Chest pain after motor vehicle collision with an abnormal ECG - blunt cardiac injury? OMI? normal variant?
Discussion:Significant cardiac trauma occurs in approximately 10% of patients with severe blunt chest trauma. Isolated coronary artery dissection from blunt trauma is a very rare event. Traumatic dissections are most often seen in the LAD, followed by the RCA and LCX. It is thought that this is due to the relative anterior position of the LAD. The ECG is a report from the myocytes of their condition. They do not know the etiology of acute complete ischemia. No matter if its typical ACS, traumatic dissection causing acute occlusion, or spasm, it is the same result to the myocytes, and the same findings can be present o...
Source: Dr. Smith's ECG Blog - December 30, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
DAPT blues in ACS : Does Prasugrel really bother to know about the coronary anatomy before it acts ?
It appears,antiplatelet agents are waging a turf war on the CAD battlefield. It is no secret either, the fight often goes beyond academic reasons. Though NSTEMI connotes a true cardiac emergency, it consists of a highly heterogeneous population. A patient with UA can be treated even at home (Low-grade angina with little ECG changes, when it’s due to Increase demand situation). While, in the other extreme of NSTEMI, a patient with a GRACE score >200, in Ischemic LVF, might need an emergency multivessel angioplasty along with Mitra clip ± ECMO support.
Antiplatelet agents along with heparin will re...
Source: Dr.S.Venkatesan MD - October 19, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome oral anticoagulants warfarin acitrom prasugrel 2b3a vs prasugrel coronary anatomy in nsteacs dapt mapt NSTEMI guidelines esc acc 2020 prasugrel vs aspirin vs ticagrelor reopro vs prasugrel themis twilight study Source Type: blogs
Chest Pain and Ischemic ST Depression — but there is no Cath Lab available. Thrombolytics?
===================================MY Comment by KEN GRAUER, MD (7/14/2020):===================================This middle-aged man with hypertension and hyperlipidemia presented to the ED with 2 hours of new-onset chest pain — and the ECG shown in Figure-1. The patient was hemodynamically stable. No prior tracing was available for comparison.HOW would you interpret the ECG shown in Figure-1?Immediate cath lab activation was not an option in this hospital. Should acute thrombolysis be used?Figure-1: The initial ECG in the ED (See text).My THOUGHTS on ECG #1...
Source: Dr. Smith's ECG Blog - July 14, 2020 Category: Cardiology Authors: ECG Interpretation Source Type: blogs
Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on?
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely. When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA. ===================================MY Comment by KEN ...
Source: Dr. Smith's ECG Blog - June 27, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Why should the three antiplatelet siblings Tica ,Prasu & Clopi fight perennially?
Anti-platelet drugs find a place virtually in every prescription written by a cardiologist for CAD.No doubt, it sits right on top among the highest prescribed medication in the world. They are used in all forms of CAD/ ACS. It becomes mandatory in post PCI as a stent maintenance protocol. Cardiologists (at least me) are exhausted with so many studies with these drugs. When we thought we are relaxing for a while, the current issue of circulation release a big meta-analysis with 50,000 patient data.It tries to draw fresh battle lines between the three friendly P2Y12 inhibitors.
https://doi.org/10.1161/CIRCULATI...
Source: Dr.S.Venkatesan MD - June 12, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome anti platelet drug bms vs des isar react 5 themis stents for high bleeding risk biofreedom onyxone ticagrelor vs prasugrel vs clopidogrel Source Type: blogs
1 hour of CPR, then ECMO circulation, then successful defibrillation....
An elderly woman had sudden ventricular fibrillation.She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). ECMO Flow was achieved after approximately 1 hour of high quality CPR.After good ECMO flow was established, she was successfully defibrillated.Here is her monitor rhythm:Notice the " Shark Fin " morphology in lead I monitor rhythm.Also notice that the arterial line mean arterial pressure is 63 mmHg, but there is no waveform (and SpO2 says " no pulse " ), as the flow is continuous on ECMO and the LV function at this point was ext...
Source: Dr. Smith's ECG Blog - May 18, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Issues in thrombolysis: There may not be anything called “ Absolute contraindication ”
This post was originally written in 2013.
A middle-aged man with STEMI came to our CCU. It is just another case of STEMI and asked my fellow to lyse.
But it was not the case . He, told me, Sir, the patient had a syncope following chest pain and he has injured his face and Jaw. He was actively bleeding. When I saw this face, it was indeed frightening.
What shall we do ? When a patient with STEMI presents with bleeding facial Injury
Rush for Immediate PCI (Which was of course not possible in our place as it happened out of office hours! )
Take that ultimate risk and thrombolysis
Give only heparin ( Many times it ...
