recognition and initiation of therapy to lower triglyceride levels using either plasmapheresis or intravenous insulin infusion +/- heparin infusion. Insulin infusion is used more commonly, while plasmapheresis is preferred in pregnancy. Medications such as fibrates and omega-3 fatty acids can be used to maintain long-term triglyceride reduction to prevent the recurrence of pancreatitis, especially in patients with persistent triglyceride elevation despite lifestyle modifications. Statins can be used in patients for ASCVD reduction in patients with a 10-year ASCVD risk > 5%, age > 40 years old, and diabetes or diabetes with end-organ damage or known atherosclerosis. Consider preferential use of icosapent ethyl as an omega-3 fatty acid for triglyceride lowering if the patients fit the populations that appeared to benefit in the REDUCE IT trial. Apply targeted dietary interventions within the context of an overall healthy dietary pattern, such as a Mediterranean or DASH diet. Limit full-fat dairy, fatty meats, refined starches, added sugars, and alcohol. Encourage high-fiber vegetables, whole fruits, low-fat or fat-free dairy, plant proteins, lean poultry, and fish. Pay special attention to the cooking oils to ensure the patient is not using palm oil, coconut oil, or butter when cooking. Instead, use liquid non-tropical plant oils. Initiate a very low-fat diet (< 5% of total daily calories from fat) for 1-4 weeks when TG levels are > 750 mg/dL. Recommend and encourage patients to exercise regularly, with a minimum goal of 150 minutes/week of moderate-intensity aerobic activity. If weight loss is required, aim for more than >225 - 250 minutes/week. Develop patient-centered and multidisciplinary stra...
Andrea Scotti, MD, JACC: Case Reports Deputy Editor, is joined by authors Richard Carrick, MD, PhD and Drew Bidmead, BS discussing this study from Carrick et al presented at ACC.25 and published in JACC: Case Reports. Left atrial dissection is a rare, but potentially serious, complication that most commonly arises following mitral valve surgeries. In this report, we describe an unusual case of left atrial dissection that occurred after multi-valve surgical replacement in a patient with hypertrophic cardiomyopathy. While permanent pacemaker placement was required due to recurrent episodes of complete heart block, the patient was otherwise managed safely using a conservative approach without surgical re-intervention.
Mary Norine Walsh, MD, MACC, JACC: Case Reports Deputy Editor, is joined by author Dena Hayes, MD, discussing this study from Hayes et al presented at ACC.25 and published in JACC: Case Reports. The diagnosis of cardiac sarcoidosis (CS) is often challenging, particularly in atypical cases. The authors describe a case of a previously healthy 33-year-old woman who was found to have a biatrial mass and evidence of a diffuse inflammatory or neoplastic process on multimodality imaging. Percutaneous biopsy of the cardiac mass was performed and histopathology revealed granulomas consistent with CS. This case adds to the growing number of reports of CS presenting as an intracardiac mass.
Julien Dreyfus, MD, PhD, JACC: Case Reports Associate Editor, is joined by author Khalid Shakfeh, MD, discussing this study from Shakfeh et al presented at ACC.25 and published in JACC: Case Reports. A 56 year old man with chronic chest pain syndrome presented with sudden onset of weakness. Evaluation for a stroke revealed a large mass in the right atrium measuring approximately 2.2 x 2.0 cm immediately above the tricuspid valve annulus and adjacent to the atrio-ventricular groove on TTE. Cardiac MRI ruled out intracardiac mass, but rather demonstrated an RCA fusiform aneurysm. Coronary CTA characterized this as two fusiform RCA aneurysms. A LHC confirmed this. Giant coronary aneurysms appearing as a large space-occupying intracavitary cardiac mass are rarely diagnosed. Escalating multimodal imaging is essential for accurate diagnosis and surgical planning. Kawasaki disease can have a late presentation and should be considered in the differential diagnosis of coronary aneurysms. A multimodal imaging approach is essential for accurate diagnosis and management of giant coronary aneurysms.
Sandra M. Oliver-McNeil, DNP, ACNP-BC, FACC, JACC: Case Reports Deputy Editor, is joined by author Liam S. Flanagan, MD discussing this study from Flanagan et al presented at ACC.25 and published in JACC: Case Reports. Pulmonary arterial hypertension (PAH) has a diverse range of etiologies and carries significant morbidity and mortality. Here, a 45-year-old female presented with shortness of breath and was found to be in acute right heart failure due to PAH. Exam demonstrated features of scurvy. She initially required vasopressors, supplemental oxygen therapy, and PAH therapies but rapidly improved with vitamin C supplementation.
