MINOCA vs TpNOCA
TpNOCA: Troponin-positive nonobstructive coronary arteries
Apparent myocardial infarction in the absence of obstructive coronary artery disease
MINOCA: Myocardial Infarction With Nonobstructive Coronary Arteries
Term reserved for only those who have evidence of ischemia related myocardial necrosis
MINOCA included only coronary disorders like coronary dissection, plaque disruption, coronary spasm, microvascular dysfunction, coronary thrombus and embolism (recanalized).
TpNOCA includes in addition to MINOCA, myocardial disorders like myocarditis, takotsubo cardiomyopathy and other cardiomyopathies as well as non cardia...
Source: Cardiophile MD - September 10, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
What is the differential of this very unusual ECG?
Take a look at this ECG first without clinical context:What do you think?There is sinus bradycardia with very unusual shortened QT interval (approximately 400 ms), for a QTc (Bazett) 358 ms. The T-waves have high amplitude and narrow bases, reminiscent of hyperkalemia, maybe also with hypercalcemia. The T-waves are not bulky or fat, and are therefore not hyperacute regardless of their amplitude.Short QTc is rare, but has been described as less than 360 ms for males and less than 370 ms for females. Furthermore, less than 330 ms (males) or less than 340 ms (females) can be termed " very short QTc " and, in the absence of re...
Source: Dr. Smith's ECG Blog - September 1, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
The ECG was correct. The angiogram was not.
In this study, approximately 10% of Transient STEMI had no culprit found:Early or late intervention in patients with transient ST ‐segment elevation acute coronary syndrome: Subgroup analysis of the ELISA‐3 trialOne must use all available data, including the ECG, to determine what happened.Final Diagnosis?If the troponin remained under the 99% reference, then it would be unstable angina. If it rose above that level before falling, it would be acute myocardial injury due to ischemia, which is, by definition, acute MI. If that is a result of plaque rupture, then it is a type I MI. The clinical presentat...
Source: Dr. Smith's ECG Blog - August 12, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fight Aging! Newsletter, August 5th 2019
In conclusion, with study of the frailty syndrome still in its infancy, frailty analysis remains a major challenge. It is a challenge that needs to be overcome in order to shed light on the multiple mechanisms involved in the pathogenesis of this syndrome. Although several mechanisms contribute to frailty, immune system alteration seems to play a central role: this syndrome is characterized by increased levels of pro-inflammatory markers and the resulting pro-inflammatory status can have negative effects on various organs. Future studies should aim to better clarify the immune system alteration in frailty, and seek to esta...
Source: Fight Aging! - August 4, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Impaired Monocyte to Macrophage Transition Implicated in Cardiovascular Disease
The innate immune cells called macrophages are vitally important to the health and function of tissues. They help to coordinate the intricate dance of stem cells, somatic cells, and immune cells that produces tissue regrowth and tissue maintenance. They destroy errant cells and pathogens. They have a variety of other roles as well. But where do macrophages come from? While some macrophages are generated within tissues, it is generally the case that in damaged or diseased tissues, most macrophages were originally monocytes. Circulating monocytes in the bloodstream enter tissues in response to chemical cues and then transfor...
Source: Fight Aging! - July 29, 2019 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Bizarre T-wave inversions, with Negative U-waves and Very long QT. And a myocardial viability study.
This 60-something year old male was admitted and his hospital course complicated by GI bleed, hemodynamic instability, and a nadir hemoglobin less than 5 g/dL. An ECG was relatively normal.The next AM, his potassium was measured at 2.9 mEq/L, so another ECG was recorded.He was asymptomatic.The previous ECG from one week prior had been relatively normal.There are bizarre inverted T-waves and also inverted U-waves (see the 2nd inverted bump?)The QT is incredibly longThere is some subtle STE in inferior leads but also STE in I, aVL.There is STE before the bizarre TU inversion in leads V3-V6.There are some artifacts that...
Source: Dr. Smith's ECG Blog - July 23, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Do you recognize these ECGs? STEMI? LVH? What?
What do you think of these ECGs?I came across the first one reading it blind for a study. I was certain I knew the diagnosis, and went to the chart to confirm.The first 3 were recorded on one day.ECG 1:ECG 2:ECG 3:ECG 4, recorded 12 days later:These ECGs are classic for abenign variant in Black males. I was certain it would be a relatively young black male without cardiac pathology.Result from chart:It was a black male in his 40s.The first ECG, and then the next two (1-3), were recorded for chest and abdominal pain. The patient was ultimately diagnosed with biliary colic.The patient ruled out for MI by se...
