Joint Trauma System Clinical Practice Guideline: Acute Coronary Syndrome (ACS). 14 May 2021.

Deployed medical providers at all roles of care must be prepared to recognize and manage acute coronary syndrome (ACS). Under optimal conditions, treatment is initiated with medical therapy and may be followed by prompt coronary angiography and revascularization. Emergent percutaneous coronary intervention (PCI) is not available in most deployed locations, however, and the time for such intervention is often dependent on long-range evacuation. This CPG provides guidance on best management for ACS patients in the deployed and resource-constrained environment.

A Hidden Culprit Illuminated with Advanced Cardiac Imaging.

This case demonstrates the complementary benefit of utilizing multimodality cardiac imaging in the assessment of myocardial infarction with nonobstructive coronary artery disease especially when a culprit lesion is not discovered upon initial coronary catheterization. Use of cardiac magnetic resonance imaging, optical coherence tomography, and invasive coronary angiography together solidified the diagnosis of unstable, complex coronary artery disease in this case.

Sixty-four-multislice computed tomography in a patient with arrhythmogenic right ventricular dysplasia.

Arrhythmogenic right ventricular dysplasia (ARVD) is an inheritable cardiomyopathy that is characterized by fibrofatty infiltration of the RV myocardium, often resulting in arrhythmias and sudden cardiac death. The diagnosis often requires imaging of the right ventricle, typically by magnetic resonance imaging. We describe a case of AVRD in which cardiac computed tomography was used as the imaging method for the right ventricle. The CT images showed changes consistent with ARVD to include RV enlargement, excessive trabeculations, fatty infiltration, and marked RV hypokinesia. We believe these images show a novel use for multislice CT in the diagnostic evaluation of patients with suspected ARVD.

Isolated cardiac cysticercosis in an adolescent.

Cardiac cysticercosis is a rare and typically asymptomatic infection. We report a case of a young man from Cameroon with a left ventricular cyst discovered during a screening echocardiogram. Computed tomography and plain films did not reveal additional cysts. Serology was negative. The patient had the cyst surgically removed for suspected echinococcosis. Sectioning demonstrated a cysticercus. The literature on cardiac cysticercosis is reviewed.

Impact of perioperative cardiac assessment guidelines on management of orthopedic surgery patients.

PURPOSE: The study assessed whether the American College of Cardiology/American Heart Association (ACC/AHA) preoperative cardiac assessment guidelines impact patient management and predict major cardiac events in patients undergoing orthopedic surgery. SUBJECTS AND METHODS: We conducted a retrospective review of 338 consecutive orthopedic preoperative evaluations performed by internal medicine consultants. Major cardiac events were defined as myocardial infarction, congestive heart failure, and sudden cardiac death. RESULTS: Major cardiac events occurred in 5.7% of patients. Patients with minor or absent ACC/AHA clinical risk predictors were less likely to have major cardiac events (P = .007). More than half (51%) of patients meeting ACC/AHA indications for noninvasive cardiac tests did not receive them. However, most (69%) major cardiac events occurred in patients not meeting criteria for cardiac testing. Abnormal noninvasive cardiac testing results did not alter medication recommendations and only resulted in coronary revascularization in 0.6% of patients. Only 3% of patients with abnormal noninvasive cardiac testing results had major cardiac events. Patients with abnormal cardiac test results were more likely to have recommendations for perioperative beta-blockade (P <.01). Patients aged more than 70 years (odds ratio 5.0; 95% confidence interval, 1.32-19.28) and patients undergoing hip surgery (odds ratio 7.5, 95% confidence interval, 1.02-54.55) were more likely to have major cardiac events. Major cardiac events occurred in 12% of urgent and 4% of elective procedures (P = .009). CONCLUSIONS: The ACC/AHA guidelines accurately predict cardiac risk in orthopedic surgery. Abnormal noninvasive cardiac test results rarely affected preoperative recommendations, but improved compliance with beta-blocker therapy. Advanced age, urgent procedures, and hip surgery were associated with increased risk of major cardiac events.

An international landmine telehealth symposium between Hawaii and Thailand using an Internet2 and multi-protocol videoconferencing bridge.

An international telehealth symposium was conducted between healthcare institutions in Hawaii and Thailand using a combination of Asynchronous Transfer Mode, and Internet2 connectivity. Military and civilian experts exchanged information on the acute and rehabilitative care of landmine victims in Southeast Asia. Videoconferencing can promote civil-military cooperation in healthcare fields that have multiple international stakeholders.

A novel approach to tele-echocardiography across the Pacific.

Telecardiology provides remote delayed interpretation of echocardiographic images through a store and forward program between the interpreting center, Tripler Army Medical Center, Honolulu Hawaii, and the image acquisition center, Guam Naval Hospital, Guam USA. This routine store and forward system has inherent delay, limiting application for management of acute medical conditions. In this case report we describe a novel methodology for real-time echocardiograpic interpretation methodology integrated methodology with the eICU system (VISICU Inc., Baltimore MD). This case report demonstrates the feasibility of a clinically relevant remote real-time echocardiographic interpretation strategy, utilizing commonly available equipment.