Giant T inversion and NSVT
Giant T inversion with NSVT
Holter tracing showing giant T wave inversion and non sustained ventricular tachycardia, both at the beginning of the tracing and at the end. Ventricular ectopic beats are also seen in between. Variation in QRS amplitude of the NSVT beats are evident. It is likely that this will soon progress to torsades des pointes in the setting of gross QT interval prolongation. QT interval is seen as 640 ms in a cycle with cycle length of 600 ms. So, the QTc will be 640 ms. The first ventricular ectopic is followed by a good compensatory pause while the second one is almost an interpolated ventricular ecto...
Source: Cardiophile MD - February 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs
A 50-something with cocaine chest pain and ST Elevation in V1 - V3
CONCLUSIONS -- SUMMARY Moderately increased left ventricular wall thickness.Normal left ventricular size and systolic function with an estimated EF of 68%.No regional wall motion abnormality.Dynamic intracavitary gradient, peak 34 mmHg at rest and mmHg with Valsalva.Indeterminate left-sided diastolic parameters. The hypertrophy is somewhat more prominent at the apex. This, in conjunction with the dynamic intracavitary gradient, raisesconcern for hypertrophic cardiomyopathy. Learning PointsRight precordial ST Elevation: Septal STEMI vs. LVH:Here is a typical case of massive LVH, with secondary ST Elevat...
Source: Dr. Smith's ECG Blog - February 9, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
How to follow up Hypertrophic cardiomyopathy ? : Too much reliance on LVOT gradient is problematic
Hypertrophic cardiomyopathy (HCM) is the most common primary disorder of cardiac muscle. The incidence is about 1 in 500, which would mean 1.5 crore HCM patients will be living on our planet at any moment. The root cause of pathology is located in 20 odd genes that define cardiac muscle protein integrity. (Myosin, Troponin, Titin, etc) This leads to the bizarre architecture of cardiac muscle, prone to progressive fibrosis.(Paradoxically, 90% of HCM have normal or supernormal contractility till very late stages, proving that the much-dreaded term myocardial disarray has little effect on contractility. It is all the more f...
Source: Dr.S.Venkatesan MD - February 5, 2021 Category: Cardiology Authors: dr s venkatesan Tags: hypertrophic cardiomyopathy criley concept hocm hcm lobster claw hcm lobster claw is pulsus bisferiens mavacamten explorer trial what is the mechanism of hocm gradient lvot Source Type: blogs
Sarah ’ s Wheat Belly health and life transformation
Sarah’s story reminds us how the simple matter of diet can shape our lives for decades, affecting energy, body weight, emotional health–just about every aspect of our physical and social lives before we finally stumble on the right answers. After many years of struggling with poor health, relying on prescription medications that never addressed underlying causes, it therefore came as a surprise to Sarah that she could indeed achieve magnificent health without the drugs by simply following the diet programmed into human genetic code and supplementing nutrients that are deficient in modern life.
...
Source: Wheat Belly Blog - January 28, 2021 Category: Cardiology Authors: Dr. Davis Tags: Open grain-free Inflammation joint pain wheat belly Source Type: blogs
Typical chest pain and hypotension, Activate the Cath lab?
I was texted this ECG with the info that the patient " clinically looked like he was having a myocardial infarction " :What do you think?There is atrial and ventricular pacing. Both spikes are best seen in V1 and V2 (as always, if you click on the image, it enlarges). The QRS is very very wide. On the image below, I have drawn lines in every lead from the QRS onset (blue) and QRS end (red). I measure the QRS duration at about 280 ms. Of course, all ventricular paced rhythm is wide, but not often this wide. One must always consider hyperkalemia when the QRS is very wide, but the K turned ...
Source: Dr. Smith's ECG Blog - January 17, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Acute chest pain, ST Depression in V2 and V3, relief with Nitroglycerine, " normal " coronaries, and apical ballooning. Is it takotsubo?
This was submitted by Michael Fischer, one of our outstanding2nd year EM residents at Hennepin Healthcare.CaseA previously healthy female in her 40s presented 1 hour after abrupt onset 10/10 crushing chest pain that started while brushing her hair that morning. The pain radiated to her bilateral jaw and right shoulder, and did not seem to be exertional or pleuritic in nature. Here is her pre-hospital ECG: What do you think?Smith: V2 and V3 have some minimal ST depression with downsloping. This is highly suggestive of posterior MI.This was read by EMS as non-specific. Aspirin 324mg was given by EMS. Ni...
Source: Dr. Smith's ECG Blog - January 8, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fight Aging! Newsletter, December 28th 2020
In conclusion, our study demonstrated that the molecular processes of aging are relatively subtle in their progress, and the aging process of every tissue depends on the tissue's specialized function and environment. Hence, individual gene or process alone cannot be described as the key of aging in the whole organism.
Mouse Age Matters: How Age Affects the Murine Plasma Metabolome
A large part of metabolomics research relies on experiments involving mouse models, which are usually 6 to 20 weeks of age. However, in this age range mice undergo dramatic developmental changes. Even small age differences may l...
