An elderly patient with stuttering chest pain. Don't jump to conclusions.
I was reading ECGs on the system and saw this one, and instantly knew the probable ECG diagnosis:What do you think?I went to the patient ' s chart:Elderly woman with stuttering chest pain and SOB, and dizziness.What do you think now?This is a very typical ECG for Hypertrophic Cardiomyopathy. I sent it to our EKG Nerdz group and Jesse McLaren replied: " Apical HOCM "It reminded me of many other cases I have seen, such as this one: Left Bundle Branch Block with Less Than 1 mm of Concordant ST Elevation (in the Setting of Hypertrophic Cardiomyopathy)HOCM that mimicked LBBB with OMI (concordant STE in V5)Case continu...
Source: Dr. Smith's ECG Blog - December 26, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fight Aging! Newsletter, December 25th 2023
This study generates a comprehensive single-cell transcriptomic atlas of human atherosclerosis including 118,578 high-quality cells from atherosclerotic coronary and carotid arteries. By performing systematic benchmarking of integration methods, we mitigated data overcorrection while separating major cell lineages. Notably, we define cell subtypes that have not been previously identified from individual human atherosclerosis scRNA-seq studies.
Besides characterizing granular cell-type diversity and communication, we leverage this atlas to provide insights into smooth muscle cell (SMC) modulation. We integrate genome...
Source: Fight Aging! - December 24, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Profiling the Development of Gene Therapies at Rejuvenate Bio
Here find a high-level look at the work of Rejuvenate Bio, a gene therapy company aiming to manipulating aging metabolism into a better shape. They have chosen to focus on the strategy of altering tissues to generate signal molecules known to be influential in the progression of aging. This is perhaps the easiest way forward for any gene therapy platform. Gene therapies are clearly the future, but at present it is somewhere between hard, expensive, and impossible to specifically target a gene therapy to most organs or cell types or tissues. If one can use one of the few established approaches, such as delivery of a gene th...
Source: Fight Aging! - December 21, 2023 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Concerning EKG with a Non-obstructive angiogram. What happened?
CONCLUSION: Given resolution of severe CP in association with the above marked improvement of ST-T wave abnormalities in virtually all leads during the less than 1 hour between the recording of ECGs #1 and #2 — this strongly suggests reopening of a " culprit " vessel (whichever vessel this was) — regardless of the fact that " no obstructive lesion was seen " at the time the cardiac catheterization happened to be done.The more than doubling of Troponin (even though " normal limits " for Troponin were not surpassed) — is consistent with a brief OMI, with only...
Source: Dr. Smith's ECG Blog - December 19, 2023 Category: Cardiology Authors: Willy Frick Source Type: blogs
Idiopathic dilated cardiomyopathy
Idiopathic dilated cardiomyopathy is a form of dilated cardiomyopathy with unknown etiology characterised by progressive left ventricular dilatation and systolic dysfunction. Pathologically, there is increase in the size and weight of the heart. There is ventricular dilatation with near normal wall thickness. The myocardial systolic dysfunction is out of portion to the fibrosis.
The incidence of idiopathic dilated cardiomyopathy varies from 3-10 cases per 100,000 population. Death from progressive pump failure occurs at the rate of about 25% in first year, 35-40% in two years and upto 40-80% over five years. Stabiliz...
Source: Cardiophile MD - December 15, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Proportionality is a major element in the ECG Diagnosis of OMI.
This middle aged patient presented with chest pain:What do you think?There is VERY low voltage. There is some ST Elevation, but it is MINIMAL. But look how small the QRS is!!Let ' s stretch out the QRS vertically so it is not so tiny:On upper left is the original. On the right are the precordial leads stretched vertically, so that the QRS is not tiny. Now you can see the STE and Hyperacute T-wave better.I published, and Emre Aslanger externally validated,the4-Variable formula for differentiating the ST Elevation of LAD OMI from Normal ST Elevation. It is derived/validated/...
Source: Dr. Smith's ECG Blog - December 13, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
" A patient just arrived as a transfer for NSTEMI. "
Conclusion: Our THANKS to Dr. Frick for his detailed and highly insightful presentation. CREDIT to him for masterful correlation of clinical events to each ECG — that thoroughly supports his explanation of the successful treatment received by this patient with evolving LAD OMI.QUESTION: Isn ' t it so much EASIER with the lead-to-lead comparison facilitated by Figure-1 — to see the subtle-but-important evolution of ST-T wave changes that so closely correspond to clinical events? (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - December 7, 2023 Category: Cardiology Authors: Willy Frick Source Type: blogs
What's new in midwifery - research - 17th November 2023
Not so new, again, but still useful, I hope.Can we improve discussions with pregnant women about previous trauma, NIHR plain language summary of a research study.Role of midwives (and other health professionals) in responding to gender based violence, an editorial (open access); and a research study onthe preparedness of nurses and midwives about domestic violence and abuse (also open access).Peripartum cardiomyopathy - 20 year population study (also open access). (Source: Browsing)
Source: Browsing - November 17, 2023 Category: Databases & Libraries Tags: midwifery Source Type: blogs
What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?
