A young woman with epigastric pain. ECG Crochetage sign? What is the significance?
A former resident texted me this ECG, done for epigastric pain in an 18 year old. The pain resolved immediately with treatment for acid reflux, and in the clinician's opinion was clearly GI in origin, but he wanted to know what the strange waves in the QRS were:See the unusual notching in II, III, aVF, and V2-V4.I had no idea what they were. They reminded me of theDelayed Activation Wave associated with circumflex acute MI.See this case: https://hqmeded-ecg.blogspot.com/2018/05/is-there-delayed-activation-wave.html.But they are clearly different from this.I put it on Facebook EKG club and this is the response:No one knew for certain what that was, butKen Grauer suspected artifact (due to lead placement over an artery) or aCrochetage sign, which is strongly associated with atrial septal defect. I looked up Crochetage sign and it sure does look like it!You can always rely on Ken.I told my former resident:The latter (Crochetage) is important because it is seen in atrial septal defect. I not sure the cardiologist will know this. You should make certain she gets an echo specifically looking for ASD (especially if still present on a repeat ECG). Let the referral cardiologist know. He will notify the patient but, unfortunately, because she will follow up in a different system, he will not have follow up.Crochetage signYou can see many more images of the Crochetage sign here.See the 5 articles below.“...
CONCLUSION: Data suggest different roles of opioidergic system and their antagonist in pain control and mood in PTSD. However, further investigations need to be done in order to reveal the role of endogenous opioidergic system and opioidergic antagonist system as a mediator in PTSD patients suffering from acute or chronic pain. PMID: 32492768 [PubMed - as supplied by publisher]
Authors: Saito I PMID: 32493882 [PubMed - as supplied by publisher]
CONCLUSIONS: Although statistical significance was not reached, the efficacy of prasugrel was potentially different between stroke subtypes, warranting further studies. PMID: 32493881 [PubMed - as supplied by publisher]
CONCLUSIONS: MSG administered parenterally to the higher dose to adult rats affects the immunoreactivity of S100β protein in PAG. Phenotypic changes of the studied cells may indicate reactivity of glial cells and increased expression of the studied protein whereas a decrease in their number may result from the increased protein secretion into the extracellular space or cytotoxic death of glial cells. PMID: 32495938 [PubMed - as supplied by publisher]
Publication date: Available online 4 June 2020Source: Orthopaedics &Traumatology: Surgery &ResearchAuthor(s): Roger Erivan, Anna Tardieu, Guillaume Villatte, Matthieu Ollivier, Christophe Jacquet, Stéphane Descamps, Stéphane Boisgard
LUNG CANCER symptoms include difficulty breathing, headaches, and persistent chest pain. But you could also be at risk of an advanced tumour if you develop a subtle sign on your eyes. Could you be at risk of lung cancer?
AbiomedÂ said it has received approval for an IDE to start an early feasibility study of what it is calling the âworldâs smallest heart pump.â Â The Danvers, MA-based company said the first-in-human trial will look at the 9 French Impella ECP heart pump in high-risk percutaneous coronary intervention (PCI) patients. Â The primary endpoint of the study is successful delivery, initiation, and maintenance of adequate hemodynamic support and a composite rate of major device-related adverse events during high-risk PCI. Â The stu...
Conclusion: Direct compression of ICA is rare complication of pituitary apoplexy, which caused cerebral ischemia. Conventional angiography should be necessary for accurate diagnosis and prompt surgical decompression should be the treatment of choice. PMID: 32494388 [PubMed]
Publication date: Available online 4 June 2020Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Losser Marie-Reine, Lapoix Coline, Delannoy Matthieu, Champigneulle Benoit, Payen Didier
Publication date: Available online 4 June 2020Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Michael Cardinale, Pierre Esnault, Jean Cotte, Pierre J Cungi, Philippe Goutorbe