How does stress cause heart disease? Cardiology Basics
Stress and heart disease have various aspects. Stress can lead to increase in risk factors for cardiovascular disease as well as precipitate symptoms in a hitherto silent cardiovascular disease. There is also a condition known as stress cardiomyopathy or broken heart syndrome, typically precipitated by an acute stressful event like loss of spouse in an elderly female. Most older persons have build-up of atherosclerotic plaques in the coronary arteries. When there is a sudden severe stress, heart rate and blood pressure can shoot up due to sympathetic overactivity. There is also the release of stress hormones like adrenali...
Source: Cardiophile MD - October 16, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Chest pain in children – Cardiology Basics
Chest pain in children – Cardiology Basics Even though chest pain in children is a common symptom, unlike in adults it is seldom due to heart disease. Most often the cause of chest pain in children is not a major life threatening disease. Still chest pain can cause restriction of activities, absence from school and cause of anxiety to children and their parents. A good history and physical examination can give a lot of information to exclude any potentially serious condition causing chest pain, though it is rare. Costochondritis is a common cause of chest pain in adolescent and preadolescent girls. It can b...
Source: Cardiophile MD - October 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is a myocardial bridge? Cardiology Basics
Normally the coronary arteries are located outside the myocardium. Occasionally a segment of the coronary artery passes through the myocardium. This causes a narrowing of that region in systole and is known as myocardial bridging. Myocardial bridging can be recognized as narrowing of a region of the coronary artery in systole which normalizes in diastole. Usually myocardial bridges do not cause myocardial ischemia as normally the blood flow into the myocardium occur mostly during diastole. Still myocardial bridges can rarely cause  myocardial ischemia and cause chest pain. Rarely this may need recurrent hospital admi...
Source: Cardiophile MD - October 10, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Athlete ’s heart – Cardiology Basics
Athlete’s heart – Cardiology Basics Athlete’s heart is thickening of the heart muscle due to constant training in response to increased circulatory demand. Athlete’s heart is not dangerous, it is a physiological adaptation of the heart to training and increased load. It is associated with a slow heart rate, called athlete’s bradycardia. The slower resting heart rate is a protective mechanism to prevent undue rise with exercise as normally heart rate increases with intensity of exercise. There is an increase in the size of the chambers of the heart and increased efficacy of pumping to meet the high demand duri...
Source: Cardiophile MD - October 8, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Acute chest pain: " Activate the Cath Lab!!!!! " Or not?
I was called to the resuscitation room to manage a STEMI patient.I walked into the resuscitation area and was handed this ECG:What did I say?Within 3 seconds, I said: " That is a Fakeout " . (i.e., a STEMI mimic)  Everyone was perplexed.  This patient had presented with chest pain and had ST Elevation and they were certain this was a STEMI and they were going to activate the cath lab.Interestingly, my very smart partner Richard Gray who also reads all my blog posts, was working in triage and had already seen this ECG just as it was recorded, and immediately recognized this as a STEMI mimic. He went to the ch...
Source: Dr. Smith's ECG Blog - October 6, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

Think about genetics in heart disease [PODCAST]
Subscribe to The Podcast by KevinMD. Catch up on old episodes! “Despite these high numbers, we cardiologists often look to genetic screening last in our diagnostic workup. But without genetic screening, we can’t always see the whole picture in our cardiomyopathy patients. Once we’ve excluded coronary disease as an etiology, available diagnostic tools such as Read more… Think about genetics in heart disease [PODCAST] originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 29, 2022 Category: General Medicine Authors: Tags: Podcast Cardiology Genetics Source Type: blogs

Atrial functional mitral regurgitation
Atrial functional mitral regurgitation occurs secondary to left atrial disease, without left ventricular dilatation and intrinsic mitral valve disease. Atrial functional MR typically occurs in the setting of long-standing atrial fibrillation. It is associated with increased mortality risk and hospitalization for heart failure [1]. Reported prevalence of atrial functional MR in patients with AF vary between 3 to 15%. These patients have worse clinical outcome [2]. Dilatation of the mitral annulus, atriogenic tethering of mitral leaflets and insufficient mitral leaflet remodeling are thought to be important pathogenic mecha...
Source: Cardiophile MD - September 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is Wellens ’ syndrome?
What is Wellens’ syndrome? The original description of Wellens’ syndrome dates back to 1982 in which they identified a subgroup of patients admitted with unstable angina who are at high risk of development of an extensive anterior wall myocardial infarction. These patients with critical stenosis high in the left anterior descending coronary artery, had characteristic ST-T segment changes in the precordial leads on or shortly after admission. They noted this finding in 26 of their 145 patients admitted because of unstable angina. In spite of symptom control with nitroglycerine and beta blockade, 12 of the 16 pat...
Source: Cardiophile MD - September 26, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

