Chest pain in an Elderly Woman

This case was sent by one of our great FOAM colleagues, Salim Rezaie of REBEL EM!!"A 67 y/o female with PMH of Type 2 DM, HTN, Hyperlipidemia, and Hx of MI x 2, with chronic kidney disease awoke at 2am with left sided chest pain. She arrived at 2:45 AM and had this initial ECG below:"What do you think? Smith response: There is sinus rhythm.  There is No significant ST elevation in any lead.   There are large, symmetric T-waves in I, aVL, V2-V5 diagnostic of proximal LAD occlusion.  There are also down-up T-waves in III and aVF (these are very specific RECIPROCAL findings and clinch the diagnosis.)Salim was very worried about these T-waves and so brought the patient the Medical Resus room and did an immediate bedside echo (not shown) which he read as a lateral wall motion abnormality; then he activated the cath lab.He recorded a second ECG 5 minutes after the first:Now there is obvious high lateral ST elevation, as well as STE in V2, V3, V4, V5.He writes:"Patient was immediately taken to cath lab. Initial Troponin was (I'm not sure if 0.03 is level of detection or 99% reference, and I did not clarify that with Salim)."We obtained that result after the patient was already gone. Subsequent Troponin I values were 53.6 ng/mL and 152.04 ng/mL."  This is a large anterior MI."In my mind this was a circ lesion due to STE elevation in lateral leads, but…."Cath showed:"Prox LAD 70% lesionLarge D1 100% occlusion...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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We report a case of a young male with no prior genitourinary history who presents to an emergency department with sudden onset gross hematuria, clot retention, and right-sided flank pain. On evaluation, he was found to have a renal artery aneurysm bleeding into his collecting system and underwent renal artery embolization and rapid resolution of his hematuria. Renal vascular pathology should be considered in the differential diagnosis and timely diagnosis of this condition is imperative as surgical interventions have proven to be life-saving. PMID: 32065873 [PubMed - in process]
Source: Canadian Journal of Urology - Category: Urology & Nephrology Tags: Can J Urol Source Type: research
CONCLUSIONS: BTX-A treatment using either a trigone-sparing or trigone-including injection template resulted in significant, but not location-dependent, improvement in IC/BPS symptom scores at 30 and 90 day points post-procedure with no significant difference in post-treatment complication profiles. PMID: 32065870 [PubMed - in process]
Source: Canadian Journal of Urology - Category: Urology & Nephrology Tags: Can J Urol Source Type: research
Authors: Burgmaier K, Hackl A, Ehren R, Kribs A, Burgmaier M, Weber LT, Oberthuer A, Habbig S Abstract The outcome of extremely low-birth-weight (ELBW) and very low-birth-weight (VLBW) infants has substantially improved in recent years. As acute kidney injury is frequent in these infants due to various risk factors, there is an increasing demand for renal replacement therapy in these patients. Data on that topic, however, are scarce. We review the available literature on that topic and report our experience on temporary dialysis in three extremely immature infants (two ELBW and one VLBW) with acute kidney failure. ...
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
CONCLUSION: Large variability exists in the definitions, methods of reporting, and analysis of PD-associated peritonitis across trials and observational studies. Standardizing definitions for reporting of peritonitis and associated outcomes will better enable assessment of the comparative effect of interventions on peritonitis. This will facilitate continuous quality improvement measures through reliable benchmarking of this patient-important outcome across centers and countries. PMID: 32063197 [PubMed - as supplied by publisher]
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
CONCLUSIONS: Insertion-related complications leading to significant adverse events following laparoscopic placement of PD catheters are common. Many complications occur before the start of PD. Insertion-related complications are an important area of focus for future research and quality improvement efforts. PMID: 32063191 [PubMed - as supplied by publisher]
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
Authors: Melo TL, Meireles MS, Kamimura MA, Cuppari L Abstract BACKGROUND: Decreased appetite is a symptom often found in chronic kidney disease. Poor appetite may negatively affect food intake, what in long-term may contribute to the development of protein-energy malnutrition. METHODS: An Appetite and Food Satisfaction Questionnaire (AFSQ) was developed consisting of a question that assesses the level of appetite through a facial hedonic scale and five other questions adapted from the Buckner and Dwyer tool that assess some aspects related to food satisfaction. Each question received an arbitrary score of 0 to...
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
Authors: Pratt RM, West ML, Tennankore KK Abstract Hypercalcemia due to excess parathyroid hormone (PTH) production is a common condition among patients with end-stage renal disease (ESRD), often referred to as tertiary hyperparathyroidism. There are limited effective medical treatment options currently available for such patients. Denosumab is a monoclonal antibody that inhibits osteoclast activation, thereby reducing calcium release from bones. Denosumab has been used to treat medically-refractory hypercalcemia in non-ESRD patients with hyperparathyroidism. Denosumab has also been used to treat non-PTH-mediated h...
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
Basal cell carcinoma (BCC) is the most common skin cancer type in humans. Various factors play a role in BCC occurrence, but sunlight exposure is the most common etiologic factor. This case series presents three patients who had scarring after severe traumas (a deep abrasion, burn, and puncture injury); a long time after the respective traumatic events, a BCC occurred in the scar tissue. The lesions were excised, and BCCs were diagnosed based on histopathology. Although several etiologic factors may play a role in trauma-related BCC, the main mechanism remains unclear. A correct diagnosis with biopsy and an assessment of t...
Source: Advances in Skin and Wound Care - Category: Dermatology Tags: ONLINE EXCLUSIVE Source Type: research
Excessive masculinity is linked to a significantly increased risk for death by suicide in men, a finding that underscores the central role of gender in suicide death, new research shows.Medscape Medical News
Source: Medscape Emergency Medicine Headlines - Category: Emergency Medicine Tags: Psychiatry News Source Type: news
Publication date: Available online 19 February 2020Source: Canadian Journal of CardiologyAuthor(s): Hsin-Fu Lee, Yi-Hsin Chan, Pei-Ru Li, Jia-Rou Liu, Tze-Fan Chao, Lung-Sheng Wu, Shang-Hung Chang, Yung-Hsin Yeh, Chi-Tai Kuo, Lai-Chu See, Gregory Y.H. LipAbstractBackgroundEvidences of clinical outcomes for oral anticoagulants and antiplatelet treatment (APT) in atrial fibrillation (AF) patients with critical limb ischemia (CLI) are very limited.MethodsIn this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, 1,223 AF patients with CLI taking DOACs, warfarin, or APT wer...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
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