Return to McAllen: A Father-Son Interview
By IAN ROBERTSON KIBBE
You are going to hear a little more about McAllen, TX on THCB Shortly. And before we dive into what’s happened there lately, I thought those of you who weren’t here back in the day might want to read an article on THCB from July 2009. Where then THCB editor Ian Kibbe interviewed his dad David Kibbe about what he was doing as a primary care doc in McAllen–Matthew Holt
By now, Dr. Atul Gawande’s article on McAllen’s high cost of health care has been widely read. The article spawned a number of responses and catalyzed a national discussion on cost controls and t...
Source: The Health Care Blog - January 27, 2023 Category: Consumer Health News Authors: matthew holt Tags: Uncategorized David Kibbe Ian Robertson Kibbe McAllen Physicians TX Source Type: blogs
Intraoperative Imaging for Porcelain Aorta
Diffuse calcification of ascending aorta which may extend down is known as “Porcelain aorta”. Intraoperative epiaortic echocardiography along with manual palpation during surgery has been described as the most sensitive technique for detecting ascending aortic atheroma and calcification [1].
A prospective study evaluated this in hundred consecutive patients undergoing coronary bypass or valve surgery [2]. Ascending aorta was assessed by manual palpation by the operating surgeon, intraoperative transesophageal echocardiography and epiaortic ultrasound using linear and phased-array imaging. No difference was noted...
Source: Cardiophile MD - December 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
See OMI vs. STEMI philosophy in action
by Emre AslangerDr. Aslanger is our newest editorial member. He is an interventional cardiologist in Turkey. Dr. Aslanger is also the author of the DIFFOCULT study:Emre K. Aslanger,a,⁎ Özlem Yıldırımtürk,b Bar ış Şimşek,c Emrah Bozbeyo ğlu,c Mustafa Aytek Şimşek,a Can Y ücel Karabay,b Stephen W. Smith,d and Muzaffer De ğertekina DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. International Journal of Cardiology Heart& VasculatureCaseA 40-year-old man presents with...
Source: Dr. Smith's ECG Blog - December 22, 2022 Category: Cardiology Authors: Emre Aslanger Source Type: blogs
Thrombus, tumor or vegetation?
This question is often faced by the echocardiographer while evaluating a mass detected on the heart valves or cardiac chambers. Usual method is to take it in the clinical context. There could also be non-infective vegetations of marantic endocarditis which are almost impossible to differentiate from infective vegetations. Marantic vegetations can be suspected in the presence of small and multiple vegetations changing from one examination to another, without associated abscess or valve destruction [1]. It may be noted that echocardiography is neither 100% specific nor 100% sensitive for the diagnosis of infective endocardi...
Source: Cardiophile MD - December 15, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Endometrial cavity fluid, pyometra
Sonography of the uterus in a middle aged female shows:=Large fluid-filled endometrial cavity with particulate matter = usually caused by obstruction to outflow of fluid from the endometrial cavity = TVS scan advised to rule out carcinoma cervix = CT scan confirmation needed = ultrasound images below suggest pyometra or purulent fluid collection in endometrial cavity For more visit:Sonography of uterus (Source: cochinblogs)
Source: cochinblogs - December 6, 2022 Category: Radiology Source Type: blogs
December 2022: Which is Best? Manual or Drill for IO Access in Neonates
Intraosseous (IO) vascular access use in children began in the 1940s, but the practice was abandoned when intravenous catheters were invented. A resurgence of interest in IO access began decades later, and the procedure was first added to the Pediatric Advanced Life Support guidelines in 1986. Intraosseous access has now become the preferred access method over central line placement and for peripheral IV access that takes longer than 30 seconds.Initially, manual intraosseous needles were used for neonatal resuscitations because they were the only tools available. Once we learned the skill, manual IO needles served their pu...
Source: M2E Too! Mellick's Multimedia EduBlog - November 30, 2022 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Asynchronous Telemedicine Is Coming And Here Is Why It ’ s The Future Of Remote Care
Asynchronous telemedicine is one of those terms we will need to get used to in the coming years. Although it may sound alien, chances are you have been using some form of it for a while.
With the progress of digital health, especially due to the pandemic’s impact, remote care has become a popular approach in the healthcare setting. It can come in two forms: synchronous telemedicine and asynchronous telemedicine.
Synchronous refers to having discussions in real-time: the patient and the healthcare provider are connected with an audio or audio-visual link to have a live consultation.
Asynchro...
