Can a bedside echocardiogram help rule out STEMI in patients with suspicious ECG ?
Can a bedside echocardiogram help rule out STEMI in patients with suspicious ECG?No, it can’t (Though, it may be tempting to use a rapid echo to look for wall motion defect to rule out ACS ) If your answer was No, probably you don’t need to read any further in this post. Diagnosis of STEMI* is based onClinicalECGBio-Markers *Please note, two of the most popular investigations namely Echo and Coronary angiogram are missing in the list.Middle-aged man with chest pain. Can an echocardiogram help you confirm STEMI here? Most likely not. It may still be a evolving STEMI. But, observation, serial ECGs, and Troponin is the answer. (ECG -Source /Representative)Though, echocardiography, a great noninvasive imaging tool at the point of care, it stands almost helpless in the diagnosis of the commonest cardiac emergency ie ACS. It can be called as mother of all paradox even visualizing the myocardium directly with high-quality imaging will not tell you, whether there is ongoing ACS or not. Relying on wall motion defects without diagnostic ECG changes to diagnose STEMI can be misleading for the simple reason, both unstable angina and old MI can be a 100 % confounding effect. Similarly, absence of WMA doesn’t rule out an evolving STEM(Apart from the bizarre behavior of Ischemic cascade, In the early hours only subendocardial wall stress is noted, that is not good enough to cause visible WMA)Role of CAG ...
We describe the most highly recommended generic and disease-specific PRO tools in SCD and discuss the challenges of incorporating them in clinical practice. EXPERT OPINION: PRO measures are essential to incorporate into SCD clinical trials either as primary or secondary outcomes. The use of PRO measures in SCD facilitates a patient-centered approach, which is likely to lead to improved outcomes. Significant challenges remain in adapting PRO tools to routine clinical use and in developing countries. PMID: 33034214 [PubMed - as supplied by publisher]
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...
Currently in fellowship doing bread/butter procedures (MBB, epidurals, PNB, few SCS/PNS trials, etc.) and just interviewed at a private practice spot where they do a lot of procedures that I will have not done any training in prior to graduating (e.g. IT pump, SI fusion, Vertiflex, Kypho, MILD, Discectomy, lots of SCS/PNS trials etc) and significant amount of "OR pain procedures" at a very busy practice seeing 30-40 pts/day - how many of you are commonly performing these procedures and are... private practice concern
Publication date: October 2020Source: Brain, Behavior, and Immunity, Volume 89Author(s): Fernando Lopes, Fernando A. Vicentini, Nina L. Cluny, Alexander J. Mathews, Benjamin H. Lee, Wagdi A. Almishri, Lateece Griffin, William Gonçalves, Vanessa Pinho, Derek M. McKay, Simon A. Hirota, Mark G. Swain, Quentin J. Pittman, Keith A. Sharkey
BEST supplements to relieve joint pain: Is your arthritis playing up? The wetter and colder months could partially be to blame. These two pills may help.
Authors: Kim H, Lim YM, Lee EJ, Kim HW, Ahn HS, Kim KK PMID: 33029979 [PubMed]
CONCLUSIONS: More than half of the iIONP patients had an enhanced oculomotor nerve in MRI. A few of them also had elevated CSF IgG synthesis rate, but no further evidence for inflammation was found. The administration of steroids seemed to have no benefit other than increasing the blood glucose level. PMID: 33029972 [PubMed]
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]
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
Publication date: Available online 10 October 2020Source: Journal of Acupuncture and Meridian StudiesAuthor(s): Natália Freire Valente, Eliezer de Sousa Cardoso, Juliana Alencar da Silva Resende, Jeferson Antônio Santos