All this teaching makes a difference! And a new paper on subtle ST Elevation.
This study shows that patients with coronary occlusion frequently have minimal ST elevation. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - December 29, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Post operative cardiac arrhythmias
Post operative cardiac arrhythmias are a major cause of morbidity and mortality, more so following surgery for congenital heart disease. Tolerability of arrhythmia is less in the postoperative period than for similar arrhythmia in the preoperative period. Hemodynamic instability is more likely due to the possibility of myocardial dysfunction. Cardiopulmonary bypass, injury to the conduction system during surgery, metabolic and electrolyte abnormalities, especially hypokalemia and hypomagnesemia contribute to the increased incidence of postoperative arrhythmias. Stress of the surgery with enhanced sympathetic tone and use ...
Source: Cardiophile MD - November 23, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery ECG / Electrophysiology Source Type: blogs
Top stories in health and medicine, November 20, 2014
From MedPage Today:
No Benefit to CABG, Mitral Valve Repair Combo. A year after coronary artery bypass graft surgery (CABG) and mitral valve repair, patients with moderate ischemic mitral regurgitation did not seem to benefit from having the two procedures versus having only CABG.
Watchman Proves Long-Term Mettle in AFib. Left atrial appendage closure in atrial fibrillation patients using the Watchman device bested warfarin therapy for preventing the combined outcomes of stroke, systemic embolism, and cardiovascular death.
A Role for the Microbiome for Arthritis in Kids?. Children who were exposed to antibiotics had an i...
Source: Kevin, M.D. - Medical Weblog - November 20, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Heart Neurology Source Type: blogs
What happened after the PCI?
A middle-aged male with h/o CABG x 3, previous stents, and aortic valve and aortic root replacement presented primarily with headache, but also told the medics that he had chest pain (for 6 hours) because he "knew they would respond faster than if he said headaches." The chest pain was right sided rib and shoulder pain, worse with inspiration, sharp, and sometimes 7-8/10. But the headache was much worse. Chest pain was not relieved by sublingual NTG.He has noticed worsening exertional dyspnea, such that he feels he can only walk about a block before experiencing "chest tightness. Here is his ED ECG ...
Source: Dr. Smith's ECG Blog - October 30, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Grand-Aides And Health Policy: Reducing Readmissions Cost-Effectively
Hospital readmissions for the same condition within 30 days likely should not occur, and most often indicate system failure. Readmitted patients are either discharged too early, should be placed into palliative care or hospice, or most often are victims of a failure in transition of care from hospital to home. Most hospitals and physicians would like to eliminate such readmissions, particularly now that payers like Medicare are penalizing hospitals for high rates of readmission. Numerous approaches have been tried to reduce readmissions, with recent published improvements between a 2 percent and 26 percent reduction.
The G...
Source: Health Affairs Blog - October 29, 2014 Category: Health Management Authors: Arthur Garson Tags: Access All Categories Health Care Costs Health Care Delivery Hospitals Payment Quality Workforce Source Type: blogs
A Hybrid of de Winter's T-waves and Diffuse Subendocardial Ischemia: Left Main Ischemia
A very elderly woman who was highly functional complained of jaw pain and called 911. Her BP was 80/40 with a puls of 45. Here is her prehospital ECG:There is ST elevation in aVR, but also in aVL, V1 and V2. There is diffuse, marked ST depression, in II, III, aVF, V3-V6. The computer appropriately read ****Acute MI**** The ST elevation vector is superior and anterior, not to the right as one would expect with the typical "ST elevation in aVR MI", which would be reciprocal to diffuse ST depression (I, II, V3-V6). This ST elevation vector is also not only towards aVL, as one would expect of...
Source: Dr. Smith's ECG Blog - October 24, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Cardiology MCQ 341: Type 5 myocardial infarction
According to universal definition of myocardial infarction, Type 5 myocardial infarction is:
a) Myocardial infarction secondary to plaque rupture
b) Myocardial infarction secondary to hypotension
c) Myocardial infarction due to stent thrombosis
d) Myocardial infarction associated with coronary artery bypass grafting
["Click here for the answer with explanation", "Correct Answer:"]
d) Myocardial infarction associated with coronary artery bypass grafting
Myocardial infarction associated with coronary artery bypass grafting (CABG) is termed type 5.
Read more on types of myocardial infarction according to universal def...
Source: Cardiophile MD - October 11, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Learn the essence of Interventional coronary care in 180 seconds flat !
Your clock starts now !
Chronic stable angina : Most can be effectively managed by optimal /intensive medicines and life style Interventions .About 10% will require PCI/CABG.
ACS – STEMI: Primarily managed with rapid and competent pre-hospital care with prompt thrombolysis in or out of hospital .Patients with large STEMI who develop complications (Again about 10 %) require PCI and few additional lives can be saved.
