Unstable Angina still exists. It can be missed especially high sensitivity troponin is not used. Sometimes you can catch it on the ECG.
A 50-something woman with H/o HTN, ESRD, CAD S/p complex PCI to ostial LAD and ramus (10/2020) and CABG x3 (LIMA to LAD, SVG to OM, SVG to ramus)She complained of intermittent episodes of substernal chest pain, radiating to left shoulder, lasting 2-3 minutes.This had been worked up before at another ED on 3 occasions for the same chest discomfort.--The 1st time, she was " ruled out " with a point of care (POC) troponin ＜0.03 ng/mL.--The 2nd time, she was " ruled out " again with a POC troponin ＜0.03 ng/mL.--The 3rd time, she " ruled out " with a laboratory-based 4th generation troponin at 0.018 ng/m...
Source: Dr. Smith's ECG Blog - September 5, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Weekly Overseas Health IT Links –27th August 2022.
In this study, researchers gathered a diverse group of participants; 43 percent were Black, and 68 percent were women. They also considered factors such as age and insurance status when drawing conclusions.The study occurred through a clinical trial, where all participants were randomly assigned to have their next visit occur through either phone or video-based platforms. The central unit of measurement was visit satisfaction rate, reported on a ten-point scale. Researchers noted noninferiority data based on whether patient satisfaction between the telehealth methods exceeded a -15 percent margin.-----https://www.theverge....
Source: Australian Health Information Technology - August 27, 2022 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs
Acute chest pain and a bizarre ECG
Written by Pendell MeyersA middle aged adult presented with acute undifferentiated chest pain.Here is his ECG at triage:What do you think?I sent this ECG with no clinical information to Dr. McLaren, who replied simply " Artifact " . He is referring to an artifactual ECG pattern that corresponds with the cardiac cycle which is known as " arterial pulse tapping artifact. " See the discussion and links at the end of the post for more information, but this phenotype of ECG artifact is not yet well understood (to my knowledge). In some cases, it has been attributed to placement of an electrode near a pulsing anatomic...
Source: Dr. Smith's ECG Blog - August 26, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
New onset IRBBB
A PubMed search for new onset incomplete right bundle branch block returned 7 citations of which only two were on incomplete right bundle branch block. Another search on new onset IRBBB returned 40 citations but they were on RBBB rather than IRBBB.
The first result on IRBBB was in a study on hybrid transthoracic periventricular device closure of ventricular septal defects [1]. Three of their 59 patients developed incomplete right bundle branch block. One of them resolved during follow up. One had mild residual VSD shunt.
The second was on electrophysiological study before and after paramembranous ventricular septal ...
Source: Cardiophile MD - August 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs
Very fast narrow complex tachycardia
A 50-something with h/o palpitations, chest pain, and EF of 40% (of unknown etiology) presented with chest pain.Blood pressure, perfusion, and mental status were normal. Patient was comfortable appearing. Here is his initial ED ECG:Narrow Complex Tachycardia at a rate of 217AModified Valsalva was attempted without success.Then 6 mg of adenosinewas given. There was a 2 second interruption, and then this rhythm strip was recorded: There is now a wide complex, with RBBB pattern. For unknown reason, the right bundle no longer repolarizes in time for the next beat. It is r...
Source: Dr. Smith's ECG Blog - August 23, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
A woman in her 30s with several days of chest pain and an episode of altered mental status.
Written by Pendell Meyers, reviewed by Smith, Grauer, McLarenA woman in her early 30s with history of diabetes had 2-3 days of gradual onset nonradiating chest pain with associated nausea, malaise, and shortness of breath. Then she had an " abrupt change in her mental status and became more somnolent and less responsive " at home in front of her family. Her family called EMS, who found the patient awake and alert complaining of worsening chest pain compared to the prior few days.En route to the ED, they recorded this ECG and transmitted it, asking whether the cath lab should be activated:What do you think?There is sinus rh...
Source: Dr. Smith's ECG Blog - August 15, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Inferior ST Elevation and Hyperacute T-waves, but Patient is Pain Free. What is going on?
Conclusion — the 145 pts studied by de Zwaan, B är& Wellens in 1982 continue to provide clinical insight into the nature of Wellens ' Syndrome some 40 years after this manuscript was written. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - August 12, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Hackers, Breaches And The Value Of Health Data: 2022 E-Book Update
As solutions like remote care are becoming the norm, 3D printing disrupts the normal supply chain and the number of life science studies on tools like artificial intelligence (A.I.) skyrocket, it’s become clear that we are not anticipating the digital health era; we are in the digital health era. This was to come sooner or later, but the pandemic accelerated the process by years.
However, along with the enhanced healthcare landscape that digital health brings along, there is the pressing issue of privacy. To put it bluntly, there is no digital health without sacrificing a part of our privacy. The advanced techno...