CardioNerds (Dr. Rick Ferraro and Dr. Dan Ambinder) join Dr. Sri Mandava, Dr. David Meister, and Dr. Marissa Donatelle from the Columbia University Division of Cardiology at Mount Sinai Medical Center in Miami. Expert commentary is provided by Dr. Pranav Venkataraman. They discuss the following case involving a patient with cardiac sarcoidosis presenting as STEMI: A 57-year-old man with a history of hyperlipidemia presented with sudden onset chest pain. On admission, he was vitally stable with a normal cardiorespiratory exam but appeared in acute distress and was diffusely diaphoretic. His ECG revealed sinus rhythm, a right bundle branch block (RBBB), and ST elevation in the inferior-posterior leads. He was promptly taken for emergent cardiac catheterization, which identified a complete thrombotic occlusion of the mid-left circumflex artery (LCX) and large obtuse marginal (OM) branch, with no underlying coronary atherosclerotic disease. Aspiration thrombectomy and percutaneous coronary intervention (PCI) were performed, with one drug-eluting stent placed. An echocardiogram showed a left ventricular ejection fraction (EF) of 31%, hypokinesis of the inferior, lateral, and apical regions, and an apical left ventricular thrombus. The patient was started on triple therapy. A hypercoagulable workup was negative. A cardiac MRI was obtained to further evaluate non-ischemic cardiomyopathy. In conjunction with a subsequent CT chest, the results raised suspicion for cardiac sarcoidosis with systemic involvement. In view of a reduced EF and significant late-gadolinium enhancement, electrophysiology was consulted to evaluate for ICD candidacy. A decision was made to delay ICD implantation until a definitive diagnosis of cardiac sarcoidosis could be established by tissue biopsy. The patient was started on HF-GDMT and discharged with a LifeVest. Close outpatient follow-up with cardiology and electrophysiology was arranged. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Cardiac Sarcoidosis Presenting as STEMI Cardiac sarcoidosis can present with a variety of symptoms, including arrhythmias, heart block, heart failure, or sudden cardiac death. Symptoms can be subtle or mimic other cardiac conditions. Conduction abnormalities, particularly AV block or ventricular arrhythmias, are common and may be the initial indication of cardiac involvement with sarcoidosis. The additive value of Echocardiography, FDG-PET, and cardiac MR is indispensable in the diagnostic workup of suspected cardiac sarcoidosis. Specific role of MRI/PET: Both cardiac MRI and FDG-PET provide a complementary role in the diagnosis of cardiac sarcoidosis. Cardiac MRI is an effective diagnostic screening tool with fairly high sensitivity but is limited by its inability to decipher inflammatory (“active” disease) versus fibrotic myocardium. FDG-PT helps to make this discrimination, refine the diagnosis, and guide clinical management. Ultimately, these studies are most useful when interpreted in the context of other clinical information. Primary prevention of sudden cardiac death in cardiac sarcoidosis focuses on risk stratification, with ICD placement for high-risk patients. For patients awaiting definitive diagnosis, a LifeVest may be used as a temporary measure to protect from sudden arrhythmic events until an ICD is placed. Notes - Cardiac Sarcoidosis Presenting as STEMI 1. Is STEMI always a result of coronary artery disease? By definition, a STEMI is an acute S-T segment elevation myocardial infarction. This occurs when there is occlusion of a major coronary artery, which results in transmural ischemia and damage,
This case report comes to you from Brigham and Women's Hospital in Boston, a huge teaching hospital that serves the Harvad Medical School. The 52-year-old female presented with clumsiness and paresthesia of the right hand that had persisted for several days. She also had a headache and three weeks prior to presentation had undergone a suboccipital craniotomy for a Chiari I malformation. To complicate things, there was a past medical history of migraines and a family history of a Factor V Leiden mutation. The identified diagnosis is one in which evidence is limited for aspects of management, and the topics of uncertainty and mentorship in medicine also arise in this discussion.Guest Galina Gheihman, MD D (Brigham and Women's Hospital; Harvard Medical School) HostsAssociate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)HaeLynn Gim (Harvard Medical School) ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by Dr Sebastiaan Lambooy.Key Reference (Spoiler Alert)* * * * *Isolated Cortical Vein Thrombosis [Neurohospitalist. 2023] Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.
A puzzling pair of Case Reports from the most recent issue of the journal. First up (1:35) is a man in his mid-fifties, presenting with lumbar spine fractures, which then developed into confusion, vomiting, and abdominal pain. An x-ray showed dilated intestinal loops and his blood sodium levels were low. https://pn.bmj.com/content/25/1/87 The second case (23:06) involves a 21-yo woman, who presented at 18 weeks pregnant with multiple episodes of right upper limb tonic extension, and subsequently developed new-onset refractory status epilepticus (NORSE). https://pn.bmj.com/content/25/1/56 The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the February 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital. Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim and Brian O'Toole. Thank you for listening.
