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...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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teo D Abstract Background: Altered balance is a common and debilitating symptom of fibromyalgia. Previous studies have investigated balance under single-task conditions that do not reflect real-life situations. The present study evaluated the impact of a simultaneous cell-phone conversation on balance performance in a case-control cohort from Spain. Methods: A cross-sectional case-control study was performed in 34 women recruited from local self-help organizations and university facilities (n = 18 fibromyalgia cases; n = 16 healthy, pain-free controls). Participants performed the 3...
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
In this study, sitagliptin nanoparticles (sizes ranging from 210 to 618 nm) were developed. The bioadhesion properties of the nanoparticles, as well as the swelling of the nanoparticles on the mucus membrane aided in sustained drug release. The pattern of drug release was in accordance with the Peppas model. Fourier-transform infrared (FTIR) spectroscopy demonstrated that there were no significant interactions between sitagliptin and chitosan. Differential scanning calorimetry (DSC) results showed an absence of drug peaks due to the fact that the drug was present in an amorphous state. Mucoadhesive nanoparticles wer...
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
Conclusion: Condylar tissue changes point to the osteoclastic activity in the posterior region of the condyle. These adaptive changes point to bone resorption in the posterior condyle. Type II collagen and VEGF contribute to the MCC remolding induced by the TIPD. The ultrastructural changes in the posterior condylar area in response to mechanical stresses are recoverable at the initial stage. PMID: 31815128 [PubMed - in process]
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
Abstract For bone tissue engineering, the porous scaffold should provide a biocompatible environment for cell adhesion, proliferation, and differentiation and match the mechanical properties of native bone tissue. In this work, we fabricated porous polyetherimide (PEI) scaffolds using a three-dimensional (3D) printing system, and the pore size was set as 800 μm. The morphology of 3D PEI scaffolds was characterized by the scanning electron microscope. To investigate the mechanical properties of the 3D PEI scaffold, the compressive mechanical test was performed via an electronic universal testing system. F...
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
Abstract Objectives: The target of this study was to explore the coronary angiography characteristics for symptomatic patients with prior coronary artery bypass graft (CABG). Methods: Between 2009 and 2017, 993 patients who had undergone CABG but subsequently suffered recurrent symptoms in Beijing Anzhen Hospital were selected for this study and divided into either medical therapy (MT) group (n = 351) or percutaneous coronary intervention (PCI) group (n = 642) based on the treatment. Clinical data were analyzed between two groups. Results: Patients in the MT group were older a...
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
Abstract Neurological diseases particularly Alzheimer's disease (AD), Parkinson's disease (PD), stroke, and epilepsy are on the rise all around the world causing morbidity and mortality globally with a common symptom of gradual loss or impairment of motor behaviour. Striatum, which is a component of the basal ganglia, is involved in facilitating voluntary movement while the cerebellum is involved in the maintenance of balance and coordination of voluntary movements. Dopamine, serotonin, gamma-aminobutyric acid (GABA), and glutamate, to name a few, interact in regulating the excitation and inhibition of motor neuro...
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
CONCLUSIONS Radiation can induce vasogenic edema and is associated with the RBI occurrence and development. VEGF protein is highly relevant to the induction of edema and thrombosis in the acute phase of RBI and in the early delayed phase of RBI, including vascular repair and regeneration, thrombus ablation and other events. Human recombinant endostatin can reduce the progression of cerebral edema during the early onset of RBI. PMID: 31816619 [PubMed - in process]
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Source: Journal of Synchrotron Radiation - Category: Physics Authors: Tags: X-ray free-electron lasers single-particle diffraction pulse energy coherence beam profile research papers Source Type: research
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Source: Journal of Perinatal Medicine - Category: Perinatology & Neonatology Source Type: research
In conclusion, the study indicates that MFX relieves a depressive-like state in LPS-induced mice through the inhibition of the NLRP3 inflammasome and the enhancement of the neurogenesis pathway. PMID: 31814820 [PubMed - in process]
Source: Neural Plasticity - Category: Neurology Authors: Tags: Neural Plast Source Type: research
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