Young man with Gunshot wound to right chest with hemorrhagic shock, but bullet path not near heart
A young man presented with a gunshot wound to the right chest, with hemo-pneumothorax and hemorrhagic shock.He got a chest tube and intubation and massive transfusion and stabilized.CT of chest showed the bullet path through his right lung but nowhere near his heart.But he did get an EKG:What is this? There were times when it would be usurped by sinus tachycardia, then return to this rhythm.There is a wide complex. It is irregular. It is not fast (cannot be VT). There is no atrial activity to suggest atrial fibrillation. There are whatcould be interpreted as delta wavesif, and only if, th...
Source: Dr. Smith's ECG Blog - March 7, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Young man with Gunshot wound to right chest with hemorrhagic shock, but bullet path not near heart. A case of irregular accelerated idioventricular rhythm (AIVR)
A young man presented with a gunshot wound to the right chest, with hemo-pneumothorax and hemorrhagic shock.He got a chest tube and intubation and massive transfusion and stabilized.CT of chest showed the bullet path through his right lung but nowhere near his heart.But he did get an EKG:What is this? There were times when it would be usurped by sinus tachycardia, then return to this rhythm.There is a wide complex. It is irregular. It is not fast (cannot be VT). There is no atrial activity to suggest atrial fibrillation. There are whatcould be interpreted as delta wavesif, and only if, th...
Source: Dr. Smith's ECG Blog - March 7, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Higher Risk of Myocardial Infarction, Heart Failure, and Atrial Fibrillation Noted After Spinal Cord Injury
There are several factors which increase the risk of cardiovascular disease in survivors of spinal cord injury. They have a greater prevalence of obesity, dyslipidemia, metabolic syndrome and diabetes mellitus. Energy expenditure is lesser both due to lack of motor function and lack of opportunities to engage in physical activity. Autonomic dysfunction caused by spinal cord injury is associated with abnormalities in blood pressure, heart rate variability, arrhythmias and blunted cardiovascular response to exercise which can limit the capacity to perform physical activity [1].
A recent large study from Korea compared over 5...
Source: Cardiophile MD - February 27, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology 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
Acute dyspnea in an older woman, is it OMI?
Written by Willy FrickA woman in her 90s with a history of end stage renal disease and complete heart block status post dual chamber pacemaker presented from home with acute onset dyspnea. ECG is shown below.What do you think?The ST and T wave abnormalities jump off the page, but let ' s set that aside just for a moment to review the tracing systematically. The rate is 60 (and remember, slower heart rates are often seen in OMI). Close inspection revealsventricular pacing spikes, best seen in aVL. Many ECG readers will not comment any further on rhythm once ventricular pacing has been identified, but it...
Source: Dr. Smith's ECG Blog - February 18, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
A young man with persistent palpitations
Written by Pendell MeyersA teenager was playing basketball when he suddenly developed palpitations and lightheadedness. He presented soon afterward at the Emergency Department with ongoing symptoms. Mentation and blood pressure were normal. He had no chest pain or shortness of breath. Heart rates on the monitor fluctuated from 180-250 bpm.Here is his triage ECG:What do you think?The ECG shows an irregularly irregular polymorphic wide complex rhythm, with some R-R intervals as short as approximately 220 msec or even less. But it is not disorganized enough to be polymorphic ventricular tachycardia. The rhythm is therefo...
Source: Dr. Smith's ECG Blog - February 16, 2024 Category: Cardiology Authors: Pendell Source Type: blogs
A teenager involved in a motor vehicle collision with abnormal ECG
Written by Pendell MeyersA teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. He was intubated for altered mental status. Chest trauma was suspected on initial exam. Here is his initial ECG around 1330:What do you think?The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. It is very unlikely that a previously healthy teenager would have such disease of the conduction system, bringing up the possibility of blunt cardiac injury in this clinical setting.Trauma CTs showed a " mi...
Source: Dr. Smith's ECG Blog - February 6, 2024 Category: Cardiology Authors: Pendell Source Type: blogs
Rate or Rhythm Control in Atrial Fibrillation?
(Source: Cardiophile MD)
Source: Cardiophile MD - February 3, 2024 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs
What is this ECG finding? Do you understand it before you hear the clinical context?
Written by Pendell MeyersFirst try to interpret this ECG with no clinical context:The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. These are Osborn waves usually associated with hypothermia. There is also large T wave inversion and long QT.Clinical context:A man in his 50s was found down outside in the cold, unresponsive but with intact vital signs. He was intubated on arrival at the ED for mental status and airway protection due to vomiting. Initial vitals included...
Source: Dr. Smith's ECG Blog - February 2, 2024 Category: Cardiology Authors: Pendell Source Type: blogs
ACC atrial fibrillation guidelines 2023
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - January 20, 2024 Category: Internal Medicine Tags: cardiovascular guidelines Source Type: blogs
A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?
The patient is female in her 80s with a medical hx of previous MI with PCI and stent placement. She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The last echocardiography 12 months ago showed HFmrEF.She presented to the emergency department after a couple of days of chest discomfort. The ECG below was recorded. What is your assessment? How would you manage this patient?The ECG was interpreted as showing atrial flutter with 2:1 conduction. The patient was deemed stable and...
Source: Dr. Smith's ECG Blog - January 10, 2024 Category: Cardiology Authors: Magnus Nossen 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
My battle with atrial fibrillation
A while ago, I wrote about my experience during an attack of atrial fibrillation (afib), lamenting the fact that my management never included a proper physical exam. Nevertheless, chemical cardioversion was successful, and my hospital stay was brief. The episode was precipitated by a small pulmonary embolus acquired during sinus surgery the day before. I
Read more…
My battle with atrial fibrillation originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - December 31, 2023 Category: General Medicine Authors: Martin C. Young, MD Tags: Conditions Cardiology 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
Fight Aging! Newsletter, November 20th 2023
In this study, we attempted to further explain the role, exact mechanism and target of ICA in treating AD from the ferroptosis perspective. We found that ICA could improve the neurobehavioral, memory, and motor abilities of AD mice. It could lower the ferroptosis level and enhance the resistance to oxidative stress. After inhibition of MDM2, ICA could no longer improve the cognitive ability of AD mice, nor could it further inhibit ferroptosis. Network pharmacological analysis revealed that MDM2 might be the target of ICA action.
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Particulate Air Pollution and Its Effects on the Mechan...
Source: Fight Aging! - November 19, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