Source: The Medical Futurist - November 30, 2022 Category: Information Technology Authors: Andrea Koncz Tags: Telemedicine & Smartphones telehealth remote care Asynchronous telemedicine Source Type: blogs
A woman in her 20s with syncope
Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and GrauerA woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope.Her initial vital signs revealed a temp of 97.7F, HR 125, RR 20, BP 115/90, and an oxygen saturation of 95% on room air. Upon arrival, she did not appear in acute distress. She was noted to be tachycardic and her heart sounds were distant on physical exam. She had a normal respiratory effort, and her lungs were clear to...
Source: Dr. Smith's ECG Blog - November 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
What is myocardial stunning and hibernation? Cardiology Basics
Just as you can get stunned for some time if hit on the head, part of the myocardium can also stop functioning following transient coronary obstruction. This usually occurs following a myocardial infarction after which the occluded coronary artery gets opened up spontaneously or by thrombolytic therapy or primary angioplasty.
After a variable period of time, the stunned myocardium usually recovers full function. During the period of stunning, if a large part of myocardium is involved, the person may have features of heart failure due to decreased left ventricular systolic function. Myocardial stunning is the reason for he...
Source: Cardiophile MD - October 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is myocardial viability assessment? Cardiology Basics
Myocardial viability means regions of myocardium which can recover its function if the blood supply is normalized. Viable myocardium will improve after restoring blood supply while non-viable myocardium will not.
So myocardial viability assessment is important in deciding whether the person will benefit from revascularization procedures like coronary angioplasty and coronary bypass surgery.
There are two types of viable myocardium, stunned myocardium and hibernating myocardium. Stunned myocardium needs only time to recover while hibernating myocardium needs restoration of blood supply. Stunned myocardium is transient dela...
Source: Cardiophile MD - October 12, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is a myocardial bridge? Cardiology Basics
Normally the coronary arteries are located outside the myocardium. Occasionally a segment of the coronary artery passes through the myocardium. This causes a narrowing of that region in systole and is known as myocardial bridging. Myocardial bridging can be recognized as narrowing of a region of the coronary artery in systole which normalizes in diastole.
Usually myocardial bridges do not cause myocardial ischemia as normally the blood flow into the myocardium occur mostly during diastole. Still myocardial bridges can rarely cause myocardial ischemia and cause chest pain. Rarely this may need recurrent hospital admi...
Source: Cardiophile MD - October 10, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Athlete ’s heart – Cardiology Basics
Athlete’s heart – Cardiology Basics
Athlete’s heart is thickening of the heart muscle due to constant training in response to increased circulatory demand. Athlete’s heart is not dangerous, it is a physiological adaptation of the heart to training and increased load. It is associated with a slow heart rate, called athlete’s bradycardia.
The slower resting heart rate is a protective mechanism to prevent undue rise with exercise as normally heart rate increases with intensity of exercise. There is an increase in the size of the chambers of the heart and increased efficacy of pumping to meet the high demand duri...
Source: Cardiophile MD - October 8, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is coronary calcium scoring? Cardiology Basics
Coronary calcium scoring is done from a plain multidetector computed tomography (CT) scan. MDCT produces images of coronary arteries in multiple thin slices. Calcium deposits in plaques within the coronary arteries can be found from these images. Calcium deposits occur within atherosclerotic lesions inside the coronary arteries. Some of these plaques can rupture later and lead to clot formation and total occlusion causing acute myocardial infarction.
Coronary calcium scoring can be done as an outpatient test from the X-ray department. As no contrast medium is injected, there is no risk of allergic reactions unlike CT coro...
Source: Cardiophile MD - October 6, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
October 2022: A Case of Ankle Annihilation
“Has your ankle been a problem for a long time?"I felt a sense of déjà vu looking at my patient's foot. I had seen this before: Someone with diabetes who had worsening, long-standing ankle pain, and had seen various doctors over the years.As before, my patient's foot was swollen, without ulcerations or signs of cellulitis or acute trauma. Perhaps we would do better this time. We could optimize our resource utilization, have him spend less time in the emergency department, and offer better care.Still, we began with an x-ray, and predicted that this symptom was one that some people with diabetes develop chronica...
Source: Lions and Tigers and Bears - October 6, 2022 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Does the Aortic root contract or relax during ventricular systole ?
Some time back I asked this question in one of my classes for the fellows and found no takers. Not even a guess? I realized later it was indeed a tough question. The heart is not the only dynamic organ as we generally believe. The entire aorta which is the extension of the left ventricle has to be dynamic according to the physics of ventricular-arterial coupling and the momentum of blood flow.
What happens to the aortic dimension with systole?
Even prior to systole, there is evidence, Aorta gets ready to receive the blood from the LV. So, the Aortic root is larger at the onset of systole. (Ref 2 It is been g...
Source: Dr.S.Venkatesan MD - October 1, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Anatomy of heart Uncategorized aortic root dynamism cardiology research topic Source Type: blogs
