Anterior STEMI and multiform PVCs with Narrow Coupling Interval. When to give beta blockers in acute MI?
Conclusion of first report:In patients with anterior Killip class II or less ST-segment –elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI.Conclusion of 2nd report: In patients with anterior Killip class ≤II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer h...
Source: Dr. Smith's ECG Blog - October 19, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
The Doctor Who Thwarted the Charge of the General Medical Council – Part 1
By SAURABH JHA
After Dr. Hadiza Bawa-Garba was convicted for manslaughter for delayed diagnosis of fatal sepsis in Jack Adcock, a six-year-old boy who presented to Leicester Royal Infirmary with diarrhea and vomiting, she was referred to the Medical Practitioners Tribunal (MPT). The General Medical Council (GMC) is the professional regulatory body for physicians. But the MPT determines whether a physician is fit to practice. Though the tribunal is nested within the GMC and therefore within an earshot of its opinions, it is a decision-making body which is theoretically independent of the GMC.
The tribunal met in 2017, 6 ...
Source: The Health Care Blog - August 5, 2018 Category: Consumer Health News Authors: at RogueRad Tags: NHS #BawaGarba @roguerad Source Type: blogs
The EBM Wars: When Evidence has a Price – The ECMO Trials (Part 2)
By ANISH KOKA
The year was 1965, the place was Boston Children’s and a surgery resident named Robert Bartlett took his turn at the bedside of a just born baby unable to breathe. This particular baby couldn’t breathe because of a hole in the diaphragm that had allowed the intestines to travel up into the thoracic cage, and prevent normal development of the lungs. In 1965, Robert Bartlett was engaged in the cutting edge treatment of the time – squeeze a bag that forced oxygenated air into tiny lungs and hope there was enough functioning lung tissue to participate in gas exchange to allow the body...
Source: The Health Care Blog - June 17, 2018 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs
Chest Pain and Inferior ST Elevation.
Conclusion:In hemodynamically stable patients with chest pain, sinus tachycardia aids in the identification of patients unlikely to have type I MI, especially in those with HR> 120 bpm. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - June 17, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Shock index and modified shock index for prediction of myocardial damage and clinical outcome of STEMI
Shock index is the ratio of heart rate to systolic blood pressure which allows rapid bedside risk stratification [1]. Modified shock index is the ratio of heart rate to mean arterial pressure [2]. Reinstadler SJ et al [2] used these indices to predict the myocardial damage and clinical outcome of ST segment elevation myocardial infarction (STEMI). They found that STEMI patients with elevated shock index had more severe myocardial and microvascular damage and it was associated with major adverse cardiac events (MACE) at 1 year.
This multicenter study analyzed around eight hundred patients dicotomized to an admission shock ...
Source: Cardiophile MD - June 6, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Chest pain, Ventricular Paced Rhythm, and a Completely Normal Angiogram 3 Months Prior.
One of our graduates, Rochelle Zarzar, who is now an education fellow, sent me this from one of the hospitals she works at now:An elderly woman presented with chest pain. She had been nauseous the night before and did not feel well, then awoke 2 hours prior with chest pain.She had had a completely normal angiogram 3 months prior.Here is that angiogram report:The left main coronary artery is normal.Left anterior descending is a type 3 vessel and is normal.Left circumflex is nondominant and normal.The right coronary artery is dominant and normal.The nurses immediately recorded an ECG. This was 2 hours after the o...
Source: Dr. Smith's ECG Blog - May 29, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
A middle aged man with ST depression and a narrow window of opportunity
Written by Pendell MeyersI received a text at 18:13 of an ECG taken several minutes prior, with no clinical information and only the question " De Winters? "Here is the ECG:What would you tell the treating team???I responded at 18:14 PM:" I think it ' s posterior STEMI (OMI) instead of de Winter. Cath lab immediately is indicated. "I clarified further:" De Winter would need hyperacute T waves (not present here), and would indicate acute occlusion of the territory in the affected leads; so if there was de Winter in anterior leads, that would mean the anterior wall is the one involved. Here we have isolated posterior STD, wi...
Source: Dr. Smith's ECG Blog - May 19, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
ST-Elevation in aVR with diffuse ST-Depression: An ECG pattern that you must know and understand!
