Starting a list of some of the best blog cases here....
1. I just remembered this one:Chest Pain and Cardiogenic Shock with Profound ST Depression& STE in aVR. Activate the Cath Lab?2. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - October 11, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Inferolateral ST elevation, vomiting, and elevated troponin
Another post written by Pendell Meyers, with edits from Dr. Smith:A male in his late 40s presented with nausea, vomiting, and epigastric abdominal pain of several hours duration. An ECG was recorded from triage:What is your interpretation?The ventricular rate is 160 bpm and regular with narrow complex. Rhythm differential is therefore sinus tachycardia, SVT (AVRT, AVNRT, etc), or atrial flutter. There is clear ST elevation present in V4-V6, as well as II, III, and aVF. No clear reciprocal changes in aVL, however with this distribution you could consider a very rare case in which high lateral STE cancels out reciprocal STD....
Source: Dr. Smith's ECG Blog - October 6, 2017 Category: Cardiology Authors: Pendell Source Type: blogs
The High Cost of Public Reporting
ANISH KOKA MD
In an age where big data is king and doctors are urged to treat populations, the journey of one man still has much to tell us. This is a tale of a man named Joe.
Joseph Carrigan was a bear of a man – though his wife would say he was more teddy than bear. He loved guitar playing, and camp horror movies. Those who knew him well said he had a kind heart, a quick wit and loved cats.
I knew none of these things when I met Joe in the Emergency Department on a Sunday afternoon. I had been called because of an abnormal electrocardiogram – the ER team was worried he could be having a heart attack. ...
Source: The Health Care Blog - September 18, 2017 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Cardiac surgery High-risk Quality Reporting Source Type: blogs
The Cost of Public Reporting
ANISH KOKA MD
In an age where big data is king and doctors are urged to treat populations, the journey of one man still has much to tell us. This is a tale of a man named Joe.
Joseph Carrigan was a bear of a man – though his wife would say he was more teddy than bear. He loved guitar playing, and camp horror movies. Those who knew him well said he had a kind heart, a quick wit and loved cats.
I knew none of these things when I met Joe in the Emergency Department on a Sunday afternoon. I had been called because of an abnormal electrocardiogram – the ER team was worried he could be having a heart attack. ...
Source: The Health Care Blog - September 18, 2017 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs
Huge ST Elevation in V2 and V3. What is it?
A 30-something presented with methamphetamine use and agitation. He was sedated, then had an ECG as part of his workup:He was stabilized and observed.He was still confused 8 hours later when I was now on duty, and he was found to have a heart rate of 140, so another ECG was recorded:There is one lead (V2) with massive ST elevation.Since there is very little STE in V1 or V3, there must be lead misplacement.I suspected some lead misplacement and ordered another with the leads corrected:Now there is massive STE in BOTH leads V2 and V3What do you think?What do you want to do?What do you think? This is what I thought:...
Source: Dr. Smith's ECG Blog - June 4, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Is it Possible to Die from a Broken Heart?
You're reading Is it Possible to Die from a Broken Heart?, originally posted on Pick the Brain | Motivation and Self Improvement. If you're enjoying this, please visit our site for more inspirational articles.
Falling in love is one of the most beautiful and exciting feelings in the world. We need only to think of our beloved partner and our heart skips a beat. We are full of energy and plans for the future.
Yet what about when the romance dies? What happens to our heart then? Anyone who’s been properly lovesick knows how painful it is to feel so lovelorn, so sad, and so worthless. It seems to us that our loss i...
Source: PickTheBrain | Motivation and Self Improvement - May 30, 2017 Category: Consumer Health News Authors: Greystone Tags: featured happiness health and fitness popular reading best books best health books best self-improvement blogs broken heart can you die from a broken heart cardiac love mental health pickthebrain stress wellness Source Type: blogs
Abiomed Unveils 3rd Generation Impella CP Heart Pump for PCI and Cardiogenic Shock
Abiomed, the maker of implantable cardiac assistive devices, has just announced its new 3rd generation Impella CP heart pump. The device is designed to assist the native heart during percutaneous coronary interventional (PCI) procedures that can be difficult to tolerate for fragile patients, as well as to stabilize those post cardiac infarct that resulted in cardiogenic shock.
The new version of the Impella CP is able to move more than four liters of blood per minute, the previous version of the pump maxing out right at four liters per minute. In order to be able to offer Impella CP’s support to more patients, a n...
Source: Medgadget - May 10, 2017 Category: Medical Devices Authors: Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs
Research and Reviews in the Fastlane 178
LITFL: Life in the Fast Lane Medical Blog
LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 178th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Justin Morgenstern and Chris Ni...
