Localisation of Ventricular Tachycardia by Surface ECG
Surface ECG can be used to identify the site of origin of ventricular tachycardia. QRS morphologic patterns and vectors are helpful in discerning the activation pattern of the myocardium. Chest wall deformity as well as metabolic and drug effects can cause limitations in analysis sometimes [1]. Identification of site of origin of VT is useful while planning catheter ablation. It is also useful in correlating with the clinical situation as in post myocardial infarction scar related VT. Another instance is for correlation with findings on imaging modalities like echocardiography and cardiac magnetic resonance imaging [2].
F...
Source: Cardiophile MD - April 23, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Learning new lessons from a stressful “ ST segment ”
This is the Incidental ECG of an apparently healthy 50-year-old businessman, recorded while applying for health insurance
How will you describe this ECG?
Let me magnify it for you
Why this big fuss about this ECG?
Such ECGs are so common. Looking at the ST segment, we are supposed to think of significant CAD,, LVH, Aortic stenosis or variants of cardiomyopathy, and sometimes electrolytic shifts. The fact that it is recorded at rest, and the patient is absolutely asymptomatic, it is very unlikely there is ongoing ischemia.It could be a myocardial origin or an unk...
Source: Dr.S.Venkatesan MD - April 22, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized non specific st segment Source Type: blogs
Compare these two ECGs. Do either, neither, or both show anything important?
One case sent by Dr. Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve SmithTake a look at these two ECGs below from two patients in the ED, first without any clinical context. Full case details and outcomes are below.Case 1:Case 2: Case 1:What do you think?This was sent to Dr. Smith by SamGhali (@EM_RESUS) with zero other info. Smith ' s response was: " OMI Mimic. "Later, this info was supplied by Sam:This
ECG was recorded in a 23-year-old African American man with a history
of psychiatric illness, acute alcohol/drug intoxication, brought in by
police officers status post being ...
Source: Dr. Smith's ECG Blog - April 17, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
What's new in midwifery - 13th April 2023
I know, it is not long since the last set of posts. I am (as you can guess) a bit behind. Here are some more recent things you might want to know. All sorts of things in one post this time.NewsAddressing Inequities to IMPROVE Maternal Health for All, from the director of the National Library of Medicine, for Black Maternal Health Week in the USA.NICE guidanceGenedrive MT-RNR1 ID Kit for detecting a genetic variant to guide antibiotic use and prevent hearing loss in babies: early value assessment, HTE6, 30th March 2023.ReportsNHS Preceptorship for Midwifery - , March 2023. This is the ...
Source: Browsing - April 13, 2023 Category: Databases & Libraries Tags: midwifery Source Type: blogs
A 40-something woman with acute pulmonary edema -- see the Speckle Tracking echocardiogram.
A 49 year old woman with h/o COPD only presented with sudden dyspnea. She had acute pulmonary edema on exam. PrehospitalConventional algorithm interpretation: ANTERIOR INFARCT, STEMITransformed ECG by PM Cardio:PM Cardio AI Bot interpretation:OMI with High ConfidenceWhat do you think?There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD.This is proximal LAD Occlusion until proven otherwise.On arrival, lung ultrasound confirmed pulmonary edema (B lines). An ECG was recorded:ED ECG 1:The findings are still present but not nearly as profound now...
Source: Dr. Smith's ECG Blog - April 12, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Off and on chest pain for 24 hours in a 50s year old man
Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell MeyersA man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath. His pain was initially mild, then became severely worse several hours prior to presentation, but then eased off again and was minimal on arrival. There was no associated diaphoresis, nausea, vomiting, arm pain, jaw pain, syncope, lightheadedness or other acute symptoms.Initial vitals: Temp 36.7 C, BP 161/79, RR...
Source: Dr. Smith's ECG Blog - April 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A woman in her 50s with chest pain and dyspnea
Submitted by anonymous, written by Pendell MeyersA woman in her 50s presented to the Emergency Department with chest pain and shortness of breath that woke her from sleep, with diaphoresis. She had a prior history of " NSTEMI " one month ago, during which she had a coronary angiogram reportedly showing no stenosis in any coronary artery. Her vitals were within normal limits.Here is her triage ECG:PM Cardio Version (see original screenshot I received below)Original image. What do you think?Here is the prior ECG on file (from 1 month ago, when she was having " NSTEMI " with high sensitivity troponin peaking at 200 ng/L):What...
Source: Dr. Smith's ECG Blog - March 17, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 40s with epigastric pain and ST Elevation
Case submitted by Magnus Nossen MD, written by Pendell MeyersA previously healthy man in his 40s presented to the ED with epigastric abdominal pain off and on for several days. Vitals were within normal limits.It is unclear whether he had active pain at the time of the first ECG:What do you think?Here is PM Cardio ' s Queen of Hearts interpretation (AI ECG interpretation trained by Meyers, Smith, and PM Cardio team using thousands of cases and their outcomes):The output number ranges from 0 to 1, with numbers closer to zero meaning likely NOT OMI, and numbers closer to 1 meaning OMI. This result of 0.0002 is obviousl...
