A man in his 50s with acute chest pain and diffuse ST depression
Submitted by Alex Bracey, with edits by Meyers and SmithA man in his 50s with history of type B aortic dissection with prior TEVAR experienced acute onset chest pain at rest and presented to the Emergency Department. Here is his ECG on arrival:What do you think?Here is a prior ECG on file (presumed baseline):There is sinus rhythm with minimal STD in V5, V6, II, III, aVF. There is the tiniest amount of STE in aVL, but the T wave is not hyperacute (instead there is a terminal inversion). I would call this ECG consistent with subendocardial ischemia, but also the question of possible high lateral OMI (for which I am not ...
Source: Dr. Smith's ECG Blog - March 19, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Fight Aging! Newsletter, February 8th 2021
This study was divided in two phases: CALERIE-1 and CALERIE-2. CALERIE-1 study was performed to assess the possible effects induced by a reduction of 10-30% of caloric intake on body composition parameters and lipid profile after 6 and 12 months in a population of middle-aged non-obese subjects. CALERIE-1 results showed an improvement in lipid and glycemic profile and a reduction in body weight (BW) and fat mass.
CALERIE-2 was the largest multi-center study on CRD. A total of 220 subjects were enrolled randomly with a 2:1 allocation into two subgroups: 145 in the CRD group and 75 in the ad libitum group. The CRD gro...
Source: Fight Aging! - February 7, 2021 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Cellvie Seed Funded to Develop Mitochondrial Transplantation as a Therapy
Mitochondria are the power plants of the cell, producing chemical energy store molecules to power cellular processes. They are also embedded deeply into may core functions of the cell, from replication to programmed cell death. Mitochondrial function declines throughout the body with age, for reasons that are likely downstream of other more fundamental damage. Mitochondrial dynamics change in ways that make mitochondria more resilient to removal via mitophagy when worn or broken, and mitophagy itself loses efficiency. This may or may not be connected to mitochondrial DNA damage. It is unclear as to whether the progressive ...
Source: Fight Aging! - February 2, 2021 Category: Research Authors: Reason Tags: Longevity Industry Source Type: blogs
Why didn ’ t you try ECMO for my dad , doctor ? I feel really guilty !
It is just past midnight: This is a gloomy conversation between a patient’s son and a cardiologist in the silent waiting room, just outside the dim-lit ICU of a popular 4-star hospital in Chennai.
“I am sorry to say, Mr. B., your father didn’t make it. Has succumbed to the heart attack. We have been trying to resuscitate him for the past one hour. We have done everything. We have managed to open up IRA, and 2 more critical blocks still it couldn’t help. It was a massive one. Sorry again.
“Doctor, I feel very bad. What went wrong, I want to know. Doc, did you try ECMO ?,” the ...
Source: Dr.S.Venkatesan MD - February 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Technology ecmo IABP impella tandem heart ecmo Source Type: blogs
Chest pain, ST Elevation, and tachycardia in a 40-something woman
A prehospital cath lab activation for STEMI came through with the information that the 40-something woman had chest pain and a pulse of140.We were immediately skeptical that the patient had a STEMI because of the high heart rate. She would have to be in cardiogenic shock with a massive STEMI for that. Certainly possible, but when the heart rate is so high, be skeptical.The patient arrived with this ECG:Here the heart rate is obviously no longer 140What do you think?ECG: it certainly appears to be an anterior STEMI, but it is important to realize that right ventricular ischemia from either inferior and RV STEMI ...
Source: Dr. Smith's ECG Blog - January 30, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
ECMO – Extracorporeal membrane oxygenation
ECMO – extracorporeal membrane oxygenation
ECMO – Extracorporeal membrane oxygenation – has been in use for the past four decades to support persons who are unlikely to survive with mechanical ventilation. ECMO is used in both adult and pediatric practice, though in the initial years, use of ECMO was restricted to pediatric intensive care. The enthusiasm for use of ECMO in adults have been triggered by the beneficial effect noted during the last H1N1 influenza pandemic [1]. In contrast from cardiopulmonary bypass which is used for a short period during cardiac surgery, ECMO is used to support for a ...
Source: Cardiophile MD - December 26, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Source Type: blogs
Extreme widespread ST depression, with ST Elevation in aVR. What do you think?
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 - December 16, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
" Pay me now, or pay me later "
This patient presented with acute pulmonary edema without chest pain.A bit of history prior to showing the ECG:The patient had been hospitalized at a different hospital for pneumonia and NonSTEMI for a week. The troponin I had peaked at 40 ng/mL, and echo showed multiple wall motion abnormalities and EF of 35%. The patient suffered third degree heart block with bradycardia and required permanent pacemaker placement. A troponin that high is usually associated with Occlusion.I reviewed the ECGs from that hospital and they donot show OMI. But many ECGs in patients with OMI do not reveal the OMI, even when I ...
