ECG in coronary artery disease
ECG changes in coronary artery disease (CAD) can be in any of the waves or segments. Diagnosis of acute myocardial infarction in the emergency room still relies mostly on the ECG, though other investigations are there to supplement.
P wave abnormalities
P wave being an atrial event, is not usually involved directly by CAD. But indirectly, there can be evidence of atrial enlargement if there is left ventricular dysfunction. Atrial arrhythmias are observed in atrial infarction.
Abnormalities of PR segment
PR segment contains the atrial repolarization wave (Ta) though it is not usually evident. PR segment depression can occu...
Source: Cardiophile MD - September 28, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC atrial infarction juvenile pattern Juvenile T inversion Loss of R wave progression Pardee’s sign pathological Q waves PR segment depression primary ventricular fibrillation ST segment abnormalities T wave abnormalities Source Type: blogs
Chamber enlargements on ECG
Atrial enlargement
The normal P wave has a maximum amplitude of 2.5 mm (0.25 mV) and a maximum width of 2.5 mm (100 ms). In right atrial enlargement, the amplitude increases while in left atrial enlargement, it is the width (duration) which increases. Both increases in biatrial enlargement. P wave abnormalities are best assessed in leads II and V1. Normal P wave is upright in lead II. In V1, a tiny initial spike is followed by a shallow negative wave.
P mitrale: P mitrale is a notched and broad P wave with taller second peak indicating left atrial enlargement. It may be noted that initial part of P wave is contributed b...
Source: Cardiophile MD - September 27, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC incomplete right bundle branch block pattern Left ventricular pressure overload left ventricular volume overload LVH strain pattern P mitrale P pulmonale P tricuspidale Right ventricular pressure overload right ventricular volume ove Source Type: blogs
Palpation of precordium and adjacent areas
Palpation initially confirms the findings of inspection and further looks for new findings.
Apex beat: Apex beat is defined as the lowest and outer most point of definite cardiac impulse. If apex beat is not felt on left side, immediately check on right side or else we might miss a dextrocardia. There some who even palpate both sides simultaneously for this reason. Apex beat is initially felt with the palm of the hand and then localized with the index finger. Sometimes it may be difficult to palpate in obese individuals and in those with emphysema. Palpation in held expiration and in the left lateral position may help in...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs
Young Man with a Heart Rate of 257. What is it and how to manage?
A 30-something was in the ED for some minor trauma when he was noted to have a fast heart rate. He acknowledged that he had palpitations. but only when asked. He had a history heavy alcohol use. Blood pressure was normal (109/83).Here is his 12-lead:There is a wide complex tachycardia with a rate of 257, with RBBB and LPFB (right axis deviation) morphology.The Differential Diagnosis is: SVT with aberrancy(#) [AVNRT vs. WPW (also called AVRT*)] Atrial flutter with 1:1 conduction, with aberrancy VT coming from the anterior fascicle (fascicular...
Source: Dr. Smith's ECG Blog - September 6, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Tei index – Myocardial performance index
Tei index – Myocardial performance index
Tei index – myocardial performance index (MPI) is the ratio of the time spent in isovolumetric activity divided by the time spent in ventricular ejection [1]. In other words, it is the sum of isovolumic contraction and relaxation times divided by the ejection time [2].
MPI = (ICT + IRT) / ET
ICT: isovolumic contraction time; IRT: isovolumic relaxation time; ET: ejection time
Myocardial performance index has an inverse relation with global ventricular function in that increasing values indicate worsening global ventricular function. There is good correlation between Doppl...
Source: Cardiophile MD - September 6, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs
Accordion sign – Cardiology MCQ – Answer
Accordion sign – Cardiology MCQ – Answer
Accordion sign on magnetic resonance imaging (MRI) is seen in – Correct answer: 3. Arrhythmogenic right ventricular cardiomyopathy
A focal crinkling of the right ventricular outflow tract and subtricuspid regions on MRI in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVD/C) has been called “accordion sign” [1]. It was observed in 60% of the mutation carriers and none of those without the mutation (p < 0.001).
{Another accordion sign (also called concertina sign) has been described in computed tomography (CT) after administration of or...
Source: Cardiophile MD - August 24, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Genetic DCM – Cardiology MCQ – Answer
Genetic DCM – Cardiology MCQ – Answer
Association of genetic DCM (Dilated cardiomyopathy) – Correct answer: 4. All of the above.
