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CardioNerds\xa0(Amit Goyal\xa0&\xa0Daniel Ambinder) join University of California San Diego (UCSD) cardiology fellows (Harpreet Bhatia, Dan Mangels, and Quan Bui) for\xa0a relaxing beach bonfire\xa0in the beautiful city of San Diego! They discuss a challenging case of\xa0post-transplant\xa0cardiac allograft vasculopathy. Dr. Hao (Howie) Tran provides the E-CPR and program director Dr. Daniel Blanchard provides a message for applicants.\xa0Episode notes were developed by Johns Hopkins internal medicine resident\xa0Richard Ferraro\xa0with mentorship from University of Maryland cardiology fellow\xa0Karan Desai.\xa0\xa0\n\n\n\n\n\nJump to: Patient summary - Case media - Case teaching - References \n\n\n\n\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 man in his late 20s with a past medical history of orthotopic heart transplant, presents with one-week of\xa0progressive\xa0lower extremity edema and dyspnea with NYHA class IV symptoms.\xa05 years prior, he underwent orthotopic heart transplant for arrhythmogenic right ventricular cardiomyopathy.\xa0Subsequently,\xa0he has had multiple\xa0episodes of rejection or recurrent graft dysfunction. On presentation, he was normotensive and borderline tachycardic.\xa0Exam revealed elevated JVP, decreased breath sounds, and pitting edema.\xa0 Labs demonstrated leukocytosis, acute kidney injury, and elevated pro-BNP.\xa0TTE demonstrated LVEF 35%,\xa0apical akinesis, and grade III diastolic dysfunction (all similar to prior).\xa0He was initially diuresed and RHC/EMB was performed to evaluate for rejection. Early in his course, the patient unfortunately suffered a PEA arrest with ROSC was quickly achieved after 1 minute of CPR. He was intubated and cannulated for VA ECMO. EMB demonstrated ISHLT Grade 1R cellular rejection and he was ultimately listed for re-transplant. Shortly thereafter, the patient received an OHT. His pathology demonstrated intimal thickening of all his coronaries, consistent with coronary artery vasculopathy, felt to be the major contributor to his presentation.\xa0\xa0\n\n\n\n\n\n\n\nCase Media\n\n\n\nECG\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\n1.\xa0What is CAV?\xa0\xa0\n\n\n\nCAV stands for cardiac allograft vasculopathy. Within the transplanted heart, CAV is the proliferation of vascular smooth muscle and intimal thickening in the epicardial coronary arteries and microvasculature leading to diffuse narrowing. CAV is common, present in greater than 30% of patients at 5 years post-transplant. It is a\xa0significant contributor to post-transplant mortality after the first year.\xa0\xa0CAV, in contrast to typical atherosclerotic lesions, is diffuse and concentric while atherosclerosis tends to be focal with eccentric luminal narrowing and heterogenous plaque composition. Patients s/p OHT can still develop typical coronary artery disease,