Cardiologists need to keep an open mind and be capable of listening to, and learning from, the Emergency Physician
Conclusion: This represents the largest study of patients with VPR and angiographically-proven ACO. The MSC were highly sensitive and specific for the diagnosis of ACO in patients presenting to the ED with VPR and symptoms of acute coronary syndrome.===================================MY Comment by KEN GRAUER, MD (10/4/2020):===================================Today ’s case provides a superb example of how acute OMI can sometimes be definitively recognized even in the presence ofpacing. Unfortunately, this was not recognized by the cardiology team despite&nbs...
Source: Dr. Smith's ECG Blog - October 4, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Inspection of precordium
Precordial examination starts with inspection, though inspection and palpation are often combined in regular practice. Some of the features to look for are:
Sternal deformities: Pectus excavatum is concavity of the sternum, and is the commonest congenital malformation of the chest wall which may be associated with congenital heart diseases like ventricular septal defect. Pectus carinatum is sternal prominence, also known as pigeon chest, which can occur in congenital heart disease with large left to right shunts in infancy.
Visible pulsations: Suprasternal pulsations can be seen in aortic aneurysm and aortic regurgitatio...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs
Don ’ t Confuse the Art and Science of Medicine: PCI vs CABG for Left Main Disease
It is often said that medicine is both an art and a science. In an imperfect world this is both inevitable and desirable. But it is extremely important that the two should not be confused with each other. In particular, because the “science” side of the equation has achieved overwhelming prestige and authority, it is...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - August 20, 2020 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery People, Places & Events Policy & Ethics CABG guidelines left main disease LMCA PCI Source Type: blogs
What is a useful next step in the evaluation of this patient with Chest pain and this ECG?
Written by Pendell Meyers, submitted by Daryl Williams, edits by Steve SmithA man in his sixties with prior CAD and CABG experienced chest pain and pressure off and on for three days. He saw his primary doctor during this time who had suspected GI related symptoms and increased his PPI medication. On the third day it became more intense and had associated radiation to his neck and left arm, and this reminded the patient of his prior MI symptoms, so he presented to the Emergency Department. It is unclear how long he had constant symptoms during those three days.Here is his triage ECG (no prior was available in our system):W...
Source: Dr. Smith's ECG Blog - July 18, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Syncope and ST Elevation on the Prehospital ECG
DiscussionThus, no further ECGs were recorded and there was no angiogram or stress test or CT coronary angiogram. Acute MI does not often present with syncope alone, without any other symptom, so the pretest probability of acute MI is low.However, the troponins are high and, in my opinion, the data above does not rule out the possibility of type 1 MI. There were very elevated troponins without a significant known stress (which might cause a type 2 MI). The troponins are NOT consistent with STEMI (OMI), which typically has a troponin I of at least 5 ng/mL. Nevertheless, I don ' t think a thrombosis r...
Source: Dr. Smith's ECG Blog - June 19, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Are there benefits of cardiac catheterization for stable coronary artery disease?
One of the main causes of chest pain is a blockage of blood flow down the coronary arteries, the blood vessels that deliver oxygenated blood to our heart muscle to allow it to beat. Depending on how fast the blockage forms, it is labeled as either a stable or unstable blockage.
Unstable blockages occur quickly when an atherosclerotic plaque ruptures within the coronary artery and a clot forms on top of it. The clot, along with the plaque, can obstruct blood flow, deprive heart muscle of oxygen, and lead to a heart attack. This is called an acute coronary syndrome, and it frequently requires a minimally invasive procedure c...
Source: Harvard Health Blog - May 21, 2020 Category: Consumer Health News Authors: Darshan Doshi, MD, MS Tags: Health Heart Health Tests and procedures Source Type: blogs
Brown vs white adipose tissue roles of pericardial fat
This study was conducted using serum and adipose tissue samples collected from pericoronary depots in patients undergoing coronary artery bypass grafting and patients without coronary artery disease undergoing aortic valve replacement [3].
Adipokine synthesis pattern of epicardial also changes in obesity and dyslipidemia. Adiponectin synthesis comes down and proinflammatory adipokines like leptin, tumour necrosis factor alpha, interleukin 1 beta, interleukin 6 and resistin gets synthesised. These are proinflammatory, causing macrophage infiltration, destruction of microvasculature and increase in fibrosis [1]. In one study...
Source: Cardiophile MD - April 28, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Is angioplasty plus stenting or coronary artery bypass surgery better for treating left main coronary artery disease?
This study found no difference between the two treatments for the main endpoint. The stenting group had a slightly higher rate of death, but it wasn’t due to cardiac causes. (There were slightly more patients in the stenting group who died from infection and cancer, which was felt to be unrelated to the procedure.) Similar to NOBLE, EXCEL also found that patients undergoing stenting had higher rates of needing bypass surgery or repeat stenting. There was no difference in stroke rates.
A recent meta-analysis (a study that pools together and analyzes many studies) found that bypass surgery and stenting were equal in terms ...