Source: The Medical Futurist - August 11, 2022 Category: Information Technology Authors: Pranavsingh Dhunnoo Tags: Covid-19 Digital Health Research E-Patients Future of Medicine Future of Pharma Genomics Health Sensors & Trackers Healthcare Design Healthcare Policy Personalized Medicine Security & Privacy Telemedicine & Smartphones amazon dev Source Type: blogs
A man in his 40s with multitrauma from motor vehicle collision
DiscussionThis is a case where clinical context is of vital importance, because the EKG manifestations of cardiac contusion are fairly unpredictable. Intramyocardial hemorrhage, edema, and necrosis of myocardial muscle cells are characteristics of cardiac contusion. All of these cause troponin elevation, making troponin a very specific marker for cardiac injury. It is suggested that a troponin that is within normal reference range at about 4-6 hours from the inciting event suggests strongly the absence of cardiac injury in blunt chest trauma (Sybrandy).The EKG is not generally sensitive for cardiac contusion. The right ven...
Source: Dr. Smith's ECG Blog - August 6, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
What happens if you don't recognize Hyperacute T-waves?
The origin of these ECGs cannot be revealed. Time 0:Sinus rhythm with an intraventricular conduction delay (QRS is about 120 ms)Hyperacute T-waves in V2-V5, Diagnostic of Proximal LAD occlusion, but without ANY ST Elevation except for less than 1 mm in aVL, and 0.25 mm in lead I.There is also minimal STE in aVL with reciprocal STD in II, III, aVF.Notice that there is plenty of R-wave in V2 and V3.This should be an obvious case of acute proximal LAD Occlusion. However, it was missed.In this, case the Hyperacute T-waves are preceded by subtle ST Depression in V2 and V3. Thus, they are specifically the ...
Source: Dr. Smith's ECG Blog - August 3, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 60s with dizziness, nausea, chest pain, and LBBB
Submitted and written by Parker Hambright MD, peer reviewed by Meyers, McLaren, Grauer, SmithA man in his late 60s called EMS for acute dizziness, nausea, vomiting, and chest pain shortly after beginning his morning exercise. The symptoms lasted for only about 15 minutes and then resolved spontaneously. He was brought to the ED and evaluated in less than one hour from onset of symptoms. His history included known CAD, HTN, HLD, prior MI with LAD stent, AAA repair, and reported dizziness/vertigo.Here are his EMS and ED triage ECGs (unclear whether symptoms still present or resolved at time of these ECGs, but it seems that s...
Source: Dr. Smith's ECG Blog - August 1, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Assessing Heart Function and Fluid Status with Cardiac Scales: Interview with John Lipman, CEO, and Corey Centen, Founder, Bodyport
Bodyport, a medtech company based in San Francisco, developed the Bodyport Cardiac Scale, a set of weighing scales that can non-invasively assess fluid status and heart function. The scales can detect these signals through the feet when a patient steps onto the device. The technology is intended to be convenient and requires only 20 seconds each morning, and should easily lend itself to integration into a daily routine.
The device can transmit the data on cardiac hemodynamic parameters to clinicians through cellular networks, and uses AI-based algorithms to identify a variety of hemodynamic biomarkers to aid in ear...
Source: Medgadget - July 29, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Exclusive Bodyport Source Type: blogs
Two patients with chest pain and LVH: Neither STEMI criteria, nor Armstrong criteria, can identify occlusion or reperfusion
Written by Jesse McLarenTwo patients presented with chest pain and LVH on ECG. Patient 1: 65 year old with an hour of left sided chest painPatient 2: 70 year old with 30 minutes of chest pain with nausea and diaphoresisWhat do you think? How do you tell which had an Occlusion MI (OMI)?Do STEMI criteria help? Both have anterior STE in two contiguous leads that exceed STEMI criteria, but both also have LVH. LVH produces tall R waves in the left sided leads with secondary ST depression and T wave inversion, and deep S waves in the right sided leads with secondary ST elevation and tall T waves. In the first patient t...
Source: Dr. Smith's ECG Blog - July 29, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A man in his 50s with hypoxemic respiratory failure from COVID pneumonia develops chest pain
Submitted by anonymous, written by Parker Hambright, MD, peer reviewed by Meyers, Smith, McLarenA man in his 50s with a past medical history of hypertension and tobacco use disorder, who tested COVID positive 11 days prior, presented to the emergency department with worsening shortness of breath over several days. He was tachypneic and hypoxemic down to as low as 44% with reportedly good SpO2 waveform before EMS applied noninvasive ventilation with improvement to 85-89%. Although history was limited by extremis, the report is that there was no chest pain at initial presentation, only shortness of breath.Here is his ECG on ...
Source: Dr. Smith's ECG Blog - July 25, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
A woman in her 40s with intractable nausea and vomiting, dyspnea, and lightheadedness
Submitted and written by Oriane Longerstaey MD, peer reviewed by Meyers, Smith, and McLarenA woman in her 40s with diabetes and HLD presented with nausea and vomiting x3 days. She was seen on day 1 of symptoms at an outside ED, no ECG performed, and sent home with return precautions and zofran, which she had been taking around the clock for persistent nausea and vomiting. She presented on day 3 of symptoms because of new onset dyspnea, tachycardia, lightheadedness, and heart palpitations. She had a " burning " sensation in her chest but no " pain " .A 12 lead EKG was obtained at triage: - Sinus rhythm at 96 bpm&...
Source: Dr. Smith's ECG Blog - July 21, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
