A man in his 50s with abdominal pain and a computer read of ***Acute MI ***
Submitted by Dr. Arjun J V, Written by Pendell MeyersA man in his 50s with history of diabetes presented with acute onset abdominal pain and nausea.Here is his ECG at triage:What do you think?Sinus bradycardia. The QRS is narrow but very abnormal with significant LVH. There are widespread, dramatic, and discordant ST and T wave deviations which are due to the LVH. Look at leads III and aVF here for a particularly important lesson for your eyes. In these leads, the QRS does not actually have radically large QRS voltage, but yet there is substantial (easily meeting STEMI criteria) ST elevation which is due to LVH ...
Source: Dr. Smith's ECG Blog - January 8, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
How to check for pulsus paradoxus?
Pulsus paradoxus is an exaggeration of the normal inspiratory fall in blood pressure. The paradox in pulsus paradoxus is that the pulse is not well felt when the heart sounds are still audible. The extent of fall in inspiratory pressure can be documented using a sphygmomanometer.
Pulsus paradoxus
Pulsus paradoxus is the typical finding in cardiac tamponade, though it can occur more commonly in obstructive airways disease. In obstructive airways disease, it is due to the wide swing in intrathoracic pressure. Other less likely causes are constrictive pericarditis and restrictive cardiomyopathy. It has also been reported in ...
Source: Cardiophile MD - December 31, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
Hyperacute T-waves -- missed. Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) may be due to transient thrombotic Occlusion MI.
Coronary thrombosis (twice in the same patient!!) without a stenosis or even a culpritDo not miss the last image at the bottom that shows the series of T-waves in V4-V6I recently had a discussion with an incredibly smart and fantastic ECG and Cardiology expert. He was skeptical that you can have OMI with Wellens waves without having a major stenosis on angiogram.I told him I ' ve seen it on occasion and that this happens due to thrombosis of non-obstructive lesions that lead to complete occlusion but that thencompletely lyse and do not show stenosis by the time of the angiogram. I said that even if there is not...
Source: Dr. Smith's ECG Blog - December 29, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 50s with acute chest pain, now resolved, has 2 undetectable troponins. CT Coronary Angiogram?
Written by Pendell MeyersA man in his 50s presented to the ED with chest pain described as pressure, without radiation, acute onset about three hours prior to arrival. He had had stuttering less severe versions of this pain all week that usually went away after a few minutes. He also had diaphoresis and dyspnea. He had extensive family history of CAD with CABG ' s in the mid 50s for multiple relatives, but he had no personal known history of CAD. It is unclear whether he had pain at the time of triage, but notes describe that his pain had subsided by the time of EM physician evaluation:Triage at approximately 21...
Source: Dr. Smith's ECG Blog - December 6, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Toothache, incidental Wide Complex Tachycardia
Discussion by our ElectrophysiologistSmith: “I thought that the wide complex tachy (WCT) could be AVRT or VT” EP: " Antidromic AVRT morphology would essentially be the same as “VT” originating from ventricular the insertion site of the accessory pathway. Therefore, traditional criteria for SVT with aberrancy do not apply to antidromic AVRT (except, that negative concordance can never be AVRT!) " Smith: “But then when the patient converted and had PVCs of exactly the same morphology as the WCT, that it must be VT and not AVRT ” EP: " In cases of intermittent pre-excitation, you cou...
Source: Dr. Smith's ECG Blog - November 17, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fight Aging! Newsletter, November 15th 2021
This article will review the relationship between diabetes mellitus and AD as it relates to tau pathology. More understanding of the link between diabetes mellitus and AD could change the approach researchers and clinicians take toward both diseases, potentially leading to new treatments and preventative strategies in the future.
Signaling from White Fat Tissue Contributes to Age-Related Hair Follicle Dysfunction
https://www.fightaging.org/archives/2021/11/signaling-from-white-fat-tissue-contributes-to-age-related-hair-follicle-dysfunction/
Changes in fat tissue behavior in the skin take place with age,...
Source: Fight Aging! - November 14, 2021 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Piling on the Senescent Cells: How Young Can One Die of Old Age?
The authors of today's open access paper use the provocative question "how young can you die of old age?" as a framing device, a way to consider what is known of the way in which type 2 diabetes and obesity harm people over the course of years and decades. These are, of course, very well studied conditions. A great deal of time has been spent and a great deal of ink spilled on the topic of exactly what excess visceral fat and the pathologies of diabetes do to an individual, at the level of cells, at the level of organs, and, most visibly, to overall health and mortality. What is new, as of recent years, is the understandin...
Source: Fight Aging! - November 8, 2021 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Fight Aging! Newsletter, November 8th 2021
In conclusion, in less common and visible cardiovascular diseases, it is crucial to recognize substantial progress and achievement, given that penetration of such information into clinical practice and the patient community can be inconsistent. Diseases such as hypertrophic cardiomyopathy, pulmonary arterial hypertension, and ATTR cardiac amyloidosis, once linked to a uniformly adverse prognosis, are now associated with the opportunity for patients to experience satisfactory quality of life and extended longevity.
VitaDAO, a Novel Approach to Crowdfunding Life Science Research
https://www.fightaging.org/archiv...
Source: Fight Aging! - November 7, 2021 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Agitation, Confusion, and Unusual Wide Complex Tachycardia. What is it, why did it occur, and how to treat?
