Cardiology – Page 2 – Resus Review

Retrograde IVC and Hepatic Vein Opacification in Profound Cardiogenic Shock

Charles Bruen2016-10-13T18:16:31-05:00November 26th, 2013|Cardiology, Radiology, Stabilization|

Sometimes imaging can reveal remarkable physiology. A 40-year-old man presented with profound fatigue and abdominal pain that had begun the day before but substantially worsened over the last 12 hours. He reported not experiencing any chest pain, shortness of breath, nausea/vomitin

So it begins… The debate on troponin in the U.S.

Charles Bruen2016-10-13T18:16:33-05:00August 11th, 2013|Cardiology|

This is my first official contribution to Resus Review. I wanted to start with a follow up on my recent comment on cardiac troponin. Cardiac biomarkers, particularly troponin, have become an essential tool in the work up of patients with symptoms suggestive of ischemia in which an "AC

Limit troponins to evaluation of cardiac ischemia and ACS

Charles Bruen2014-10-16T18:20:46-05:00August 11th, 2013|Cardiology|

Its important to understand that in the US the FDA has not yet approved the high-sensitivity (hs) troponin assays. Therefore we are still talking about the so-called contemporary troponin assays. The current assay is a good test, and the high-sensitivity troponin will have even better

DKA presenting as Wide Complex Tachcyardia

Charles Bruen2016-10-13T18:16:36-05:00May 18th, 2013|Cardiology, ECG, Stabilization|

29-year-old man with history of type 1 diabetes mellitus and currently living in a hotel, presented to the emergency department with 2-weeks of feeling ill with had accelerated and was much worse over the last 2 days. This included a productive cough, subject fevers, and frequent v

Ultrasound Guided Stellate Ganglion Block for Refractory Ventricular Fibrillation

Charles Bruen2016-10-13T18:16:39-05:00March 27th, 2013|Cardiology, Procedures, Ultrasound|

An unconventional approach for treatment for ventricular storm may be an ultrasound-guided block of the stellate ganglion which provides sympathetic stimulation of the heart. This may reduce cardiac irritability and facilitate defibrillation.

Pitfalls and Pearls of Temporary Transvenous Cardiac Pacing

Charles Bruen2016-10-13T18:16:39-05:00March 21st, 2013|Cardiology, ECG, Procedures|

Cardiac pacemakers and their malfunctions are often daunting for the emergency physician to diagnose and manage. This is the first part of a series covering this area. Part 1. Pitfalls and pearls of temporary transvenous pacing. Part 2. Procedural instructions for placing a transve

Basal ballooning in reverse takotsubo (stress cardiomyopathy)

Ultrasound of Reverse Takotsubo

Charles Bruen2016-10-13T18:16:41-05:00March 10th, 2013|Cardiology, Ultrasound|

Reverse takotsubo (stress cardiomyopathy) with hyperdynamic apex and complete akinesia of the base (as opposed to the classic apical ballooning).

Lead Placement for Posterior ECG

Charles Bruen2016-10-13T18:16:41-05:00March 10th, 2013|Cardiology, ECG|

The leads V4-V6 are removed and substituted for V7-V9 as shown below. On most EKg machines, the labels areno automatically changed so it is important to cross out the labels for V4-V6 and write in V7-V9. It is also helpful for future clinicians, if you note in your read that it is a p

High Energy Defibrillation for Incessant Ventricular Fibrillation

Charles Bruen2016-10-13T18:16:41-05:00March 10th, 2013|Cardiology, Procedures|

A 45-year-old man with severe coronary heart disease s/p CABG but with an unprotected left main, presented to the emergency department for evaluation and suffered a ventricular fibrillation cardiac arrest. CPR and BVM ventilation was initiated immediately. The patient underwent an

STEMI with Dual Culprit Lesions

Charles Bruen2016-10-13T18:16:41-05:00March 10th, 2013|Cardiology, ECG|

This 59-year-old gentlemen presented with 3 hours of severe upper sternal chest pressure that radiated to his throat which he described as “strangulating”. No previous cardiac history.

Coronary Artery Naming Convention

Charles Bruen2016-10-13T18:16:41-05:00February 18th, 2013|Cardiology|

The names of the major coronary arteries are well known. However, the nomenclature of the secondary coronary arteries can be confusing. Familiarity with the names of these vessels is useful when reading coronary angiogram reports, having discussions with your interventionalist, and do

Peripartum Cardiomyopathy

Charles Bruen2013-11-30T00:30:22-06:00February 18th, 2013|Cardiology|

What is the etiology of peripartum cardiomyopathy? The etiology is unknown; multiple etiologies have been proposed. The most substantiated etiology is viral myocarditis.. It is thought that the relative immunosuppression of pregnancy may increase the risk of viral myocarditis (JEM, V.