Source: Harvard Health Blog - April 27, 2020 Category: Consumer Health News Authors: Darshan Doshi, MD, MS Tags: Health Heart Health Surgery Source Type: blogs
Radiation induced coronary artery disease – RICAD
Radiation induced coronary artery disease – RICAD
Radiation induced coronary artery disease (RICAD) is an important long term sequelae of radiotherapy to the chest region. The most common conditions associated with RICAD are breast cancer and Hodgkin’s lymphoma. The risk is higher in Hodgkin’s lymphoma because they receive a higher dose of radiotherapy [1]. It may be noted that radiation is used in the treatment of about 50% of cancers [2]. Hence the importance of RICAD.
Radiation causes vascular endothelial injury. It initiates and accelerates atherosclerosis. Proinflammatory cytokines were increased in ...
Source: Cardiophile MD - April 27, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Onco Cardiology Source Type: blogs
Fight Aging! Newsletter, April 27th 2020
In conclusion, our study demonstrated that Nrf2 deficiency promoted the increasing trend of autophagy during aging in skeletal muscle. Nrf2 deficiency and increasing age may cause excessive autophagy in skeletal muscle, which can be a potential mechanism for the development of sarcopenia.
To What Degree is Chondrocyte Hypertrophy in Osteoarthritis Due to Cellular Senescence?
https://www.fightaging.org/archives/2020/04/to-what-degree-is-chondrocyte-hypertrophy-in-osteoarthritis-due-to-cellular-senescence/
Senescent cells are large. They do not replicate, that function is disabled, but it is as if they go...
Source: Fight Aging! - April 26, 2020 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Heart Attack Risk is Age-Related, but Aging Also Makes Treatments Less Effective
Aging makes everything worse. Its mechanisms of damage and consequence degrade tissue function to the point of catastrophic failure, as in a heart attack. That same damage also makes the immediate consequence of a heart attack worse, and reduces regenerative capacity and the ability to respond to therapies. All in all degenerative aging is an unpleasant business, lacking an upside. The right way forward is to periodically repair the damage before it reaches a pathological level, rather than working on ways to mitigate the consequences of a sizable burden of damage.
Aging elevates the susceptibility of the heart to...
Source: Fight Aging! - April 21, 2020 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
A man in his 60s with chest pain. The ST segments and T waves are ALWAYS interpreted in the context of their QRS.
Written by Pendell MeyersA man in his 60s with history of CAD, CABG, HTN, DM, and smoking presented with chest pain,and shortness of breath over the past 1 hour, and a mild cough over the past few days, of course asking for COVID testing.Here is his ECG on presentation (shown to me with no information):What do you think?Raw Findings: - RBBB (some will also say LPFB) - Negative T-waves in V1-V3 - STD in V1-V6, I, aVL - STE in aVR - V2 has strange QRS morphology that does not seem to fit in the progression between V1 and V3, possibly lead misplacementInterpretation:In the context of RBBB, it is norma...
Source: Dr. Smith's ECG Blog - April 12, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Recognizing and treating depression may help improve heart health
Depression affects about 20% of Americans in their lifetime, and is one of the leading causes of disability. The rates of depression are even higher in those with cardiovascular disease (CVD). Depression affects 38% of patients undergoing coronary artery bypass graft surgery, and the risk of depression is three times as high in patients who have experienced a heart attack compared with the general population. Depression also makes it much more likely that CVD patients will be readmitted to the hospital and report heart-related symptoms.
Yet much of the time, symptoms of depression in those with CVD go unrecognized. And as ...
Source: Harvard Health Blog - April 2, 2020 Category: Consumer Health News Authors: Alyson Kelley-Hedgepeth, MD Tags: Anxiety and Depression Health Heart Health Source Type: blogs
Stress echocardiography – MCQ – Answer
Stress echocardiography – MCQ – Answer
Stress echocardiography is useful when – Correct answer: d) All of the above
Hibernating myocardium is viable myocardium Low dose dobutamine infusion improves the contraction of hibernating myocardial segments which are chronically ischemic. Such patients may benefit from revascularization procedures like coronary artery bypass grafting or percutaneous coronary intervention.
Back to question (Source: Cardiophile MD)
Source: Cardiophile MD - April 1, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs
A man in his 30s with chest pain
Written by Pendell Meyers, case submitted by Tom FieroA man in his 30s walked into the ED complaining of chest pain. His triage ECG was done at 11:30 (no prior was available):What do you think?Sinus tachycardiaNormal QRS complex pattern, with borderline low voltageVery slight STE in leads V2-V5Proportionally large and fat T-waves in V4-5 with straightening of the ST segmentsT-waves also concerning in II, III, aVF, with inappropriately negative T-waves in aVLUsing the LAD OMI vs. BER formula:3 Variable: 27.34 (positive for OMI, using STE60V3=1.5mm, QTc=444, RWV4=2.0mm)4 Variable: 23.01 (positive for OMI, using QRS amplitude...
Source: Dr. Smith's ECG Blog - March 28, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
