A man in his 60s with acute chest pain
Sent by anonymous, written by Pendell MeyersA man in his 60s presented with acute chest pain with diaphoresis. He had received aspirin and nitroglycerin by EMS, with some improvement. His vitals were within normal limits. Here is his triage ECG:2045:What do you think?The ECG is subtle, but diagnostic of infero-posterior OMI. The QRS is normal, yet in aVL the normal upright small QRS complex is followed by in appropriately large-volume T wave inversion, which is reciprocal to the T waves in lead III, which are probably hyperacute if compared to available baseline. Corroborating this is the subtle ST depression in V2-V3 whic...
Source: Dr. Smith's ECG Blog - February 6, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Chest pain, and Cardiology didn't take the hint from the ICD
Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and GrauerA 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The screening physician ordered an EKG and noted his ashen appearance and moderate distress. Triage EKG:What do you think?Triage physician interpretation: -sinus bradycardia-lateral ST depressionsWhile there are lateral ST depressions (V5, V6) the deepest ST depressions are in V4. Additionally, lead V3 has ST depressions, which are always abnormal (recall that lead V3 will haveST elevation under nor...
Source: Dr. Smith's ECG Blog - January 23, 2023 Category: Cardiology Authors: Bracey Source Type: blogs
Quiz post: do either or both of these patients have high lateral OMI / South African flag sign?
Written by Pendell Meyers, edits by SmithTwo patients presented with acute chest pain/pressure. Here are their ECGs:Patient 1:Patient 2:See below for " answers " , and below that for both cases." Answers " : Patient 1 shows very subtle high lateral OMI, South African flag sign. She had an acute LAD OMI in the process of reperfusion, see case below.Patient 2 has a normal variant ECG which mimics high lateral OMI, and ruled out for MI, see case below.Here is theSouth African Flag sign (Figure by Ken Grauer — with the original 12-lead from Patient 1 attached below — See his Comment from theApril 8, 2022 post in...
Source: Dr. Smith's ECG Blog - January 12, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 50s with acute chest pain and LVH
Sent by Drew Williams, written by Pendell MeyersA man in his 50s with history of hypertension was standing at the bus stop when he developed sudden onset severe pressure-like chest pain radiating to his neck and right arm, associated with dyspnea, diaphoresis, and presyncope. EMS arrived and administered aspirin and nitroglycerin. He reported several weeks of intermittent chest pain similar to the active pain, worsening over the past 2-3 days, some of them as long as an hour, but all spontaneously resolved and were of less intensity than the current symptoms.There are 2 very instructive posts which we link to at the bottom...
Source: Dr. Smith's ECG Blog - December 14, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said " Nothing too exciting. "
This article fails to specify whether it was troponin I or T, but I contacted the institution and they used exclusively troponin I during that time period.Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. The impact of ST-segment elevation on the prognosis of patients with Takotsubo cardiomyopathy. J Electrocardiol [Internet] 2022;Available from: http://dx.doi.org/10.1016/j.jelectrocard.2022.09.009Cardiology opinion: Takotsubo Cardiomyopathy (EF 30-35%)V Fib Cardiac arrestProlonged QTCNSTEMI (Smith comment: is it NSTEMI or is it Takotsubo? -- these are entirely different)Moderate sin...
Source: Dr. Smith's ECG Blog - November 30, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Which chemotherapeutic agent is well known to cause coronary vasospasm?
5-fluorouracil is well known to cause coronary vasospasm. 5-fluorouracil and its orally active prodrug capecitabine are fluoropyrimidines, belonging to the class of antimetabolites used for treatment of malignancies of breast, head and neck tumours and gastrointestinal tumours.
Mechanisms for coronary vasospasm
Endothelial cell damage with cytolysis and denudation
Increased endothelin-1 bioactivity leading to vasoconstriction
When high dose infusions are given, coronary vasospasm with angina, arrhythmia or even sudden death can occur in up to 5% of patients. Vascular toxicity occurs generally within 72 hours of the...
Source: Cardiophile MD - November 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
How to swallow a pill
You’ve been swallowing things your entire life: breast milk (or formula), food––maybe a marble or small Lego. But did you know that swallowing pills is different? Let’s start with how not to swallow a pill. Sorry, but Bruce Willis in all five Die Hard movies is incorrect. You don’t just take a small handful of aspirin,
Read more…
How to swallow a pill originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 11, 2022 Category: General Medicine Authors: Susan J. Baumgaertel, MD Tags: Meds Medications Source Type: blogs
Medications Should be Carefully Controlled as Alzheimer's Advances
While Alzheimer's specific drugs may help slow symptoms for some people, they also may increase the risk of hip fractures, fainting, urinary problems, and other health issues. Most researchers now think that a time comes when many medications for the elderly are no longer beneficial and may be harmful.
