Introduction: Cardiovascular disease (CVD) is the leading cause of death worldwide. However, the lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) population experiences significant disparities in CVD risk factors, placing them at higher risk for developing CVD. Assessing and addressing risk factors (RF) in this population requires identifying and addressing modifiable barriers in a timely fashion. We aimed to evaluate trainee assessment of CVD RF in the LGBTQ community while identifying potential barriers as opportunities for intervention. Methods: This was a multi-institutional study performed at three academic training programs in Georgia. An anonymous questionnaire was used to assess trainees' (interns, residents, and medical students) identification and perception of CVD RF in the LGBTQ community. The data was compiled and analyzed to identify perceived barriers to LGBTQ CVD RF assessment by medical trainees. Results: A total of 168 surveys were returned. More than a third (37%; 62/168) of trainees noted that the LGBTQ community is at increased risk of developing CVD compared to their cisgender heterosexual peers. Only 3.6% (6/168) reported complete confidence in assessing CVD risk factors in the LGBTQ community. The most identified (90%; 152/168) RF was environmental stress such as discrimination, rejection, and violence followed by HIV/AIDs (83%; 139/168) and hormone replacement therapies (81%; 136/168). Almost half (48%; 77/161) of trainees noted that they address risk factors for CVD in the LGBTQ community less than 25% of the time, listing a lack of knowledge of the unique risk factors in the LGBTQ community 45% (69/152) as the most significant barrier. Conclusion: Identifying and addressing unique CVD RF in LGBTQ populations is pivotal to improving overall CVD outcomes. Medical teaching teams and training programs can play a leading role in educating trainees about these unique risk factors and helping to address knowledge barriers. Our study demonstrates that medical trainees are largely unaware that the LGBTQ community is at increased risk for CVD, presenting a significant opportunity to address cardiovascular health disparities in this community through intentional changes in the structure of medical education.

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Stress-induced cardiomyopathy, otherwise known as takotsubo cardiomyopathy, typically presents with chest pain and acute left ventricular failure with unobstructed coronary arteries. There is an increase in disease incidence as clinicians are becoming more aware of this clinical entity. An atypical variant exists where there is left ventricular dysfunction with apical sparing. Various precipitants have been described in the literature, however, there has not been any documented case following massive gastrointestinal bleeding. We report an atypical variant of takotsubo cardiomyopathy following a gastrointestinal bleed with review of the pathophysiologic mechanisms behind the disease process.