What happens when you don't recognize an OMI?
This was sent by an " avid reader. " The case was from his hospital, which does not have a cath lab. He was very frustrated by the care the patient received from his partner, and the absence of an appropriate openness to learning by those in his department.CaseA 60-something male was sent in from a cardiologists ' office after presenting there with chest pain. The office ECG is unavailable.The pain had been intermittent for a few days, but worse on the day of admission.Here was the initial ECG:To me, and to him, this is an obvious acute LAD occlusion.There are hyperacute T-waves, especially in V2, plus ot...
Source: Dr. Smith's ECG Blog - May 6, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Can you see through this paced rhythm?
Written by Pendell MeyersAn elderly female with known CAD and multiple stents, pacemaker, stroke, and COPD presented with 2 hours of midsternal, nonradiating chest pain at rest. Apparently on arrival to the ED the patient described her pain more as " crampy " abdominal pain, but also chest discomfort.Here is her initial ECG during active symptoms:What do you think?There is dual chamber paced rhythm (atrial and ventricular pacer spikes) with resulting LBBB-like morphology. There is massive excessively discordant STE in II, III, aVF, as well as V4-V6. There is reciprocal excessively discordant STD in I and aVL. Additionally,...
Source: Dr. Smith's ECG Blog - April 24, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
Impella may gradually replace the balloon pump in cardiogenic shock
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - March 9, 2019 Category: Internal Medicine Tags: cardiovascular critical care Source Type: blogs
Effect of venoarterial ECMO on LV afterload – Cardiology MCQ – Answer
Effect of venoarterial ECMO on LV afterload – Cardiology MCQ – Answer
Effect of venoarterial ECMO on left ventricular afterload: Correct answer: b. Increases
Venoarterial extracorporeal membrane oxygenation (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...
Source: Cardiophile MD - February 16, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.
Conclusions When high sensitivity cardiac troponin testing is performed widely or without previous clinical assessment, elevated troponin concentrations are common and predominantly reflect myocardial injury rather than myocardial infarction. These observations highlight how selection of patients for cardiac troponin testing varies across healthcare settings and markedly influences the positive predictive value for a diagnosis of myocardial infarction.-----------------------------------------------------------Comment by KEN GRAUER, MD (2/5/2019):-----------------------------------------------------------Exce...
Source: Dr. Smith's ECG Blog - February 5, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
IABP for Cardiogenic Shock – Cardiology MCQ – Answer
IABP for Cardiogenic Shock – Cardiology MCQ – Answer
Routine placement of Intra Aortic Balloon Pump (IABP) for cardiogenic shock is a Class — recommendation as per the 2017 European Society of Cardiology Guidelines for ST-segment elevation myocardial infarction [1,2] – Correct answer: 4. Class III
IABP-SHOCK II trial and its 6 year follow up data [2] did not show any mortality benefit for those who were randomly assigned to receive IABP support. There were no differences in the frequency of recurrent myocardial infarction, repeat revascularization, stroke or rehospitalization for a cardiovascular...
Source: Cardiophile MD - January 21, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
IABP for Cardiogenic Shock – Cardiology MCQ
IABP for Cardiogenic Shock – Cardiology MCQ
Routine placement of Intra Aortic Balloon Pump (IABP) for cardiogenic shock is a Class — recommendation as per the 2017 European Society of Cardiology Guidelines for ST-segment elevation myocardial infarction:
Class I
Class IIa
Class IIb
Class III
Please post your answer as a comment below
The post IABP for Cardiogenic Shock – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - January 19, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Evidence-Based Satire
By SAURABH JHA
Sequels generally disappoint. Jason couldn’t match the fear he generated in the original Friday the 13th. The sequel to the Parachute, a satirical piece canvassing PubMed for randomized controlled trials (RCTs) comparing parachutes to placebo, matched its brilliance, and even exceeded it, though the margin can’t be confirmed with statistical significance. The Parachute, published in BMJ’s Christmas edition, will go down in history with Jonathan Swift’s Modest Proposal and Frederic Bastiat’s Candlemakers’ Petition as timeless satire in which pedagogy punched above, indeed depended on, their absurd...
Source: The Health Care Blog - December 22, 2018 Category: Consumer Health News Authors: at RogueRad Tags: OP-ED RogueRad Source Type: blogs
Can you see through this wide complex rhythm?
