While congenital heart disease historically was a pathology primarily restricted to specialized pediatric centers, advances in technology have dramatically increased the number of people living into adulthood, the number of complications faced by these patients, and the number of patients visiting non-specialized emergency departments for these concerns. Clinicians need to be aware of the issues specific to patients’ individual congenital defects but also have an understanding of how typical cardiac pathology may manifest in this special group of patients. This manuscript attempts to provide an overview of this diverse but increasingly common group of adult patients with congenital heart diseases, including a review of their anatomical variants, the complications they face at the highest rates, and ways that emergency physicians may need to manage these patients differently to avoid causing harm.

Pregnancy induces significant physiologic changes that impact the cardiovascular system, potentially exacerbating pre-existing cardiac conditions or precipitating new illnesses. Pregnant patients with cardiac emergencies pose unique challenges, as standard interventions may pose risks to the developing fetus. This article aims to enhance emergency physicians’ confidence in managing pregnancy-related cardiac emergencies by providing a structured approach to initial evaluation and stabilization. We review eight common categories of pregnancy-associated cardiac illness: gestational hypertension and pre-eclampsia, cardiomyopathy, arrhythmias, valvular disease, aortopathies, congenital heart disease and pulmonary hypertension, coronary disease, and anticoagulation-related complications. For each condition, we summarize relevant pregnancy-specific pathophysiology and outline evidence-based, personalized emergency management strategies.

Background: Gender disparities have been reported in Emergency Medicine (EM) residency milestone attainment, with some studies showing male residents achieving higher competency-based ratings than female residents despite similar clinical exposure. Prior research suggests subjective faculty evaluation and implicit bias may contribute to these differences. The influence of resident self-assignment of patients on milestone attainment remains unclear, and the potential contribution of differential patient exposure through self-selection has not been directly investigated. Objectives: To determine whether gender differences exist in the types of patients or acuity levels that EM residents self-assign to determine if this could potentially explain the differences seen in EM milestone achievement across genders. Methods: Design and Setting: Retrospective chart review of EM resident patient selection at the Mayo Clinic Arizona Emergency Department from September 2018 through December 2022. Patients: The study was conducted at a single academic emergency department with resident and attending physician staffing. The study was determined to be IRB exempt. Data Collection: Epic electronic medical record data included resident and attending gender, patient demographics, chief complaint, Emergency Severity Index (ESI) triage level, vital signs, method of arrival, and procedures performed. Statistical Analysis: Continuous variables were compared using Student’s t-test or Wilcoxon rank-sum test; categorical variables were compared using chi-square test. Significance was set at p < 0.05. Analyses were performed using SAS version 9.4. Results: A total of 14,279 cases were analyzed. No significant differences were observed between female and male residents in patient chief complaint, age, race, gender, means of arrival, attending gender (p = 0.10872), or total procedures performed (p = 0.23102). Female residents saw patients with higher initial respiratory rates (p = 0.04313) and trended non-significantly toward higher-acuity ESI levels 1–2 (p = 0.07214). Conclusion: When residents self-assign patients in the emergency department, no meaningful gender differences exist in patient selection, procedural exposure, or gender attending assignment. These findings suggest that observed gender disparities in milestone attainment are unlikely driven by clinical exposure or patient selection, supporting that other factors may contribute to these differences.