Job Stress and Heart Rate Variability: Findings From the ELSA-Brasil Cohort

Conclusions Job control was associated with HRV in a large cohort of civil servants. Nevertheless, it is important to emphasize that only the LF index remained associated with low job control. Further studies are needed to develop a greater understanding of the relationship of psychosocial aspects and autonomic balance.
Source: Psychosomatic Medicine - Category: Psychiatry & Psychology Tags: ORIGINAL ARTICLES Source Type: research

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Written by Pendell MeyersA male in his early 50s presented with waxing and waning chest pain starting at rest. He had multiple cardiovascular risk factors and the EM physician strongly suspected ACS.Here is his initial ECG:What do you think?Sinus rhythm-STE in V1-V5, possibly a tiny amount in V6, and small amount in I and aVL, and II-Reciprocal STD (although perhaps isoelectric at J point, immediate STD after the J point) with very ischemic appearance in lead III (down-up T-wave is strongtly suggestive)-Large T-waves in V2-V4, which may be either a normal variant or hyperacute-Very tiny Q wave in lead V2, as well as V6, I,...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
In this study, approximately 10% of Transient STEMI had no culprit found:Early or late intervention in patients with transient ST ‐segment elevation acute coronary syndrome: Subgroup analysis of the ELISA‐3 trialOne must use all available data, including the ECG, to determine what happened.Final Diagnosis?If the troponin remained under the 99% reference, then it would be unstable angina.  If it rose above that level before falling, it would be acute myocardial injury due to ischemia, which is, by definition, acute MI.  If that is a result of plaque rupture, then it is a type I MI.  The clinical presentat...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
We describe a case of tejocote exposure from a weight-loss supplement resulting in severe cardiotoxicity. CASE REPORT: A healthy 16-year-old girl presented to an emergency department after ingesting eight pieces of her mother's tejocote root weight-loss supplement. At arrival, she was drowsy, had active vomiting and diarrhea, and had a heart rate of 57 with normal respirations. Her initial blood chemistries were unremarkable, except for an elevated digoxin assay of 0.7 ng/mL (therapeutic range 0.5-2.0 ng/mL). All other drug screens were negative. She later developed severe bradycardia and multiple episodes o...
Source: Journal of Medical Toxicology - Category: Toxicology Authors: Tags: J Med Toxicol Source Type: research
Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
We report 65 studies, 51 patients (mean age of 13  ± 4 years; 75% males), with aortic stenosis (AS) who had a maximal exercise test between 2005 and 2016. We defined three groups based on resting mean Doppler gradient across their aortic valve: severe AS (n = 10; gradient of ≥ 40 mmHg), moderate AS (n = 20; gradient 25–39 mmHg), and mild AS (n = 35; gradient ≤ 24 mmHg). We studied symptoms (chest pain) during exercise, resting electrocardiogram changes (left ventricular hypertrophy [LVH]), complex arrh...
Source: Pediatric Cardiology - Category: Cardiology Source Type: research
CONCLUSIONS: Only one third of adult residents of Warsaw had normal ECG, and about a half of both young and asymptomatic individuals. The most often observed ECG abnormalities in men were intra-ventricular conduction disturbances, and ST segment depression and negative T wave changes in case of women. Atrial fibrillation was the most prevalent arrhythmia. We did not found statistically significant time trends for repolarization changes, conduction disturbances and arrhythmia. PMID: 31354161 [PubMed - as supplied by publisher]
Source: Polish Heart Journal - Category: Cardiology Authors: Tags: Kardiol Pol Source Type: research
This is a very commonly missed ECG of a terrible condition.  In this case, it was almost dismissed.  I present many other similar ECGs at the bottom that were indeed missed or dismissed.CaseI was texted this ECG from a physician assistant who works by himself in several small Emergency Departments.He is a particularly smart and well trained emergency medicine PA (because he trained at Hennepin).He added the words:" What do you think?  70-something male with DM, HTN, no previous MI, with Chest pain "What doyouthink?Here was my response:" Definite Huge Occlusion MI (OMI). STEMI! This is a bad on...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Written by Pendell Meyers, with edits by Steve SmithA man in his early 40s with history of MI s/p PCI presented with bilateral anterior chest pain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). He also described a syncopal episode just prior to onset of symptoms. He had used cocaine approximately 20 minutes prior to onset of symptoms.He still had active pain on arrival to the ED.Here is his triage ECG:What do you think?His baseline ECG was on file:--Sinus rhythm--Subtle STE in V1-V5, II, III, and aVF--Q-waves in V1-V5, as well as II, III, and aVF which must...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
I awoke in the morning and discovered a text with this ECG that was sent 6 hours prior by a former resident:" 60 year old with classic chest pain.  The cath lab is occupied for the next 90 minutes.  Cards says " not a STEMI " .  Thinking of giving lytics. "What do you think?What do you do?I texted back: " Sorry for delay!  Was sleeping.  This is OMI!!  Did you give lytics?  Proximal LAD.  Great catch! "There is 0.5 mm of ST Elevation in V3-V6.  The T-wave in V4 is far too large for the QRS.  The LAD occlusion formula would be very high due to t...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Written and submitted by Ashley Mogul, with edits by Pendell Meyers and Steve SmithA man in his 40s with recent smoking cessation but otherwise no known past medical history presented due to chest pain since the previous evening. The pain has been constant and associated with vomiting and diaphoresis. He decided to present the following day when the pain had not stopped.Here is the presenting ECG (no prior available):What do you think?Relevant findings include slight STE in V1 with an upright T-wave, slightly large T-waves in V2-3 (possibly hyperacute if compared to baseline), and slight reciprocal depression in II, III, a...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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