UTHSC PA Program Podcast

In this episode, we review hypertensive emergency, a life-threatening condition defined by severely elevated blood pressure accompanied by acute end-organ damage. We discuss the underlying pathophysiology of vascular endothelial injury and impaired autoregulation, along with common risk factors such as chronic uncontrolled hypertension, medication nonadherence, kidney disease, stimulant use, and endocrine disorders. The episode highlights classic clinical presentations including neurologic deficits, chest pain, pulmonary edema, acute kidney injury, and retinal changes, emphasizing the importance of identifying organ dysfunction rather than focusing on the blood pressure number alone. We also cover diagnostic evaluation, including laboratory testing, EKG, imaging, and fundoscopy, as well as evidence-based treatment with carefully titrated IV antihypertensive therapy to avoid overly rapid blood pressure reduction.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Peixoto AJ. Acute severe hypertension. N Engl J Med. 2019;381(19):1843-1852. doi:10.1056/NEJMcp1901117
3. Bress AP, Anderson TS, Flack JM, et al. The management of elevated blood pressure in the acute care setting: a scientific statement from the American Heart Association. Hypertension. 2024;81(8):e94-e106. doi:10.1161/HYP.0000000000000238
4. Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2025;86(18):1567-1678. doi:10.1016/j.jacc.2025.05.007

In this episode, we review giant cell arteritis (GCA), an autoimmune large-vessel vasculitis that most commonly affects the temporal arteries and can lead to devastating ischemic complications if not recognized early. We discuss the underlying inflammatory pathophysiology, major risk factors including advanced age and polymyalgia rheumatica, and the hallmark presentation of temporal headache, jaw claudication, scalp tenderness, and transient vision loss. The episode also covers key diagnostic findings such as elevated ESR and CRP, the classic "halo sign" on Doppler ultrasound, and why temporal artery biopsy remains the gold standard for diagnosis. Treatment focuses on the urgent initiation of high-dose glucocorticoids to prevent permanent vision loss and other vascular complications.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Weyand, C. M., & Goronzy, J. J. (2023). Immunology of Giant Cell Arteritis. Circulation research, 132(2), 238–250. https://doi.org/10.1161/CIRCRESAHA.122.322128
3. Samson, M., Corbera-Bellalta, M., Audia, S., Planas-Rigol, E., Martin, L., Cid, M. C., & Bonnotte, B. (2017). Recent advances in our understanding of giant cell arteritis pathogenesis. Autoimmunity reviews, 16(8), 833–844. https://doi.org/10.1016/j.autrev.2017.05.014
4. Cacoub, P., Vieira, M., Langford, C. A., Tazi Mezalek, Z., & Saadoun, D. (2025). Large-vessel vasculitis. Lancet (London, England), 406(10514), 2017–2032. https://doi.org/10.1016/S0140-6736(25)01436-9

In this episode, we review atrial flutter, a supraventricular tachyarrhythmia caused by a reentrant electrical circuit within the atria that produces the classic "sawtooth" flutter waves on EKG. We discuss the underlying pathophysiology, major risk factors including heart failure, COPD, coronary artery disease, hypertension, hyperthyroidism, and obstructive sleep apnea, and the typical presentation of palpitations, dyspnea, fatigue, and chest pain. Diagnostic evaluation focuses on recognizing the characteristic 2:1 AV conduction pattern with atrial rates near 300 bpm and ventricular rates around 150 bpm. We also cover acute management with rate control, rhythm control, and cardioversion, as well as long-term treatment strategies including catheter ablation and anticoagulation guided by the CHA₂DS₂-VASc score.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Writing Committee Members, Joglar JA, Chung MK, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2024;83(1):109-279. doi:10.1016/j.jacc.2023.08.017
3. Wolfes, J, Ellermann, C, Frommeyer, G. et al. Comparison of the Latest ESC, ACC/AHA/ACCP/HRS, and CCS Guidelines on the Management of Atrial Fibrillation. J Am Coll Cardiol EP. 2025 Apr, 11 (4) 836–849.
4. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199-e267. doi:10.1161/CIR.0000000000000041

