Internal Medicine Commons^™

Use Of Va Ecmo In Patients With Acute Pulmonary Embolism Presenting With Obstructive Cardiogenic Shock Undergoing Mechanical Thrombectomy, Luke Taylor, Otoniel Espinoza, Omar O. Hernandez, Shannon Biggers, Shirin Miller, Srinivas Yallapragada, Amer Alaiti, Andrew Fredericks, Song Li, Claudius Mahr

North Texas Research Forum 2025

Background Patients with massive/sub-massive pulmonary embolism (PE) and right ventricular strain have a significant risk of hemodynamic collapse. VA ECMO support provides an excellent salvage option for patients with acute/unstable pulmonary embolism with obstructive cardiogenic shock undergoing mechanical thrombectomy. Using VA-ECMO for a “protective PE” procedure allows control of hemodynamics and enables interventionalists to perform the thrombectomy in a more controlled environment. Here, we present our experience. Methods A retrospective data analysis on consecutive VA ECMO patients with cardiogenic shock secondary to pulmonary embolism was abstracted from August 2022 to June 2024. Results Patient characteristics and outcomes are described in …

Coexisting Type A And B Aortic Dissection With Extension To Carotid Arteries Resulting In Acute Ischemic Stroke, Dung Nguyen, Jilpa Shah, Amnah Andrabi

North Texas Research Forum 2025

Coexisting Type A and B aortic dissection with extension to carotid arteries resulting in acute ischemic stroke Abstract Background: Acute aortic dissection (AAD) is a rare cause of ischemic stroke. Additionally, it is even rarer to have a combined type A and type B aortic dissection. ADD is a high-mortality disease that can lead to immediate decompensation and can be masked by stroke-like symptoms, which can result in delayed or missed diagnosis. We report a patient with acute ischemic stroke (AIS) with subsequent combined type A and type B aortic dissection. Case Report: A 47-year-old man was admitted to the …

Atypical Presentation Of Moyamoya Disease Presenting With Severe Headache: A Case Report, Nilay Bhatt, Tirth Vyas

Gulf Coast Division GME Research Day 2025

No abstract provided.

Micra-Scopic Hero: Rare Unroofed Cornoary Sinus Complicating Pacemaker Placement, Suhas Tatapudi, E Castillo, Jeby Kalathoor, Zuhair Ali, Hytham Rashid, R Cargioli

Gulf Coast Division GME Research Day 2025

No abstract provided.

Out Of Left Field Lv Thrombus: Incidental Finding In Patient Presenting With Abdominal Pain, Chak Lam Yeung, Shivani Gandi, Shakir Al-Ezzi, Nicole Huang, Adhikari Pragyan

North Texas Research Forum 2025

Introduction: Left Ventricular thrombus (LVT) is one of the most feared complications post myocardial infarction due to the high incidence of embolization. LVT typically form after myocardial infarction and the presence of low ejection fraction (EF), both of which contribute to Virchow’s triad for thrombus formation. LVT are less common in the absence of these risk factors or pre-existing cardiovascular disease. This case report explores the incidental discovery of LVT in a patient, without any known cardiovascular disease, who presented for treatment of acute pancreatitis. Case Presentation: 42-year-old male with past medical history of alcohol use disorder and recurrent pancreatitis …

Not Your Typical Chest Pain: Anomalous Rca, Suhas Tatapudi, Nomair Ashraf, E Castillo, Jeby Kalathoor, Hytham Rashid, Ibrahim Yazji, M Daniel

Gulf Coast Division GME Research Day 2025

No abstract provided.

Granulomatosis With Polyangiitis Presenting As An Anterior Mediastinal Mass: A Rare Manifestation, Maya Khasho, Christopher L. Bray, Miguel E. Rodriguez

North Florida Division GME Research Day 2025

No abstract provided.

Cannabis Induced 2nd Degree Av Block, Shivani Gandhi, Vineeth Lekkala, Muhammad Suleman, Anvitha Manduva

North Texas Research Forum 2025

Cannabis use, both medical and non-medical, has seen a marked increase following the growing trend of legalization. While the immediate effects of cannabis on mental and physiological states are well-documented, its potential impact on the cardiovascular system remains an area of growing concern. Cannabis-induced arrhythmias, particularly atrioventricular (AV) block, are rare but potentially life-threatening events that can present in young, otherwise healthy individuals (Heckle et al., 2018). This case highlights the importance of recognizing cannabis as a potential contributing factor in the development of AV block.

Upper Extremity Deep Venous Thrombosis, Adrian S. Reta, Michaela Mckissack

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

A Case Of Severe Synodic Stenosis In A Patient With Granalomatosis With Polyangitis Requiring Tracheostomy, Yousuf Sherwani, Mohan Sengodan

North Texas Research Forum 2025

Granulomatosis with polyangiitis (GPA) is characterized by vasculitis of small and medium sized blood vessels and granulomatous lesions of the upper respiratory tract. A rare condition associated with GPA, subglottic stenosis, presents in about 20% of cases on inpatient GPA. Symptoms such as stridor, hoarseness, dyspnea and dysphagia are hall marks of subglottic stenosis. Here we present the case of a male patient with life threatening subglottic stenosis that required tracheostomy.

