UTHSC PA Program Podcast

Cardiovascular - Torsades de Pointes

In this episode, we cover torsades de pointes, a life-threatening form of polymorphic ventricular tachycardia associated with a prolonged QT interval. We break down the electrophysiology behind delayed ventricular repolarization and early afterdepolarizations, which set the stage for this distinctive "twisting" QRS pattern on EKG. High-yield risk factors—including electrolyte abnormalities (low potassium, magnesium, calcium), QT-prolonging medications, bradycardia, and female sex—are emphasized to help with rapid clinical recognition. We walk through classic presentations such as palpitations, syncope, and sudden collapse, and outline the diagnostic approach with EKG confirmation and targeted lab evaluation. Management focuses on immediate IV magnesium sulfate, correction of underlying causes, and escalation to defibrillation or pacing in unstable or refractory cases. References 1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 2. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of ventricular arrhythmias. Circulation. 2018;138(13):e272–e391 3. Drew BJ, Ackerman MJ, Funk M, et al. Prevention of torsade de pointes in hospital settings. Circulation. 2010;121(8):1047–1060

Cardiovascular - Stress Cardiomyopathy

In this episode, we dive into stress (Takotsubo) cardiomyopathy, a reversible form of acute left ventricular systolic dysfunction that often mimics acute coronary syndrome but occurs without obstructive coronary artery disease. We unpack the proposed mechanism of a catecholamine surge leading to myocardial stunning, producing the classic apical ballooning pattern on imaging. The discussion highlights key risk groups—especially postmenopausal women following emotional or physical stressors—and the typical presentation of chest pain, dyspnea, and EKG changes resembling STEMI. We walk through the diagnostic approach, emphasizing the role of echocardiography and coronary angiography in distinguishing this condition from true ischemic disease. Management focuses on supportive heart failure therapy, with most patients experiencing full recovery within weeks. References 1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 2. Templin C, Ghadri JR, Diekmann J, et al.Clinical features and outcomes of Takotsubo cardiomyopathy. New England Journal of Medicine. 2015;373(10):929–938 3. Pelliccia F, Kaski JC, Crea F, Camici PG.Takotsubo syndrome: pathophysiology and treatment. JAMA Cardiology. 2023;8(3):273–282

Cardiovascular - Pericardial Effusions

In this episode, we cover pericardial effusion, the accumulation of fluid within the pericardial sac, and its progression to cardiac tamponade, a life-threatening emergency. We break down the pathophysiology of increased intrapericardial pressure impairing ventricular filling, emphasizing how the rate of fluid accumulation is just as critical as volume. Common etiologies—including infection, malignancy, autoimmune disease, uremia, and post-MI syndromes—are reviewed alongside key clinical presentations such as dyspnea, chest pain, and fatigue. We highlight classic exam findings of tamponade, including Beck's triad (hypotension, JVD, muffled heart sounds) and pulsus paradoxus. Diagnostic strategies focus on echocardiography as the gold standard, with supportive EKG and imaging findings. Management ranges from treating underlying causes in stable cases to emergent pericardiocentesis in tamponade. High-yield pearls emphasize rapid recognition to prevent hemodynamic collapse and death. References 1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 2. Klein AL, Abbara S, Agler DA, et al. Evaluation and management of pericardial disease. JAMA. 2021;325(10):1022–1036. 3. Imazio M, Adler Y. Management of pericardial effusion. Nature Reviews Cardiology. 2020;17(11):698–7123 4. Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. European Heart Journal. 2015;36(42):2921–2964.

Cardiovascular - Patent Ductus Arteriosus

In this episode, we review patent ductus arteriosus (PDA), a common congenital heart defect characterized by persistent connection between the aorta and pulmonary artery, resulting in a left-to-right shunt and pulmonary overcirculation. We break down the underlying physiology of failed ductal closure after birth, including the roles of oxygen tension and prostaglandins, and discuss why premature infants are at highest risk. Clinically, we highlight presentations ranging from asymptomatic small PDAs to larger defects causing tachypnea, poor feeding, failure to thrive, and signs of heart failure. Classic exam findings—especially the continuous "machinery" murmur and bounding pulses—are emphasized alongside diagnostic confirmation with echocardiography. Management strategies include NSAID therapy (indomethacin or ibuprofen) in preterm infants and catheter-based or surgical closure for persistent or symptomatic cases. Key pearls focus on early recognition to prevent complications such as pulmonary hypertension, Eisenmenger syndrome, and heart failure. References 1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2. Sathanandam S, Gutfinger D, O'Brien L, et al. Patent ductus arteriosus: current management strategies. Journal of the American College of Cardiology. 2020;75(22):2927–2938 3. Benitz WE. Patent ductus arteriosus in preterm infants. Pediatrics. 2020;146(2):e20201209 4. Backes CH, Rivera BK, Bridge JA, et al. Contemporary management of patent ductus arteriosus. Journal of Perinatology. 2021;41(2):273–282.

Cardiovascular - Hypertrophic Cardiomyopathy

In this episode, we explore hypertrophic cardiomyopathy (HCM)—a common inherited cardiac disorder defined by unexplained left ventricular hypertrophy, most often involving the interventricular septum. We break down the underlying genetics of autosomal dominant sarcomere mutations and how they lead to myocyte disarray, diastolic dysfunction, and dynamic left ventricular outflow tract obstruction. Clinically, we highlight hallmark features such as exertional dyspnea, chest pain, syncope, and the classic systolic murmur that increases with Valsalva and decreases with squatting. The episode also reviews diagnostic strategies with echocardiography as the gold standard, along with EKG and cardiac MRI for further evaluation. Management focuses on beta-blockers as first-line therapy, risk stratification for implantable cardioverter-defibrillator (ICD) placement, and key medication considerations. High-yield pearls emphasize HCM as the leading cause of sudden cardiac death in young athletes, the importance of family screening, and avoiding therapies that reduce preload. References 1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of hypertrophic cardiomyopathy. Circulation. 2020;142(25):e558–e631. 3. Maron BJ, Desai MY, Nishimura RA, et al. Hypertrophic cardiomyopathy: a review. New England Journal of Medicine. 2018;379(7):655–668