CardioNerds (Amit Goyal) join University University of Mississippi Medical Center cardiology fellows (Catherine Lowe, Chris Latour and Adi Sabharwal) as they sit at the reservoir enjoying a great view of the water at the Pelican Cove Grill in Jackson, MS. They discuss and educational case of decompensated heart failure and shock in the setting of severe functional mitral regurgitation treated with MitraClip. Dr. Kellan Ashley provides the E-CPR and program director Dr. Trey Clark provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Richard Ferraro with mentorship from University of Maryland cardiology fellow Karan Desai.
The CardioNerds Cardiology Case Reports series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an “Expert CardioNerd Perspectives & Review” (E-CPR) for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus.
We are teaming up with the ACC FIT Section to use the #CNCR episodes to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an E-CPR segment and a message from the program director.
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76 year-old male with a history of non-ischemic heart failure and CRT-D placement, A-Fib, and chronic kidney disease presents with persistent shortness of breath. He had experienced a number of recent hospitalizations for heart failure exacerbations (7 in the last 9 months at a number of hospitals). Symptoms were primarily dyspnea on limited exertion, orthopnea, paroxysmal nocturnal dyspnea, and lower extremity edema. Patient was on guideline-directed medical therapy including salcubitril-valsartan, metoprolol, spironolactone, and apixaban for A-Fib. Physical exam was positive for S3, IV/VI holosystolic murmur at the apex with radiation to the axilla, bibasilar rales, and bilateral 3+ lower extremity edema. ECG with a-sensed/v-paced rhythm at 72 beats per minute and evidence of left atrial dilation. Echo exhibited LV ejection fraction of 30-35% with global hypokinesis, RVSP 56mmHg, moderately thickened mitral leaflets with posterior leaflet restriction and 4+ eccentric posteriorally-directed mitral regurgitation, estimated regurgitant orifice 0.43cm2, regurgitant volume 57mL, mean gradient across the valve 3mmHg. Subsequently admitted to the hospital with decompensated heart failure, labs notable for Cr 2.43, proBNP 2417, lactate 2.6. The patient acutely received diuresis, and given repeat hospitalizations with severe functional mitral regurgitation was considered fro MitraClip placement. This was performed one month following hospitalization without complication, and at two months following MitraClip placement the patient noted improvement in dyspnea, orthopnea, and PND, had not required repeat hospitalization.
A. Right atrial pressure
B. Right ventricular pressure
C. Pulmonary artery pressure
D. Wedge pressure
C. Pre and post MitraClip left atrial pressure
Episode Schematics & Teaching
The CardioNerds 5! – 5 major takeaways from the #CNCR case