A woman in her 60s with 6 hours of chest pain, dyspnea, tachycardia, and hypoxemia
Discussion:The management in this case is unfortunately common practice at many places around the world where we receive cases. Why would an interventionalist violate multiple recommendations from their own guidelines and watch at 10am while an LAD occlusion plays out in front of them? What could explain why some providers do not seem interested in the fact that LAD occlusion can be identified by something other than STEMI criteria? Or why the wall motion abnormality matching the distribution of concern is ignored? The only plausible explanation is that they have been taught that this is standard practice. Under the STEMI ...
Source: Dr. Smith's ECG Blog - August 23, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Dynamic ST Change in a mid-50s Man with Chest Pain
===================================MY Comment by KEN GRAUER, MD (8/21/2020):===================================The patient is a mid-50s man who presented to the ED for new-onset chest pain of ~1 hour duration. His symptoms awakened him from sleep. He was still having chest pain in the ED at the time ECG #1 was done (Figure-1).QUESTION:HOW would YOU interpret his initial ECG that is shown in Figure-1?Figure-1: The initial ECG in this case (See text).MY THOUGHTS on ECG #1: Although significant baseline artifact is seen (especially in the limb leads) — the tra...
Source: Dr. Smith's ECG Blog - August 21, 2020 Category: Cardiology Authors: ECG Interpretation Source Type: blogs
A man in his 40s with chest pain reproducible with palpation
Written by Pendell Meyers, submitted by George KonstantinouA man in his early 40s with history of smoking and hypertension presented to the ED with substernal and right sided chest pain of 8 hours duration. The pain had first started after a stressful event and had waxed and waned several times over the 8 hours. The pain was reproducible with palpation on the right side of the chest.Here is his initial ECG:Notice the leads configuration (this ECG comes to us from Greece).There is sinus rhythm with very small STE in V2-V3. The T waves in V2-V5 are very concerning for hyperacute T waves with increased area under the curve. C...
Source: Dr. Smith's ECG Blog - August 3, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
A case of misinterpreted troponins, in spite of a very suspicious ECG....
This 50-something male with previous history of MI presented for intermittent CP and SOB for 2 days. CP lasted for hours at a time, was described as pleuritic, without radiation, but relieved by nitro. He was given nitro and full dose aspirin by EMS. Prehospital ECG was similar to first ED ECG.Here is the ED ECG for ED visit #1:It is very abnormal, with potentially ischemic downsloping ST depressionThere were 3 ECGs during an ED visit for chest pain one month earlier. Let ' s call that ED visit zero.Here is the last EKG from ED visit zero:There is minimal ST depression without the downsloping.Her...
Source: Dr. Smith's ECG Blog - July 20, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Gender differences in cardiovascular disease: Women are less likely to be prescribed certain heart medications
Cardiovascular disease (CVD) is the leading killer of both women and men in the US. Despite the significant impact CVD has on women, awareness and education for women’s heart disease has historically been low. A recent study, based on data from over two million patients, suggests that women were less likely to be prescribed aspirin, statins, and certain blood pressure medications compared to men.
CVD is a group of diseases involving the heart or blood vessels. It includes high blood pressure (hypertension), coronary artery disease, heart attacks, heart failure, heart valve problems, and abnormal heart rhythms. CVD ca...
Source: Harvard Health Blog - July 16, 2020 Category: Consumer Health News Authors: Hannah Gaggin, MD, MPH Tags: Drugs and Supplements Heart Health Women's Health Source Type: blogs
Chest Pain and Ischemic ST Depression — but there is no Cath Lab available. Thrombolytics?
===================================MY Comment by KEN GRAUER, MD (7/14/2020):===================================This middle-aged man with hypertension and hyperlipidemia presented to the ED with 2 hours of new-onset chest pain — and the ECG shown in Figure-1. The patient was hemodynamically stable. No prior tracing was available for comparison.HOW would you interpret the ECG shown in Figure-1?Immediate cath lab activation was not an option in this hospital. Should acute thrombolysis be used?Figure-1: The initial ECG in the ED (See text).My THOUGHTS on ECG #1...
Source: Dr. Smith's ECG Blog - July 14, 2020 Category: Cardiology Authors: ECG Interpretation Source Type: blogs
Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on?
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely. When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA. ===================================MY Comment by KEN ...
Source: Dr. Smith's ECG Blog - June 27, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Exploring Nature ’s Treasure Trove of Helpful Compounds
A cone snail shell. Credit: Kerry Matz, University of Utah.
Over the years, scientists have discovered many compounds in nature that have led to the development of medications. For instance, the molecular structure for aspirin came from willow tree bark, and penicillin was found in a type of mold. And uses of natural products aren’t limited to medicine cabinet staples and antibiotics. A cancer drug was originally found in the bark of the Pacific yew tree, and a medication for chronic pain relief was first isolated from cone snail venom. Today, NIGMS supports scientists in the earliest stages of investigating natural pro...