This ECG is nearly pathognomonic. What is it? (hint: it's not Wellens')
I was texted this ECG:What did I say?My response: " takotusubo "Even without a history, this is the likely diagnosis.  Later, I obtained the history: 60-something woman who presented with agitation and had taken a benzodiazepine overdose.  There was no report of chest pain.  She had a respiratory alkalosis, with venous pH of 7.56 (equivalent to an arterial pH of higher than 7.60 and possibly contributing to the long QT and ECG abnormalities).  Electrolytes were normal.  She was also on Duloxetine, which can prolong the QT, and on Lithium (but her level was very low).This is almost certainly ta...
Source: Dr. Smith's ECG Blog - September 19, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

Fight Aging! Newsletter, September 5th 2022
Conclusion Coupled with the animal data, and the existing human trial data for safety, the results here suggests that someone should run a formal, controlled trial of flagellin immunization in older people, 65 and over. The goal would be to see whether (a) this sort of outcome holds up in a larger group of people, and (b) there is a meaningful impact on chronic inflammation and other parameters of health that are known to be affected by the aging of the gut microbiome. The most interesting part of the data is perhaps the decline in microbial diversity, when considered against the gains elsewhere. Microbial dive...
Source: Fight Aging! - September 4, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

Searching for Age-Slowing Drugs in the Antidiabetic Portfolio
Data for the ability of metformin to slow aging has researchers looking at other antidiabetic drugs these days, even given that the evidence for metformin to have a meaningful impact on aging in non-diabetic animals is not great, very mixed, and even the human data for a modest addition of a few years in type 2 diabetes patients is most likely not as good as the impact of exercise and control of weight. Still, repurposing drugs to produce modest effects in a different condition has long been a going concern; regulators make it so hard to develop new drugs that it makes economic sense to repurpose existing drugs, even when ...
Source: Fight Aging! - August 31, 2022 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Cardiomyopathy in muscular dystrophies
Important muscular dystrophies due to mutations in structural cytoskeletal dystrophin gene are known as dystrophinopathies. They include Duchenne muscular dystrophy, Becker muscular dystrophy and X-linked dilated cardiomyopathy. Primary presentation of most dystrophinopathies is skeletal muscle weakness. Duchenne muscular dystrophy is caused by mutations leading to absence of functional dystrophin. Becker muscular dystrophy is due to mutations resulting in reduced amounts of shortened dystrophin protein. Cardiac muscle being a striated muscle, is affected in many types of muscular dystrophies. Cardiomyopathy would contrib...
Source: Cardiophile MD - August 30, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Very fast narrow complex tachycardia
A 50-something with h/o palpitations, chest pain, and EF of 40% (of unknown etiology) presented with chest pain.Blood pressure, perfusion, and mental status were normal.  Patient was comfortable appearing.  Here is his initial ED ECG:Narrow Complex Tachycardia at a rate of 217AModified Valsalva was attempted without success.Then 6 mg of adenosinewas given.  There was a 2 second interruption, and then this rhythm strip was recorded:  There is now a wide complex, with RBBB pattern.  For unknown reason, the right bundle no longer repolarizes in time for the next beat.  It is r...
Source: Dr. Smith's ECG Blog - August 23, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

A man in his 50s with hypoxemic respiratory failure from COVID pneumonia develops chest pain
Submitted by anonymous, written by Parker Hambright, MD, peer reviewed by Meyers, Smith, McLarenA man in his 50s with a past medical history of hypertension and tobacco use disorder, who tested COVID positive 11 days prior, presented to the emergency department with worsening shortness of breath over several days. He was tachypneic and hypoxemic down to as low as 44% with reportedly good SpO2 waveform before EMS applied noninvasive ventilation with improvement to 85-89%. Although history was limited by extremis, the report is that there was no chest pain at initial presentation, only shortness of breath.Here is his ECG on ...
Source: Dr. Smith's ECG Blog - July 25, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

A woman in her 40s with intractable nausea and vomiting, dyspnea, and lightheadedness
 Submitted and written by Oriane Longerstaey MD, peer reviewed by Meyers, Smith, and McLarenA woman in her 40s with diabetes and HLD presented with nausea and vomiting x3 days. She was seen on day 1 of symptoms at an outside ED, no ECG performed, and sent home with return precautions and zofran, which she had been taking around the clock for persistent nausea and vomiting. She presented on day 3 of symptoms because of new onset dyspnea, tachycardia, lightheadedness, and heart palpitations. She had a " burning " sensation in her chest but no " pain " .A 12 lead EKG was obtained at triage: - Sinus rhythm at 96 bpm&...
Source: Dr. Smith's ECG Blog - July 21, 2022 Category: Cardiology Authors: Pendell Source Type: blogs