This episode delves into key findings in the literature, focusing on the nuances of neuromuscular blockade in pediatric patients and novel advancements in intubation techniques to enhance patient safety. We explore significant insights from recent studies that highlight age-related differences in recovery times from neuromuscular blockade and practical recommendations. We also discuss a novel flexible stylet for intubation and the implications of intravenous catheter design during emergency needle decompression.Highlights include:• Exploring age-based variability in neuromuscular recovery • Understanding the effects of volatile anesthetics on younger patients • Emphasizing the importance of quantitative monitoring in pediatrics • Introducing a new flexible intubation aid to enhance airway management • Discussing a case report on emergency needle thoracostomy • Practical recommendations for training to improve response in emergency situationsFor show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/243-unlocking-insights-for-safer-anesthesia-key-findings-from-the-literature-and-a-case-report/© 2025, The Anesthesia Patient Safety Foundation
CardioNerds (Dr. Colin Blumenthal and Dr. Saahil Jumkhawala) join Dr. Rohan Ganti, Dr. Nikita Mishra, and Dr. Jorge Naranjo from the Rutgers – Robert Wood Johnson program for a college basketball game, as the buzz around campus is high. They discuss the following case involving a patient with ventricular tachycardia: The case involves a 61-year-old man with a medical history of hypothyroidism, hypertension, hyperlipidemia, seizure disorder on anti-epileptic medications, and major depressive disorder, who presented to the ER following an out-of-hospital cardiac arrest. During hospitalization, he experienced refractory polymorphic ventricular tachycardia (VT), requiring 18 defibrillation shocks. Further evaluation revealed non-obstructive hypertrophic cardiomyopathy (HCM). We review the initial management of electrical storm, special ECG considerations, diagnostic approaches once ischemia has been excluded, medications implicated in polymorphic VT, the role of multi-modality imaging in diagnosing hypertrophic cardiomyopathy, and risk stratification for implantable cardioverter-defibrillator (ICD) placement in patients with HCM. Expert commentary is provided by Dr. Sabahat Bokhari. Episode audio was edited by CardioNerds Intern and student Dr. Pacey Wetstein. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - A Curious Case of Refractory Ventricular Tachycardia - Rutgers-Robert Wood Johnson Diagnostic Uncertainty in VT Storm: In VT storm, ischemia is a primary consideration; when coronary angiography excludes significant epicardial disease, alternative causes such as cardiomyopathies, channelopathies, myocarditis, electrolyte disturbances, or drug-induced arrhythmias must be explored. ST elevations in ECG lead aVR: ST elevations in lead aVR and diffuse ST depressions can sometimes represent post-arrest oxygen demand and myocardial mismatch rather than an acute coronary syndrome. This pattern may occur in the context of polymorphic VT (PMVT), where myocardial oxygen demands outstrip supply, especially after an arrest. While these ECG changes could suggest myocardial ischemia, caution is needed, as they might not always indicate coronary pathology. However, PMVT generally should raise suspicion for underlying coronary disease and may warrant a coronary angiogram for further evaluation. Medication Implications in PMVT and HCM: Certain medications, including psychotropic drugs (e.g., antidepressants, antipsychotics) and anti-epileptic drugs, can prolong the QT interval or interact with other drugs, thereby increasing the risk of polymorphic VT in patients with underlying conditions like HCM. Careful management of these medications is critical to avoid arrhythmic events in predisposed individuals. Multi-Modality Imaging in HCM: Cardiac MRI with late gadolinium enhancement (LGE) is invaluable in assessing myocardial fibrosis, a key predictor of arrhythmic risk, and can guide decisions regarding ICD implantation. Echocardiography and contrast-enhanced CT can provide additional insights into structural abnormalities and risk assessment. Polymorphic VT in Nonobstructive HCM: Polymorphic ventricular tachycardia (PMVT) can occur in nonobstructive hypertrophic cardiomyopathy due to myocardial fibrosis and disarray, even in the absence of significant late gadolinium enhancement and left ventricular outflow tract obstruction. ICD Risk Stratification in HCM: Risk stratification for ICD placement in HCM includes assessment of clinical features such as family history of sudden cardiac death, history of unexplained syncope, presence of nonsustained VT on ambulatory monitoring,
This case report describes a 42-year-old male from Arizona with a complex course characterised by fever following an orthotopic liver transplant. A general approach to fever in the post-transplant patient is discussed, along with specific considerations regarding travel in post-transplant patients or those on immunosuppressants for other indications. A/Prof Camille Kotton and Dr Simran Gupta from the Massachusetts General Hospital and Brigham and Women's Hospital take listeners through the case and related issues in a step-by-step manner at a level targeted for trainees and generalists.Guest A/Prof Camille Kotton (Massachusetts General Hospital, Harvard University)Dr Simran Gupta (Brigham and Women's Hospital, Harvard University) HostsAssociate Professor Stephen Bacchi FRACP (Fulbright Fellow, Mass General Brigham; University of Adelaide)Christina Gao (University of Adelaide)ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by doctors Maansi Arora, Brandon Stretton, Matt Lim and Ben Cook.Key Reference (Spoiler Alert)* * * * *Coccidioidal Meningitis after Liver Transplantation in a Nonendemic Region: A Case Report [Transplantation 2006]Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.
