What is a useful next step in the evaluation of this patient with Chest pain and this ECG?
Written by Pendell Meyers, submitted by Daryl Williams, edits by Steve SmithA man in his sixties with prior CAD and CABG experienced chest pain and pressure off and on for three days. He saw his primary doctor during this time who had suspected GI related symptoms and increased his PPI medication. On the third day it became more intense and had associated radiation to his neck and left arm, and this reminded the patient of his prior MI symptoms, so he presented to the Emergency Department. It is unclear how long he had constant symptoms during those three days.Here is his triage ECG (no prior was available in our system):What do you think?Raw Findings: - Normal, narrow QRS complex (other than the Q waves) - 0.5 mm STE in III and aVF - STD in I and aVL, V2-V5 (maximal in V2) - Q waves in II, III, and aVF, as well as very small Q waves in V5 and V6Interpretation:Acute to subacute inferoposterior OMIInferior STE with Q waves and slight STE without obviously hyperacute T waves could be acute, subacute, chronic (inferior LV aneurysm), or acute on chronic (new MI superimposed on an old LV aneurysm.The tall R-wave in V2 could be due to old or subacute posterior MI.Old MI with persistent STE, just like acute MI, may indeed have reciprocal ST depression (aVL) and old posterior MI (posterior aneurysm) can have persistent ST depression. So a large R-wave in V2 with ST depression could be old or subacute, as well as acute.There is no good way to differentiate inferior...
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]
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): Mario Gennaro Mazza, Rebecca De Lorenzo, Caterina Conte, Sara Poletti, Benedetta Vai, Irene Bollettini, Elisa Maria Teresa Melloni, Roberto Furlan, Fabio Ciceri, Patrizia Rovere-Querini, COVID-19 BioB Outpatient Clinic Study group, Francesco Benedetti
Publication date: October 2020Source: Brain, Behavior, and Immunity, Volume 89Author(s): Xiaoqin Liu, Trine Munk-Olsen, Clara Albiñana, Bjarni J. Vilhjálmsson, Emil M. Pedersen, Vivi Schlünssen, Marie Bækvad-Hansen, Jonas Bybjerg-Grauholm, Merete Nordentoft, Anders D. Børglum, Thomas Werge, David M. Hougaard, Preben B. Mortensen, Esben Agerbo
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]
Written by Pendell MeyersA man in his 50s with HTN, HLD, obesity, and restrictive lung disease presented with shortness of breath worsening over the past 3 days. He also had a cough and subjective fevers. He denied chest pain. His vitals were within normal limits.Here is his triage ECG (no baseline available):What do you think?Findings: - sinus rhythm at about 100 bpm - STE in I and aVL (meets STEMI criteria) - hint of STD in III and aVF - STD in V1 and V2 - hyperacute T-waves in I and aVL (with reciprocal negative hyperacute T in III)Interpretation:This is definitive evidence of acute transmural i...