Interventionalist at the Receiving Hospital: " No STEMI, no cath. I do not accept the transfer. "
Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? Yes. We don ' t know how many though.I was texted these ECGs by a recent residency graduate after they had all been recorded, along with the following clinical information:A 50-something with no cardiac history, but with h/o Diabetes, was doing physical work when he collapsed. He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab.Here is the initial ED ECG:This is pretty obviously and inferior posterior OMI, right?There is slight inferior ST Elevation, with reciprocal ST de...
Source: Dr. Smith's ECG Blog - September 20, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Doctors Urge Caution in Interpretation of Research in Times of COVID-19
September 9, 2020
To:
American College of Cardiology
American College of Chest Physicians
American College of Physicians
American College of Radiology
American Heart Association
American Society of Echocardiography
American Thoracic Society
European Association of Cardiovascular Imaging
European Society of Cardiology
European Society of Radiology
Heart Rhythm Society
Infectious Disease Society of America
North American Society of Cardiovascular Imaging
Radiologic Society of North America
Society of Cardiovascular Magnetic Resonance
Soci...
Source: The Health Care Blog - September 17, 2020 Category: Consumer Health News Authors: Christina Liu Tags: COVID-19 Medical Practice Patients Physicians myocarditis Saurabh Jha Source Type: blogs
21 year old woman with CP, SOB, then syncope, and with ST depression with T-wave inversion in V1-V3
In this study, except for troponin elevation,Gestalt was the best predictor.The article does not specify the QT correction methodWhy is right ventricular hypertrophy (RVH) not found in this large study of syncope? Probably because it is not common enough to be identified in a general syncope study. Not every high risk factor will be identified in such studies, but it is obvious that RVH is a dangerous condition and that, if identified on ECG, needs further workup. Why were so few ECG findings predictive?Because most abnormal ECG findings were considered adverse outcomes in their own right and not eva...
Source: Dr. Smith's ECG Blog - August 31, 2020 Category: Cardiology Authors: Steve Smith 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
Podcast: Debating ‘ Anti-Psychiatry ’ Advocacy
Conclusion, do not visit cardiologists. They will give you heart attacks. No, that’s ridiculous. It’s so mind blowing that anyone even said this, right? It’s just ugh. Obviously, people who are extremely sick and who are at risk of killing themselves get psychiatric care. No kidding. So, yeah, this is, in fact, very dangerous.
Gabe: The word bullshit is not big enough. This is the literal equivalent of me saying that I looked at fifty thousand people who went to the hospital in the last year. And you were much more likely to die if you had a hospital admission. Now, I’m talking physical health now. ...
Source: World of Psychology - July 14, 2020 Category: Psychiatry & Psychology Authors: Not Crazy Podcast Tags: General Mental Health and Wellness Not Crazy Podcast Psychiatry Treatment Source Type: blogs
A man in his 60s with shockable arrest, then ROSC, and no STEMI - what will you do?
Conclusion: I suspect one or more of the anterior leads was placed too high on the chest (especially given the deep negative P wave in lead V1) — butregardless, the poor R wave progression we see in ECG #1 is consistent with prior anterior infarction (and this patient ’s past medical history is remarkable for a prior “silent” heart attack).ReST-T Wave Changes — There are some nonspecific ST-T wave changes in some limb leads (ie,leads I, II, aVL) — but these do not look acute. Of much more concern (as per Drs. Oberst, Mogul and Meyers) — there is 0.5-1.0mm of J-point ST elevation in leads V1-through V5, with a...
Source: Dr. Smith's ECG Blog - June 14, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his sixties with chest pain
Written by Pendell MeyersA man in his sixties with no prior history of CAD presented with fluctuating central chest pain that started the night before presentation, then went away, then woke him up from sleep the morning of presentation. The pain was 10/10 on arrival, with SOB. Although he also had some nasal drip and sore throat, he had no cough or fevers (this occurred during peak COVID).Here is his triage ECG:What do you think?Normal P-waves would have upright morphology in the inferior leads (especially lead II) and usually biphasic (up-down) morphology in V1. These p-waves are negative in almost all leads except for a...
Source: Dr. Smith's ECG Blog - June 2, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Are there benefits of cardiac catheterization for stable coronary artery disease?
One of the main causes of chest pain is a blockage of blood flow down the coronary arteries, the blood vessels that deliver oxygenated blood to our heart muscle to allow it to beat. Depending on how fast the blockage forms, it is labeled as either a stable or unstable blockage.
Unstable blockages occur quickly when an atherosclerotic plaque ruptures within the coronary artery and a clot forms on top of it. The clot, along with the plaque, can obstruct blood flow, deprive heart muscle of oxygen, and lead to a heart attack. This is called an acute coronary syndrome, and it frequently requires a minimally invasive procedure c...