On today's podcast: 1) Fire-Scarred Los Angeles Braces for More Extreme Wind 2) DOJ Report Says Trump Would Have Been Convicted in Election Case 3) China Weighs Sale of TikTok US to Musk as a Possible OptionSee omnystudio.com/listener for privacy information.
Two more fascinating Case Reports from the latest issue of the journal. The first case (1:15) is of a 57-yo woman, with an intermittent posterior headache, which had an associated bilateral pressure-like sensation. Her symptoms had begun on a recent trip to Sri Lanka. https://pn.bmj.com/content/24/6/526 Following on is the second case (22:18), which features a 54-yo man experiencing deterioration in his speech and mobility. He had a background of chronic HIV infection with ongoing treatment. https://pn.bmj.com/content/24/6/507 The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the June 2024 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital. Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim and Brian O'Toole. Thank you for listening.
CardioNerds (Dr. Dan Ambinder and guest host, Dr. Pooja Prasad) join Dr. Donny Mattia from Phoenix Children's pediatric cardiology fellowship, Dr. Sri Nayak from the Mayo Clinic – Arizona adult cardiology fellowship, and Dr. Harrison VanDolah from the University of Arizona College of Medicine - Phoenix Med/Peds program for a sunrise hike of Piestewa Peak, followed by some coffee at Berdena's in Old Town Scottsdale (before the bachelorette parties arrive), then finally a stroll through the Phoenix Desert Botanical Gardens to discuss a thought-provoking case series full of clinical cardiology pearls. Expert commentary is provided by Dr. Tabitha Moe. Episode audio was edited by Dan Ambinder. They discuss the following case: Cardiology is consulted by the OB team for a 27-year-old female G1, now P1, who has just delivered a healthy baby boy at 34 weeks gestation after going into premature labor. She is experiencing shortness of breath and is found to have a significant past cardiac history, including atrial fibrillation and preexcitation, now with a pacemaker and intracardiac defibrillator. We review the differential diagnosis for peripartum cardiomyopathy (PPCM) and then combine findings from her infant son, who is seen by our pediatric cardiology colleagues and is found to have severe hypertrophic cardiomyopathy (HCM). Genetic testing for both ultimately reveals a LAMP2 mutation consistent with Danon Disease. The case discussion focuses on the differential diagnosis for PPCM, HCM, pearls on Danon Disease and other HCM “phenocopies,” and the importance of good history. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media Pearls Peripartum cardiomyopathy is a diagnosis of exclusion – we must exclude other possible etiologies of heart failure! Be on the lookout for features of non-sarcomeric HCM – as Dr. Michelle Kittleson said in Episode 166, “LVH plus” states. HCM with preexcitation, heart block, strong family history, or extracardiac symptoms such as peripheral neuropathy, myopathy, or cognitive impairment should be evaluated for infiltrative/inherited cardiomyopathies! As an X-linked dominant disorder, Danon disease will present differently in males vs females, with males having much more severe and earlier onset disease with extracardiac features. Making the diagnosis for genetic disorders such as Danon disease is important for getting the rest of family members tested as well as the opportunity for specialized treatments such as gene therapy Up to 5% of Danon disease cases may be due to copy number variants, which may be missed in genetic testing that does not do targeted deletion/duplication analysis!). Notes What is the differential diagnosis for peripartum cardiomyopathy? Peripartum cardiomyopathy is a diagnosis of exclusion – we must exclude other possible etiologies of heart failure! First, ensure that you are not missing an acute life-threatening etiology of acute decompensated heart failure – pulmonary embolism, amniotic fluid embolism, ACS, and SCAD should all be ruled out. Second, a careful history can identify underlying heart disease or risk factors for the development of heart failure, such as substance use, high-risk behaviors that put one at risk for HIV infection, and family history that suggests an inheritable cardiomyopathy. Lastly, a careful review of echocardiographic imaging may also identify underlying etiologies that warrant a change in management. Diagnosis of peripartum cardiomyopathy is important to consider as within 7 days of onset, patients may be eligible for treatment with bromocriptine – consider referring ...
