A Case Series of Lyme Carditis with Complete Heart Block

Case 1 A 25-year-old Caucasian male with a history of a benign functional heart murmur presented to the emergency department for evaluation of 10 days of dyspnea with minimal exertion, such as walking a few blocks or climbing a flight of steps. Dyspnea was accompanied by moderate, dull, left-sided chest pain, which had been progressively worsening over the previous 3-5 days. The symptoms initially occurred only with exertion, but progressed to last 30-45 minutes after discontinuation of activity. He also noticed palpitations during these episodes, but did not try any remedies for his symptoms. Of note, two weeks prior to presentation, the patient had been camping in Shenandoah National Park, Virginia for four days. During that trip, he sustained over 30 mosquito bites, but never noticed any tick bites or rashes. He also traveled to Brazil five months ago, during which time he took malaria prophylaxis

From the Editors

We are proud to publish the 14th issue of the Jefferson Medicine Forum. The editorial staff would like to acknowledge the support of Dr. Diemer in producing this year’s forum. We appreciate your guidance and support in bringing this issue to print. Over the years, the Medicine Forum has provided a unique opportunity for our housestaff and medical students to not only share scholarly activities, but also to pursue their interests outside of the medical field. This year, we are proud to announce the addition of medical application reviews as well as an opinion piece on the use of opiates in primary care – a controversial topic that often leads to heated debates. We have also been fortunate enough to include interesting travel experiences, unique case reports, and exciting review articles, along with some breathtaking photography and original cartoon

Limitations of the Perioperative Cardiovascular Evaluation for Assessing Coronary Artery Disease: A Case Report

INTRODUCTION The American College of Cardiology (ACC) and the American Heart Association (AHA) publ ished pre-operative risk stratification guidelines in 2014. These guidelines have routinely been used by physicians to pre-operatively risk stratify patients. In this case report, a patient was found to have multi-vessel coronary artery disease post-operatively in the setting of unremarkable cardiac work-up preoperatively. This case highlights a limitation of the 2014 ACC/AHA guidelines

Smartphone App Reviews

Smartphone App Reviews for Doximity, ECG Source, Heart Failure Trails, QX Calculate

Secondary membranous nephropathy associated with guillain-barré syndrome.

Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome (NS) in adults. It may be primary, usually mediated by IgG4 anti-phospholipase A2 autoantibodies or secondary to various other conditions. Guillain- Barré syndrome (GBS) has been associated with MN, but a cause and effect relation has not been proven. We present a case of concurrent development of GBS and severe NS, with renal biopsy demonstrating MN. IgG4 stain was negative, indicating that most likely, the MN was secondary and probably caused by the underlying GBS

Comparing Effectiveness Between Departments of Initiatives to Improve Stroke Prevention for Atrial Fibrillation Patients

The use of anticoagulants in patients with atrial fibrillation (AF) can reduce the risk of stroke, but the rates of anticoagulant use at Jefferson University hospital were not previously monitored. Direct oral anticoagulants (DOACs) are an alternative to warfarin for anticoagulation, having the benefit of higher stroke prevention, lower bleeding rates and less frequent blood work. The goal for this study was to measure anticoagulation rates and DOAC utilization and then design an intervention to improve both of these parameters. Through mining of the AllScripts ambulatory electronic health record (EHR), the rates of anticoagulation and choice of anticoagulant in AF patients by provider in the departments of Internal Medicine, Family Medicine and Cardiology were obtained. An educational intervention was designed based on the results of a survey of providers. Clinicians were provided their individual rates of anticoagulation and further information about DOACs, falls risk, and risk calculation for AF patients. The results of this intervention were an increase in the rate of anticoagulation in the department of Cardiology (from 75.7% to 81%), while Internal Medicine (74%) and Family Medicine (66.7%) remained unchanged. The rate of DOAC utilization increased in Internal Medicine (46.4% to 53%), Family Medicine (32% to 42%) and Cardiology (36% to 49%). Improving anticoagulation rates and utilization of DOACs in AF patients is possible by providing performance data to clinicians and creating targeted educational interventions. As the Jefferson transition to Epic EHR occurs, collection of advanced AF and anticoagulation data will expand and the quality improvement efforts will become more refined. Presentation: 42:4

Barriers to Anticoagulation in Atrial Fibrillation among Cardiologists, Internists and Family Physicians

Current Performance: The rates of AC in patients 18 years or older who visited general internists \u26 family physicians not seen by cardiologists from 4/30/2013 to 4/30/2015, cardiologists from 11/29/2012 to 11/29/2014 and all 3 specialties from 1/30/2014 to 1/30/2016 were derived from the EHR. A 12-question survey was shared using RedCap with these physicians to examine potential reasons for not prescribing AC.http://jdc.jefferson.edu/patientsafetyposters/1002/thumbnail.jp

ST elevation myocardial infarction in a young adult: Expect the unexpected

Background Acute myocardial infarction (MI) in young adults can present a diagnostic and therapeutic challenge Kawasaki disease (KD) is a vasculitis of unknown etiology that occurs in infancy and childhood Coronary artery aneurysms (CAA) are the most serious complication of untreated KD seen in upto 25% of patients Thrombosis of these CAA or coronary stenosis can present as MI in less than 2% of cases which mainly occur in the 1st year of disease onset Late presentations in adult life is extremely rarehttps://jdc.jefferson.edu/medposters/1006/thumbnail.jp