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CardioNerds\xa0(Amit\xa0&\xa0Dan)\xa0 join Vanderbilt University cardiology fellows (Tara Holder, Majd El-Harasis, and Amar Parikh) for a Sunday morning brunch, Nashville style! They discuss an enthralling case of bicuspid aortic valve with critical aortic stenosis complicating pregnancy. Program director Dr. Julie Damp provides the E-CPR and a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Tommy Das with mentorship from University of Maryland cardiology fellow Karan Desai.\xa0\n\n\n\n\n\nJump to: Patient summary - Case figures & media - Case teaching - Educational video - References - Production team\n\n\n\n\n\n\n\nEpisode graphic by Dr. Carine Hamo\n\n\n\n\n\n\n\nThe\xa0CardioNerds Cardiology Case Reports\xa0series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an\xa0\u201cExpert CardioNerd Perspectives & Review\u201d (E-CPR)\xa0for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus.\n\n\n\nWe are teaming up with the\xa0ACC FIT Section\xa0to use the\xa0#CNCR episodes\xa0to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an\xa0E-CPR\xa0segment and a message from the program director.\n\n\n\nCardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza\n\n\n\n\n\n\n\n\n\n\n\nPatient Summary\n\n\n\nA 22yo transgender\xa0F2M\xa0man (G1P0000) at 32w5d was found to have a late-peaking systolic ejection murmur on a regularly scheduled OB visit. He reported recent left-sided exertional chest pain and intermittent lightheadedness, as well as a history of\xa0a childhood heart murmur.\xa0TTE showed a bicuspid aortic valve\xa0(LCC-NCC fusion)\xa0with severe aortic stenosis (peak velocity 4.83 m/s, mean gradient of 56 mmHg, AVA at 0.5 cm2 and Dimensionless Index at 0.15).\xa0Furthermore, there was preserved ejection fraction and no associated\xa0aortopathy.\xa0\xa0\xa0\n\n\n\nFollowing a syncopal episode, the patient was admitted for cardiac optimization prior to delivery.\xa0With shared decision making, he ultimately delivered via cesarean section prior to valvular intervention. Post-partum, he underwent balloon aortic valvuloplasty with improvement in mean aortic gradient to 27 mmHg and trace aortic insufficiency. He was asymptomatic at 5 months post-procedure with\xa0similar gradients across the aortic valve on\xa0TTE.\xa0\xa0\xa0\n\n\n\n\n\n\n\n\nCase Media\n\n\n\n\nChest - X ray Final gradients: Peak velocity 4.83 m/s Mean >50 (56) mmHg AVA 0.5 (AVAi=0.27) DOI=0.15\n\n\n\n\n\n\nhttps://youtu.be/YF8TrNmsGh4\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nEpisode Schematics & Teaching\n\n\n\nClick to enlarge ???\n\n\n\n\n\n\n\nThe CardioNerds 5! \u2013 5 major takeaways from the #CNCR case\n\n\n\nHemodynamics change dramatically during pregnancy. Cardiac output increases by 30-50% during pregnancy due to:\xa0\u2191 SV, \u2191HR, \u2193SVR.\xa0\xa0Immediately post-partum, patients with existing valvular lesions are at high risk of heart failure!\xa0Hemodynamic changes peripartum are unpredictable.\xa0\xa0\u2191Preload: relief of IVC compression, auto-transfusion of 300-500mL blood from placenta with each uterine contraction, and intravenous fluids and/or blood products.\xa0\u2193Preload: hemorrhage\xa0\u2191Afterload: SBP & DBP increase with each uterine contraction\xa0\u2193Afterload: systemic vasodilation from epidural and spinal analgesia\xa0\u2191CO: by up to 30% in the first stage of labor and up to 80% in the immediate post-partum period. 2/2 \u2191SV.\xa0Most pregnant patients with symptomatic AS can be managed medically,