Dando sequência à série "Naruhodo Entrevista" de conversas descontraídas com cientistas brasileiras e brasileiros, chegou a vez da Médica, Doutora em Fisiopatologia em Clínica Médica e Livre Docência em Pneumologia, Suzana Tanni.Só vem!> OUÇA (90min 14s)*Naruhodo! é o podcast pra quem tem fome de aprender. Ciência, senso comum, curiosidades, desafios e muito mais. Com o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.Edição: Reginaldo Cursino.http://naruhodo.b9.com.br*Suzana Erico Tanni possui graduação em Medicina pela Universidade Estadual Paulista Júlio de Mesquita Filho (1998), doutorado em Fisiopatologia em Clínica Médica [Botucatu] pela Universidade Estadual Paulista Júlio de Mesquita Filho (2008) e Livre Docente em Pneumologia pela Universidade Estadual Paulista Júlio de Mesquita Filho (2018). Atualmente é Professora Associada da Universidade Estadual Paulista Júlio de Mesquita Filho. Foi presidente da Sociedade Paulista de Pneumologia e Tisiologia (2022-2023). Coordenadora da Comissão de Epidemiologia e Pesquisa Clínica da Sociedade Brasileira de Pneumologia e Tisiologia, com responsabilidade na construção de guidelines nacionais de conteúdo respiratório.Desde 2010 atua como Docente do curso MECOR - Methods in Epidemiologic, Clinical and Operations Research da American Thoracic Society e da Associación Latino Americana do Thorax. Atualmente é Docente Líder do nível 2, para realização de manual de procedimento operacionais e plano de análise estatística.É Editora Associada do periódico Jornal Brasileiro de Pneumologia na área de Epidemiologia e DPOC, na Revista Médica Brasileira na área de pneumologia e da Frontiers Medicine-Respiratory Diseases. Atua como "Guest Editor" nos periódicos Frontiers in Case Report in Respiratory Diseases e Women in Science: Pulmonary Medicine 2023.Desde 2008, atua em Estudos Multicêntricos sobre Doenças Respiratórias. Faz parte do 4-Consortium for Clinical Characterization of COVID-19 By EHR (4CE) liderado por pesquisadores da Harvard Medical School, Boston, USATem experiência na área de Medicina, com ênfase em Pneumologia, atuando principalmente no seguinte tema: doenças pulmonares; doença pulmonar obstrutiva crônica, tabagismo e covid-19.Lattes: http://lattes.cnpq.br/4887507894734442*APOIE O NARUHODO PELA PLATAFORMA ORELO!Um aviso importantíssimo: o podcast Naruhodo agora está no Orelo: https://bit.ly/naruhodo-no-oreloE é por meio dessa plataforma de apoio aos criadores de conteúdo que você ajuda o Naruhodo a se manter no ar.Você escolhe um valor de contribuição mensal e tem acesso a conteúdos exclusivos, conteúdos antecipados e vantagens especiais.Além disso, você pode ter acesso ao nosso grupo fechado no Telegram, e conversar comigo, com o Altay e com outros apoiadores.E não é só isso: toda vez que você ouvir ou fizer download de um episódio pelo Orelo, vai também estar pingando uns trocadinhos para o nosso projeto.Então, baixe agora mesmo o app Orelo no endereço Orelo.CC ou na sua loja de aplicativos e ajude a fortalecer o conhecimento científico.https://bit.ly/naruhodo-no-orelo
CardioNerds (Dr. Yoav Karpenshif – Chair of the CardioNerds Critical Care Cardiology Council) join Dr. Munim Khan, Dr. Shravani Gangidi, and Dr. Rachel Goodman from Tufts Medical Center's general cardiology fellowship program for hot pot in China Town in Boston. They discuss a case involving a patient who presented with stress cardiomyopathy leading to cardiogenic shock. Expert commentary is provided by Dr. Michael Faulx from the Cleveland Clinic. Notes were drafted by Dr. Rachel Goodman. A young woman presents with de novo heart-failure cardiogenic shock requiring temporary mechanical circulatory support who is found to have basal variant takotsubo cardiomyopathy. We review the definition and natural history of takotsubo cardiomyopathy, discuss initial evaluation and echocardiographic findings, and review theories regarding pathophysiology of the clinical syndrome. We also highlight complications of takotsubo cardiomyopathy, with a focus on left ventricular outflow obstruction, cardiogenic shock, and arrythmias. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Takotsubo cardiomyopathy is defined as a reversible systolic dysfunction with wall motion abnormalities that do not follow a coronary vascular distribution. Takotsubo cardiomyopathy is a diagnosis of exclusion; patients often undergo coronary angiography to rule out epicardial coronary artery disease given an overlap in presentation and symptoms with acute myocardial infarction. There are multiple echocardiographic variants of takotsubo. Apical ballooning is the classic finding, but mid-ventricular, basal, and biventricular variants exist as well. Patients with takotsubo cardiomyopathy generally recover, but there are important complications to be aware of. These include arrhythmia, left ventricular outflow tract (LVOT) obstruction related to a hyperdynamic base in the context of apical ballooning, and cardiogenic shock. Patients with Impella devices are at risk of clot formation and stroke. Assessing the motor current can be a clue to what is happening at the level of the motor or screw. Notes What is Takotsubo Syndrome (TTS)? TTS is a syndrome characterized by acute heart failure without epicardial CAD with regional wall motion abnormalities seen on echocardiography that do not correspond to a coronary artery territory (see below).1 TTS classically develops following an acute stressor—this can be an emotional or physical stressor.1 An important feature of TTS is that the systolic dysfunction is reversible. The time frame of reversibility is variable, though generally hours to weeks.2 Epidemiologically, TTS has a predilection for post-menopausal women, however anyone can develop this syndrome.1 TTS is a diagnosis of exclusion. Coronary artery disease (acute coronary syndrome, spontaneous coronary artery dissection, coronary embolus, etc) should be excluded when considering TTS. Myocarditis is on the differential diagnosis. What are the echocardiographic findings of takotsubo cardiomyopathy? The classic echocardiographic findings of TTS is “apical ballooning,” which is a way of descripting basal hyperkinesis with mid- and apical hypokinesis, akinesis, or dyskinesis.3 There are multiple variants of TTS. The four most common are listed below:3(1) Apical ballooning (classic TTS)(2) Mid-ventricular variant(3) Basal variant (4) Focal variant Less common variants include the biventricular variant and the isolated right ventricular variant.3 Do patients with TTS generally have EKG changes or biomarker elevation? Patients often have elevated troponin, though the severity wall motion abnormalities seen on TTE i...
Discover insights into the challenging landscape of Cushing syndrome, where adrenal variations require careful diagnostic and therapeutic strategies. In this podcast, Sina Jasim, MD, MPH, Editor-in-Chief of the AACE Clinical Reports (ACCR) and Associate Professor of Medicine at Washington University School of Medicine, leads a compelling discussion on two unique cases featured in the ACCR article, Histopathologic Differences Between Adrenocorticotropic Hormone–Dependent and Adrenocorticotropic Hormone–Independent Adrenal Hyperplasia Causing Cushing Syndrome. Authors, Amir H Hamrahian, MD, Endocrinologist, Associate Professor, and Medical Director of the Comprehensive Adrenal Center at Johns Hopkins University School of Medicine, and Ezra Baraban, MD, Assistant Professor of Pathology at Johns Hopkins University School of Medicine, explain the diagnostic challenges for each case, the decision-making process between medical and surgical approaches, and the critical role of pathology in guiding clinical care. Read the full case report in ACCR at https://www.aaceclinicalcasereports.com/article/S2376-0605(22)00066-9/fulltext.
CardioNerds (Dr. Dan Ambinder and Dr. Rick Ferraro) join Dr. Mansi Oberoi and Dr. Mohan Gudiwada from the University of Nebraska Medical Center discuss a case of constrictive pericarditis. Expert commentary is provided by Dr. Adam Burdorf, who serves as the Program Director for the Cardiovascular Medicine Fellowship at the University of Nebraska Medical Center. The case discussed involves a 76-year-old woman with a history of monoclonal gammopathy of undetermined significance, chronic obstructive pulmonary disease, type 2 diabetes mellitus, and squamous cell carcinoma was admitted to the hospital for worsening shortness of breath, swelling in lower extremities, hyponatremia, and urinary tract infection. CT chest to evaluate for pulmonary embolism showed incidental pericardial calcifications; the heart failure team was consulted for the management of her decompensated heart failure. Echo images were nondiagnostic. Subsequent invasive hemodynamic monitoring showed elevated right and left-sided filling pressures, diastolic equalization of LV and RV pressures, and positive RV square root sign with ventricular interdependence. Cardiac MRI showed septal flattening on deep inspiration and septal bounce, suggestive of interventricular dependence. After a heart team discussion and with shared-decision making the patient opted for medical management owing to her comorbidities and frailty. Enjoy this 2024 JACC State-of-the-Art Review to learn more about pericardial diseases and best practices for pericardiectomy (Al-Kazac et al., JACC 2024) US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - Constrictive Pericarditis Echo: Left Ventricular ejection fraction = 55-60%. Unclear septal motion in the setting of atrial fibrillation MRI: Diastolic septal flattening with deep inspiration as well as a septal bounce suggestive of interventricular dependence and constrictive physiology References Garcia, M. Constrictive Pericarditis Versus Restrictive Cardiomyopathy. Journal of the American College of Cardiology, vol. 67, no. 17, 2016, pp. 2061–2076. Pathophysiology and Diagnosis of Constrictive Pericarditis. American College of Cardiology, 2017. Geske, J., Anavekar, N., Nishimura, R., et al. Differentiation of Constriction and Restriction: Complex Cardiovascular Hemodynamics. Journal of the American College of Cardiology, vol. 68, no. 21, 2016, pp. 2329–2347. Constrictive Pericarditis. ScienceDirect. Constrictive Pericarditis. Journal of the American College of Cardiology, vol. 83, no. 12, 2024, pp. 1500-1512.