Source: Life in the Fast Lane - April 6, 2017 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Intensive Care Pediatrics Procedure R&R in the FASTLANE Radiology Respiratory Resuscitation Toxicology and Toxinology Education emergency Emergency Medicine recommendations Review Source Type: blogs
Tachycardia, Dehydration, and New ST Elevation in a 20-something, then a Surprise.
p.p1 {margin: 0.1px 0.0px 0.1px 0.6px; font: 10.0px Arial; color: #4d4d4d; background-color: #fefefe}A male in his early 20s presented intoxicated, with no CP or SOB. An ECG was obtained for tachycardia.First ECG:Sinus tachycardia at 150.There is inferior ST Elevation and Q-waves that appear to be Inferior STEMI.There is reciprocal ST depression in aVL.Is this STEMI?The patient was very dehydrated.The physicians were worried about STEMI, and so did a Point of Care Cardiac Ultrasound which showed IVC collapse and hyperdynamic function.The patient had a previous visit with dehydrationThere had been some, but less, ...
Source: Dr. Smith's ECG Blog - March 18, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Coronary artery disease: Primary care and prevention – 5
Previous
Statin for primary prevention
Very high lipid levels of the order of LDL cholesterol above 190 mg/dL calls for usage of statins for primary prevention. High intensity statins can be considered in this scenario as in acute coronary syndrome. When the LDL cholesterol level is between 70-189 mg/dL, primary prevention with moderate intensity statin may be considered if they are diabetic and have significant other risk factors for CAD. It is reasonable to measure SGPT/ALT levels before initiating statins and while on treatment so that values above 3 times the upper limit are not reached. Caution is advised in those abo...
Source: Cardiophile MD - December 21, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs
Coronary artery disease: Primary care and prevention – 3
Previous
Special strategy for STEMI
STEMI needs early reperfusion and hence special strategies to minimise the first medical contact (FMC) to reperfusion time. In a center capable of primary PCI, the aim is to achieve a door to balloon time of less than 90 minutes. The earlier the infarct related artery is opened, the better, as more myocardium is salvaged – ‘time means muscle’, in terms of salvaged myocardium at jeopardy. If the patient presents to a center without PCI facility, if transfer and PCI is feasible within 120 minutes, that has to be given top priority. In such situations, door in door out (DI...
Source: Cardiophile MD - December 19, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs
Coronary artery disease: Primary care and prevention – 2
Previous
Check for differential diagnosis
Some of the important differential diagnosis in the case of acute coronary syndrome are acute pulmonary embolism, aortic dissection, pneumothorax, esophageal disease, perforated peptic ulcer, cholecystitis, gastritis and sometimes even Herpes Zoster of left thoracic region in pre-eruptive phase. A good history, physical findings and sometimes time are needed for an accurate differential diagnosis. Checking for asymmetry of peripheral pulses is often resorted to for excluding aortic dissection, though it may still miss an aortic dissection sparing the branches as in descending thora...
Source: Cardiophile MD - December 18, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs
Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!
CONCLUSION:The variables that interplay in cases of severe aortic stenosis are what cause these patients to be so difficult to manage, and specific therapies targeted to fix one issue often worsen the effects of another issue. If someone is in respiratory distress, their airway and breathing needs to be secured, either through non-invasive or invasive means. Next, the patient ’s blood pressure needs to be stabilized. Oftentimes the most appropriate agent will be a positive inotrope, with consideration of a vasoactive agent in persistent hypotension. Once a patient is stabilized, determining the extent of damage to their ...
Source: Dr. Smith's ECG Blog - November 18, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest Pain and Cardiogenic Shock with Profound ST Depression & STE in aVR. Activate the Cath Lab?
A middle-aged woman with known severe coronary disease had onset of substernal chest pain while at dialysis. 911 was called. A prehospital ECG was similar to the first ED ECG, which is shown below. The patient arrived with a systolic blood pressure of 90 mm Hg, too low to administer nitroglycerine. An initial lactate was elevated at 5.5.She was given aspirin, heparin, and ticagrelor.Here is her initial ED 12-lead ECG:There is atrial fibrillation with a rate of approximately 114.There is extreme ST depression in multiple leads and ST elevation in aVR, suggesting left main and/or 3 vessel disease ischemia...
Source: Dr. Smith's ECG Blog - November 15, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Predictors of contrast induced AKI – Cardiology MCQ
Predictors of contrast induced acute kidney injury:
a) Estimated glomerular filtration rate (eGFR)
b) ST elevation myocardial infarction (STEMI)
c) Cardiogenic shock
d) All of the above
e) None of the above
Correct answer: d) All of the above
These are also the strongest predictors of AKI requiring dialysis. Roxana Mehran and associates developed a comprehensive risk prediction score which included age, hemoglobin level, pre-existing chronic kidney disease, volume of contrast administered during the percutaneous intervention, need for IABP (intra aortic balloon counterpulsation) and a few other variables. Presen...
Source: Cardiophile MD - October 31, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