Written by Pendell MeyersA 76 year old man with history of CHF, moderate aortic stenosis, insulin-dependent diabetes, hypertension, stroke, CAD s/p stents, CKD, PVD, OSA presented to the ED with shortness of breath and chest pain off and on for 2 weeks. This afternoon his symptoms intensified so he called EMS.In the ED he appeared acutely ill, with HR 100-115, RR 20-25, BP 93/52, hypoxic to 88-92% on 5L nasal cannula, afebrile.Here is his presentation ECG, followed by his baseline ECG on file:Presentation ECG.Baseline ECG.The presentation ECG shows ventricular paced rhythm at rate of approximately 120 bpm. The J-point in V...
Source: Dr. Smith's ECG Blog - December 12, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
The crazy science of coronary reperfusion : When TIMI 1 & 2 beats “ TIMI 3 ” in the myocardial salvage race . . . cardiologists get confused !
The prime job of cardiologists is to restore coronary blood flow in an emergency fashion. While we do this with reasonable success ,there is still a missing link between our Initial aim and achieved goal.
It’s all too common situation in any busy cath lab , to see two similar STEMI patients with identical time window & proximal LAD as IRA , in totally different scenarios. In the first patient we find a trickle of flow in LAD , who is relatively comfortable with normal LV function (In whom , emergency primary PCI might appear redundant.) While the other patient , even after rapidly established TIMI 3 flow , LV...
Source: Dr.S.Venkatesan MD - December 8, 2018 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
The 4 Physiologic Etiologies of Shock, and the 3 Etiologies of Cardiogenic Shock
A 60-something presented with hypotension, bradycardia, chest pain and back pain.She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension. She had a mechanical aortic valve. She was on anti-hypertensives including atenolol, and on coumadin, with an INR of 2.3. She was ill appearing. BP was 70/49, pulse 60.A bedside echo showed good ejection fraction and normal right ventricle and no pericardial fluid. Here is the initial ECG:What do you think?This ECG actually looks like a left main occlusion (which rarely presents to the ED alive): ST Elevation in...
Source: Dr. Smith's ECG Blog - November 30, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.
Written by Pendell Meyers with edits by Steve SmithA male in his 60s presented with off and on shortness of breath and chest pressure over the past few days. He was hypertensive and tachycardic, with mildly increased work of breathing. Here is his initial ECG:What do you think? What will you do for this patient? How many problems does he have?When the team saw this ECG, we obviously noticed the large STE in the inferior leads, with STD in V1-V5, I, and aVL, and STE in V6. However we also noticed that the rhythm is rapid, regular, and narrow, with no P-waves, at a rate of approximately 200 bpm, and therefore not sinus ...
Source: Dr. Smith's ECG Blog - November 26, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Was the intern correct?
Written by Pendell Meyers, case submitted by Max Macbarb, edits by Steve SmithA 71 year old gentleman with history of CAD and PCI presented with acute chest pain and normal vitals signs. He was triaged to the general area of the emergency department after an initial review of this ECG by a senior resident or attending physician correctly interpreted " No STEMI. "An intern who has attended my lectures and has begun reading this blog picked up the chart and flipped to the ECG and saw this:Presentation ECG at 6:57 AM. What do you think?I texted this to Dr. Smith with no clinical information and he replied immediately af...
Source: Dr. Smith's ECG Blog - November 18, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR
Written by Pendell Meyers84 yo M with history of a “valve problem” presented for sudden onset chest pain and trouble breathing while eating lunch.He was sitting bolt upright, diaphoretic, tachypneic, with bilateral crackles. Although his BP was 126/84, he was in acute cardiogenic shock.Here is his initial ECG:Sinus tach with occasional PACs. Relatively normal QRS complex with diffuse significant ST depression including leads V2-V6, I, aVL, II, III, and aVF, with ST elevation in aVR. The vector of ST depression is maximal in leads V5 and II, consistent with diffuse subendocardial ischemia. There is no evidence of any si...
Source: Dr. Smith's ECG Blog - October 31, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 80s with chest pain
Written by Pendell MeyersA male in his 80s with history of colon cancer, HTN, and CAD with a newly placed LAD stent approximately 1 month ago, presenting with acute shortness of breath and chest pain. No prior ECG.Here is his ECG at 07:08:There is STE in V2, I and aVL, but it does not meet STEMI criteria because there are no two contiguous leads with STE meeting criteria. There is also STD in V3-V6, as well as II, III, and aVF. There is likely lead misplacement involving V2 explaining the R-wave progression. These findings and their associated morphology are definite evidence of transmural ischemia of the anterior and late...
Source: Dr. Smith's ECG Blog - October 22, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