Source: Harvard Health Blog - May 21, 2020 Category: Consumer Health News Authors: Darshan Doshi, MD, MS Tags: Health Heart Health Tests and procedures Source Type: blogs
Syncope and Chest Pressure, then an Unusual Bradycardia with Shock
This case is from one of our fantastic 3rd year residents, Aaron Robinson.A woman in her 60s with SyncopeA woman in her 60s presented to a facility with syncope. She had a history of CHF, pulmonary hypertension,CAD s/pCABG, and ESRD on hemodialysis. She had a dialysis run the day prior. Prehospital VS were: BP 115/70, HR 65, RR 12. The patient did not have a 12 lead completed pre-hospital.She arrived at the ED awake, alert, and complaining only ofmild chest discomfort. A 12 lead ECG was immediately completed:Aaron showed this to me and this is what I said:Suggestive of inferior posterior MI, but not dia...
Source: Dr. Smith's ECG Blog - May 15, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 50s with fever and shortness of breath
Written by Pendell MeyersA man in his 50s with HTN, HLD, obesity, and restrictive lung disease presented with shortness of breath worsening over the past 3 days. He also had a cough and subjective fevers. He denied chest pain. His vitals were within normal limits.Here is his triage ECG (no baseline available):What do you think?Findings: - sinus rhythm at about 100 bpm - STE in I and aVL (meets STEMI criteria) - hint of STD in III and aVF - STD in V1 and V2 - hyperacute T-waves in I and aVL (with reciprocal negative hyperacute T in III)Interpretation:This is definitive evidence of acute transmural i...
Source: Dr. Smith's ECG Blog - May 10, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Soft Actuator and Sensor for Underactive Bladder Treatment
Researchers at the National University of Singapore have developed a soft sensor and actuator to monitor bladder volume and help empty it on-demand. The device is intended to be implanted on the bladder surface during a surgical procedure to treat patients who cannot completely empty their bladders voluntarily.
Patients can suffer from an underactive bladder following a spinal cord injury, meaning that they cannot easily sense when the bladder is full, or completely empty it. Approximately 80% of patients who suffer a spinal cord injury will demonstrate some bladder dysfunction. Not only is this inconvenient and upsetti...
Source: Medgadget - May 6, 2020 Category: Medical Devices Authors: Conn Hastings Tags: Neurology Rehab Surgery Source Type: blogs
Go to the hospital if you need emergency care, even in the era of COVID-19
In the era of COVID-19, the hospital must be a place of mystery to those on the outside. I imagine some think it’s bustling with activity, with caregivers scurrying around at a frenetic pace. Of course, we’ve seen video on the news from hard-hit New York City or Lombardy, Italy, when they were at their initial peak of the COVID-19 epidemic. But the reality is that, in most hospitals around the country, it is actually somewhat calmer than usual.
This calm makes sense given the mandate for social distancing, working from home, and canceling nonessential activities. What doesn’t make sense is this: in the emergency depa...
Source: Harvard Health Blog - May 5, 2020 Category: Consumer Health News Authors: Scott Weiner, MD Tags: Emergency Planning Heart Health Hypertension and Stroke Source Type: blogs
Most common myocardial disorder in obesity – Cardiology MCQ – Answer
Most common myocardial disorder in obesity – Cardiology MCQ – Answer
Most common myocardial disorder in obesity – Correct answer: b) Heart failure with preserved ejection fraction
Most common myocardial disorder in obesity is heart failure with preserved ejection fraction [1]. This is mostly due to reduced distensibility of the left ventricle causing left ventricular diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF). On the other way round, obesity is common in those with HFpEF [2].
In obesity, due to reduced distensibility of the left ventricle, even slight increase in fill...
Source: Cardiophile MD - April 28, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Guess the culprit with ST Elevation in posterior leads
A middle aged man had off and on chest pain for 2 weeks, then 2 hours of more severe and constant pain.Here was his ED ECG, which was identical to the prehospital ECG. He did not get prehospital activation.What do you think?There is sinus rhythm with ST depression in I, II, aVF and V2-V6. It is maximal in V3 and V4. This usually means posterior MI,whether the T-wave is upright or not.There is also some ST elevation in aVR, which must be present whenever there is ST depression in I and II (a lead between I and II is (-) aVR, opposite aVR; if ST segments in I and II are negative, then theymust also be negat...
Source: Dr. Smith's ECG Blog - April 23, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 60s with chest pain. The ST segments and T waves are ALWAYS interpreted in the context of their QRS.
Written by Pendell MeyersA man in his 60s with history of CAD, CABG, HTN, DM, and smoking presented with chest pain,and shortness of breath over the past 1 hour, and a mild cough over the past few days, of course asking for COVID testing.Here is his ECG on presentation (shown to me with no information):What do you think?Raw Findings: - RBBB (some will also say LPFB) - Negative T-waves in V1-V3 - STD in V1-V6, I, aVL - STE in aVR - V2 has strange QRS morphology that does not seem to fit in the progression between V1 and V3, possibly lead misplacementInterpretation:In the context of RBBB, it is norma...
Source: Dr. Smith's ECG Blog - April 12, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