In this episode, we review rheumatic heart disease, a chronic valvular complication that develops after acute rheumatic fever following untreated Group A Streptococcal pharyngitis. We discuss the autoimmune pathophysiology driven by molecular mimicry, leading to inflammatory damage of the heart valves, particularly the mitral valve. Clinical manifestations including migratory polyarthritis, carditis, murmurs, Sydenham chorea, erythema marginatum, and subcutaneous nodules are reviewed along with the classic Jones criteria used for diagnosis. We also cover characteristic echocardiographic findings, long-term complications such as mitral stenosis, atrial fibrillation, heart failure, and embolic stroke, and treatment strategies including antibiotics, anti-inflammatory therapy, and secondary prophylaxis with penicillin.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nature Reviews Disease Primers. 2016;2(1). doi:10.1038/nrdp.2015.84
3. Dougherty S, Okello E, Mwangi J, Kumar RK. Rheumatic heart disease. Journal of the American College of Cardiology. 2023;81(1):81-94. doi:10.1016/j.jacc.2022.09.050
4. Marijon E, Mirabel M, Celermajer DS, Jouven X. Rheumatic heart disease. The Lancet. 2012;379(9819):953-964. doi:10.1016/s0140-6736(11)61171-9

In this episode, we review cardiac tamponade, a life-threatening condition caused by rapid accumulation of fluid within the pericardial sac leading to impaired ventricular filling and hemodynamic collapse. We discuss the underlying pathophysiology of rising intrapericardial pressure, common causes including malignancy, infection, autoimmune disease, uremia, trauma, and post-MI complications, and why the rate of fluid accumulation is often more important than the total volume. Clinical presentation, including dyspnea, chest pain, tachycardia, hypotension, and shock, is reviewed alongside classic exam findings such as Beck's triad and pulsus paradoxus. We also cover high-yield diagnostic findings on echocardiography, EKG, and chest imaging, as well as emergent management with pericardiocentesis and definitive treatment of the underlying cause.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Adler Y, Ristić AD, Imazio M, et al. Cardiac tamponade. Nature Reviews Disease Primers. 2023;9(1). doi:10.1038/s41572-023-00446-1
3. Spodick DH. Acute cardiac tamponade. New England Journal of Medicine. 2003;349(7):684-690. doi:10.1056/nejmra022643
4. Wang TK, Klein AL, Cremer PC, et al. 2025 concise clinical guidance: An ACC expert consensus statement on the diagnosis and management of pericarditis. JACC. 2025;86(25):2691-2719. doi:10.1016/j.jacc.2025.05.023

n this episode, we review atrioventricular (AV) blocks, focusing on the mechanisms, EKG findings, clinical presentation, and management of first-, second-, and third-degree heart block. We discuss how conduction delays through the AV node can range from benign prolongation of the PR interval to complete electrical dissociation between the atria and ventricles. Key distinctions between Mobitz type I (Wenckebach) and Mobitz type II are emphasized, along with the life-threatening implications of complete heart block. Clinical symptoms such as bradycardia, dizziness, syncope, fatigue, and hypotension are reviewed, as well as important causes including ischemic heart disease, medications, fibrosis, and increased vagal tone. We also cover hallmark EKG patterns, indications for pacing, and high-yield clinical pearls to help listeners confidently recognize and manage AV conduction abnormalities in both exams and clinical practice.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Ahmed I. Atrioventricular Block. StatPearls [Internet]. February 12, 2024. Accessed March 15, 2026. https://www.ncbi.nlm.nih.gov/books/NBK459147/.
3. Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Journal of the American College of Cardiology. 2019;74(7). doi:10.1016/j.jacc.2018.10.044
4. Wung S-F. Bradyarrhythmias. Critical Care Nursing Clinics of North America. 2016;28(3):297-308. doi:10.1016/j.cnc.2016.04.003

