OMI in a pediatric patient? Teenagers do get acute coronary occlusion, so don't automatically dismiss the idea.
Acute coronary syndrome in a pediatric patient?Written by Kirsten Morrissey, MD with edits by Bracey,
Grauer, Meyers, and Smith An older teen was transferred from an outside hospital
with elevated serum troponin and and ECG demonstrating ST elevations. The patient was obese and had a medical history of only recurrent tonsillitis status post tonsillectomy and adenoidectomy but was otherwise healthy and fully vaccinated. He reported 1.5 days of chest pain that started as substernal and crushing in nature awakening him from sleep and occasionally traveling to right side of neck. The pain ...
Source: Dr. Smith's ECG Blog - December 5, 2023 Category: Cardiology Authors: Bracey Source Type: blogs
TWiV 889: COVID-19 clinical update #110 with Dr. Daniel Griffin
outbreaks, viral load in vaccinated and unvaccinated individuals, predictive capacity of symptoms in children, comparison of antigen tests, incidence of myocarditis after vaccination, steroids during replication phase, Paxlovid efficacy and safety, fluvoxamine, sabizabutin, colchicine, and prevalence of infection in Africa. (Source: virology blog)
Source: virology blog - April 16, 2022 Category: Virology Authors: Vincent Racaniello Tags: This Week in Virology antiviral coronavirus COVID-19 delta inflammation Long Covid monoclonal antibody pandemic SARS-CoV-2 vaccine vaccine booster variant of concern viruses Source Type: blogs
A 30-something with inferior ST Elevation. OMI? Pericarditis? Normal Variant ST Elevation?
This study showed that ANY ST depression in lead aVL is highly sensitive for inferior OMI, and that zero patients with pericarditis had this feature.Of the 154 patients with catheterization laboratory diagnosis of inferior STEMI, 154 patients (sensitivity, 100%; CI, 98%-100%) had some degree of ST depression in lead aVL (at least 0.25mm). In addition, all 154 patients demonstrated T-wave inversion in lead aVL (sensitivity, 100%; CI, 98%-100%). Of the 49 pericarditis patients, zero (0%) had any ST-segment depression in lead aVL (CI, 0%-7%), and 7 (14%) of 49 (CI, 7%-27%) had T-wave inversion in aV...
Source: Dr. Smith's ECG Blog - February 16, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Drugs for COVID-19: A Publishing Epidemic
As of April 9, PubMed listed 2,868 scientific publications which incorporate the word “COVID”. 323 of these (11.3%) were related to drugs under study for treatment of the disease. No fewer than thirty-one such drugs had been proposed since this pandemic first appeared on the planet four months earlier.
Graph 1 depicts the cumulative numbers of COVID-19 infection (per 100,000 global population) and introductions of relevant drugs into the Literature during February 14 to April 3. Note that both increased by a factor of approximately 16-fold during this period.
In a...
Source: GIDEON blog - April 12, 2020 Category: Databases & Libraries Authors: Uri Blackman Tags: Epidemiology Graphs Source Type: blogs
" Pericarditis " strikes again
Written by Pendell MeyersA man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. Several hours prior to presentation, while driving his truck, he started experiencing new central chest pain, without radiation, aggravating/alleviating factors, or other associated symptoms. On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. On exam the patient was well appearing, with normal vitals signs other than BP 155/82, no murmurs or rubs, normal pulses, no reproducible chest pain.Here is his triage ECG:Wha...
Source: Dr. Smith's ECG Blog - December 12, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
One Physician ’s Frustrations of Practicing Amidst the CHIPHIT Complex and Implications for the Future of the U.S. Healthcare System
By HAYWARD ZWERLING, MD
The high cost, low quality and systemic inequities of the U.S. healthcare system have been the impetus for its redesign. Our healthcare system is now controlled by Consolidated Healthcare institutions, Insurance companies, Pharmaceutical companies and Health Information Technology companies (CHIPHIT complex). The CHIPHIT complex, along with the Federal Government, will create and control our future healthcare system. Ominously missing from this list are independent healthcare policy experts, independent healthcare providers and members of the general public.
Historical precedents have demonst...
Source: The Health Care Blog - May 8, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Health Policy Hayward Zwerling health inequities US Healthcare Source Type: blogs
Why the wheelchair? Could it be gout?
When Paul Manafort appeared in court for sentencing recently, he was in a wheelchair and pleaded for leniency, in part because “his confinement had taken a toll on his physical and mental health.” He reportedly had symptoms of depression and anxiety — but what was the health problem that put him in a wheelchair? According to multiple news reports, the answer is gout. Yes, that ancient disease you may have thought didn’t exist anymore has stricken Mr. Manafort. He joins the rising number of people in the country diagnosed with this common disease.
What is gout?
Gout is a cause of severe joint pain and inflammation....
