Know About Cardiogenic Shock
When the heart is not able to pump enough blood for the needs of the body and the blood pressure falls, it is known as cardiogenic shock. Most important cause of cardiogenic shock is a heart attack. It is more likely to occur in those who are older, having blocks in multiple blood vessels of the heart, and in those with a previous heart attack. Cardiogenic shock is a potentially life threatening condition and needs urgent treatment. Even with treatment about half of those with cardiogenic shock might die.
Those with cardiogenic shock may have severe shortness of breath, weak pulse, rapid heart-beats, low blood pressure, un...
Source: Cardiophile MD - April 10, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Noisy, low amplitude ECG in a patient with chest pain
Written by Colin Jenkins. Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. Edits by Willy Frick.A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness. They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They denied fever, cough, dyspnea, and sick contacts. They described the chest pain as severe, crushing, and non-radiating. It was not wo...
Source: Dr. Smith's ECG Blog - January 15, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
How cardiogenic shock in NSTEMI is different from STEMI?
Cardiogenic shock (CS)is the most feared event following STEMI. The incidence is up to 5 to 10% with a mortality rate of around 50-60%. Still, we are finding it hard to bring this down below 50 % .There is one less addressed issue in ACS literature. We tend to perceive CS as an exclusive complication of STEMI. The fact is that NSTEMI can also result in CS is less recognized. The incidence is half of that of STEMI, i.e., 2.5-5%.
Mechanism of CS in NSTEMI
One may ask, how can CS occur in NSTEMI with partial occlusion with a non trans-mural MI. ACS pathophysiology is not that simple. Ischemic LV dysfunction (Global stun...
Source: Dr.S.Venkatesan MD - December 30, 2023 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Uncategorized acc aha esc guidlines on stemi shock cardiogenic shock cardiogenic shock in stemi vs nstemi cs in stemi vc nstemi grace registry how is cardiogenic shock in nstemi different from stemi ? iglobal lv stu Source Type: blogs
See this " NSTEMI " go unrecognized for what it really is, how it progresses, and what happens
Written by Nathanael Franks MD, reviewed by Meyers, Smith, Grauer, etc.A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest.Triage ECG at Time = 0: Smith: I am suspicious for posterior OMI due to ST depression in V2 and V3Baseline EKG (several months prior):Smith: Now I am even more suspicious of posterior OMI, as the baseline ECG has normal ST elevation in V2 and V3ECG Interpretation:The tri...
Source: Dr. Smith's ECG Blog - November 3, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Should we activate the cath lab? A Quiz on 5 Cases.
Imagine you just started your ED shift. It ' s a busy Friday afternoon. Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECGs that has not been overread by a physician. All of the patients presented with chest pain, and they are all in triage.Which, if any, of these patients has OMI, with myocardium at risk and need for emergent PCI?ECG#1ECG#2ECG#3ECG#4ECG#5See outcomes of all 5 below, with the Queen of Hearts AI Bot interpretation.YOU TOO CAN HAVE THE PM Cardio AI BOT!! (THE PM CARDIO OMI AI APP)If you want this bot to help you make the early diagnosis of OMI and...
Source: Dr. Smith's ECG Blog - October 8, 2023 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
What is the infarct artery? What does the post PCI ECG show? What does the convalescent ECG show?
What is the infarct artery? I usually don ' t ask this question, as it is rarely relevant to the decision to activate the cath lab. This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit LesionNevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery:An elderly patient had onset of chest pain one hour prior. He called 911. Here is the prehospital ECG.What do you think?I think it looks like an inferior posterior OMI. The medics thought so too and activated the cath lab from the prehospital.The Qu...
Source: Dr. Smith's ECG Blog - October 6, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 50-something with Regular Wide Complex Tachycardia: What to do if electrical cardioversion does not work?
Case submitted by anonymous. Written by Smith. Ken ' s piece at the bottom is excellent.A 50-something presented with sudden onset palpitations 8 hrs prior while sitting at desk at work. He had concurrent sharp substernal chest pain that resolved, but palpitations continued.Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Past medical history includes coronary stenting 17 years prior. A brief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality.Initial ED ECG:What do you think?This wa...
Source: Dr. Smith's ECG Blog - September 20, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 50-something with Regular Wide Complex Tachycardiaa: What to do if electrical cardioversion does not work?
Case submitted by anonymous. Written by Smith. Ken ' s piece at the bottom is excellent.A 50-something presented with sudden onset palpitations 8 hrs prior while sitting at desk at work. He had concurrent sharp substernal chest pain that resolved, but palpitations continued.Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Past medical history includes coronary stenting 17 years prior. A brief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality.Initial ED ECG:What do you think?This wa...