Truncation mutations in titin gene (TTN) was found in 13% of non familial DCM cases in one study [1]. LMNA and SCN5A mutations have been associated with DCM with cardiac conduction abnormalities [2].
Back to question
References
Angharad M Roberts, James S Ware, Daniel S Herman, Sebastian Schafer, John Baksi, Alexander G Bick, Rachel J Buchan, Roddy Walsh, Shibu John, Samuel Wilkinson, Francesco Mazzarotto, Leanne E Felkin, Sungsam Gong, Jacqueline A L MacArthur, Fiona Cunningha...
Source: Cardiophile MD - August 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Accordion sign – Cardiology MCQ
Accordion sign – Cardiology MCQ
Accordion sign on magnetic resonance imaging (MRI) is seen in:
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy
Amyloid cardiomyopathy
Post your answer as a comment below. Correct answer will be published after 2 days.
The post Accordion sign – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - August 22, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Genetic DCM – Cardiology MCQ
Genetic DCM – Cardiology MCQ
Association of genetic DCM (Dilated cardiomyopathy):
Lamin A/C gene (LMNA)
Titin gene (TTN)
Atrioventricular (AV block)
All of the above
Click here for the correct answer
The post Genetic DCM – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - August 21, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
This is double plus ungood news
It ' s one study, and it isn ' t very long follow-up, just two or three months, butthis is a very ugly result. German researchers did magnetic resonance imaging of the hearts of 100 people who had recovered from Covid-19. Two thirds of them had not been hospitalized. It turned out that 78% of them had abnormal results indicating inflammation of the heart muscle, and/or reduced cardiac functioning, regardless of the severity of their illness. They don ' t fully explain how the sample of patients was obtained but they describe them as " unselected, " in other words they are assumed to be representative of all patients ...
Source: Stayin' Alive - August 17, 2020 Category: American Health 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
A middle aged female with " heartburn " and a " normal ECG " per the computer
This is a re-posting of a Tweet by Robert Jones (@RJonesSonoEM), reproduced with permission, written by Pendell MeyersA middle aged female with history of smoking presented to the ED with " bad heartburn. "Here is her prior baseline ECG (first), and her ED ECG (second):Baseline:ED ECG:What do you think? Do you agree with the computer ' s interpretation of " Normal ECG " ?This was posted on Twitter and Dr. Smith (and several others) replied that it shows OMI. Dr. Smith said " No " (meaning " No, I do not agree with the computer " ). " New ST elevation in V4-V6. New distortion of S wave in V4 - OMI - distal LAD likely. "The ...
Source: Dr. Smith's ECG Blog - August 7, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Fight Aging! Newsletter, July 20th 2020
This study was the first to demonstrate a causal relationship between glial senescence and neurodegeneration. In this study, accumulations of senescent astrocytes and microglia were found in tau-associated neurodegenerative disease model mice. Elimination of these senescent cells via a genetic approach can reduce tau deposition and prevent the degeneration of cortical and hippocampal neurons.
Most recently, it was shown that clearance of senescent oligodendrocyte progenitor cells in AD model mice with senolytic agents could lessen the Aβ plaque load, reduce neuroinflammation, and ameliorate cognitive deficits. This...
Source: Fight Aging! - July 19, 2020 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
What is a useful next step in the evaluation of this patient with Chest pain and this ECG?
Written by Pendell Meyers, submitted by Daryl Williams, edits by Steve SmithA man in his sixties with prior CAD and CABG experienced chest pain and pressure off and on for three days. He saw his primary doctor during this time who had suspected GI related symptoms and increased his PPI medication. On the third day it became more intense and had associated radiation to his neck and left arm, and this reminded the patient of his prior MI symptoms, so he presented to the Emergency Department. It is unclear how long he had constant symptoms during those three days.Here is his triage ECG (no prior was available in our system):W...
Source: Dr. Smith's ECG Blog - July 18, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Targeting Senescent Cells in the Heart
Senescent cells accumulate with age, and their inflammatory secretions disrupt tissue structure and function. In the heart, the presence of senescent cells contributes to fibrosis, hypertrophy, and other aspects of the progression towards heart failure. Since senescent cells actively maintain a disrupted state of cells and tissue, targeted removal can quickly and significant reverse aspects of aging and age-related disease. This has been demonstrated in numerous organs, including the heart, in animal studies. For example, even the structural changes of ventricular hypertrophy can be reversed via treatments that selectively...
Source: Fight Aging! - July 16, 2020 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