HEALTH NEWS Why Raspberries Are the New Heart-Healthy Superfruit Effects of Ashwagandha (Withania Somnifera) on Stress and Anxiety: A Systematic Review and Meta-analysis Magnetic stimulation effective in helping Parkinson's patients walk Vitamin E deficiency may lead to increased colorectal cancer risk: Chinese meta-analysis Exposure to phthalates could be linked to pregnancy loss Children who claim previous life memories: A Case Report and Literature Review
CardioNerds (Amit Goyal) join Dr. Merna Hussien, Dr. Akhil Kallur, Dr. Abhinav Saxena, and Dr. Brody Deb from the MedStar Georgetown - Washington Hospital Center in DC for a stroll around Rock Creek Park as they discuss an unusual case of cobalt cardiomyopathy. Expert commentary is provided by Dr. Nana Afari Armah. Episode audio was edited by CardioNerds Intern Christiana Dangas. The case is of a middle-aged woman with a past medical history of hypertension, hyperlipidemia, and bilateral hip replacements, who presented with subacute progressive exertional dyspnea, orthopnea, and constitutional symptoms and was found to have SCAI Stage C cardiogenic shock. Transthoracic echocardiogram showed severely reduced left ventricular ejection fraction (LVEF, 20-25%) and a moderate pericardial effusion. Cardiac catheterization revealed biventricular failure with elevated filling pressures. A cardiac MRI showed diffuse late gadolinium enhancement (LGE) in the left ventricle. Endomyocardial biopsy showed nonspecific chronic inflammation. However, the evidence of mitochondrial heavy metal toxicity and elevated cobalt levels made the diagnosis of cobalt cardiomyopathy. The patient underwent revision of hip joint implants to ceramic implants and started chelation therapy. However, due to persistent stage D heart failure despite normalization of cobalt levels, she underwent orthotropic heart transplantation. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case MEdia - Cobalt Cardiomyopathy Pearls - Cobalt Cardiomyopathy A good history goes a long way in diagnosing non-ischemic cardiomyopathy (NICM). Common problems can have uncommon presentations requiring a high degree of suspicion for diagnosis. Imaging features can overlap between causes of NICM. History helps in targeting further histological workup and uncovering the root cause. Multidisciplinary effort is essential in making a rare diagnosis. Taken from1 - Singh M, Krishnan M, Ghazzal A, Halushka M, Tozzi JE, Bunning RD, Rodrigo ME, Najjar SS, Molina EJ, Sheikh FH. From Hip to Heart: A Comprehensive Evaluation of an Infiltrative Cardiomyopathy. CJC Open. 2021 Nov 1;3(11):1392–5. Notes - Cobalt Cardiomyopathy How common is cobalt cardiomyopathy? When should it be suspected? Cobalt cardiomyopathy is incredibly rare, with only a handful of reported cases. 2 It is also known as beer drinkers' cardiomyopathy, as cobalt was added to beer for fortification in Quebec 3, where it was first reported. Cobalt cardiomyopathy is characterized by its rapidly progressive nature, the presence of low voltages on EKG, and diffuse infiltration. Patients also complained of a previous history of anorexia and weight loss and were found to have polycythemia and thyroid abnormalities on labs. This syndrome was very similar to wet beriberi except for the absence of a therapeutic response to thiamine. Taken from - 2 Later, this was noted in patients with total metal hip arthroplasty 4–6, especially in patients with metal-on-metal hip arthroplasty, which led to corrosion and leakage of cobalt into the bloodstream. The syndrome in these patients was similar to those in beer drinkers from Quebec. This figure, taken from 2, shows the reports of Cobalt cardiomyopathy after cobalt alloy prostheses. [HX1] What is the pathophysiology of cobalt cardiomyopathy? Cobalt has a variety of effects on the heart, both microscopically and biochemically.Cobalt may have multiple calcium-mediated cardiac effects and may also interfere with the Krebs cycle and ATP generation by mitochondria. Histology may show modest changes with no inflammatory response o...
