A 58 year old collapses in the hot sun

A 58 yo male was out working in the hot sun for 2-3 hours. He stated he almost passed out, and bystanders called 911. They give him water with salt, as he thought he was dehydrated.When medics arrived, he was alert, sweating, and felt weak.  He walked to the ambulance for evaluation.  He denied headache, chest pain, nausea / vomiting and dyspnea. He had no cardiac history, meds, or risk factors. Vitals were obtained, and placed on cardiac monitor, including this 12 lead prehospital ECG: QTc =  320 ms; (QTc = 374 ms)The computer measures the ST Elevation at the J-point for you.Here it is 4.08 mm in V2, and 2.84 in V3, as well as 2.34 mm in V4.This looks worrisome for anterior MI, and with ST elevation in aVL and reciprocal ST depression in inferior leads, it looks like aproximal LAD occlusion.Or is it normal variant ST Elevation (often known as early repolarization?)This has been thoroughly studied by me and Dr. Emre Aslanger (an interventionalist) in a series of articles:Here is the3-variable formula for differentiating normal variant STE from LAD occlusion.The 3-variable formula has been superceded by the 4-variable formulaCalculate the 4-variable formula at MDcalc, or get the iPhone app ( "SubtleSTEMI" ), or the Android app ( "ECG Smith" )This 4-variable formula wasexternally validated by Emre Aslanger.Then, Dr. Aslanger produced asimpler formula that does not require QT correction.In these studies differentiating Subtl...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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hat H Abstract PURPOSE: Individuals with poor physical and mental health may face elevated risk for suicide, particularly suicide by firearm. METHODS: This retrospective cohort study used statewide, longitudinally-linked ED patient record and mortality data to examine 12-month incidence of firearm suicide among emergency department (ED) patients presenting with a range of physical health problems. Participants included all residents presenting to a California ED in 2009-2013 with nonfatal visits for somatic diagnoses hypothesized to increase suicide risk, including myocardial infarction, congestive heart fail...
Source: Annals of Epidemiology - Category: Epidemiology Authors: Tags: Ann Epidemiol Source Type: research
Conclusion, do not visit cardiologists. They will give you heart attacks. No, that’s ridiculous. It’s so mind blowing that anyone even said this, right? It’s just ugh. Obviously, people who are extremely sick and who are at risk of killing themselves get psychiatric care. No kidding. So, yeah, this is, in fact, very dangerous. Gabe: The word bullshit is not big enough. This is the literal equivalent of me saying that I looked at fifty thousand people who went to the hospital in the last year. And you were much more likely to die if you had a hospital admission. Now, I’m talking physical health now. ...
Source: World of Psychology - Category: Psychiatry & Psychology Authors: Tags: General Mental Health and Wellness Not Crazy Podcast Psychiatry Treatment Source Type: blogs
Abstract AIMS: Spontaneous coronary artery dissection (SCAD) is increasingly recognised as a cause of myocardial infarction, but psychological characteristics of patients with SCAD have not yet been extensively investigated. We assessed the prevalence of a broad range of psychological and clinical factors, and their inter-relationships in patients with a history of SCAD. Furthermore, we investigated whether specific clusters of patients with SCAD can be identified. METHODS: Participants were recruited between March and May 2019 from a Dutch SCAD database and completed online questionnaires...
Source: Netherlands Heart Journal - Category: Cardiology Authors: Tags: Neth Heart J Source Type: research
Stress caused by uncertainty can be paralyzing. The information we are getting about the coronavirus seems to be changing by the hour — creating unprecedented uncertainty. There is a good reason your nerves are jangle, or you are feeling unsettled or anxious. Uncertainty is perceived as unsafe and potentially painful. Whether the situation is predictably positive or predictably negative, your brain prefers something familiar to something unfamiliar. Under stress, our brains depend on instinct rather than rational thought because the part of the brain responsible for critical thinking is busy dealing with the psycholo...
Source: Embrace Your Heart Wellness Initiative - Category: Cardiology Authors: Tags: Stress Management uncertainty Source Type: blogs
DiscussionWhich subacute STEMI should go to the cath lab?Simplified:IF there is subacute STEMI by ECG or other criteria AND:1. Symptoms onset is within 48 hours AND2. There are persistent symptoms OR persistent ST ElevationThen the patient should go for emergent angiogram/PCI.I think it makes sense to extend this beyond 48 hours because ischemia can be so intermittent.Schomig et al. randomized patients with:STEMI12-48 hours of symptomsNo persistent symptomsPersistent ST ElevationNo hemodynamic or electrical instability, no pulmonary edemaThe patients who received emergent PCI had significantly smaller median left ventricul...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Conclusion: Our results indicate similar prevalence rates of comorbid psychiatric symptoms to studies carried out in the Middle East and North Africa (MENA) region and relatively high attendance and referral rates to psychiatric services.Implications: The results shed light on the clinical profile of patients in this region and support the need for integrated collaborative medical services. Moreover, findings have important implications for health care policies pertaining to resource distribution and funding.IntroductionMedical care has traditionally been dominated by a separation between disciplines catering to physiologi...
Source: Frontiers in Psychiatry - Category: Psychiatry Source Type: research
We report a patient with mild carbon monoxide poisoning who had acute dyspnea as the earliest symptom and was later diagnosed with non-ST elevation myocardial infarction (NSTEMI) and acute left heart failure. Patient concerns: A 73-year-old woman complained of dizziness and fatigue with shortness of breath after carbon monoxide intoxication. Diagnoses: This patient had a clear history of carbon monoxide poisoning, acute respiratory distress, bilateral lung dry and moist rale, chest X-ray showed bilateral pulmonary edema, Electrocardiograph indicated general depression of the ST segment of the leads in the chest, card...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Medication side-effects can seem unbearable at times: dry mouth, nausea, dizziness, constipation. Certain prescriptions can also increase our risks for developing chronic conditions like thyroid disease and diabetes. Three years ago, I decided that the pills’ side-effects weren’t worth the relief they brought, so I slowly weaned off all my medication. I then plummeted into a severe depression that ended up taking a far greater toll on my health than the nuisance of my drugs. You may be justifiably concerned about how your mood stabilizer and antidepressant are altering your biochemistry, but also consider the g...
Source: World of Psychology - Category: Psychiatry & Psychology Authors: Tags: Depression General Medications Antidepressant Cognitive Decline Diabetes Mood Stabilizer Source Type: blogs
We present a case of MAOI-induced hypertensive crisis leading to significant troponin release after soft cheese intake. A 51-year-old lady presented with left-sided chest pain, palpitations and headache in the context of significant hypertension after eating soft cheese. She had a similar episode 2 month prior to this presentation, which resulted in a diagnosis of non-ST elevation myocardial infarction after a troponin of 2768 ng/L (Ref 
Source: Cardiovascular Toxicology - Category: Cardiology Authors: Tags: Cardiovasc Toxicol Source Type: research
In August, The New York Times published a guest op-ed by a man named David Roberts who suffered from severe chronic pain for many years before finally finding relief. The piece immediately went viral, with distinguished news journalist and personality Dan Rather posting it to his Facebook page with the addendum that it could “offer hope” to some pain patients. However, for many of us in the chronic pain community, particularly women, the piece was regarded with weariness and frustration. The first and most prominent source of annoyance for me regarding this piece was the part when the author finally discloses h...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Behavioral Health Pain Management Women's Health Source Type: blogs
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