Cardiac arrest with anterior-inferior STEMI: Guess the value of the initial ED high sensitivity Abbott troponin I

A ~40 year old woman started having chest discomfort.  She called 911 after an uncertain amount of time.  EMS arrived and recorded thisprehospital ECG:Obvious Anterior and Inferior STEMI, consistent with LAD occlusionAfter recording this ECG, the patient went intoventricular fibrillation.She was rapidly defibrillated.The cath lab was activated by the paramedics.She arrived complaining of chest pain, with a BP of 110/70.An ED ECG was recorded:It looks worse stillAside: Should the patient receive antidysrhythmics to prevent recurrent VT/VF?  See discussion below on both beta blockers and other anti-dysrhythmics.The patient went to the cath lab.22 minutes after leaving for the cath lab, the initial High Sensitivity Troponin I returned (Abbott Architect, Limit of detection by FDA guidelines at 4 ng/L, 99% Upper Reference Limit for Women = 16 ng/L).  It had been drawn at arrival.Result: Below 4 ng/L (below the level of detection)Angiogram/Intervention100% Distal LAD occlusion due to coronary dissection was found and opened and stented.Repeat ECG next day:The 2nd troponin, drawn 3 hours, 25 minutes after arrival, returned at 803 ng/L.Here is the troponin profile over 7 blood draws (more than is necessary!).  You can see that the highest value (which may or may not be the peak) was over 16,000 ng/L.  16,665 ng/L roughly correlates with a level of 16.665 ng/mL on the older, contemporary (4th generation) Abbott troponin I assay.  It is typi...
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
This study is the first to provide a direct link between this inflammation and plaque development - by way of IFITM3. Scientists know that the production of IFITM3 starts in response to activation of the immune system by invading viruses and bacteria. These observations, combined with the new findings that IFITM3 directly contributes to plaque formation, suggest that viral and bacterial infections could increase the risk of Alzheimer's disease development. Indeed, researchers found that the level of IFITM3 in human brain samples correlated with levels of certain viral infections as well as with gamma-secretase activ...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Fight Aging! publishes news and commentary relevant to the goal of ending all age-related disease, to be achieved by bringing the mechanisms of aging under the control of modern medicine. This weekly newsletter is sent to thousands of interested subscribers. To subscribe or unsubscribe from the newsletter, please visit: https://www.fightaging.org/newsletter/ Longevity Industry Consulting Services Reason, the founder of Fight Aging! and Repair Biotechnologies, offers strategic consulting services to investors, entrepreneurs, and others interested in the longevity industry and its complexities. To find out m...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
CONCLUSION: On the basis of a broadly based research and participatory development process, a set of indicators has been developed that enables comprehensive evaluation of the regional quality of care of cross-indication, integrated care models focusing on common diseases. In order to be able to increasingly evaluate aspects of care coordination and patient orientation, health promotion as well as nursing, palliative and emergency care in the future, it would be helpful if routine data were collected or made accessible in these areas as well. PMID: 32467041 [PubMed - as supplied by publisher]
Source: Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen - Category: Health Management Tags: Z Evid Fortbild Qual Gesundhwes Source Type: research
ConclusionsA history of MST is common among older women veterans and associated with a range of medical and mental health diagnoses. These findings call attention to the need for additional research in this understudied population, and the importance of trauma-informed care approaches for women across the lifespan.
Source: Journal of General Internal Medicine - Category: Internal Medicine Source Type: research
Cardiac rehabilitation (CR), or “cardiac rehab,” is a multifaceted, medically supervised program proven to improve heart health and outcomes in people with certain types of cardiovascular disease. CR revolves around three major components: an individualized exercise and training program, education on topics related to heart health, and stress reduction. CR is currently recommended for the following diagnoses: angina (chest pain); heart attack with or without angioplasty or bypass surgery; heart failure with reduced ejection fraction (HFrEF); and heart surgery including heart valve procedures or heart or heart/l...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Exercise and Fitness Health Heart Health 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
This study sought to investigate what could be learned from how these men have fared. The men were born in 1925-1928 and similar health-related data from questionnaires, physical examination, and blood samples are available for all surveys. Survival curves over various variable strata were applied to evaluate the impact of individual risk factors and combinations of risk factors on all-cause deaths. At the end of 2018, 118 (16.0%) of the men had reached 90 years of age. Smoking in 1974 was the strongest single risk factor associated with survival, with observed percentages of men reaching 90 years being 26.3, 25.7, ...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
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
This study had a large sample size and obtained positive findings in both patients’ subjective ratings and in inflammatory marker levels. It demonstrates the benefits of adding Tai Chi to an antidepressant regimen but does not examine the specific effect of Tai Chi on depression.Field et al. (16) investigated the effects of combined Tai Chi/yoga in 92 prenatally depressed pregnant women. They found that women practicing Tai Chi/yoga (20 min per week for 12 weeks) had lower depression, anxiety, and sleep disturbance scores compared to a waitlist control group (Table 1). This study had a large sample size and provided ...
Source: Frontiers in Psychiatry - Category: Psychiatry Source Type: research
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