Source: Fight Aging! - December 27, 2020 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Mitochondrial Proton Leak Implicated in Cardiovascular Dysfunction Leading to Heart Failure
In this report, we investigated the effect and underlying mechanism of action of SS-31 on aged cardiomyocytes, especially on the mitochondrial proton leak. Using the naturally aged rodent model we provided direct evidence of increased proton leak as the primary energetic change in aged mitochondria. We further show that the inner membrane protein ANT1 mediates the augmented proton entry in the old mitochondria. Most significantly, we demonstrate that SS-31 acutely prevents the excessive mitochondrial proton entry and rejuvenates mitochondrial function through direct association with ANT1 and stabilization of the ATP syntha...
Source: Fight Aging! - December 23, 2020 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
A 45 year old smoker presents with palpitations, is discharged, and is found dead 2 days later
A 45 year old smoker presented with palpitations. He had no other medical problems. There was no syncope. He was on no medications.Unfortunately, no other information is available, but that is enough to provide an learning point.Here is the EKG:Do you see anything worrisome?There are PVCs, and these might be the cause of the palpitations (whether they are indeed the source of the palpitations could easily be ascertained by asking the patient if the palpitations are still present during the ECG). However, there are wide QS-waves (0.8 ms) in III and aVF, and they have afragmented QRS (extra spike...
Source: Dr. Smith's ECG Blog - December 14, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Will PCI reverse LV dysfunction in Ischemic cardiomyopathy ?
PCI is effective in relieving angina, what does it do to LV dysfunction?
This is a fundamental query in the principles of revascularisation of CAD . The term LV dysfunction can convey a bizarre meaning.It can constitute any of the combinations of the following.Cell death, necrosis, scarring, fully dead, partially dead, partially viable, apoptotic cells that are clustered across various myocardial segments. These cells are interwoven with fibrotic interstitium. Microvascular integrity is also altered.
Cells stretch, slip and slide with one another. Contractile architecture is lost. This is referred to as remodeling.In the...
Source: Dr.S.Venkatesan MD - December 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: CABG for Ischemic DCM Dilated cardiomyopathy Uncategorized How effective is pci in reversing lv dysfunction ? REHEAT STICH CABG PCI MEDICAL THERAPY revascularisation in ischemic dcm Source Type: blogs
Why AF is often well tolerated in Hypertrophic cardiomyopathy ?
Up to 25 % of LV filling is done by atrial contraction. Atrial booster function is important in LV outflow lesions. This can be critical in patients who have diastolic deformities of LV. ( an audible or even palpable S4 confirms the atrial kick in these situations ) This is how we were taught for decades right. Still, it may hold good in many left-sided condtions, but in HCM it definitely seems to be not true.
A succinct review of this topic makes a good read.
Incidence if AF in HCM is about 20% (Mostly paroxysmal 70 % , Persistent /Permanent 30 %)
Mechanism of AF IN HCM
Incre...
Source: Dr.S.Venkatesan MD - November 29, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation af in hocm affirm study atrial fibrillation in hypertrophic cardiomyopathy current guidelines in hcm hcm hocm mechansim of af in hcm pathophysiologyof hcm Source Type: blogs
A Covid patient with cough and Fever. Why does the ST-T wave look so abnormal?
I was reading through a stack of ECGs and saw this one. What is going on here?At first glance, it looks like a low atrial rhythm, with a negative P-wave in inferior leads. There appear to be inferior QS-waves and and intraventricular conduction delay (computer measure QRS at 120 ms).There appear to be very strange down up T-waves.On closer inspection, the P-wave in V1 appears biphasic, which should not happen in a low atrial rhythm.Then we see that there is another P-wave inbetween, superimposed on the T-wave, in V1.Then we see that in lead II, the negative P-waves have another negative P-wave between...
Source: Dr. Smith's ECG Blog - November 15, 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
Stress and the heart: Lessons from the pandemic
This study is a cautionary tale regarding the impact of stress. It serves as a good reminder that we should all strive to minimize stress, even in these trying times, and improve how we handle it. Some practical tips for managing stress including choosing healthy foods, exercising regularly, getting enough sleep, and staying connected with friends and family.
The post Stress and the heart: Lessons from the pandemic appeared first on Harvard Health Blog. (Source: Harvard Health Blog)
Source: Harvard Health Blog - October 14, 2020 Category: Consumer Health News Authors: Alyson Kelley-Hedgepeth, MD Tags: Coronavirus and COVID-19 Heart Health Stress Source Type: blogs
Cardiologist declines taking patient to the cath lab. Patient dies.
Sent by anonymous, written by Pendell MeyersA middle aged man presented with acute shortness of breath. Apparently he denied chest pain. Here is his first ED ECG:What do you see?Findings: - Sinus tachycardia - Poor R wave progression - STD in leads V3 and V4 - there is almost an appearance of STE in V6, but it is not definite - there is also slight STE in aVL with slight reciprocal STD in inferior leads Impression: Diagnostic of posterior OMI [and the subtle lateral involvement (aVL) supports this] until proven otherwise. STD maximal in V1-V4 (in this case V3-V4) is in my opinion the sing...
Source: Dr. Smith's ECG Blog - October 11, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