ACS-NSTEMI : This is the group that demand an important role for PCI . All true high risk UA/NSTEMI patients should receive urgent coronary angiogram and critical...
Source: Dr.S.Venkatesan MD - October 3, 2014 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions csa ethics in cardiology interventional cardiology management of pci pci ptca in a nutshell priamry pci vs thrombolysis stemi vs nstemi Source Type: blogs
Techniques that May Actually Save Your V-Fib Patient
Winning teams have depth, and games are often won from the bench or deep in the batting order. That is certainly true when competing against ventricular fibrillation, and a few tools you might not know can help these patients.
A 55-year-old man with severe coronary heart disease and previous four-vessel coronary artery bypass surgery collapsed at a mall. He also had an unprotected left main atherosclerotic plaque. Bystanders immediately began chest compressions, and the available AED, unfortunately, advised no shock.
Paramedics started bag-valve-mask ventilation and high-quality mechanical compressions with a Lucas d...
Source: Spontaneous Circulation - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Techniques that May Actually Save Your V-Fib Patient
Winning teams have depth, and games are often won from the bench or deep in the batting order. That is certainly true when competing against ventricular fibrillation, and a few tools you might not know can help these patients.
A 55-year-old man with severe coronary heart disease and previous four-vessel coronary artery bypass surgery collapsed at a mall. He also had an unprotected left main atherosclerotic plaque. Bystanders immediately began chest compressions, and the available AED, unfortunately, advised no shock.
Paramedics started bag-valve-mask ventilation and high-quality mechanical compressions with a Lucas devi...
Source: Spontaneous Circulation - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Hospital Discharge Race: is Sooner Always Better?
They say that if you can remember the 1960s, you weren’t there. I do remember this about 1966, however: I spent my birthday that year in a hospital bed, where I’d been a patient for a full month recuperating from a ruptured appendix and a nasty case of peritonitis. Back then during the dawn of civilization, it was common for patients to spend far longer in hospital than we ever would now. For example:
For North American maternity patients during the same era, the average length of stay in hospital for uncomplicated vaginal deliveries was about seven days. Today, that stay is more likely to be just 1-2 days(1).
F...
Source: Disruptive Women in Health Care - September 10, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Uncategorized Source Type: blogs
Arkansas Payment Improvement Initiative: The First Year
TweetEditor’s note: This post is part of a periodic Health Affairs Blog series, which will run over the next year, looking at payment and delivery reforms in Arkansas and Oregon. The posts will be based on evaluations of these reforms performed with the support of the Robert Wood Johnson Foundation. The authors of this post are part of the team evaluating the Arkansas model.
Arkansas payers and providers actively participated in the design of both the episodic payment and patient-centered medical home (PCMH) models the state has recently implemented. We’ve written about each of these components of the multi-payer Arkan...
Source: Health Affairs Blog - August 25, 2014 Category: Health Management Authors: William Golden, Joseph W. Thompson, Michael Motley, Mark Fendrick, Christopher Mathis, and Michael Chernew Tags: All Categories Medicaid Payment Reform States Source Type: blogs
Poor Microvascular Reperfusion ("No Reflow"): Best Diagnosed by ECG
This study demonstrates the importance of frequent static ECG’s and the insensitivity of using only 2 static ECG’s to detect reperfusion. In 58% of patients, ST segments were unstable, rising and falling, before final resolution.Infrequent static ECG’sCaliff RM et al., Failure of simple clinical measurements to predict perfusion status after intravenous thrombolysis, 1988. Methods: Califf et al. (339) performed angiography on 386 TAMI patients at 60 and 90 minutes post-administration of tissue plasminogen activator (tPA). They recorded a baseline ECG and another at 90 minutes post-tPA, before ...
Source: Dr. Smith's ECG Blog - August 9, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
The Pains of Separation
When a patient arrives to your ED fresh from karate class still in her uniform, you get a feeling about where the case is heading. This patient was 49, and reported that she always had some aches after karate. This evening, though, her pain was very different — and much more concerning. The pain had started about an hour into her class and worsened over the next 30 minutes. It was a severe achy pain over her left chest that radiated to her neck and was associated with pronounced diaphoresis. This prompted an expedited cardiac workup.
The ECG showed a sinus tachycardia with ST-elevation in V2-V3, I, aVR, aVL, with depr...
Source: Spontaneous Circulation - August 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Pains of Separation
When a patient arrives to your ED fresh from karate class still in her uniform, you get a feeling about where the case is heading. This patient was 49, and reported that she always had some aches after karate. This evening, though, her pain was very different — and much more concerning. The pain had started about an hour into her class and worsened over the next 30 minutes. It was a severe achy pain over her left chest that radiated to her neck and was associated with pronounced diaphoresis. This prompted an expedited cardiac workup.
The ECG showed a sinus tachycardia with ST-elevation in V2-V3, I, aVR, aVL, with de...
Source: Spontaneous Circulation - August 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
