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
Chest pain, RBBB but “STEMI Negative”: Is this a false cath lab activation, or a false cancellation?
A 90 year old with a history of atrial fibrillation presented with two weeks of intermittent retrosternal chest pain lasting minutes. An hour prior to presentation it became constant and more severe, accompanied by nausea and general weakness, and the paramedics brought them to the ED as a code STEMI. Heart rate was in the 50s and other vitals normal. What do you think? There ’s atrial fibrillation, a right bundle branch block, normal axis and normal voltages. RBBB should produce secondary ST depression and T wave inversion in the anterior leads with the RsR’ (as it does in V1). But here in...
Source: Dr. Smith's ECG Blog - July 18, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A Middle Aged Male diagnosed with Gastroesophageal Reflux
This middle aged male with h/o GERD but also h/o stents presented to the ED with chest pain. He had been at a clinic that day where he had complained of worsening GERD. An EKG was recorded and interpreted as normal by the computer, the clinician, and by the overreading cardiologist.He had an ECG recorded in triage (I am not certain whether the patient had active pain at this time; I believe he didnot):What do you think?Here is the patient ' s ECG from several hours ago (which was essentially the same):This shows minimal inferior ST Elevation that is howeverall but diagnostic of inferior ischemia. There is the o...
Source: Dr. Smith's ECG Blog - July 16, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
See what happens when the consultant is " Not convinced of STEMI "
Sent by Arjun V, written by Pendell Meyers, edits by SmithA man in his early 40s with history of HTN and obesity suffered sudden out of hospital cardiac arrest. EMS arrived and found him in VF. He was defibrillated successfully, but had several more episodes of VF arrest on the way to the Emergency Department. Here are some examples of his prehospital rhythms:At the ED, sustained ROSC was achieved. He was intubated with minimal available neurologic exam.He had several ECGs recorded in the ED soon after ROSC:The ECGs show likelyAFib with RBBB morphology. There isprofound right axis deviation, which likely r...
Source: Dr. Smith's ECG Blog - July 13, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Instant easy save if you understand OMI, but incredibly dangerous if you only know STEMI. Readers of this blog will instantly understand this and save lives!
Written by Pendell MeyersA man in his 60s presented with 1 hour of acute chest pain. Vitals were within normal limits.Here is his triage ECG:30 minutes later:The ECG is a classic, pathognomonic ECG for acute LAD OMI. There is STE in V1 and de Winter morphology (hyperacute T wave with depressed ST takeoff / ST depression) in V2-V4. In the lateral leads V5-V6 and I and aVL there is STD that is likely in part reciprocal to the STE in V1. Also reciprocal STD in II and aVF, or potentially also de Winter morphology in inferior leads as well. With hyperacute T wave and STE in V1 and STD in V5-6, this constitutes an LAD OMI ...
Source: Dr. Smith's ECG Blog - July 11, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Bonus Features – July 3, 3022 – Judge says Apple infringed AliveCor ’ s patent, more than half of patients have trouble managing their records, and more
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.
News
An International Trade Commission (ITC) judge has ruled that Apple infringed AliveCor’s patented personal electrocardiogram technology. The judge’s decision follows two complaints that AliveCor filed against App...
Source: EMR and HIPAA - July 3, 2022 Category: Information Technology Authors: Brian Eastwood Tags: C-Suite Leadership Health IT Company Healthcare IT Hospital - Health System AliveCor Andy Powell Apple Autonomous Revenue Cycle Management Cedar Gate Technologies DarioHealth DrFirst ECG Patents Harmony Health IT Healthcare IT To Source Type: blogs
When Normal is only Pseudo-Normal, it can deceive the caregivers.
An Aussie friend down under sent me this case. A 70-something male presented with sharp stabbing central CP. Here is the initial ECG with 7/10 CP:NormalThe pain was resolving, and another ECG was recorded with 3/10 CP:Normal, but compared to the first, the T-waves in V2 and V3 are not as tall. Hmm.......The pain completely resolved:What do you think?Now there is an all-but-diagnostic terminal T-wave inversion in V2. This is very subtle Wellens ' .The patient then developed 8/10 stabbing CP again:The T-wave in V2 is again upright, indicating re-occlusion of the LAD. There is also less T-wave inv...
Source: Dr. Smith's ECG Blog - June 29, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Bonus Features – June 26, 2022 – Walgreens gets into clinical trials, ONC offering SDOH grants, and more
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.
