A middle aged man with ST depression and a narrow window of opportunity

Written by Pendell MeyersI received a text at 18:13 of an ECG taken several minutes prior, with no clinical information and only the question " De Winters? "Here is the ECG:What would you tell the treating team???I responded at 18:14 PM:" I think it's posterior STEMI (OMI) instead of de Winter. Cath lab immediately is indicated. "I clarified further:" De Winter would need hyperacute T waves (not present here), and would indicate acute occlusion of the territory in the affected leads; so if there was de Winter in anterior leads, that would mean the anterior wall is the one involved. Here we have isolated posterior STD, with no hyperacute T wave, so that's OMI of the posterior wall. Posterior wall may have hyperacute T's if posterior ECG is recorded. "Let's go back in time and see the full case play out.A middle aged man with HTN, DM, and CAD (with two prior stents) presented for chest pain, shortness of breath, and palpitations that started several hours ago (2-3 hours) while walking his dog. He was triaged at 17:34, had normal vital signs except tachycardia, was not in cardiogenic shock, and had this ECG obtained:There is atrial fibrillation with rapid ventricular response at about 150bpm. There is massive ST depression in leads V2-V3, with smaller amounts of STD in V4-5, I, II, III, and aVF, with obligatory reciprocal STE in aVR. The J point in V6 is isoelectric, which would be unusual in the case of widespread supply/demand mismatch ischemia be...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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Source: Journal of Membrane Science - Category: Materials Science Source Type: research
ConclusionsWe conclude that AATG is a promising and safe modality for the treatment of the painful scar. There is an abundance of low-level evidence to support its use as an alternative treatment but there is a lack of high-level evidence at present to support its standard use. Future long-term randomized controlled trials with analgesic scores as the primary outcome measures are required to assess long-term efficacy.
Source: Cytotherapy - Category: Cytology Source Type: research
As it can both be costly and negatively impact care quality, clinician turnover is a concern within community behavioral health settings. When it comes to patient outcomes, though, a 12-monthstudy published inPsychiatric Services in Advance observed mixed, and surprising, results, suggesting that turnover could have different impacts on patients depending on their initial symptoms.Researchers found that turnover was associated with harmful effects for patients who were functioning well at the start of the study, yet, “Curiously, we also found that turnover was associated with no changes or positive changes” in ...
Source: Psychiatr News - Category: Psychiatry Tags: Annalee Johnson-Kwochka anxiety behavioral health settings clinician turnover depression functioning Psychiatric Services in Advance Source Type: research
Publication date: Available online 17 September 2019Source: Journal of Clinical NeuroscienceAuthor(s): Adriana Moro, Renato Puppi Munhoz, Carlos Henrique Camargo, Mariana Moscovich, Marina Farah, Hélio A.G. TeiveAbstractSpinocerebellar ataxia type 10 (SCA10) is a rare dominantly inherited neurodegenerative disorder characterized by cerebellar ataxia, dysarthria, ocular dysmetria, and seizures in some populations. Fatigue has been described in SCA1, SCA3, but has not been objectively investigated in SCA10. Our aim is to investigate the presence and related causal factors of fatigue among SCA10 patients. Twenty-eight ...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
ConclusionsSustained hypoxemia in fetal sheep leads to altered cerebrovascular resistances and loss of brain mass, similar to human fetuses with CHD. This unique model provides opportunities to investigate the pathology underlying CHD associated brain dysmaturity, as well as to evaluate potential fetal neuroprotective therapies.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
ConclusionsThese results compare favourably to those reported by ECCG. Minimally Invasive esophagectomy can be the standard approach for surgical management of esophageal cancer. Introduction of the approach in each surgeon’s practice should be benchmarked to international standards.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
ConclusionsComparisons of CABG characteristics and outcomes were conducted between the STS National Database and JCVSD to illustrate the value of international collaboration off adult cardiac surgery databases.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Publication date: Available online 17 September 2019Source: The Annals of Thoracic SurgeryAuthor(s): Sung Jun Park, Ho Jin Kim, Joon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Jae Won Lee, Cheol Hyun ChungABSTRACTBackgroundAlthough multi-arterial grafting or bilateral mammary artery use is being increasingly emphasized more than ever for this contemporary CABG practice, saphenous vein graft (SVG) is still the most frequently used CABG conduit, accounting for 80% of all CABG conduits. Researches focusing on modifiable surgical factors such as anastomosis technique, however, has been scarcely conducted; this study aims to compare...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
ConclusionsThe disproportionately of IBV, poor mental health, and lower academic achievement faced by LGBTQ youth and youth with intersecting stigmatized identities suggests that they may benefit from tailored and targeted treatments.
Source: Journal of Adolescence - Category: Child Development Source Type: research
CONCLUSION: Despite early diagnosis and management of this rare injury, the prognosis for functional recovery is guarded and largely dictated by the extent of neurological injury in the setting of concomitant brachial plexopathy. Brachial plexopathy is highly associated with axillary artery injury and its impact often underestimated in comparison due to its non-limb-threatening nature in the acute setting. Future studies should focus on the long-term prognosis for functional recovery in patients with this rare injury pattern. PMID: 31525793 [PubMed - as supplied by publisher]
Source: Zeitschrift fur Orthopadie und Unfallchirurgie - Category: Orthopaedics Tags: Z Orthop Unfall Source Type: research
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