Source: Dr. Smith's ECG Blog - September 20, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest discomfort and a dilated right ventricle. What's going on?
Written by Magnus Nossen MD, peer reviewed and edits by Smith, Meyers, GrauerA 60 something previously healthy female smoker sought medical attention after 2-3 days of intermittent chest discomfort. The chest discomfort was described as sharp. Episodes lasting 5-30 minutes. On the day of presentation she experienced another episode of chest discomfort accompanied by vomiting and throat pain. She was concerned about possible throat infection. She contacted her primary care physician. Due to the vague nature of her symptoms and the fact that she had chest discomfort and no clinical sign of throat infection she was referred f...
Source: Dr. Smith's ECG Blog - September 17, 2023 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
A man with chest pain off and on for two days, and " No STEMI " at triage.
Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen SmithA 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. Here is his triage ECG which was obtained at 20:34 during active pain.What do you think?This ECG was read as “No STEMI” with no prior available for comparison. It is true this ECG does not meet STEMI criteria (there is 1.0 mm STE in III, and possibly 0.5 mm in aVF), but there is clear evidence of OMI findings on this ECG. Leads II, III, and aVF hav...
Source: Dr. Smith's ECG Blog - June 19, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
20-something with huge verapamil overdose and cardiogenic shock
A 20-something presented after a huge verapamil overdose in cardiogenic shock. He had been seen at an outside institution and been given 6 g calcium gluconate, KCl, and a norepinephrine drip.The initial K was 3.0 mEq/L and ionized calcium was 5.5 mg/dL (sorry, Europeans, for the weird units)Here was the initial ED ECG:There is a junctional rhythm with retrograde P-waves (see the dip in the T-wave in lead II across the bottom; you can follow that up to all the other leads and see the retrograde P wave). There is also Left Bundle Branch Block (LBBB). There is huge proportionally excessively discord...
Source: Dr. Smith's ECG Blog - May 26, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Advantages of Left ventricular hypertrophy (LVH)
This is a 15-year-old post about LVH, written in 2008. Few of my colleagues, now agree with this, but still hesitate to oblige in the open, suggesting it is too good to be true! Re-posting it for your own assessment. Surprised, why cardiology community didn’t consider this observation worthy to pursue.
Advantages of Left ventricular hypertrophy (LVH)
Left ventricular hypertrophy is one of the most common clinical cardiac entity.It is recognised either by ECG or echocardiography.LVH has a unique place in cardiology as it can imply a grossly pathological state or a marker of healthy heart as in physiologica...
Source: Dr.S.Venkatesan MD - May 4, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Primary PCI and its silent encounter with “ myocardial neutrophilia ”
Myocardial infarction, a gross pathological entity renamed now as STEMI for clinical purposes, is the most famous medical emergency that triggers a series of calls. Right from 911/First medical contact, the ER, that ends up in CCU or a 24/7 cath lab. The heart, can’t wait for all these external responses when it is challenged with a vascular accident. The moment ATO occurs, two things happen. The endogenous fibrinolytic led by native tissue PA (Tpa) tries to get rid of the thrombotic plug by all its means. It succeeds in 15%. We call it spontaneous lysis or aborted MI. Many lives are lost in the remaining before th...
Source: Dr.S.Venkatesan MD - February 1, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized myocardial neutrophilia Source Type: blogs
A man in his 70s with chest pain
Case submitted by Rachel Plate MD, written by Pendell MeyersA man in his 70s presented with chest pain which had started acutely at rest and has lasted for 2 hours. The pain was still ongoing at arrival. He also noted a bilateral " odd feeling " in his arms. He stated it was similar to prior heart attacks. He had history of prior MIs and CABG, as well as diabetes, hypertension, and hyperlipidemia. Here is his triage ECG:PM Cardio version:With no other information at all, I sent this ECG to Dr. Smith, who replied: " I think it is real. V3. STD in V4-5 too. "What he means is: he thinks the signs of inferior ...
Source: Dr. Smith's ECG Blog - November 23, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
What is the Effect of venoarterial ECMO on LV afterload?
Venoarterial extracorporeal membrane oxygenation or VA-ECMO increases left ventricular afterload. VA-ECMO is used as a mechanical circulatory support for cardiogenic shock. But it results in increased left ventricular afterload which can have deleterious effects like myocardial ischemia, delayed left ventricular recovery, ventricular arrhythmias and pulmonary edema.
Several interventions have been used to unload the left ventricle during VA-ECMO. The most commonly used strategy is intra-aortic balloon pump or IABP. Other less frequently used methods are percutaneous left ventricular assist device and pulmonary vein or tra...
Source: Cardiophile MD - November 14, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
