The current STEMI paradigm: Because STEMI criteria are not met, let's wait until the myocardium is dead!!
This was sent to me by an inpatient nurse who reads this blog but wants to remain anonymous.An inpatient rapid response was called for a patient with hypotension. The patient was originally admitted for pneumonia and had been transferred out of
the ICU a day prior. He had a history of HFrEF, HTN, and AML. " When I
arrived his blood pressure was 70s/40s and he was pale and profusely
diaphoretic. " " He spoke Spanish but we did deduce that he had 7/10 chest pain radiating to the
back. " " We couldn ’t initially get a hold of the primary physician but our
hospital allows the rapid response nur...
Source: Dr. Smith's ECG Blog - April 16, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.
A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night.He reported chest pain that developed several hours prior to arrival and was 5/10 in intensity. The pain was located in the mid to left chest and developed after riding his bike. There was associated fatigue when symptoms developed and mild shortness of breath at onset of chest pain however that has since resolved. The patient states he experienced similar 7/10 chest pain 2 days prior when he had to hurry to catch the bus. He states he experience...
Source: Dr. Smith's ECG Blog - April 14, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
How can Warfarin be safe “ even in ” first trimester of pregnancy ? The story behind the 5 mg cut-off !
The well known pro-coagulant state of pregnancy is an evolutionary protective process to make blood clot quicker, to save fetal loss in early pregnancy and mitigate postpartum bleeding. Still, in many women, this natural adaptive process confers an enhanced thrombotic risk. The molecular mechanisms for this pro-coagulant state are, there is increased factor VII, fibrinogen, reduced protein S. It is interesting to note, while plasminogen levels are elevated, D-dimer is also increased, indicating an ongoing fight between pro & anticoagulant forces, converting the physiological maternal- placental bed a mini harmless DIC ...
Source: Dr.S.Venkatesan MD - March 20, 2024 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Pregnancy and heart pregnancy and heart disease Uncategorized carpreg registry zahara esc acc guidelines on pregnancy and heart disease first trmestr use of oac warfarin heparin switch over lmwh bridge in pregnancy Source Type: blogs
Why is the angiogram normal?
Written byWilly FrickA man in his 50s with a 15 pack-year smoking history presented to his primary care physician ' s office complaining of intermittent headache. He also complained of intermittent mild chest pain radiating into into both shoulders and his back, as well as occasional unexplained sweating. (Although radiation into the left arm is most classic for coronary ischemia, radiation into both arms is actually modestly more predictive). The primary care physician ' s note indicates low suspicion for cardiac ischemia, but " for completion, check troponin and ECG. " If an ECG was obtained in the office,...
Source: Dr. Smith's ECG Blog - March 17, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
A man in his 40s with 3 days of stuttering chest pain
Written byWilly FrickA man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. It started while he was at rest after finishing a workout. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It woke him the next day and radiated into his back. He was only able to sleep while sitting in a chair. He went to urgent care and had an ECG (not available) which was interpreted as normal, and was sent home. His pain returned, and he went back to the urgent care but was sent to the ER. His ECG is shown:What do you...
Source: Dr. Smith's ECG Blog - March 13, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
Fight Aging! Newsletter, March 4th 2024
In conclusion, HSV (but not CMV) infection may be indicative of doubled dementia risk.
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Increased Dietary Leucine Activates mTOR Signaling in Macrophages, Accelerating Atherosclerosis
https://www.fightaging.org/archives/2024/02/increased-dietary-leucine-activates-mtor-signaling-in-macrophages-accelerating-atherosclerosis/
Leucine is an essential amino acid, only obtained from the diet rather than synthesized by our cells. Leucine supplementation has been proposed as a way to slow the loss of muscle mass with age, as leucine processing becomes dysregulated with aging in a way...
Source: Fight Aging! - March 3, 2024 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
An Update on Progress Towards Treating Atherosclerosis at Cyclarity
Today I'll point out an interview with one of the Cyclarity Therapeutics founders, illustrative of the degree to which biotech companies are at the mercy of regulators once they arrive at the clinical stage of development. Cyclarity, formerly Underdog Pharmaceuticals, is a spin-out from the SENS Research Foundation, an organization that aims to clear roadblocks in the translational research needed for the production of rejuvenation therapies. The program that led to Cyclarity was focused on finding a way to clear 7-ketocholesterol from the body. 7-ketocholesterol is a form of oxidized cholesterol, created as a result of ox...
Source: Fight Aging! - February 27, 2024 Category: Research Authors: Reason Tags: Longevity Industry Source Type: blogs
ARCADIA Trial on Atrial Cardiopathy and Stroke
In an earlier post on Embolic Stroke of Undetermined Source (ESUS), I had mentioned about ARCADIA trial (AtRial Cardiopathy and Antithrombotic Drugs In Prevention After Cryptogenic Stroke) which was testing whether there is role for apixaban compared to aspirin for prevention of recurrent stroke in ESUS. The trial was sponsored by the National Institutes of Health, United States of America and the results have been published in February 2024. ARCADIA trial showed that in patients with cryptogenic stroke and atrial cardiopathy, apixaban did not reduce the risk of recurrent stroke compared with low dose aspirin. The study wa...
