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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Authors: Sabet Sarvestani F, Azarpira N Abstract Heart and cerebral infarctions, as two important ischemic diseases, lead to the death of tissues due to inadequate blood supply and high mortality worldwide. These statuses are started via blockage of vessels and depletion of oxygen and nutrients which affected these areas. After reperfusion and restoration of oxygen supply, more severe injury was mediated by multifaceted cascades of inflammation and oxidative stress. microRNAs (miRNAs) as the regulator of biological and pathological pathways can adjust these conditions by interaction with their targets. Also, miRNAs...
Source: Immunological Investigations - Category: Allergy & Immunology Tags: Immunol Invest Source Type: research
Publication date: Available online 10 October 2020Source: Journal of Vascular Surgery: Venous and Lymphatic DisordersAuthor(s): N.G. Shah, B.C. Wible, J.A. Paulisi, M. Zaki, P. Lamparello, A. Sista, M. Sadek, G.R. Jacobowitz, T.S. Maldonado
Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders - Category: Surgery Source Type: research
Conclusion: Ambulatory renal and cardio-vascular follow-up in case of neonatal medical history can be enhanced, with necessity to raise awareness and to edict guidelines available to pediatricians.What is Known:•There is a compelling evidence of long-term renal and cardiovascular consequences of prematurity and low birth weight.•Specific cardiovascular and renal follow-up guidelines, coming from professional organizations, are currently not available for these patients.What is New:•Pediatricians in ambulatory setting do not adapt their renal and cardiovascular follow-up in case of neonatal medical history.&b...
Source: European Journal of Pediatrics - Category: Pediatrics Source Type: research
CONCLUSIONS: MMD-associated aneurysms occurred in 3.3% of the MMD cohort in this study, of which 63.6% were major-artery aneurysms and 36.4% were non-major-artery aneurysms. The major-artery group included 17.9% that became angiographically worse, while 31.2% were growing or hemorrhaging in the non-major-artery group. PMID: 33029969 [PubMed]
Source: Journal of Clinical Neurology - Category: Neurology Tags: J Clin Neurol Source Type: research
Publication date: Available online 9 October 2020Source: Journal of Pharmacological SciencesAuthor(s): Hiroyuki Saito, Ryuichi Kambayashi, Mihoko Hagiwara-Nagasawa, Yoshio Nunoi, Ai Goto, Hiroko Izumi-Nakaseko, Shinichi Kawai, Yoshinori Takei, Akio Matsumoto, Kiyotaka Hoshiai, Yasuki Akie, Atsushi Sugiyama
Source: Journal of Pharmacological Sciences - Category: Drugs & Pharmacology Source Type: research
CONCLUSION: The ultrasonography measure of right liver lobe diameter by itself can reliably identify patients with NAFLD with a good sensitivity and specificity, however, this can be improved by adding the LAP mathematical index in our population. PMID: 33031969 [PubMed - as supplied by publisher]
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol 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
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Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
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