Unbreak My Heart: Improving The Cardiac Rehabilitation Referral Rate, Akash Patel, Samer Khalil, Iman Squires, Abed Naser, Eric Vargas, Manuel Carrazana, Olga Karasik

North Florida Division GME Research Day 2025

No abstract provided.

Endovascular Repair With A Vbx Device Covered Stent In A Patient With Leriche Syndrome, Angelo Piazza, Micheline Tantchou

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Acute Respiratory Compromise Secondary To Superior Vena Cava Syndrome In A Sickle Cell Patient. Vaso-Occlusion Triggered By Steroids?, Ashley Diaz, Priya Mohan, Abhishek Sharma, David Zarabanda, Raiko Diaz

East Florida Division GME Research Day 2025

No abstract provided.

Culture Negative Endocarditis Masquerading As Idiopathic Leukocytoclastic Vasculitis, Sania Moonnumackel, Manish Pandey, Randy Nguyen, Reuben Abreu, Seline Haci, Neelima Paladugu, Machaiah Madhrira

North Texas Research Forum 2025

Background: Infective endocarditis (IE) is a challenging disease to diagnose often presenting with heterogeneous features. Blood cultures are the gold standard for diagnosing endocarditis, but it is important to know that up to 20 % of cases of infective endocarditis have negative blood cultures. Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis and is idiopathic in 50% of cases. LCV is a rare but possible presentation of Infective endocarditis. Hence IE should be part of the differential diagnosis when LCV is diagnosed. Case summary: A 53-year-old male patient presenting right lower extremity pain and vesiculobullous lesions over bilateral upper and …

Effective Managment Of Relapsing Henoch-Schonlein Purpura With Nephropathy In An Adult With Long-Term Use Of Azathioprine, Rabia S. Mahfooz, Neil Maithel, Loiacono Agostina, Minha Aslam, Naser Elkhalili

Gulf Coast Division GME Research Day 2025

No abstract provided.

Unveiling The Mystery: Infected Endocarditis Masquerading As Right Atrial Thrombus In A Port-A-Catheter Patient, Rabia S. Mahfooz, Annmary Behanan, Babivigasan Gunasegaran, Srikrishnan Pichuthirumalai, Hannan Chaugle

Gulf Coast Division GME Research Day 2025

No abstract provided.

A Swelling Mystery: Hereditary Angioedema In Pregnancy, Karen Valadez-Cuen, Andrea Francis, Alison Rossduetscher, Micheline Tantchou

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Silent Signals: Endocarditis Disguised As Low-Back Pain In A Rheumatology Clinic, Ahmad Alomari, Miguel Rodriguez

North Florida Division GME Research Day 2025

No abstract provided.

Case Report: Left Internal Mammary Artery (Lima)/Coronary Steal Syndrome (Css) In Severe Coronary Artery Disease And End-Stage Renal Disease, Fahed Alsayed, Muhannad Badran, Sara Khasawneh, Mohan Sengodan

North Texas Research Forum 2025

Background: LIMA/coronary steal syndrome is a rare but significant complication in patients with severe coronary artery disease (CAD) who have undergone coronary artery bypass grafting (CABG) and concurrently have high-flow arteriovenous (AV) fistulas for hemodialysis. The left internal mammary artery (LIMA) is a preferred conduit for CABG due to its long-term patency and ability to sustain myocardial perfusion. However, in patients with end-stage renal disease (ESRD) requiring hemodialysis, excessive AV fistula flow can divert blood away from the LIMA graft, leading to myocardial ischemia despite graft patency. Early recognition and appropriate intervention are essential to prevent further deterioration of cardiac …

A Match Made In Heaven: The Heart And The Kidney, A Case Report On Uremic Pericardial Effusion With Complete Resolution Post Transplant, Sania Moonnumackel, Victor Delprincipe, Vivek Bhupathi, Srinivasan Rajaganapathy, Anand Karthik, Machaiah Madhrira

North Texas Research Forum 2025

Introduction: Pericardial effusion resulting from uremic pericarditis is a complication associated with chronic kidney disease (CKD). In patients with advanced CKD or End Stage renal disease (ESRD) renal transplant is the definitive treatment to improve long term outcomes. However, the presence of a large pericardial effusion poses a risk of hemodynamic compromise during transplant surgery. Options of stabilizing the patient with aggressive dialysis, pericardiocentesis or pericardial window can be considered. Here we present a case of a patient with advanced CKD who underwent pre-emptive kidney transplant and in three months had complete resolution of a large pericardial effusion noted pre-operatively. …

Streamlining Bubble Study Requests In Echo Orders: A Qi Initiative, Vineeth Lekkala, Sharvani Raguthu, Taher Yusufali, Mahmood Ahmad, Mohan Sengodan