Source: Dr. Smith's ECG Blog - December 10, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Extreme shock and cardiac arrest in COVID patient
This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED. He was moderately hypoxic. He had the following EKG recorded:Low voltage, suggests effusion.(see Ken ' s discussion of low voltage below)There is a QS-wave in V2.There is minimal, probably normal STE in V2-V6.A bedside cardiac ultrasound was normal, with no effusion. He had troponins ordered, and the first returned at 72 ng/L (Abbott Architect hs cTnI; URL for males = 34 ng/L). An elevated troponin in a COVID patient confers about 4x the risk of mortality than a normal one.He was admitted on oxygen and was&...
Source: Dr. Smith's ECG Blog - November 12, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
3 days of shoulder and chest pain, and now cardiogenic shock
I was texted these ECGs." Bad chest pressure with severe left shoulder pain 3 nights ago. Then SOB and nausea the next day. Now appears to be in cardiogenic shock. "(Later review showed systolic BPs in the range of 55 to 83. So she was quite hypotensive.)First recorded at time zero:There is sinus rhythm. Rate of only 70 suggests some beta blockade.The QT is very long.There is T-wave inversion in inferior leads, suggestive of reperfused or subacute MI.There is a Q-wave in III, so this may be subacuteThere is ST depression in V2-V4.20 minutes:Again, very long QT.Now, T-waves are upright in inferior leads, i...
Source: Dr. Smith's ECG Blog - August 27, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
A woman in her 60s with 6 hours of chest pain, dyspnea, tachycardia, and hypoxemia
Discussion:The management in this case is unfortunately common practice at many places around the world where we receive cases. Why would an interventionalist violate multiple recommendations from their own guidelines and watch at 10am while an LAD occlusion plays out in front of them? What could explain why some providers do not seem interested in the fact that LAD occlusion can be identified by something other than STEMI criteria? Or why the wall motion abnormality matching the distribution of concern is ignored? The only plausible explanation is that they have been taught that this is standard practice. Under the STEMI ...
Source: Dr. Smith's ECG Blog - August 23, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Chest discomfort, Sinus Tachycardia, Q-waves, ST Elevation, and Intermittent Wide Complex Tachycardia. Activate the Cath Lab?
This ECG was texted to me with no other information:Computer Diagnosis:SINUS TACHYCARDIAINCOMPLETE RIGHT BUNDLE BRANCH BLOCK [90+ ms QRS DURATION,TERMINAL R IN V1/V2, 40+ ms S IN I/aVL/V4/V5/V6]LEFT ANTERIOR FASCICULAR BLOCK [QRS AXIS<= -45, QR IN I, RS IN II]ANTEROSEPTAL MYOCARDIAL INFARCTION , PROBABLY RECENT [40+ ms QWAVE IN V1-V4]***ACUTE MI***What do you think? Below is my response.There is sinus tach. There is an incomplete RBBB and LAFB. There are QR-waves in aVL and V2, and a QS-wave in V3. There is ST elevation in V2 and V3, with upright T-waves in V2 and V3. There is reciprocal ST depre...
Source: Dr. Smith's ECG Blog - August 12, 2020 Category: Cardiology Authors: Steve Smith 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 30s with chest pain
Written by Pendell Meyers, case submitted by Tom FieroA man in his 30s walked into the ED complaining of chest pain. His triage ECG was done at 11:30 (no prior was available):What do you think?Sinus tachycardiaNormal QRS complex pattern, with borderline low voltageVery slight STE in leads V2-V5Proportionally large and fat T-waves in V4-5 with straightening of the ST segmentsT-waves also concerning in II, III, aVF, with inappropriately negative T-waves in aVLUsing the LAD OMI vs. BER formula:3 Variable: 27.34 (positive for OMI, using STE60V3=1.5mm, QTc=444, RWV4=2.0mm)4 Variable: 23.01 (positive for OMI, using QRS amplitude...
Source: Dr. Smith's ECG Blog - March 28, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Are these Wellens' waves?
In conclusion, the presence of negative T waves in both leads III and V1 allows PE to be differentiated simply but accurately from ACS in patients with negative T waves in the precordial leads. "Witting et al. looked at consecutive patients with PE, ACS, or neither. They found that only 11% of PE had 1 mm T-wave inversions in both lead III and lead V1, vs. 4.6% of controls. This does not contradict the conclusions of Kosuge et al., who studied a select population of patients who were known to haveeither PE or ACS -- that is, all were indeed ill. Of those select patients, ...
Source: Dr. Smith's ECG Blog - February 27, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