A 50-something male ran a 10 mile race, after which he complained of a headache. The next day, he collapsed and had a witnessed seizure.He arrived agitated and the monitor showed a wide complex tachycardia. He was very hypertensive and tachycardic.A 12-lead ECG was obtained:What is it? What therapy?There are wide complex QRS ' s with 2 different morphologies:1. RBBB configuration with an axis of about 135 degrees (lower right axis toward III)2. IVCD (neither RBBB nor LBBB) with a " Northwest " (upper right) axis toward aVRThere appear to be 3 possible P-waves, but they are not consistent and not definitel...
Source: Dr. Smith's ECG Blog - November 6, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Cardiovascular Disease is Perhaps Less Well Understood than is Widely Perceived to be the Case
In conclusion, in less common and visible cardiovascular diseases, it is crucial to recognize substantial progress and achievement, given that penetration of such information into clinical practice and the patient community can be inconsistent. Diseases such as hypertrophic cardiomyopathy, pulmonary arterial hypertension, and ATTR cardiac amyloidosis, once linked to a uniformly adverse prognosis, are now associated with the opportunity for patients to experience satisfactory quality of life and extended longevity. (Source: Fight Aging!)
Source: Fight Aging! - November 4, 2021 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Hypertrophic cardiomyopathy : Two posters that summarise everything essential
Check out these two posters* for are a quick reference on HOCM with current updated evidence. The first one details about Echo evaluation. The second one illustrates the genetic screening flow chart of the HOCM families.
Some of the queries, you will find the answers from these posters are,
1. How to recognize Intrinsic mitral valve defect by MR jet morphology?
2. How to cross-check the true LVOT gradient from MR jet?
3. When to do a provocative test to document the LVOT gradient?
4. What are the standard pre-myectomy measurements by Echo?
5. How to screen a family member of HCM? Pros and cons of Phenotyp...
Source: Dr.S.Venkatesan MD - November 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology Illistrations Cardiology Illustrations Cardiology teaching websites Cardiology-Echocardiography cardiomyopathy hocm hcm hypertrophic cardiomyopathy Uncategorized Alcohol septal ablation ASE posters on hocm hcm best illistrat Source Type: blogs
Bromocriptine has been shown to be useful in all except – Cardiology MCQ – Answer
Bromocriptine has been shown to be useful in all except:
Correct answer: 3. Peripheral arterial disease
Bromocriptine is used for suppression of lactation and in the treatment of Parkinsonism. It has been shown to be useful in type 2 diabetes mellitus as well. Recent studies have shown its benefit in peripartum cardiomyopathy [1]. Being an ergot derivative, one of the adverse effect noted in the study was peripheral arterial occlusion. 16kDa prolactin subunit has been shown to produce endothelial dysfunction cardiac muscle cell dysfunction in experimental studies. Prolactin can promote inflammation in peripartum cardiom...
Source: Cardiophile MD - October 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology 16kDa prolactin subunit peripartum cardiomyopathy Prolactin and peripartum cardiomyopathy. Prolactin can promote inflammation in peripartum cardiomyopathy Source Type: blogs
Syncope in a young man
Written by Pendell MeyersLet ' s say a young person presented with exertional syncope. They are now at baseline, asymptomatic, normal vital signs, and they have this ECG at triage:What do you think?Below are two other variations of this patient ' s resting ECG from different time periods:Answer: Arrhythmogenic Right Ventricular CardiomyopathySee the end of the post for review and details on ARVC and it ' s ECG findings, but suffice to say that this patient has sinus rhythm, small epsilon wave in some of his ECGs, and R waves in V1-V3 with TWI.Here is a close up of V1-V3:Notice the very subtle micro-voltages at the J ...
Source: Dr. Smith's ECG Blog - September 16, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Some ECG simply require pattern recognition, followed by a bit of investigation
Brooks Walsh @BrooksWalsh helped with this post One of my partners showed me this series of ECGs, without any info:I said: " It ' s a normal variant. Young black male, right? "He said, " Yes, but look at this one recorded 2 hours later. It is different " :There is T-wave inversion in V4 that was not there before.I said: " Yes, small changes can happen even with normal variants. " And there might be a slight difference in lead placement. On the 2nd ECG, V4 is farther to the right -- notice there is more S-wave than on the first and the R/S ratio is smaller. There was also a 3rd ECG at 3.5 h...
Source: Dr. Smith's ECG Blog - August 30, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Pregnancy in Hypertrophic cardiomyopathy : LSCS or vaginal delivery ?
Hypertrophic cardiomyopathy is a specific genetic disorder of myocyte (myosin and others) within the sarcomere. Though uncommon in pregnancy it raises considerable anxiety to the patient, family, and the obstetrician.
Hemodynamics
Though we tend to worry more about dynamic LVOT obstruction, it is actually the restrictive physiology of LV myocardium that might cause more concern. Three key variables operate in this entity namely preload, afterload, and contractility that determine the cardiac hemodynamics and possibly the symptoms. We know the classical consequence of pregnancy is a fall in systemic vascular resistance(...
Source: Dr.S.Venkatesan MD - August 27, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Pregnancy and heart pregnancy and heart disease Uncategorized esc ropac zahara pregnancy heart disease complicating pregnancy indication for lscs in hcm hocm lscs or normal delivery in hocm hcm pregnancy in hocm pregnancy in hypertrophic c Source Type: blogs
