Persistent Ventricular Fibrillation, ED ECMO, ED TEE, ROSC, Shark Fin ECG (also called " Giant R-wave " ), Postinfarction Regional Pericarditis. What a Case!

A 40-something suffered witnessed ventricular fibrillation, had bystander CPR, but could not be defibrillated after 4 attempts.He was transferred to the ED and put on extracorporeal life support (ECLS, ECMO).A series of ED Transesophageal echos (TEE) was done over 23 minutes before an ECG was recorded.  We usually do not get ROSC before angiography in these cases, and recording the ECG is not as important as usual, because we send them all to the cath lab by our ECMO protocol.This is before another defibrillation attempt, during chest compressions:Orientation:The probe is in the esophagus, right next to the left atrium.  so the chamber at the top of the image is the left atrium. Directly below that is the left ventricle.Flow on ECMO was successfully initiated.13 minutes later, the patient was successfully defibrillated. This was the immediate TEE:Minimal organized activity, and you can see good blood flow in the chamber due to ECMOAnother 4 minutes later:There is organized activity, but very slow and with poor contractilityAnother 6 minutes later (TEE with short axis):Contractility and heart rate are betterAn ECG was recorded:" Shark Fin "Diagnostic of Coronary Occlusion.I and aVL are involved, so this is a proximal LAD.Here are 2 more examples of Shark Fin on this blog.The patient was taken for immediate angiogram:Do you see the occlusion?Here I point it out with a red arrow:It was opened and stented:Excellent flowAn ECG was recorded after PCI:This a...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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ConclusionsThis is the largest series to date reporting>30-day follow-up for patients undergoing venous ablation procedures while receiving anticoagulation and the longest follow-up reported of any series. Durability, safety, and efficacy of vein ablation in patients receiving anticoagulation are comparable to those in control patients. Anticoagulation should not be considered a contraindication to endothermal ablation of the GSV or SSV for symptomatic venous reflux.
Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders - Category: Surgery Source Type: research
Publication date: Available online 24 January 2020Source: Seminars in Ultrasound, CT and MRIAuthor(s): Supreeta Arya, Saugata Sen, Reena Engineer, Avanish Saklani, Tarun PandeyAbstractHigh-resolution phased array external MRI is the first investigation of choice in rectal cancer for local staging, both in the primary and restaging situations. Use of MRI helps differentiate between those with good prognosis, which can be offered upfront surgery and the poor prognostic cases where treatment intensification is needed. MRI identified poor prognostic factors are threatened or involved mesorectal fascia, T3 tumors with> 5mm e...
Source: Seminars in Ultrasound, CT and MRI - Category: Radiology Source Type: research
Publication date: Available online 24 January 2020Source: Journal of Vascular and Interventional RadiologyAuthor(s): Yumei Yang, Yanfang Zhang, Yumin Wu, Jibing Chen, Bing Liang, Quanhong Chen, Qiuyu Wang, Jialing Lyu, Yong Li, Feng Mu, Duanming DuAbstractPurposeTo evaluate the efficacy and safety of percutaneous argon-helium cryoablation (CA) for hepatocellular carcinoma (HCC) abutting the diaphragm (
Source: Journal of Vascular and Interventional Radiology - Category: Radiology Source Type: research
We report, for the first time, that classical relaxing music decreases the amplitude of the brain pulsatile movements related to cerebral blood flow and mechanical properties of the brain parenchyma, which provides further evidence of the involvement of BTP in emotional reactivity. In addition, we validate the use of TPI as a non-invasive, portable and low cost tool for studies in psychophysiology, with the potential to be implemented as a biomarker in musicotherapy trials notably.
Source: International Journal of Psychophysiology - Category: Psychiatry & Psychology Source Type: research
ConclusionCombined Rendez-vous isthmoplasty is feasible, safe, and effective in experienced hands, giving the surgeon a comprehensive evaluation of the anatomy of the isthmocele, and increasing the odds of a complete resection and restoration of the anatomy 4, 5, 6, 7. In this patient, the procedure was uneventful, without any intra- or postoperative complications, and the symptoms were completely controlled.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
ConclusionsMechanical extraction is more effective for extracting fractured implant-prosthetic screws, showing a higher probability of extraction than the conventional method. Prosthetic fixing screws with a smooth shaft and threaded apical area are the easiest to extract.
Source: The Journal of Prosthetic Dentistry - Category: Dentistry Source Type: research
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Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
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Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
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Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 23. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
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