Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal

We report two serious and unusual complications of benzodiazepine withdrawal in a single patient: takotsubo cardiomyopathy and catatonia. This 61-year-old female patient was brought to the emergency department with lethargy and within hours had declined into a state of catatonia. Although there was never a complaint of chest pain, ECG showed deep anterior T-wave inversions and cardiac enzymes were elevated. An echocardiogram was consistent with takotsubo cardiomyopathy. She later received 1 mg of midazolam and within minutes had resolution of catatonic symptoms. Careful history revealed that she had omitted her daily dose of lorazepam for 3 days prior to admission. To our knowledge, the case presented herein is the first report of simultaneous catatonia and takotsubo cardiomyopathy in the setting of benzodiazepine withdrawal. The pathogenesis of both conditions is poorly understood but may be indirectly related to the sudden decrease in γ-aminobutyric acid (GABA) signaling during benzodiazepine withdrawal

Effects of cardiology review of the electrocardiogram in patients with suspected acute coronary syndromes

Misclassification of the electrocardiogram (ECG) contributes to treatment errors in patients with acute coronary syndrome. We hypothesized that cardiology ECG review could reduce these errors

Listen Before You Auscultate Bedside Cardiac Assessment Trailer

Authors: James L. Meisel, MD, MHPE,1 Daniel C. R. Chen, MD, MSc,2 Gail March Cohen, PhD, MFA,3 Sheilah A. Bernard, MD,4 Hugo Carmona, MD,5 Emil R. Petrusa, PhD,6 Isaac O. Opole, MD, PhD,7 Deborah Navedo, PhD, CPNP, FNAP,8 Vladimir I. Valtchinov, PhD,9Ahmed H. Nahas, MD,10 Carly M. Eiduson, BA,11 Nick Papps, BS, MBA12 1 Associate Chief of Staff for Education, VA Bedford Healthcare System; Associate Professor of Medicine, Dept. of Medicine, Boston University Chobanian and Avedisian School of Medicine 2 Assistant Dean of Student Affairs and Clinical Associate Professor of Medicine, General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine 3 Medical Director, AMA Ed Hub 4 Associate Professor of Medicine, Cardiovascular Medicine, Dept. of Medicine, Boston University School of Medicine 5 Assistant Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington 6 Professor of Surgery, Harvard Medical School; Department of Surgery, Learning Lab, Massachusetts General Hospital 7 Professor of Internal Medicine, Department of Internal Medicine, University of Kansas Medical Center 8 Director of Education, STRATUS Center for Simulation, Brigham and Women's Hospital 9 Assistant Professor of Radiology, Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital; Department of Biomedical Informatics, Harvard Medical School 10 Advanced Geriatric Medicine Fellow, Veterans Health Administration, New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System; Geriatrician, Yakima Valley Farm Workers Clinic, Yakima, WA, USA 11 Fourth-year medical student, University of Rochester School of Medicine & Dentistry 12 Multimedia producer, Synchro AgencyIntroduction: Bedside cardiac assessment (BCA) is deficient across a spectrum of non-cardiology trainees. Learners not taught BCA well may become instructors who do not teach well, creating a self-perpetuating problem. We aimed to improve BCA teaching and learning by developing a high-quality, patient-centered curriculum for medicine clerkship students that could be flexibly implemented and accessible to other health professions learners. Methods: With a constructivist perspective, we aligned learning goals, activities, and assessments. The curriculum used a “listen before you auscultate” framework, capturing patient history as context for a six-step, systematic approach. In the flipped classroom, short videos and practice questions preceded two, 1-hour class activities that integrated diagnostic reasoning, pathophysiology, physical diagnosis, and reflection. Activities included case discussions, JVP evaluation, heart sound competitions, and simulated conversations with patients. 268 students at four U.S. and international medical schools participated. We incorporated feedback, performed thematic analysis, and assessed learners’ confidence and knowledge. Results: Low post-test data capture limited quantitative results. Students reported increased confidence in BCA ability. Knowledge increased in both BCA and control groups. Thematic analysis suggested instructional design strategies were effective and peer encounters, skills practice, and encounters with educators were meaningful. Discussion: The curriculum supported active learning of day-to-day clinical competencies. Explicitly incorporating notions of trust, it promoted professional identity formation alongside BCA ability. Feedback and increased confidence on the late-clerkship post-test suggested durable learning. We recommended approaches to confirm this and other elements of knowledge, skill acquisition, or behaviors, and are surveying impacts on professional identity formation-related constructs