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
Is there OMI on this ECG?
This is a case I had quite a while back. The patient with no prior cardiac history presented in the middle of the night with acute chest pain, and had this ECG recorded during active pain: I did not see any ischemia on this electrocardiogram. It does not look entirely normal, since there are some nonspecific STT abnormalities, such as flattening of the T waves in aVL. There is a normal amount of ST elevation in the precordial leads. There are no hyperacute T waves. There is no inappropriate ST depression. But it certainly shows no sign of OMI.Or does it?Here is the Queen ' s interpretat...
Source: Dr. Smith's ECG Blog - December 22, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Ginger Vieira – Exercise with Type 1 Diabetes
In conclusion, Ginger Vieira’s book, Exercise with Type 1 Diabetes (affiliate link), is a must-read for anyone with diabetes who wants to incorporate exercise into their daily routine.
Ginger’s expertise and personal experiences make this book a valuable resource for understanding the impact of exercise on blood sugar levels and managing diabetes effectively.
With practical tips and a supportive approach, Ginger empowers readers to take control of their health and enjoy the benefits of exercise. Don’t miss out on this concise and informative guide! ...
Source: Scott's Diabetes Blog - December 20, 2023 Category: Endocrinology Authors: Scott K. Johnson Tags: Blog Posts Source Type: blogs
The Courage of Corporate America is Needed to End America ’ s Opioid Crisis
By RYAN HAMPTON
A Kaiser Family Foundation tracking poll published in July found that three in ten U.S. adults (29%) said they had someone in their family who struggled with opioid dependence. Also surprising, and encouraging, was the statistic that 90% support increasing access to opioid use disorder treatment programs in their communities.
As a person in recovery from opioid use disorder and advocate, my read on this data set is that the public support is there. Now more than ever, we need leaders in healthcare, public policy, and corporate America to have the courage to advance effective treatment options. T...
Source: The Health Care Blog - December 11, 2023 Category: Consumer Health News Authors: matthew holt Tags: Health Policy addiction Albertsons DEA Opiods Ryan Hampton Source Type: blogs
Occlusion myocardial infarction is a clinical diagnosis
Written by Willy Frick (@Willyhfrick). Willy is a cardiology fellow with a keen interest in the ECG in OMI.A woman in her late 70s presented with left arm pain. The arm pain started the day prior when she was at the dentist ' s office for a root canal. Her systolic blood pressure at the dentist was over 200 mm Hg. She was given nitroglycerin which improved her blood pressure, and she completed the procedure. Her arm pain abated. The pain returned that evening and woke her from sleep. She eventually fell back asleep, and woke up feeling normal the next day (the day of presentation). After dinner the day of presentatio...
Source: Dr. Smith's ECG Blog - December 11, 2023 Category: Cardiology Authors: Willy Frick Source Type: blogs
Self-management skills that are not top of the pops
When I carried out my informal survey of the pain self-management skills people had used in the past week, there were no real surprises. Movement, activity management (pacing – and I will have more to say about this in a couple of weeks!), sleep, attention management and doing something fun were all at the top of the list. Others were lower down and while they don’t get to shine as much, I’m not so sure they are as seldom used as this wee survey suggests.
At the bottom of the list is having hands-on treatment for relaxation or to feel good. OK, perhaps understandable because the whole ongoing debat...
Source: HealthSkills Weblog - December 10, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Occupational therapy Psychology Research Resilience/Health Science in practice assertiveness Clinical reasoning pain management Therapeutic approaches Source Type: blogs
Syncope While Driving. Activate the Cath Lab?
A 50-something had syncope while driving. He was belted and it was low speed. He had a prehospital ECG. He was ambulatory at the scene. He has a history of STEMI and heart failure. The medics stated he had been nauseated and diaphoretic, but he did not have any chest pain or SOB. They recorded a prehospital ECG:What do you think?I read this blinded, with no clinical information, and read it as inferior OMI. There is STE in inferior leads with a large T-wave and reciprocal ST depression in aVL with a reciprocally inverted T-wave. It is all but diagnostic of OMI. The on...
Source: Dr. Smith's ECG Blog - December 9, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
" A patient just arrived as a transfer for NSTEMI. "
Conclusion: Our THANKS to Dr. Frick for his detailed and highly insightful presentation. CREDIT to him for masterful correlation of clinical events to each ECG — that thoroughly supports his explanation of the successful treatment received by this patient with evolving LAD OMI.QUESTION: Isn ' t it so much EASIER with the lead-to-lead comparison facilitated by Figure-1 — to see the subtle-but-important evolution of ST-T wave changes that so closely correspond to clinical events? (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - December 7, 2023 Category: Cardiology Authors: Willy Frick Source Type: blogs
The Most Overhyped Technologies in Healthcare
The hype about technological development in healthcare should not blind us in terms of the probabilities and possibilities of today’s healthcare and the future of medicine. To remain objective and conscious but still optimistic, let’s look at the most overhyped technologies and keep in mind the realistic development opportunities in healing.