This case comes from Sam Ghali (@EM_RESUS). A 60-year-old man calls 911 after experiencing sudden onset chest pain, palpitations, and shortness of breath. Here are his vital signs:HR: 130-160, BP: 140/75, RR:22, Temp: 98.5 F, SaO2: 98%This is his 12-Lead ECG:He is in atrial fibrillation with a rapid ventricular response at a rate of around 140 bpm. There are several abberantly conducted beats. There is ST-Elevation in aVR of several millimeters and diffuse ST-Depression with the maximal depression vector towards Lead II in the limb leads and towards V5 in the precordial leads.ECG reading is all ab...
Source: Dr. Smith's ECG Blog - February 28, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest pain, sinus tachycardia, and ST Elevation
I was reading through ECGs on the system when I saw this one:Sinus tachycardia, rate 120Computerized QTc = 380 msWhat do you think? I was immediately worried about a proximal LAD occlusion. Although sinus tachycardia generally argues against ACS, a large anterior MI may result in such poor stroke volume that there is compensatory tachycardia and possibly impending cardiogenic shock. I looked to see if there was an ED cardiac ultrasound, and there was:Parasternal Long Axis:Poor image, but one can see that there is poor apical functionParasternal short axis:This shows poor contractility of the anterior wall.C...
Source: Dr. Smith's ECG Blog - January 22, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Ventricular pressure volume loop : An animated fusion Image
Ventricular pressure volume loop is an Important ( often feared !) concept to learn for cardiology fellows . . . I would say , It is not that hard to understand !
These loops tell us the secret hemodynamic story of a 300 gram “mass of muscle” called the heart and how It handles about 100 ml of blood every beat and successfully ejects around 70 ml into Aorta and Pulmonary artery *
While doing this life sustaining job , It would seem the heart muscle conducts a perfect, non stop, hemodynamic orchestra with 4 electro-mechanically coupled phases which is depicted as classical ventricular pressure volume lo...
Source: Dr.S.Venkatesan MD - January 14, 2018 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Animations cardiology physiology phases of cardiac cycle physiology of heart contraction pressure volume loop normal wiggers cardiac cycle Source Type: blogs
Prognosis after PCI for cardiogenic shock: it ’s better if the RCA is the culprit
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - December 17, 2017 Category: Internal Medicine Tags: cardiovascular Source Type: blogs
A 30-something with 8 hours of chest pain and an elevated troponin
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 have either PE or ACS. Of those select patients, the ones who also had T-wave in...
Source: Dr. Smith's ECG Blog - November 22, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Anterior ST Elevation with Elevated Troponin, but with low T/ST ratio, 2 Cases
Case 1This case was sent by Michael Masias (EMCurious, Twitter handle: @EMedCurious), an ultrasound fellow in the Department of Emergency Medicine at UC San Diego.He sent this ECG with the following inquiry: "What do you think about this? 21 year old with chest pain. I am getting a result of " STEMI " by using the 3-variable formula, and " no STEMI " with the 4-variable. "Computerized QTc = 418Here was my immediate answer:" Tough one! There is a very low T/ST ratio. That is to say, the J-point is very elevated in V3 and V4 but without a tall T-wave. That is unusual for both early repol and LAD occlusion, and sug...
Source: Dr. Smith's ECG Blog - November 8, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Test almost all of your most important ECG rhythm interpretation skills with this case.
Sent by Anonymous, written by Meyers, edits by Smith:A female in her 70s with history of HTN woke up around 2am with severe shortness of breath. EMS found the patient in moderate respiratory distress, hypoxemic on room air, with diffuse rales. CPAP was initiated. The prehospital ECG is unavailable but reportedly showed a wide complex regular tachycardia at around 150 bpm. 150mg amiodarone was given for presumed VT with no obvious effect.She arrived at the ED at 2:52 AM. She had normal mental status, and was in moderate respiratory distress with diffuse rales, with respiratory rate 30/min, and initial blood pressure 129/60....
Source: Dr. Smith's ECG Blog - October 26, 2017 Category: Cardiology Authors: Pendell Source Type: blogs
Cardiogenic shock with wide complex tachycardia and poor LV function in a young woman
A 30-something woman presented with CP and SOB. She was hypoxic and intubated. She had very poor LV systolic function on bedside echo. There were no B-lines and the RV was normal.The following ECG was recorded:Wide complex regular tachycardia at a rate of 140, no P-wavesWhat do you think?What do you want to do?This ECG was texted to me on my iPhonewithout any clinical information, with the question: " VT or SVT with aberrancy? "Here was my response:" Tough one, as they always are. Looks like SVT with LBBB (LBBB morphology strongly supports SVT). Lead aVR is all negative. I am going to s...
Source: Dr. Smith's ECG Blog - October 14, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
