The 4 Physiologic Etiologies of Shock, and the 3 Etiologies of Cardiogenic Shock
A 60-something presented with hypotension, bradycardia, chest pain and back pain.She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension. She had a mechanical aortic valve. She was on anti-hypertensives including atenolol, and on coumadin, with an INR of 2.3. She was ill appearing. BP was 70/49, pulse 60.A bedside echo showed good ejection fraction and normal right ventricle and no pericardial fluid. Here is the initial ECG:What do you think?This ECG actually looks like a left main occlusion (which rarely presents to the ED alive): ST Elevation in aVR, but also in V1, and what appears to be " coving " of the ST segment in aVL, which suggests ST Elevation in that lead as well.There is bradycardia, which is ominous in such a sick patient. This may be due to atenolol, but could simply be a sign of severe illness.Whereas ST elevation in aVR is usuallyreciprocal to the the ST depression of subendocardial ischemia, with a negative ST vector towards leads II and V5, and may be accompanied by STE in V1 (which is in the same direction as aVR),when there is also STE in aVLit implies a more directly superior ST axis (supported by ST depression in all of II, III, aVF).When the ST axis is directly superior, there may actually be transmural ischemia of the " base " of the heart (the base is actually the top of the heart, which really does not have a wall -- the ventricles have openings to...
A missed diagnosis of COVID-19 in this 94-year-old who presented with delirium, low-grade fever, and abdominal pain resulted in spread among healthcare workers and other patients.Age and Ageing
BEST supplements for high blood pressure: It may be possible for a person to lower their reading with the help of supplements. Health experts and studies indicate one could be particularly beneficial. What is it?
CONCLUSIONS: Small bowel obstruction resulting from LAGB tubing is an uncommon complication which was reported in few cases. Although bariatric surgery currently represents the best treatment option for morbid obesity and its related- diseases, peri- and post-operative complications have always to be taken into account. KEY WORDS: Adjustable gastric band complications, Bariatric surgery, Bowel obstruction, CT scan, LAGB tube. PMID: 32945272 [PubMed - in process]
Authors: Polistina GE, Simioli F, Imitazione P, Lanza M, Annunziata A, Fiorentino G Abstract The coronavirus disease 2019 (COVID-19) is a recent pandemic that affected more than 5 million people worldwide. Chest high resolution computed tomography (HRCT) is an essential tool in diagnosis and management of the disease. Pulmonary parenchymal opacity is a typical sign of the disease, but not the only one. Pneumothorax, pneumomediastinum, bronchiectasis and cysts are probably underrated complications of COVID-19 that can worsen prognosis, in terms of prolonged hospitalization and need of oxygen therapy. In our single c...
Conclusion: Moderate quality evidence suggests that OMTh is effective for CNCP patients. There was a significant association between visceral OMTh and reduced pain severity and disability. More robust, high-quality randomized controlled trials with larger sample sizes are required to further explore the effectiveness of the OMTh in the management of CNCP. PMID: 32946545 [PubMed - as supplied by publisher]
We report a patient with glucagonoma differentiation into a malignant form after 13 years. A 63-year-old asymptomatic man was evaluated for an enhancing lesion at the distal pancreas. Physical examination was normal. Laboratory values were normal except for an elevated serum glucagon level (206 pg/mL, Ref. 50 –150). Somatostatin and other tumor markers were normal. A PET scan confirmed abnormal uptake at the distal pancreas, correlating with a CT scan. The patient underwent laparoscopic distal pancreatectomy with resection of a 2.6-cm mass which predominantly expressed glucagon. Serum glucagon levels n ormalized imme...
Conclusion: The spatial QRS-T angle and Twvm are emerging VCG indices which are independently associated with mortality in patients with reduced left ventricular ejection fraction due to ICMP or NICMP. Using a composite score of all 3 vector indices, a maximum score was associated with poor long-term survival.Cardiology
Authors: Wang K, Pu Y, Zhang Y, Wang P Abstract The intima media thickness (IMT) of the common carotid artery (CCA) can be used to predict the risk of atherosclerosis. Many image segmentation techniques have been used for IMT measurement. However, severe noise in the ultrasound image can lead to erroneous segmentation results. To improve the robustness to noise, a fully automatic method, based on an improved Otsu's method and an adaptive wind-driven optimization technique, is proposed for estimating the IMT (denoted as "improved Otsu-AWDO"). First, an advanced despeckling filter, i.e., " Nagare's fil...
Conclusions: Ticagrelor was associated with a lower incidence of MACCEs and an increased risk of TIMI bleeding events in East Asian patients with CAD receiving PCI. PMID: 32945695 [PubMed - as supplied by publisher]
Authors: Brignardello-Petersen R PMID: 32948289 [PubMed - as supplied by publisher]
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