A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest. She said this was midsternal and felt like a tightness. This originally radiated into her left arm. Over some time and the pain moved into her other arm as well as her jaw. She also had some shortness of breath. She was brought in by ambulance and re...
Source: Dr. Smith's ECG Blog - November 15, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?
A 90-something year old woman presented with an acute mild stroke.She had a routine ECG as part of her workup:What do you think?This was shown to me in real time.I thought it had to be an inferior-lateral-posterior OMI. But the patient had no symptoms. Later, she did admit to some vague chest discomfort, but that could be due to the power of suggestion.The one strange thing that I noted at the time is that there is no reciprocal ST depression in aVL. This is extremely unusual in inferior OMI, even if there is simultaneous STE in V5-6.We studied this: In this paper on the importance of lead aVL f...
Source: Dr. Smith's ECG Blog - November 11, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Atrial DCM : A new entity in the making
A brief learning session with cardiology fellow about a possible new concept in Left heart failure.
What is the commmest cause for acute pulmonary edema?
“Left sided heart failure”
“Can you be more specific , Left sided means ?
“I meant LV failure , typically DCM of any cause or Severe un-controlled HT”
“Ok .good. Does Left Heart failure include mitral valve dysfunction also ?
“Yes sir, very much. Classical mitral stenosis and Isolated MR can cause pulmonary edema. In fact, acute AR Iis also part of left heart disease”
So far, so good, now coming to t...
Source: Dr.S.Venkatesan MD - November 4, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Atrail dcm atrial cardiomyopathy HFpEF la pressure volume loop primary atrial failure Source Type: blogs
" Non-STEMI " is a worthless term.
A 60 yo with 2 previous inferior (RCA) STEMIs, stented, called 911 for one hour of chest pain. He had no h/o heart failure. Here is the first prehospital ECG (time 0, after one hour of pain): I do not see evidence of OMI, and neither did the Queen of HeartsHere is the 2nd prehospital ECG (time 10 minutes, after 70 minutes of pain): No changeOn arrival, the first ED ECG was recorded 20 minutes after the last one (90 minutes after pain onset): What do you think?Here is his most recent previous ECG:This was recorded after intervention for inferior STEMI (with massive ST Elevation, see below), and shows inf...
Source: Dr. Smith's ECG Blog - October 30, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Continuous prolonged generalized weakness, lightheadedness, and presyncope. What might you suspect from the ECG?
A young man presented with continuous prolonged generalized weakness, lightheadedness, and presyncope. There was some dyspnea but no chest pain. Here is his ECG. This shows LVH, with high voltage.LVH can have very thick-walled ventricles and a correspondingly small LV cavity. LVH is a common etiology of heart failure with preserved ejection fraction, as it may results in a stiff ventricle with poor diastolic relaxation.See this articles: Heart Failure with Preserved Ejection Fraction (NEJM review)One etiology of LVH on the ECG is Hypertrophic Cardiolmyopathy (HOCM), and sometimes ECGs in pa...
Source: Dr. Smith's ECG Blog - October 28, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Does this T wave pattern mean anything?
Written by Michael Doyle DO and Timothy Palmieri MD. Edited by Bracey, Meyers, Grauer, and SmithA 50-something-year-old female with a history of an unknown
personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return
of spontaneous circulation. The described rhythm was an irregular, wide complex
rhythm. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin. She was successfully revived
after several rounds of ACLS including defibrillation and amiodarone.On arrival to the ED the patient was intubated with normal vi...
Source: Dr. Smith's ECG Blog - October 23, 2023 Category: Cardiology Authors: Bracey Source Type: blogs
A 20-something woman with cardiac arrest.
The patient is a 20 something female. She is healthy with no known cardiac disease. She was admitted to the neurology department due to headache and vomiting. She was found to have a viral CNS infection. A few days into her hospital stay she developedchest discomfort and the following ECG was recorded. What do you think? Why such large T-waves? Are these hyperacute T-waves? Are these ECG changes related to the CNS infection perhaps? What disease processes would you put on your list of differential diagnoses?When I saw the ECG of this patient I saw that there was definitely something " off " . I didn ' t get...
Source: Dr. Smith's ECG Blog - October 18, 2023 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