North Texas Research Forum 2025

Introduction: This quality improvement project centers around the implementation of a dedicated mechanism for ordering bubble studies in echocardiograms at Medical City North Hills Hospital. Drawing inspiration from successful implementations observed at Medical City Denton Hospital, the project aims to address existing challenges, standardize practices, and improve overall efficiency in the echocardiogram ordering workflow. Background: The echocardiogram ordering process at Medical City North Hills Hospital currently faces challenges, specifically the absence of a dedicated mechanism for ordering bubble studies. This deficiency introduces the risk of oversights, particularly in cases of syncope and stroke, thereby compromising diagnostic precision. Acknowledging these challenges, …

Dilemma In Managing Patients Presenting With Nstemi & Concurrent Gi Bleed, Mehak Sachdeva, Kathleen Mattingly, Franklin Hernandez, Jonathan Grube

North Florida Division GME Research Day 2025

No abstract provided.

Sodium-Glocuse Cotransporter-2 Inhibitor Decreases The Risk Of Heart Failure Hospitalization & Regardless Of Left Ventricular Ejection Fraction, Hussein A. Noureldine, Thais Schwartz, Qusai Alqudah, Maryam Alhousseini, Ann T. Tong

North Florida Division GME Research Day 2025

No abstract provided.

Navigating The Complexity Of Ards And Cardiogenic Shock With Veno-Arterial Ecmo: A Case Report, Sanjana Kesireddy, Mohan Sengodan

North Texas Research Forum 2025

INTRODUCTION: When deciding between VA ECMO (veno-arterial ECMO) and VV ECMO (veno-venous ECMO), the primary consideration is the underlying pathology affecting the patient’s heart and lungs. VA ECMO provides support for both the cardiovascular and respiratory systems, making it suitable for patients experiencing cardiogenic shock or combined cardiac and respiratory failure. In contrast, VV ECMO is used exclusively for respiratory failure, offering support to patients with severe lung dysfunction but intact cardiac function. CASE PRESENTATION: 41 year old male with no known past medical history presented s/p cardiac arrest secondary to aspiration pneumonia due to alcohol and opioid intoxication. Chest …

Use Of Va Ecmo In Patients With Acute Pulmonary Embolism Presenting With Obstructive Cardiogenic Shock Undergoing Mechanical Thrombectomy, Luke Taylor, Otoniel Espinoza, Omar O. Hernandez, Shannon Biggers, Shirin Miller, Srinivas Yallapragada, Amer Alaiti, Andrew Fredericks, Song Li, Claudius Mahr

North Texas Research Forum 2025

BACKGROUND: Management of VA ECMO has substantially evolved over the years. Much literature has been published regarding indications, management, and outcomes; however, limited evidence exists detailing strategies to manage, progress, and wean patients from VA ECMO. We present our experience using a VA ECMO expected progression patient management guideline. METHODS: The VA ECMO Expected Progression Patient Management Guideline, approved on June 1, 2021, consists of six goal-oriented stages with suggestive interventions for managing cardiogenic shock patients undergoing VA ECMO therapy. Patient characteristics and outcomes were collected retrospectively and compared between March 2019 to May 2021 (VA Non-Expected Progression group) and …

Recurrent Syncope In A Young Adult With Postural Orthostatictachycardia Syndrome (Pots): A Diagnostic And Therapeutic Challenge, Syed Raza, Shuchita Jhaveri, Neethu George, Julian Nguyen

Gulf Coast Division GME Research Day 2025

No abstract provided.

Atn Masquerading Rapidly Progressive Glomerulonephritis: Atypical Presentation Of P-Anca Associated Vasculitis With Rpgn, Nimmy Joy, Anabel Al Abdallah, Andrea Francis, Saurabh Pande

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Occlusive Thrombosis Of Superior Mesenteric And Portal Veins, Radhika Mohan, Genevieve Mccloskey, Curtis Wong, Hedaya Othman, Valerie Sinkler

South Atlantic Division GME Research Day 2025

No abstract provided.

Impact Of Fluid Balance On Clinical Outcomes In Icu Patients W. Pulmonary Arterial Hypertension, Geran Maule, John Rickards, Abdallah Rayyan, Moh'd Alamin Daise, Kobina Essilfie-Quaye, Peters Okonoboh

North Florida Division GME Research Day 2025

No abstract provided.

Lactate/Albumin And Rdw/Albumin Ratios For Mortality And Readmission In Post-Mi Heart Failure, Amogh Killedar, Hamza Khan, Henry Cusnir

East Florida Division GME Research Day 2025

BACKGROUND Robust biomarkers that capture the combined effects of inflammation and tissue hypoperfusion, are needed to refine post–acute myocardial infarction (AMI) risk stratification—especially in the large subset that develops congestive heart failure (CHF). Two emerging candidates are the lactate/albumin ratio (LAR) and the red-cell-distribution-width/albumin ratio (RAR). Separate studies have linked each ratio to short- and long-term mortality in critical illness, AMI, and heart failure, yet no work has directly compared their performance together. We addressed this evidence gap in a large, multi-hospital dataset.

METHODS We performed a retrospective analysis of 8 115 encounters drawn from the HCA Healthcare database (2016-2024). …