A 76 Year Old Female With Recurrent Syncope, Lightheadedness, Palpitations and Negative Stress Test
Written by Lucas Goss MD, peer reviewed by Meyers, Smith, BraceyA 76 year old female with a history of arial fibrillation not on anticoagulation, non-obstructive CAD found on coronary CTA 2 years prior, HTN, HLD, recurrent lightheadedness, and syncope status post loop recorder placement, presented for another episode of feeling lightheaded, diaphoretic, and feeling like she “was going to die.” She was discharged just the day prior for her second hospitalization for similar episodes. She was actually at the pharmacy to pick up her medicines the day after discharge when this episode occurred, and pharmacy staff sat her d...
Source: Dr. Smith's ECG Blog - September 4, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
A 60 year old man with chest pain -- many fascinating aspects to this ECG
Written and submitted by Lucas Goss MD, peer reviewed by Smith, Meyers, BraceyA 60-year old man with history of CAD and prior stents to the LAD and ramus presented with acute chest tightness and shortness of breath. He arrives to the ED at about 1 hour and 15 minutes after onset of pain, and his triage ECG is shown below:ECG#1 (no baseline available for comparison):What do you think?Sinus rhythm with PVCNo evidence of hyperkalemiaQT within normal limitsNegative P-wave in V2, so at least V1 and V2 are placed too highSTE in V2-V5, as well as lead II, III, aVFTerminal QRS distortion (TQRSD) in V3 and perhaps almost also V4&nb...
Source: Dr. Smith's ECG Blog - August 19, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
A 52 year old female with chest pain
Written by Pendell Meyers, edits by Steve SmithA 52 year old female with history of hypothyroidism and smoking presented to the ED with an episode of chest pain that began suddenly around 1500 while sitting down at work. She states it felt like a central chest pressure that radiated to her jaw. The pain had been persistently present since since 1500 (seen at 1615 in the ED), but had waxed and waned in severity, with the initial onset of pain being the worst. She had dyspnea and diaphoresis when the pain began. Coworkers called EMS who administered aspirin and NTG, which the patient says did not relieve her pain. During ini...
Source: Dr. Smith's ECG Blog - August 16, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Hypotension, altered mental status, and aVR sign - activate the cath lab?
ConclusionsSTE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - July 21, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Up, Please
By KIM BELLARD
When I think of elevator operators, I think of health care.
Now, it’s not likely that many people think about elevator operators very often, if ever. Many have probably never seen an elevator operator. The idea of a uniformed person standing all day in an elevator pushing buttons so that people can get to their floors seems unnecessary at best and ludicrous at worse.
But once upon a time, they were essential, until they weren’t. Healthcare, don’t say you haven’t been warned.
Elevators have been around in some form for hundreds of years, and by the 19th century were using steam o...
Source: The Health Care Blog - July 13, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Health Tech Health Technology elevator operators elevators Kim Bellard Source Type: blogs
A 64 year old man with chest tightness
Submitted and written by Kaley El-Arab MDPeer reviewed by Pendell Meyers, Alex Bracey, Stephen Smith A 64-year-old male with past medical history of coronary artery disease with prior MI s/p stent to RCA (2008), hypertension, dyslipidemia, and diabetes presented with acute onset of chest pain. Around 15:00 while at work he developed left-sided chest tightness that lasted for a few hours, then eventually went away, but returned the same evening around 22:00 when it woke him from sleep. He reportedly tried to “walk it off” which relieved the pain transiently. When the pain returned it was more severe and assoc...
Source: Dr. Smith's ECG Blog - July 5, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Ischemic ST depression maximal in V1-V4 (vs. V5-V6), even if less than 0.1 millivolt, is specific for Occlusion Myocardial Infarction (vs. subendocardial non-occlusive ischemia)
Conclusion: Among high-risk ACS patients, the specificity for OMI of suspected ischemic STDmaxV1-4 was 97%. STEMI criteria missed half of OMIs detected by STDmaxV1-4. These data support that any ischemic STD maximal in V1-V4 in ACS is due to OMI until proven otherwise. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - June 27, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Non invasive cardiac output monitoring
Conventionally, measurement of cardiac output was done invasively. Initially with dye dilution techniques and later by thermodilution techniques. Both needed pulmonary artery catheterization, which in turn was likely to cause morbidity if used for continuous monitoring. Almost all non-invasive cardiac imaging modalities like echocardiography, computed tomography, magnetic resonance imaging and nuclear imaging can measure cardiac output. But these are not suitable for bedside monitoring, though echocardiography may be used for intermittent bedside assessment.
Assessment of cardiac output though desirable, was most often ti...