Source: Dr.S.Venkatesan MD - May 16, 2020 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Cardiology Risk assesment cardiology- coronary care Cardiology-Coronary artery disese Primary PCI Thrombolysis relative and absolute con Source Type: blogs
Left atrial appendage closure devices
Anticoagulation for prevention of stroke is a well established modality of treatment in atrial fibrillation. But a significant number of them have bleeding complications. Hence the option of left atrial appendage closure with multiple types of devices have been developed. Left atrial appendage with its sluggish flow is the most common location for thrombus formation in atrial fibrillation.
Following devices have been used with varying success:
Watchman
Amplatzer Cardiac Plug/Amulet
Lariat suture ligation
Atriclip
PROTECT-AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillatio...
Source: Cardiophile MD - April 15, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
32 yo with right sided chest pain. Zero ST Elevation, but that does not matter.
DiscussionIn hindsight I feel there are very few alternative causes for an ECG like this other than an acute LAD occlusion. I believe this is one of those ' subtle STEMI ' cases where neither the ECG nor the symptoms are very obvious or severe and the usual evolution is not seen.I think of these cases as ' insidious infarcts ' and I have seen this in all infarct territories and I do not think they are particularly rare. Essentially the patient is fairly comfortable and the ECG is not obvious but the patient ended up with Q waves, huge troponins and we missed the opportunity to reperfuse the artery when it counts. These pat...
Source: Dr. Smith's ECG Blog - February 17, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
CO poisoning. Routine ECG recorded before hyperbaric therapy....Are they related?
This patient was working on his truck in a garage without ventilation and the vehicle was running. He felt dizzy and lost consciousness. The next thing he remembers is waking up in the ambulance. He was last seen normal at 09:00 AM and was found down at 10:30 AM. He denied chest pain, abdominal pain, SOB or any other symptoms, though he did endorse chest pressure when asked specifically.He underwent a routine ECG prior to hyperbaric therapy for CO poisoning:Obvious Massive STEMI, Proximal LAD OcclusionHis CO level returned at 34%.Further h/o revealed that he had had a proximal LAD stent placed for a Non-Occlusion MI more t...
Source: Dr. Smith's ECG Blog - December 8, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 41 year old with chest pain and a Nondiagnostic Triage ECG. Thrombolytics prior to transfer for PCI.
Conclusion:Transfer for PCI without thrombolytics is best if PCI at receiving facility can be done in less than 120 minutes from first medical contact, or less than 90 minutes from STEMI diagnosis in first ED.Thrombolytics prior to Transfer to a PCI capable facility, then rescue PCI if no reperfusion for STEMITRANSFER AMI(Cantor et al. 2009).High risk STEMI: BP less than 100, HR greater than 100 Killip class II, III, ST depression of at least 2 mm in precordial leads, ST elevation in right precordial leads (right ventricular MIAll patients get TNK-tPA.80-90% received clopidogrel 300 mg (75 mg for age over...
Source: Dr. Smith's ECG Blog - November 7, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
40-something male in a head-on Motor Vehicle Collision and Splenic Injury
A 40-something male presents to the stabilization room for evaluation following head on motor vehicle collision (MVC). Pt was reported restrained driver, hit at city speeds, with + airbag deployment.The MVC was unquestionably caused by the other car, not by this driver.The patient complained to EMS of chest pain and a prehospital EKG en route was concerning for STEMI.The patient was at all times hemodynamically stable, without evidence of any profuse bleeding.He had an ECG recorded on arrival to the ED:Anterior and Inferior STEMI with diffuse hyperacute T-waves. This ECG really can ' t be anything else.&nb...
Source: Dr. Smith's ECG Blog - October 26, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
The “ World anti-platelet ” boxing championship 2019 !
Conclusions in science is a misnomer . . . )
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - September 20, 2019 Category: Cardiology Authors: dr s venkatesan Tags: anti platelet drug anti platelet drugs antiplatelet guidleines acc aha esc clopidogrel dapt mapt ISAR REACT PLATO trial prasugrel THEMIS TRIAL ticagrelor triton timi 38 treat plato twilight trial Source Type: blogs
Antiplatelet agent given only after angiography – Cardiology MCQ
Antiplatelet agent given only after angiography – Cardiology MCQ
Which of the following agents is given only after assessing coronary anatomy by angiography in acute coronary syndrome?
Ticlopidine
Clopidogrel
Prasugrel
Ticagrelor
Post your answer as a comment below. (Source: Cardiophile MD)
Source: Cardiophile MD - September 3, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Antibiotic effect of ticagrelor
Ticagrelor is a reversible platelet adenosine diphosphate P2Y12 receptor (P2Y12) inhibitor and is quite effective as an antiplatelet agent. New research suggests an antibiotic effect for ticagrelor and the researchers suggest that further research may lead to development of a new class of antibiotics [1]. In fact there is a global need for new antibiotics, which are conspicuous by their absence in the current scenario of multidrug resistant organisms. The study published as a Research Letter in JAMA Cardiology reports on the ‘Antibacterial Activity of Ticagrelor in Conventional Antiplatelet Dosages Against Antibi...
Source: Cardiophile MD - May 20, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
