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CardioNerds\xa0(Amit Goyal\xa0&\xa0Daniel Ambinder) join\xa0Cedars-Sinai cardiology fellows (Natasha\xa0Cuk, Ronit\xa0Zadikany, Neal Yuan) for some drinks at the local pub 3rd\xa0Stop after a walk down Hollywood boulevard! They discuss a fascinating case of a massive pulmonary embolus\xa0presenting\xa0as STEMI. Dr.\xa0Babak Azarbal\xa0provides the E-CPR and program director Dr. Joshua Goldhaber provides a message for applicants.\xa0Episode notes were developed by Johns Hopkins internal medicine resident\xa0Bibin Varghese\xa0with mentorship from University of Maryland cardiology fellow\xa0Karan Desai.\xa0\xa0\xa0\n\n\n\n\n\nJump to: Patient summary - Case figures & media - Case teaching - References - Production team\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\xa0man\xa0in his mid-40s\xa0with no known past medical history presented to the ER in PEA arrest with ongoing cardiopulmonary resuscitation (CPR). Prior to his arrest, his coworkers reported that he was complaining of lightheadedness, dizziness and that he was found slumped over at his desk. His EKG in the ambulance showed STE in\xa0aVR\xa0and\xa0V1 -\xa0V4 with TWI in III and\xa0aVF\xa0initially concerning for an\xa0anterior\xa0STEMI. He was cannulated with\xa0VA-ECMO for extracorporeal cardiopulmonary resuscitation (E-CPR) and was taken to the catheterization lab emergently. In the catheterization lab, his coronary angiogram did not show obstructive coronary disease. The interventionalists decided to perform a\xa0pulmonary artery\xa0(PA) angiogram which revealed a large amount of thrombus bilaterally in the proximal PAs. He underwent surgical embolectomy with removal of almost all his clot burden. The patient was thereafter cooled for neurological protection. Unfortunately, the patient had a very poor neurological exam with lack of brainstem reflexes upon rewarming. There was loss of gray-white differentiation on CT, and EEG and evoked potential testing were consistent with severe anoxic brain injury. After discussions with the patient's family, the patient was transitioned to comfort care and\xa0subsequently passed away\xa0peacefully.\xa0\xa0\n\n\n\n\n\n\n\nCase Media\n\n\n\n\nClick to Enlarge\n\n\n\n\n\nRight Coronary Artery\n\n\n\n\n\nLeft Coronary System - 1\n\n\n\n\n\nLeft Coronary System - 2\n\n\n\n\n\n\n\nLeft Pulmonary Artery\n\n\n\n\n\nRight Pulmonary Artery\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\nThe patient presented initially with STE in aVR as well as the septal and anterior leads. What is the differential for an ST elevation in lead aVR? STE in aVR with diffuse ST depression can be a potential finding of LM or LAD stenosis. However, there have been several studies that have shown that the combination of STE and multi-lead STD was not associated with complete occlusion of a culprit vessel. Thus,