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

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.

Cardiac Amyloidosis: A Known Disease with an Unknown Presentation

Cardiac amyloidosis is an increasingly recognized entity that causes significant morbidity and mortality. Transthyretin amyloidosis (ATTR) is present in about 16% of patients with severe aortic stenosis and up to 17% of patients with heart failure with preserved ejection fraction9,10. Though the screening test of choice, echocardiography is not highly sensitive or specific, and it should not be relied upon to rule out cardiac amyloidosis, especially if clinical suspicion is high. We present a case of a 58-year-old woman with a history of bilateral carpal tunnel syndrome who presented with paresthesia and syncope. Extensive workup for neurologic, infectious, and malignant etiologies was negative. EKG was remarkable for low voltage. Transthoracic echocardiogram (TTE) was not suggestive of infiltrative disease. Subsequent cardiac MRI demonstrated diffuse biventricular late gadolinium enhancement and technetium 99M pyrophosphate scan revealed diffuse (3+) uptake, which was in stark contrast to the TTE. The diagnosis of ATTR amyloidosis allowed for prompt initiation of treatment in this patient