Source: Cardiophile MD - June 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Chest X-ray in left to right shunts
Chest X-ray is a simple, cheap and easily available investigation for the evaluation of left to right shunts. But it is often avoided in pediatric age group due to concerns of radiation. Cardiac size and lung vascularity can be readily assessed and followed up serially [1]. Lung vascularity pattern is different in pre-tricuspid and post tricuspid shunts. Pattern changes with the development of pulmonary hypertension as the shunt decreases. Cardiac size also decreases when the shunt decreases. Cardiac chamber enlargements are also different according to the level of shunt.
Chest X-ray in atrial septal defect
Atrial septal ...
Source: Cardiophile MD - May 18, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
The story of a heart transplant in a 1-year-old, as told by his mother
An excerpt from Nick’s New Heart: 30 Years and Counting. In January of 1991, at twenty-two months old, Nick had another heart catheterization. Andy and I had started thinking about the next stage of surgery to finish the heart repair. Just before Nick was discharged, I discussed it briefly with Dr. Kanter. “Tell me when […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/susan-may" rel="tag" > Susan May < /a > < /span > Tags: Patient Cardiology Source Type: blogs
What is an Intermediate coronary lesion & What shall we do with it ?
This question might squeeze the collective coronary knowledge of any cardiologist. (At least, it does for me !)
What is an intermediate coronary lesion? (ICL)
Traditionally it is an “angio-ocular reflex” measurement of coronary arterial diameter stenosis that lies between 40 to 70% (Mind you, 70 diameter stenosis is 90% area. So,we must be clear what we really mean in any revascularisation debate).
Above one is the simplest expression of ICL. (* While 70% cutoff is fairly constant, the lower limit 40% is still not a settled issue. It can even be 30 %. I think we haven’t yet named th...
Source: Dr.S.Venkatesan MD - April 25, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized diameter vs area stenosis fame s fame study ffr ifr qfr intermediate coronary lesion minimal cad coronary erosion what is intermediate coronary lesion ? Source Type: blogs
This case was flagged as a false positive cath lab activation. Why? And do you agree?
Conclusions/Summary " Indication: Chest pain with dynamic EKG changes concerning for ACS "--CAD with moderate stenosis of ostial left main.--CAD with long segment of serial stenosis of proximal to mid LAD.--Successful PCI of proximal to mid LAD with placement of 3.5 x 38 and 3.5 xLAD: Large caliber vessel.There is a long segment of serial 50-80% stenosis noted in the mid portion of the vessel. The LAD is severely tortuous and there is large caliber diagonal after an acute bend in the mid vessel. The distal and apical segments are without significant stenosis. Lesion on Mid LAD was stented in a comp...
Source: Dr. Smith's ECG Blog - April 19, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Coronary subclavian steal syndrome
Coronary subclavian steal syndrome is the diversion of blood from the coronary circulation to the exercising left upper limb after a coronary artery bypass graft (CABG) using left internal mammary artery [1]. This occurs when there is a high grade stenosis or occlusion of left subclavian artery proximal to the origin of the left internal mammary artery (LIMA). Though it is a rare phenomenon, it is a serious threat to the success of CABG.
Cardiovascular manifestation of coronary subclavian steal syndrome could be angina, myocardial infarction, malignant arrhythmias or heart failure [1]. Cerebral symptoms can occur due to ...
Source: Cardiophile MD - April 14, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Third heart sound in health and disease
Third heart sound (S3) occurs in early diastole due to rapid deceleration of transmitral blood flow as the ventricles fill [1]. It corresponds in timing to shortly after the peak of the early diastolic E wave of transmitral flow. S3 occurs just after the opening of the atrioventricular valve as blood filling the atria during ventricular systole flows quickly into the ventricles [2].
Third heart sound can occur under physiological conditions as well as in disease, though not heard in all individuals. A prospective study of 580 patients had isolated valvular mitral regurgitation in 299, aortic regurgitation in 121 and prim...
Source: Cardiophile MD - April 8, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Estimation of PCWP from E/E ’ on Tissue Doppler Imaging
Estimation of PCWP from E/E’ on Tissue Doppler Imaging
Conventionally, pulmonary capillary wedge pressure (PCWP) is measured using a catheter in the pulmonary artery. Pulmonary artery diastolic pressure measured by a Swan Ganz balloon floatation catheter at bedside is often taken as the surrogate of PCWP. Ideal method of bedside measurement is balloon occlusion of a pulmonary artery branch to get the distal pressure. But it cannot be done on a continuous basis as it will compromise flow to the territory and vascular complications can ensue. True PCWP, as the name implies, is obtained after wedging an end hole cathet...
Source: Cardiophile MD - February 27, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Estimation of PCWP from E/E' Nagueh formula Source Type: blogs