Source: Dr. Smith's ECG Blog - June 19, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
ROSC: does the ECG rule out OMI? And why does a heart just stop beating? And what rhythm is this?
This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram. It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab. So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram. This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI.What percent of shockable arrests without STE have an OMI? This large registry in Circulatio...
Source: Dr. Smith's ECG Blog - June 17, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
ROSC: does the ECG to rule out OMI? And why does a heart just stop beating? And what rhythm is this?
This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram. It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab. So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram. This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI. What percent of shockable arrests without STE have an OMI? This large registry in Circ...
Source: Dr. Smith's ECG Blog - June 17, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Understanding Machine Learning And Deep Learning In Medicine
Algorithms, datasets, machine learning, deep learning, cognitive computing, big data, and artificial intelligence: IT expressions that took over the language of 21st-century healthcare with surprising force. If medical professionals want to get ahead of the curve, they rather get familiarized with the basics of A.I. and have an idea of what medical problems they aim to solve. So, let’s take a closer look at machine learning and deep learning in medicine.
The
ante-room of artificial intelligence
The term “artificial intelligence” might be misleading
as due to the overuse of the expression, its meaning started to...
Source: The Medical Futurist - May 30, 2019 Category: Information Technology Authors: nora Tags: Artificial Intelligence in Medicine Future of Medicine AI algorithm deep learning Health Healthcare Innovation machine learning smart smart algorithm smart health technology Source Type: blogs
I was handed this ECG at triage with no information
I was at triage when this ECG of a 50-something was handed to me. He speaks no English and I really had no idea what his symptoms were, but someone had pointed to his chest, which is why they recorded an ECG.What do you think?I was pretty alarmed by the ST segments in V4 and V5, and the ST segment of the PVC in V3. V4 and V5 haveQR-waves, in addition to the STE, which suggests:1. Old MI with persistent STE2. Old MI with superimposed new STE, or3. Subacute MI. There is also STE in the normally conducted beats of V2 and V3, but that is in the context of a deep QS-wave, which was less alarming.So I looked for o...
Source: Dr. Smith's ECG Blog - May 27, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Histological processes in HCM
Four histological processes in hypertrophic cardiomyopathy (HCM):
Myocyte hypertrophy
Myocyte and myofibrillar disarray
Small vessel disease
Fibrosis
Reference
McKenna WJ, Moon JC, Sulaiman A. Understanding the Myocardial Architecture of Hypertrophic Cardiomyopathy for Clinical Care. J Am Coll Cardiol. 2019;73(20):2503-5. (Source: Cardiophile MD)
Source: Cardiophile MD - May 23, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Assessing SCD risk in HCM by CMR
Sudden cardiac death (SCD) is one of the dreaded complications of hypertrophic cardiomyopathy (HCM) and predicting it is always challenging. Clinical risk stratification algorithms lack good sensitivity and specificity. Myocardial disarray has been well documented in those who died suddenly with HCM. Cardiac magnetic resonance imaging with a novel technology known as diffusion tensor cardiac magnetic resonance (DT-CMR) is a promising way for in vivo demonstration of myocardial disarray [1].
DT-CMR can visualise myocardial microstructure by mapping the diffusion of water molecules. But it is technically challenging and ac...
Source: Cardiophile MD - May 23, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Diagnostic criteria for peripartum cardiomyopathy
Diagnostic criteria for peripartum cardiomyopathy are:
Development of heart failure in the last month of pregnancy or within 5 months after delivery
Left ventricular systolic dysfunction with ejection fraction less than 45%
No other identifiable cause for heart failure
No recognized heart disease before the last month of pregnancy
Reference
van Spaendonck-Zwarts KY1, van Tintelen JP, van Veldhuisen DJ, van der Werf R, Jongbloed JD, Paulus WJ, Dooijes D, van den Berg MP. Peripartum cardiomyopathy as a part of familial dilated cardiomyopathy. Circulation. 2010 May 25;121(20):2169-75. (Source: Cardiophile MD)
Source: Cardiophile MD - May 21, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Fight Aging! Newsletter, May 20th 2019
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more.
This content is...
Source: Fight Aging! - May 19, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