According to an article in JAMA Internal Medicine, researchers at the University of Massachusetts Medical School in Worcester looked at 5,406 nursing home residents who had late-stage Alzheimer's or dementia with more than half of them being older than 85. The scientists found that 2,911 of the patients - nearly 54 pe...
Source: Minding Our Elders - October 27, 2022 Category: Geriatrics Authors: Carol Bradley Bursack Source Type: blogs
What is PT-INR monitoring? Cardiology Basics
INR is short for International Normalized Ratio of Prothrombin Time. It is also called PT-INR. The INR monitoring is used to monitor the dosage of vitamin K antagonists like warfarin. Vitamin K antagonists are used for stroke prevention in atrial fibrillation as well as for deep vein thrombosis and pulmonary embolism. Non vitamin K oral anticoagulants (NOACs), also known as direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban and apixaban do not need INR monitoring. Warfarin is routinely used when there is a mechanical prosthetic valve, to prevent valve thrombosis and thromboembolism. As of now, DOACs are not i...
Source: Cardiophile MD - October 25, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Chest pain and anterior ST depression. What ’s the cause(s)?
Written by Jesse McLaren, with edits from Smith and GrauerA 60 year old with no past medical history presented with two hours of chest pain radiating to the left arm, with normal vitals. What do you think? I sent this to Dr. Meyers without any other information, and he responded, “do you have a prior to make sure that it is all just because of the delta wave? Would be careful to make sure it’s not inferoposterior OMI superimposed on baseline WPW.” In other words, when there are ST/T wave changes thefirst question is whether there ’s abnormal depolarization, because this will be followed by abnormal ...
Source: Dr. Smith's ECG Blog - October 13, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Fight Aging! Newsletter, October 10th 2022
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! - October 9, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Interventions Testing Program Results for Rapamycin and Arcabose in Combination
The Interventions Testing Program (ITP) at the National Institute on Aging (NIA) performs rigorous, expensive assessments of the ability of various (usually pharmaceutical) interventions to slow aging in mice. Conducting a study with rigor in this context means the use of large numbers of mice spread across multiple facilities, with careful control of the environment in order to minimize both known and unknown confounding factors in life span studies. Most of the interventions tested over the past twenty years of the ITP, on the basis of earlier studies suggesting that they may slow aging, in fact fail to extend life in mi...
Source: Fight Aging! - October 6, 2022 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Chest pain one day after a negative stress test
Discussion Points:The patient ’s ECG transmitted to ED providers by EMS showed T waves that are easily confused with the peaked T waves of hyperkalemia. Sometimes hyperacute T waves have this slimmer, taller appearance, and it can be difficult to distinguish them in these cases. The new STE in anterior leads helps to understan d these as hyperacute. Also, other signs of hyperkalemia were absent, as there was no P wave flattening or QRS broadening, bradycardia, new AV blocks or NSIVCD, bizarre QRS morphology, or Brugada patterning. Additionally the clinical context was clearly ACS in this case, and if there were remaining...
Source: Dr. Smith's ECG Blog - October 3, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Fight Aging! Newsletter, October 3rd 2022
In conclusion, based on the analysis of proteomics and transcriptome, we identified four SRMs that may affect aging and speculated their possible mechanisms, which provides a new target for preventing aging, especially skin aging.
A Popular Science Article on the State of Epigenetic Clocks
https://www.fightaging.org/archives/2022/09/a-popular-science-article-on-the-state-of-epigenetic-clocks/
This popular science article is a good view of the present state of development and use of epigenetic clocks, covering the issues as well as the promise. Epigenetic age can be measured, with many different clocks...
Source: Fight Aging! - October 2, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
A Small Lifespan Study of Combined Interventions
My attention was drawn recently to a small mouse life span study run by one of the groups that has been in the longevity community for a while now. It is interesting for testing combinations of interventions that have in the past been demonstrated to modestly slow aging in mice (such as rapamycin), or modestly improve aspects of cell function in old tissues (such as nicotinamide mononucleotide). Combinatorial studies are rare in academia and industry, for reasons that have a lot to do with (a) the perverse incentives produced by the existence of intellectual property, in that the rights to use specific interventions can be...
Source: Fight Aging! - September 26, 2022 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