Source: Dr. Smith's ECG Blog - February 23, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Cardiology update: Should mRNA vaccine myocarditis be a contraindication to future COVID-19 vaccinations ?
BY ANISH KOKA
Myopericarditis is a now a well reported complication associated with Sars-Cov-2 (COVID-19) vaccinations. This has been particularly common with the messenger RNA (mRNA) vaccines (BNT162b2 and mrna-1273), with a particular predilection for young males.
Current guidance by the Australian government “technical advisory groups” as well as the Australian Cardiology Society suggest patients who have experienced myocarditis after an mRNA vaccine may consider a non-mRNA vaccine once “symptom free for at least 6 weeks”.
A just published report of 2 cases from Australia that document myopericarditi...
Source: The Health Care Blog - January 26, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Anish Koka mRNA vaccine myocarditis Source Type: blogs
Unconscious + STEMI criteria: activate the cath lab?
Case submitted and written by Dr. Mazen El-Baba and Dr. Evelyn Dell, with edits from Jesse McLarenEMS brought a John Doe, in his 30s, who was found in an urban forest near a homeless encampment on a cool fall day. There were no signs of trauma on scene or on the patient. EMS reported an initial GCS of 8 with pupils equal and reactive. The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4.Vitals: HR 45; systolic BP was 110-120; irregular respiratory rate; oxygen saturation was normal; tympanic temperature 30; glucose was 6. In the resuscitation room, the patient had another seizure that stopped after...
Source: Dr. Smith's ECG Blog - January 21, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Epsilon Wave
Epsilon wave, the classical ECG finding in arrhythmogenic right ventricular dysplasia is seen at the end of the QRS complex. Epsilon wave is typically seen in right precordial leads though it has been noted in left precordial leads in those with left ventricular involvement. ARVD is better termed arrhythmogenic cardiomyopathy because of the possibility of left ventricular involvement. Epsilon wave represents the delayed activation of surviving islands of myocardium within the fibrofatty tissue in ARVD [1]. Some have called it as a ‘post excitation’ wave, as a corollary to the delta wave in pre excitation.
It ...
Source: Cardiophile MD - January 20, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Which is the Ideal site to ablate VT circuit ?
Management of recurrent ventricular tachycardia has developed a lot in recent times. Anti-arrhythmic drugs(AADs) were a cornerstone for recurrent and refractory VTs .Surgeries including CABG, repair of the aneurysm, and subendocardial resection has helped to control many post-MI ischemic VTs. Soon they became obsolete. Realistically, PCIs had little impact on post-MI VT for some unknown reasons. However, with the advent of ICDs and RF, ablation, a new dimension is added to this field.
ICDs, though an attractive device, don’t prevent a VT but vow to nullify the consequence of VT. This is problematic. ICDs in spit...
Source: Dr.S.Venkatesan MD - January 12, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
A teenager with chest pain, a troponin below the limit of detection, and " benign early repolarization "
Sent by anonymous, written by Pendell MeyersA male in his teens presented with complaints of chest discomfort and dyspnea beginning while exercising but without obvious injury. He immediately stopped exercising and symptoms started to improve. Later that evening he felt recurrent central chest discomfort, shortness of breath, and vomited. Symptoms have been constant since this second episode, and are still present on arrival, which seems to have been less than 1 to 2 hours from onset of symptoms. No similar symptoms in the past. No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of...
Source: Dr. Smith's ECG Blog - January 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Foobaw and more
Let me start with Damar Hamlin. His physicians haven ' t said anything publicly about what happened to him, but there are basically two possibilities. First, it is obviously uncommon but not unheard of for apparently healthy athletes to suffer cardiac arrest during exertion. This happened to Boston Celtics star Reggie Lewis. I happened to be in Boston Garden watching the first round playoff game against the Charlotte Hornets on April 29, 1993 when Lewis collapsed. All of the spectators were baffled about what had happened. Doctors at New England Baptist Hospital later diagnosed him with a heart abnormality...
Source: Stayin' Alive - January 6, 2023 Category: American Health Source Type: blogs
Missing links in IHD : What is the relationship between Ischemia & cardiac arrhythmias ?
The term Ischemic heart disease (IHD) was once very popular, but many abandoned it as it became an academic cliche. CAD & CAHD are the other terms that are equally popular and prevalent. Stable IHD was in vogue till recently, which was again replaced by “chronic coronary syndrome’ now. Honestly, I feel the original term IHD to be restored however outdated it may look. it encompasses the entire spectrum of clinical cardiac disorders.
Manifestation of Ischemia heart disease
Angina
Infarction
Cardiac failure
Arrhythmias
Silent ischemia
Sudden cardiac death
The ...
Source: Dr.S.Venkatesan MD - January 5, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions Cardiology-Arrhythmias Relationship between Ischemia and arrhytmias Source Type: blogs
