ST Elevation in aVL with reciprocal ST Depression in inferior leads and DIffuse ST depression

An elderly male had volume depletion and anemia, and complained of chest pain.We recorded this ECG:Q-waves and ST Elevation in I and aVLST Depression in inferior (reciprocal to aVL) and precordial leads.  Is it posterolateral OMI?What do you think?Notice that not only are there Q-waves in I and aVL, they are QS-waves (there are no R-waves).However, there are very well-formed R-waves in the other " lateral " leads, V5 and V6.These 4 lateral leads do notalways look identical, as V5 and V6 are more inferior that I and aVL, but they should never look this differentEXCEPT if you are recording aright sided ECG in someone withDextrocardia.Notice also that, in spite of STD in V5, there is STD in aVR. These leads are effectively opposite each other and should be reciprocal to each other.So this is lead reversal.  The computer did NOT see this.Here is what it looked like after we placed the leads correctly:This is also after blood and fluid resuscitation, so that there is less ischemia evident.This is supply/demand subendocardial ischemia, and it finally resolved with full resuscitation.Learning Points:1. R-waves in I/aVL should not be opposite to V5, V62. STD in V5 should be accompanied by STE in aVRThese points should be major clues to lead reversal.===================================MY Comment by KEN GRAUER, MD (2/11/2020):===================================ECG Courses and textbooks often pay little attention to recognition of lead misplacemen...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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ConclusionsSTE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important.Previously, Knotts et al. had published different, but also convincing, data:Knotts et al. found that such ECG findings (STE in aVR) only represented left main ACS in 14% of such ECGs: Only 23% of patients with the aVR STE pattern had any LM disease (fewer if defined as  ≥ 50% stenosis). Onl...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
ConclusionLET is a rare cutaneous lupus-specific lesion that may be associated with SLE. AITD, hypothyroidism in particular, could be an initial presentation of SLE. Increased awareness and early diagnosis of such clinical presentations may improve patient outcomes.
Source: The Egyptian Rheumatologist - Category: Rheumatology Source Type: research
Publication date: Available online 12 February 2020Source: Clinics and Research in Hepatology and GastroenterologyAuthor(s): Zelnik Yovel Dana, Berezovsky lena, Richter Vered, Shirin Haim, Broide EfratSummaryIntroductionThe cornerstone of the recommended treatment for Celiac disease (CeD) is a lifelong strict gluten-free diet (GFD). We aimed to identify prospectively the demographic, clinical, social and psychological profile associated with non-adherence to a GFD in adult CeD patients in Israel.MethodsAn anonymous online questionnaire was sent via the Israeli Celiac association and through social networks. Only CeD patien...
Source: Clinics and Research in Hepatology and Gastroenterology - Category: Gastroenterology Source Type: research
This study highlighted sex differences in areas that could account for the underuse of the procedure in both sexes, with women affected to a greater extent. Understanding these factors will help address the unmet needs of both sexes after TJA by encouraging future studies and provider education to ensure that all patients are able to access the necessary procedures for pain relief and functional improvement. PMID: 32015251 [PubMed - as supplied by publisher]
Source: The Journal of the American Academy of Orthopaedic Surgeons - Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research
In conclusion, this study suggests that epigenetic age acceleration is significantly associated with lung function in women older than 50 years. We hypothesised that this could be due to menopause. However, we have observed that menopause has minimal effect and therefore there is possibility of other unknown physiological factors at older age in females mediating the epigenetic age acceleration effect on lung function. While, it is still unknown what exactly epigenetic aging from DNA methylation measures, this study suggests it can be utilised as one of the important factors to assess women's lung health in old age. DNA me...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Written by Meyers, edits by SmithA 50-ish year old man was working construction when he suddenly collapsed. Coworkers started CPR within 1 minute of collapse. EMS arrived within 10 minutes and continued CPR and ACLS, noting alternating asystole and sinus bradycardia during rhythm checks. He received various ACLS medications and arrived at the ED with a perfusing rhythm.Initial vitals included heart rate around 100 bpm and BP 174/96. Here is his initial ECG, very soon after ROSC:What do you think?Sinus tachycardia.  There is incomplete RBBB (QRS duration less than 120 ms).  There is diffuse STD, maximal in V4-V5 a...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
ConclusionsThe final conceptual model, which includes salient symptoms and impacts of congenital thrombotic thrombocytopenic purpura and reflects the disease burden, was derived by integrating inputs from the literature review, expert opinion, and patient interviews, and will be used to develop a congenital thrombotic thrombocytopenic purpura –specific, patient-reported outcome instrument.
Source: The Patient - Patient-Centered Outcomes Research - Category: International Medicine & Public Health Source Type: research
This study investigated the prevalence of depression and explored fatigue, QOL, and pain that is associated with depression in patients on first admission to a hematologic oncology unit. METHODS: This descriptive study measured depression, QOL, and fatigue with the Patient Health Questionnaire-9, the Functional Assessment of Cancer Therapy (FACT)-General, and the FACT-Anemia scale, respectively. Pain levels were examined with a numeric rating scale. FINDINGS: 58 patients participated; 17 reported moderate to severe depression, which highly correlated with fatigue, QOL, and pain. Among all factors, multivariate an...
Source: Clinical Journal of Oncology Nursing - Category: Nursing Authors: Tags: Clin J Oncol Nurs Source Type: research
Reena Goswami1, Gayatri Subramanian2, Liliya Silayeva1, Isabelle Newkirk1, Deborah Doctor1, Karan Chawla2, Saurabh Chattopadhyay2, Dhyan Chandra3, Nageswararao Chilukuri1 and Venkaiah Betapudi1,4* 1Neuroscience Branch, Research Division, United States Army Medical Research Institute of Chemical Defense, Aberdeen, MD, United States 2Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States 3Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States 4Department of Physiology and Biophysics, Case Western Reserve University, Clev...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more. This content is...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
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