Source: Biomedical Beat Blog - National Institute of General Medical Sciences - June 24, 2020 Category: Research Authors: Chrissa Chverchko Tags: Chemistry, Biochemistry and Pharmacology Bacteria Cool Tools/Techniques Medicines Microbes Source Type: blogs
What's new in midwifery - 17th June 2020
Some recent things you may need to know...Current news‘Black mothers were already scared’: coronavirus home births (Guardian video, about experiences in Pennsylvania)Global healthMonitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in LiberiaRelated blog postClinical effectivenessLabor dystocia (AHRQ)ResearchDoes low-dose aspirin initiated before 11 weeks ' gestation reduce the rate of preeclampsia? (AJOG)Early amniotomy after cervical ripening for induction of labor: a systematic review and meta-analysis of randomized controlle...
Source: Browsing - June 17, 2020 Category: Databases & Libraries Tags: midwifery Source Type: blogs
Why should the three antiplatelet siblings Tica ,Prasu & Clopi fight perennially?
Anti-platelet drugs find a place virtually in every prescription written by a cardiologist for CAD.No doubt, it sits right on top among the highest prescribed medication in the world. They are used in all forms of CAD/ ACS. It becomes mandatory in post PCI as a stent maintenance protocol. Cardiologists (at least me) are exhausted with so many studies with these drugs. When we thought we are relaxing for a while, the current issue of circulation release a big meta-analysis with 50,000 patient data.It tries to draw fresh battle lines between the three friendly P2Y12 inhibitors.
https://doi.org/10.1161/CIRCULATI...
Source: Dr.S.Venkatesan MD - June 12, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome anti platelet drug bms vs des isar react 5 themis stents for high bleeding risk biofreedom onyxone ticagrelor vs prasugrel vs clopidogrel Source Type: blogs
Can you believe this? Ticagrelor approved for Primary Prevention of STEMI
It’s all happening. FDA approves Ticagrelor for high-risk cad primary prevention and stroke. I am sure, even Astra Zenica wouldn’t have expected this. At best, the evidence from THEMIS for this Indication, can be called as a statistical extrapolation of comical proportion. Meanwhile, Ticagrelor thanks Aspirin for its extreme kindness for agreeing to co-live with it.
The twitter reacts. This one is fromDr. Davide Capodanno , current Editor In chief , of EuroIntervention, the journal with one of the top Impact factor with a huge following. New FDA label for ticagrelor in "high-risk CAD patient...
Source: Dr.S.Venkatesan MD - June 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized fda approves ticagrelor THEMIS TRIAL ticagrelor for primary prevetnion Source Type: blogs
Fight Aging! Newsletter, May 25th 2020
In conclusion, our results suggest a previously unknown mechanism whereby the canonical NF-κB cascade and a mitochondrial fission pathway interdependently regulate endothelial inflammation.
Lin28 as a Target for Nerve Regeneration
https://www.fightaging.org/archives/2020/05/lin28-as-a-target-for-nerve-regeneration/
Researchers here show that the gene Lin28 regulates axon regrowth. In mice, raised levels of Lin28 produce greater regeneration of nerve injuries. Past research has investigated Lin28 from the standpoint of producing a more general improvement in regenerative capacity. It improves mitochondr...
Source: Fight Aging! - May 24, 2020 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Linking Inflammation and Mitochondrial Dysfunction in Endothelial Tissue
In conclusion, our results suggest a previously unknown mechanism whereby the canonical NF-κB cascade and a mitochondrial fission pathway interdependently regulate endothelial inflammation. (Source: Fight Aging!)
Source: Fight Aging! - May 22, 2020 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
1 hour of CPR, then ECMO circulation, then successful defibrillation....
An elderly woman had sudden ventricular fibrillation.She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). ECMO Flow was achieved after approximately 1 hour of high quality CPR.After good ECMO flow was established, she was successfully defibrillated.Here is her monitor rhythm:Notice the " Shark Fin " morphology in lead I monitor rhythm.Also notice that the arterial line mean arterial pressure is 63 mmHg, but there is no waveform (and SpO2 says " no pulse " ), as the flow is continuous on ECMO and the LV function at this point was ext...
Source: Dr. Smith's ECG Blog - May 18, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
What do you think the echocardiogram shows in this case?
A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chest pain. Here is the EMS ECG:Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVROf course this pattern is most often seen from etoliogies other than ACS. The ECG only tells you there is ischemia, not the etiology of it.Nevertheless, the clinical situation made other etiologies unlikely.EMS gave 324 mg aspirin and 3 sublingual NTG, which the patient stated reduced the substernal chest pain from an 8/10 to 4/10.Here is the ED ECG on arrival:Less STE/STDProvider ' s Clinical Impression:&nbs...
Source: Dr. Smith's ECG Blog - May 12, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