You know the saying: the pessimist says the glass is half empty, the optimist says it is half full, and, well, the cynic asks who drank the other half? I’m truly an optimist – especially when it comes to the future of medicine and healthcare, but we need to ask the uncom...
Source: The Medical Futurist - December 5, 2023 Category: Information Technology Authors: berci.mesko Tags: Future of Medicine 3d printing robotics virtual reality wearables GC1 hype organs Source Type: blogs
My Cancer Story
By JEFF GOLDSMITH
On Christmas Eve 2014, I received a present of some profoundly unwelcome news: a 64 slice CT scan confirming not only the presence of a malignant tumor in my neck, but also a fluid filled mass the size of a man’s finger in my chest cavity outside the lungs. Two days earlier, my ENT surgeon in Charlottesville, Paige Powers, had performed a fine needle aspiration of a suspicious almond-shaped enlarged lymph node, and the lab returned a verdict of “metastatic squamous cell carcinoma of the head and neck with an occult primary tumor”.
I had worked in healthcare for nearly forty years when ca...
Source: The Health Care Blog - December 5, 2023 Category: Consumer Health News Authors: matthew holt Tags: Medical Practice The Business of Health Care Cancer Jeff Goldsmith Medicare Advantage Patient Experience Source Type: blogs
Patients are Not “Consumers”: My Cancer Story
By JEFF GOLDSMITH
On Christmas Eve 2014, I received a present of some profoundly unwelcome news: a 64 slice CT scan confirming not only the presence of a malignant tumor in my neck, but also a fluid filled mass the size of a man’s finger in my chest cavity outside the lungs. Two days earlier, my ENT surgeon in Charlottesville, Paige Powers, had performed a fine needle aspiration of a suspicious almond-shaped enlarged lymph node, and the lab returned a verdict of “metastatic squamous cell carcinoma of the head and neck with an occult primary tumor”.
I had worked in healthcare for nearly forty years when ca...
Source: The Health Care Blog - December 5, 2023 Category: Consumer Health News Authors: matthew holt Tags: Medical Practice The Business of Health Care Cancer Jeff Goldsmith Medicare Advantage Patient Experience Source Type: blogs
“ S/he ’ s just not taking the message on board ” – A word to clinicians
I’ve heard it many times, probably said it myself some years back. You’ve presented an idea to the person, but they just don’t seem to be ‘getting it.’ What to do, what to do?
The context of this kind of problem is often when someone’s pain isn’t settling down, or when some kind of self-management strategy is being recommended. To the clinician, the message is probably quite logical: “Here’s some information about pain that I am telling you about” and the unspoken assumption is that the person ought to listen carefully, maybe ask some questions, but essentially...
Source: HealthSkills Weblog - December 4, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Clinical reasoning Coping Skills healthcare Occupational therapy pain management Therapeutic approaches Source Type: blogs
The Impact of Healthcare Professional ’ s Sports and Fitness Activities on Personal and Professional Life
In 2010, a third of the world’s population was considered physically inactive. Back then it was estimated that approximately 5 million deaths were attributable to physical inactivity, making it the fourth leading cause of mortality worldwide.
To address this global issue, a whole society approach consisting of “policy and environmental changes” to make physical activity “an easier choice for leisure and transportation purposes”. An example of this is the recent proliferation of bike lanes in many of our cities. We also need to adjust our social and cultural norms to promote physical activit...
Source: The Orthopedic Logbook - December 2, 2023 Category: Orthopaedics Authors: Remo Aguilar Tags: Habits Health fitness physical activity physical inactivity Physician Health sedentary Sports Source Type: blogs
Knee osteoarthritis and Pavarotta
Well, earlier this week we had to say goodbye to our eldest cat, Pavarotta. She was 19 years old.
Here, in brief, is what happened: last Monday, November 27, I heard a scary, very loud howl coming from the dining room, where the kitties have their water fountain. I got there in time to see Pavarotta fall on the floor and begin scrambling about, trying to get up. A few of our other cats came running and sat around her…I think they wanted to help. After hearing my reassuring voice (but I was freaking out, truth be told), she finally lay down and rested for about a half hour, then got up and seemed almost normal. She ev...
Source: Margaret's Corner - December 1, 2023 Category: Cancer & Oncology Authors: Margaret Tags: Blogroll death of a cat gonoartrosi knee osteoarthritis Source Type: blogs
Quiz post: 2 similar patients with similar ECGs. Which, if any, or both, are OMI? Will you outperform the Queen of Hearts?
Written by Pendell MeyersTwo adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both were awake and alert with normal vital signs. Both cases had an EMS ECG that was transmitted to the ED physician asking " should we activate the cath lab? "What do you think? Here they are:Patient 1, ECG1:Zoll computer algorithm stated: " ***STEMI***, Anterior Infarct "Patient 2, ECG1:Zoll computer algorithm stated: " ST elevation, probably benign early repolarization... "Queen of hearts interpretations:Patient 1, ECG1:Patient 2, ECG1:Patient 1 Clinical Course and Outcome:The EM physician d...
Source: Dr. Smith's ECG Blog - November 29, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