Source: Harvard Health Blog - March 29, 2019 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Arthritis Bones and joints Health Inflammation Source Type: blogs
Watch what happens when " pericarditis " and morphine cloud your judgment
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve SmithCaseA 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain “similar to his prior MI, but worse.” The pain initially started the daypriorto presentation. The pain roused him from sleep but subsided without intervention. Around 19 hours later, he experienced the same pain, which prompted his presentation to the ED. By this time, three hours had passed from the onset of the pain but it was no longer present. Here is his initial ECG:00:04What do you think? - Sinus rhythm at ~70 bpmSTE in...
Source: Dr. Smith's ECG Blog - July 3, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
You Diagnose Pericarditis at your Peril (at the Patient's Peril!)
The source of this case is anonymous.A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chest pain radiating to " both axilla " as well as the upper back. She was reportedly " pacing in her room while holding her chest " .The initial tracing (EKG 1) was obtained.Clinician and EKG machine read of acute pericarditis.What do you think?There is sinus rhythm. There is diffuse ST elevation in II, III, aVF and V3-V6. One might agree with the computer and the clinician because there is inferolateral ST elevation without any recip...
Source: Dr. Smith's ECG Blog - June 20, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
To activate or not to activate?
Written by Pendell Meyers, with edits by Steve SmithI was texted this ECG with no clinical information:(This will be called ECG-2)What do you think?I replied " Actually I think this might be a false positive. "The ECG shows sinus rhythm with relatively normal QRS complex followed by large STE in V1-V3, with ~4mm STE in V2. There are no pathologic Q-waves, no terminal QRS distortion. I do not think there is any STD in the inferior leads; there is a tiny amount of PR depression (normal) and the J-point is exactly on line with the PR interval. In lead III the T-wave does slope downward at first, but I just didn ' t think this...
Source: Dr. Smith's ECG Blog - March 5, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
ST Elevation after Stab Wound to the Heart
A young man presented after a stab wound to the chest. Rapid ED diagnosis of cardiac penetrating trauma was made by ED ultrasound, and the patient went to the OR and had a wound to the right atrium repaired. There was no laceration of any coronary vessel. He did well. Because of tachycardia, this ECG was recorded at day 3:There is sinus tach with diffuse ST depression, and a bit of ST depression in lead III. There is PR depression, especially in leads II and V5. QTc is 383 ms.This diffuse ST elevation is clearly due to pericarditis, especially given the clinical scenario. It is slightly u...
Source: Dr. Smith's ECG Blog - February 7, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Funtabulously Frivolous Friday Five 176
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 176.
Question 1
Piperazine was first introduced as an anti parasitic drug in 1953 but it has a side affect. What is ‘worm wobble’?
+ Reveal the Funtabulous Answer
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Cerebral Ataxia
The neurotoxic effects are usually seen after the initial doses, and resolution of symptoms is rapid and complete within 24...
Source: Life in the Fast Lane - February 10, 2017 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five Albright's bezoar cerebral ataxia colchicine Hello Kitty Kallmann's meadow saffron Puberty Rapunzel Syndrome snakes Taiwan wobble worm Source Type: blogs
Health care costs – the big problems
Physicians often wonder in what reality we have the current health care cost problem. Contrast physician payments with the pharmaceutical industry.
As an internist with over 35 years experience, my payment schedule is exactly the same as a newly minted internist. Can anyone think of another profession that does not get some credit for experience and reputation?
Can anyone imagine a payment system that encourages you to spend less time with your patient, because you payment for a 15 minute visit is likely the same as a 20 minute visit? Can you consider the implications of a system that encourages volume rather than a...
Source: DB's Medical Rants - August 27, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Addressing Generic Drug Unaffordability And Shortages By Globalizing The Market For Old Drugs
Dramatic increases in the price of generic drugs have focused the attention of policymakers and the public on the limitations of marketplace economics as a means of managing drug costs and access. In recent years, prices have increased sharply for established products that have been in use for 50 years or more. These include colchicine for gout (50-fold), digoxin for heart failure (6-fold), and isoproterenol for heart rhythm abnormalities (5-fold).
In one prominent example, Turing Pharmaceutical raised the cost of pyrimethamine (Daraprim), a 62-year old treatment for toxoplasmosis by over 5,000 percent, from $13 to $750 pe...
Source: Health Affairs Blog - February 23, 2016 Category: Health Management Authors: Alfred Engelberg, Jerry Avorn and Aaron Kesselheim Tags: Costs and Spending Drugs and Medical Technology Health Policy Lab Payment Policy Public Health Big Pharma Daraprim generic drugs Hatch-Waxman Act Turing Pharmaceuticals Source Type: blogs
MKSAP: 72-year-old man with acute swelling and severe pain of the right knee
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old man is evaluated in the emergency department for acute swelling, severe pain, and warmth of the right knee that woke him from sleep. He does not recall any inciting injury to the knee. Three months ago, he had an acutely swollen great toe that improved within 3 days, for which he did not seek treatment. History is also significant for hypertension and diabetes mellitus. Medications are hydrochlorothiazide and metformin.
On physical examination, temperature is 37.8 °C (100.1 °F), blood pressure is...
Source: Kevin, M.D. - Medical Weblog - February 20, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Rheumatology Source Type: blogs
