The echo of an unanswered ring: Improving the rate of reporting abnormal findings on echocardiography at TJUH

Aim: To improve the rate of reporting abnormal echo findings verbally to primary patient care teams. Goal: Increase the rate of attending reported abnormal echo findings to a patient\u27s primary team by 75% in 6 months

Improving Advanced Care Planning Discussion and Documentation

Our goal is to improve ACP discussion and documentation in patients above the age of 65 in our Jefferson Hospital Ambulatory Practice (JHAP) resident clinic. By instituting procedural changes within the EMR and the clinic, as well as improving provider education, we hope that residents can carry out a comprehensive and streamlined discussion regarding advanced care planning. We will institute these changes over the next 3 months, and we predict that there will be an increase in ACP discussion and uploading of appropriate documentation to 50% and 25%, respectively

A Shocking Case of Far-Field Atrial Oversensing in Giant-Cell Myocarditis

We report a unique case of delivery of inappropriate implantable cardioverter-defibrillator therapies related to a “perfect storm”: presence of an integrated lead, insufficient lead slack related to right heart dilation resulting in shock coil misplacement, myocarditis with loss of R waves, and the concomitant occurrence of an incessant atrial tachycardia. (Level of Difficulty: Advanced.

Improving Utilization of SGLT2 Inhibitors in the Inpatient Setting

SGLT2 inhibitors have been shown to have a significant benefit for patients with DM2 or CAD (DAPA-HF, Emperor-reduced) The usage of these medications are low compared to other Goal Directed Medical Therapy. There are multiple contributing factors as to why these medications are underutilized Our aim is to assess barriers against prescription of SGLT2-i at the time of discharge from TJUH and to increase utilization after placement on formulary

MANAGEMENT OF LDL-C IN HIGH RISK FEMALE PATIENTS WITH ASCVD- A CROSS-SECTIONAL STUDY

Therapeutic Area: ASCD/CVD in Women Background: The 2018 ACC/AHA guidelines recommend an LDL-C of 70mg/dL as a threshold to initiate non-statin medications in patients with a history of a major ASCVD event. Analysis of the PINNACLE Registry and the TRANSFORM LDL-C Risk Initiative identified female patients as a high risk population with a low likelihood of achieving an LDL-C 70mg/dL despite having a history of a major ASCVD event, of which only 27% were on the max dose of a high intensity statin. Only 10.4% were noted to be on additional non-statin lipid lowering therapies, of which Ezetimibe was the most prescribed (76.9%) while PCSK9 inhibitors were the least prescribed (7.7%). CVA was the most common observed major ASCVD event (45.8%), while HTN and HLD were the most common associated comorbidities (85.9%, 83.4%). Conclusion: Although the 2018 ACC/AHA guidelines recommend initiating non-statin medications in patients with a major ASCVD event, clinical implementation of these guidelines has not yet become widespread. In this study, we identify female patients as a high risk population that does not meet these guidelines at our institution. Further studies will focus on implementing a quality initiative program to improve the prescribing practices of non-statin medications in this population

Another Case of Takotsubo Syndrome: Excluded by the Presence of Significant Coronary Artery Disease, or Caused by Significant Coronary Artery Disease?

Takotsubo syndrome (TTS) is a reversible condition of abnormal myocardial contraction that was first given this name in Japan by Dr. Sato in 1991. The name comes from the Japanese word for “octopus trap,” which has a similar shape to that of the left ventricle on ventriculography during Takotsubo syndrome. It is also known as broken heart syndrome, stress-induced cardiomyopathy, or apical ballooning syndrome. The first descriptions of this phenomenon date as far back as the 1960s. TTS typically presents with symptoms and clinical signs suggestive of acute coronary syndrome (ACS). It may include ST segment elevations on electrocardiogram (ECG) characteristic of acute ischemia even though the syndrome is not caused by direct myocardial ischemia. On echocardiography, TTS is usually characterized by segmental wall motion abnormalities (SWMA) with hyperdynamic contraction of the left ventricular basal walls and akinesis of the apical walls. This results in the “apical ballooning” and is notably not in the distribution of typical coronary artery anatomy. Traditionally, the diagnosis of TTS involves the aforementioned findings and coronary angiography showing no obstructive coronary artery disease (CAD). We present here a case of an acute lateral ST-elevation myocardial infarction (STEMI) with subsequent cardiogenic shock due to TTS