In this episode, we review atrial septal defects (ASDs), one of the most common congenital heart defects characterized by persistent communication between the atria resulting in a left-to-right shunt. We discuss the major ASD subtypes, including secundum, primum, sinus venosus defects, and patent foramen ovale, along with the pathophysiology behind right heart enlargement and pulmonary overcirculation. Clinical presentation ranges from asymptomatic childhood disease to adult symptoms such as fatigue, dyspnea, palpitations, syncope, and exercise intolerance. Key physical exam findings including fixed splitting of S2 and systolic flow murmurs are highlighted, as well as classic diagnostic findings on echocardiography and EKG. We also cover indications for surgical versus transcatheter closure, long-term complications such as pulmonary hypertension and atrial arrhythmias, and important clinical pearls for recognizing and managing ASD in both pediatric and adult patients.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Geva T, Martins JD, Wald RM. Atrial septal defects. The Lancet. 2014;383(9932):1921-1932. doi:10.1016/s0140-6736(13)62145-5
3. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease. Journal of the American College of Cardiology. 2008;52(23). doi:10.1016/j.jacc.2008.10.001
4. Turner ME, Bouhout I, Petit CJ, Kalfa D. Transcatheter closure of atrial and ventricular septal defects. Journal of the American College of Cardiology. 2022;79(22):2247-2258. doi:10.1016/j.jacc.2021.08.082

In this episode, we review atrial fibrillation (AF), the most common sustained cardiac arrhythmia, and discuss the underlying mechanisms driving its characteristic "irregularly irregular" rhythm. We cover the pathophysiology of chaotic atrial electrical activity, major risk factors including advanced age, hypertension, obesity, heart failure, and sleep apnea, and the growing prevalence of AF in the aging population. Clinically, patients may present with palpitations, fatigue, dyspnea, dizziness, chest pain, or exercise intolerance, while some remain asymptomatic. We break down the diagnostic approach with emphasis on classic EKG findings including absent P waves, fibrillatory baseline activity, and variable R-R intervals. Management focuses on the modern AF-CARE approach, including stroke prevention with anticoagulation, rate and rhythm control strategies, and aggressive risk factor modification.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Bizhanov KA, Аbzaliyev KB, Baimbetov AK, Sarsenbayeva AB, Lyan E. Atrial fibrillation: Epidemiology, pathophysiology, and clinical complications (literature review). Journal of Cardiovascular Electrophysiology. 2022;34(1):153-165. doi:https://doi.org/10.1111/jce.15759
3. Gawałko M, Linz D. Atrial fibrillation detection and management in hypertension. Hypertension. 2023;80(3):523-533. doi:10.1161/hypertensionaha.122.19459
4. Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (eacts). European Heart Journal. 2024;45(36):3314-3414. doi:10.1093/eurheartj/ehae176

In this episode, we cover torsades de pointes, a life-threatening form of polymorphic ventricular tachycardia associated with a prolonged QT interval. We break down the electrophysiology behind delayed ventricular repolarization and early afterdepolarizations, which set the stage for this distinctive "twisting" QRS pattern on EKG. High-yield risk factors—including electrolyte abnormalities (low potassium, magnesium, calcium), QT-prolonging medications, bradycardia, and female sex—are emphasized to help with rapid clinical recognition. We walk through classic presentations such as palpitations, syncope, and sudden collapse, and outline the diagnostic approach with EKG confirmation and targeted lab evaluation. Management focuses on immediate IV magnesium sulfate, correction of underlying causes, and escalation to defibrillation or pacing in unstable or refractory cases.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of ventricular arrhythmias. Circulation. 2018;138(13):e272–e391
3. Drew BJ, Ackerman MJ, Funk M, et al. Prevention of torsade de pointes in hospital settings. Circulation. 2010;121(8):1047–1060

In this episode, we dive into stress (Takotsubo) cardiomyopathy, a reversible form of acute left ventricular systolic dysfunction that often mimics acute coronary syndrome but occurs without obstructive coronary artery disease. We unpack the proposed mechanism of a catecholamine surge leading to myocardial stunning, producing the classic apical ballooning pattern on imaging. The discussion highlights key risk groups—especially postmenopausal women following emotional or physical stressors—and the typical presentation of chest pain, dyspnea, and EKG changes resembling STEMI. We walk through the diagnostic approach, emphasizing the role of echocardiography and coronary angiography in distinguishing this condition from true ischemic disease. Management focuses on supportive heart failure therapy, with most patients experiencing full recovery within weeks.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Templin C, Ghadri JR, Diekmann J, et al.Clinical features and outcomes of Takotsubo cardiomyopathy. New England Journal of Medicine. 2015;373(10):929–938
3. Pelliccia F, Kaski JC, Crea F, Camici PG.Takotsubo syndrome: pathophysiology and treatment. JAMA Cardiology. 2023;8(3):273–282