Source: Cardiophile MD - February 19, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Vomiting, Diarrhea, and " Bubbles in my Chest "
A 60-something complained of vomiting, diarrhea overnight, and " bubbles in my chest " that started just prior to calling 911.He had this ECG recorded prehospital:Smith interpretation:There are hyperacute T-waves in III and aVF, and reciprocal STD in aVL with a reciprocally inverted T-wave in aVL. There are also hyperacute T-waves in V3 and V4. There is STD in V1 and V2. So it appears to be diagnostic of OMI, but it is hard to figure out what exact territory and artery. It could be a proximal RCA with both inferior OMI, posterior OMI (pulling ST down in V1/V2), and RV OMI causing large ischemic...
Source: Dr. Smith's ECG Blog - February 12, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Why is Aspirin, everyone ’ s nemesis ?
Here is a current review on a topic, which needs some soulful Introspection
For a kid, A stands for apple in kindergarten, while in the school of cardiac sciences, A would sound as Aspirin. Such is the importance of this drug, known for its obedient, predictable efficiency in the entire spectrum of CAD right from primary prevention of CAD to emergent primary angioplasty in Cath lab. Most of us will also agree, It is a work horse drug for not only for the cardiologists , but been an anchor drug in as many critical medical therapeutics, wherever platelets are to be passivated.
We are well aware of molecular bas...
Source: Dr.S.Venkatesan MD - February 1, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha guidelines aspirin bias-against-aspirin dapt esc guidelines mapt Source Type: blogs
What do you suspect from this ECG in this 40-something with SOB and Chest pain?
I was reviewing ECGs for a study, and came across this one, and was able to get all the clinical information:What do you think?The Queen diagnosed " OMI with high confidence " due to the ST Elevation in V1-V3.Smith interpretation: This is highly likely to be due to extreme right heart strain and is nearly diagnostic of pulmonary embolism. Let me tell you about her hospitalization, discharged 1 day prior, but it was at another hospital (I wish I had the ECG from that hospitalization):The patient is 40 years old and presented to another hospital with chest pain and SOB. She had been sitting doing work when sh...
Source: Dr. Smith's ECG Blog - January 8, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Three normal high sensitivity troponins over 4 hours with a " normal ECG "
Written byWilly FrickA 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of " chest burning. " The documentation does not describe any additional details of the history. The following ECG was obtained.ECG 1What do you think?The ECG shows sinus bradycardia but is otherwise normal. There is TWI in lead III, but this can be seen in normal ECGs. No labs were obtained. The patient was given a prescription for albuterol and a referral to cardiology.Smith comment:No patient over 25 years of age with unexplained chest burning should be discharged without a troponin rule out, no matt...
Source: Dr. Smith's ECG Blog - January 5, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
Fight Aging! Newsletter, January 1st 2024
Discussion of What is Need to Speed the Pace at which Drugs to Treat Aging Arrive in the Clinic
Cellular Senescence in the Aging Brain, a Contributing Cause of Cognitive Decline
Reviewing What is Known of the Mechanisms of Taurine Supplementation Relevant to Aging and Metabolism
Blunt Thoughts on Calculating the Revealed Value of Human Life
A Look Back at 2023: Progress Towards the Treatment of Aging as a Medical Condition
Towards Adjustment of the Gut Microbiome to Slow Aging
Gene Therapy Enhances Object Recognition Memory in Young and Old Mice
Benefits of Sem...
Source: Fight Aging! - December 31, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
A Look Back at 2023: Progress Towards the Treatment of Aging as a Medical Condition
The market has been in the doldrums and it has been a tough year for fundraising, both for non-profits and biotech startups. The conferences have exhibited more of an academic focus as companies tightened belts and postponed investment rounds, while investors stayed home. Not that this halts the flow of hype for some projects, and nor has it slowed media commentary on the longevity industry as it presently stands. A few of the articles in that commmentary are even interesting to read! The field has grown and is more mature now than has ever been the case. Biotech of all forms is a challenging field with a high failure rate...
Source: Fight Aging! - December 29, 2023 Category: Research Authors: Reason Tags: Of Interest Source Type: blogs
Acute OMI or " Benign " Early Repolarization?
Written by Willy FrickA man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. He described it as severe, sharp, and substernal with associated nausea, vomiting, chills, and diaphoresis. The following ECG was obtained. Note that the machine read is" normal sinus rhythm, normal ECG. " Cardiology over read the tracing and signed the interpretation without modification.ECG 1What do you think?The Queen of Hear...
Source: Dr. Smith's ECG Blog - December 27, 2023 Category: Cardiology Authors: Willy Frick Source Type: blogs