Send us a textMpox in Pregnancy - Risks, Vertical Transmission, Prevention, and Treatment.Nachega JB, Mohr EL, Dashraath P, Mbala-Kingebeni P, Anderson JR, Myer L, Gandhi M, Baud D, Mofenson LM, Muyembe-Tamfum JJ; Mpox Research Consortium (MpoxReC).N Engl J Med. 2024 Aug 28. doi: 10.1056/NEJMp2410045. Online ahead of print.PMID: 39197097 No abstract available. Neonatal Monkeypox Virus Infection.Ramnarayan P, Mitting R, Whittaker E, Marcolin M, O'Regan C, Sinha R, Bennett A, Moustafa M, Tickner N, Gilchrist M, Kershaw A, Rampling T; NHS England High Consequence Infectious Diseases (Airborne) Network.N Engl J Med. 2022 Oct 27;387(17):1618-1620. doi: 10.1056/NEJMc2210828. Epub 2022 Oct 12.PMID: 36223535 No abstract available.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
CardioNerds Dan Ambinder and Dr. Devesh Rai join cardiology fellows and National Lipid Association lipid scholars Dr. Jelani Grant from Johns Hopkins University and Dr. Alexander Razavi from Emory University. They discuss a case involving a patient with familial hypercholesterolemia. Dr. Archna Bajaj from University of Pennsylvania provides expert commentary. Drs. Jelani Grant and Alexander Razavi drafted notes. CardioNerds Intern Pacey Wetstein engineered episode audio. This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. A classic finding in patients with familial hypercholesterolemia is the presence of markedly elevated levels of total and low-density lipoprotein cholesterol (LDL-C) with an LDL-C concentration of 190 mg/dL or greater. However, severe hypercholesterolemia is not inevitably present, and many patients who carry this diagnosis may have lower LDL-C levels. This case history describes a young woman whose mother and brother met clinical and genetic criteria for heterozygous familial hypercholesterolemia but who had only a mild elevation in LDL-C, falling to 130 mg/dL after dietary intervention. Despite this finding, genetic testing revealed the presence of the same genetic variants as were noted in her mother and brother. In addition, a second genetic variant predisposing them to cholesterol gallstone formation was identified in all three family members. If genetic testing had not been performed, the diagnosis may have been missed or delayed, resulting in an increased risk for vascular complications associated with familial hypercholesterolemia. This case supports the value of genetic testing of family members of those with familial hypercholesterolemia, even when LDL-C levels are not severely elevated. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Exposing an Unusual Presentation of Familial Hypercholesterolemia – National Lipid Association Familial hypercholesterolemia (FH) is among the most common autosomal co-dominant genetic conditions (approximately 1:200 to 1:300 for HeFH, 1:160,000 to 1:300,000 for HoFH). Genetic testing has a role for all first-degree relatives when a family history of FH is strongly suggestive, regardless of LDL-C level. Heterogeneity in ASCVD risk among individuals with FH is derived from background polygenic risk, clinical risk factors (e.g., timing of lipid-lowering initiation and adjacent risk factors), as well as subclinical atherosclerosis burden. In clinical or genetically confirmed FH, an LDL-C goal of 55 mg/dL is recommended. Beyond statins, FDA-approved non-statin therapies for FH include ezetimibe, PCSK9 mAb, bempedoic acid, inclisiran, evolocumab (only HoFH), lomitapide (only HoFH), and LDL apheresis. Notes - Exposing an Unusual Presentation of Familial Hypercholesterolemia – National Lipid Association What are the diagnostic criteria for FH? Dutch Lipid Clinic Network1 Variables: family history, clinical history, physical exam, LDL-C level, DNA (LDLR, APOB, PCSK9) Simon-Broome1 Variables: total or LDL-C, physical exam, DNA (LDLR, APOB, PCSK9), family history Emphasis on clinical history and physical exam reduces sensitivity U.S. Make Early Diagnosis Prevent Early Death (MEDPED) 1 Only one of the three where no genetic testing is required, may work well in cascade screening Variables: age, total cholesterol, family relative (and degree) with FH Definite, probable, possible, unlikely Emphasis on clinical history and physical exam reduces sensitivity
© 2020-2025 Ivy Podcast Discovery LLC