News
Walgreens has launched a clinical trial business; the company is focusing specifically on increasing racial and ethnic diversity in clinical trials, as nearly half of its 9,000 are in areas defined as “soc...
Source: EMR and HIPAA - June 26, 2022 Category: Information Technology Authors: Brian Eastwood Tags: Health IT Company Healthcare IT Hospital - Health System Biofourmis Cardiologs CarePort Centene CipherHealth Clinical Trials DiA Imaging Analysis Health Net Healthcare IT Today Bonus Features HealthCorum Healthy Alliance HIXNY Source Type: blogs
Acute chest pain and a difficult ECG
Conclusion: Whereas I did not feel we could rule out an OMI from the initial tracing shown in Figure-1 — none of the subsequent tracings in today ' s case were suggestive of an acute event. I suspect that IF the initial ECG would have beenimmediately repeated withaccurate chest lead electrode placement — that there maynot have been any need for concern about a possible acute event from the initial ECG.Learning Point: When clinical decision-making hangs in the balance and you strongly suspect an error in lead placement — it is best toimmediately repeat the ECG —&nbs...
Source: Dr. Smith's ECG Blog - June 25, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
LVH and Anterior ST Elevation: is it OMI and would you activate the cath lab?
Written by Jesse McLaren (@ECGCases), with comments by Smith and Grauer A 50 year old presented with chest pain radiating to the shoulder. They had a history of an LAD stent 10 years ago and alcohol use disorder, with repeated visits for chest pain and two code STEMIs two years ago that found no occlusive disease. What do you think? There ’s normal sinus rhythm, normal intervals, normal axis, and normal R wave progression. There’s LVH with repolarization abnormalities, including discordant ST depression and T wave inversion inferolaterally and discordant ST elevation and tall T wave in V2. Are there...
Source: Dr. Smith's ECG Blog - June 20, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A man in his 30s with chest pain and a normal bedside echo, without wall motion abnormality
In conclusion — our THANKS to Drs. Nicacio and Meyers for presenting today ' s case. As interesting as I found the initial ECG to be — the KEY point in today ' s case is that identification of suspicious (albeit indefinite) ECG findings in this patient with typical unrelieved chest pain merited timely cath (which was done within 15 minutes of ED presentation) — and this confirmed the need for prompt revascularization. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - June 17, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Eko DUO Digital ECG + Stethoscope: Exclusive Interview and Review
In the latest advancements of AI and med tech, the Eko DUO stands out as a smart and reliable product with FDA-cleared artificial intelligence (AI) algorithms being used to detect leading indicators of heart disease. More significantly, this is a smart stethoscope that boasts point-of-care ECG capabilities to detect signs of heart disease such as murmurs and arrhythmias, making it truly unique in its class and one of the first of its kind being used in the clinic.
The DUO is similar to Eko’s 3M Littmann CORE Digital Stethoscope in that it features enhanced acoustics that enable clinicians to amplify sounds to bett...
Source: Medgadget - June 8, 2022 Category: Medical Devices Authors: Alice Ferng Tags: Cardiology Exclusive Medicine Pediatrics Telemedicine Eko_Health stethoscope Source Type: blogs
ST elevation after gunshot to the chest
Conclusion: The ECG in Figure-1 would not be typical for non-traumatic acute pericarditis. However, it could be consistent with traumatic pericarditis (because ECG findings are so variable in traumatic pericarditis).NOTE: The ECG features of acute myocarditis may differ substantially from those of a " pure " pericarditis. There may be a resemblance between these 2 entities — but ST segment deviations (elevation and depression) with myocarditis may not follow the timing seen with pericarditis. In addition, Q waves may develop — so at times it may...
Source: Dr. Smith's ECG Blog - June 8, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Why do we NOT name Occlusion MI (OMI) after an EKG finding? (In contrast to STEMI, which is named after ST Elevation)
A 40-something male with no previous cardiac disease presented with chest pain.Here is his ECG:There is no clear evidence of OMI or ischemia. There is a tiny amount of STE in aVL, but it is NOT in the context of a tiny R-wave. There is a tiny amount of STD in lead III, with some non-specific T-wave flattening.I am glad that Ken Grauer (below) brings up the issue of whether the presence of " T-wave in V1 taller than T-wave in V6 " is evidence for OMI. I showed conclusively that this is a common finding in normal ECGs, though it is more common in LAD Occlusion than in norml variant STE. Moreover,...
Source: Dr. Smith's ECG Blog - June 1, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Does a Single Troponin below the 99th percentile URL Rule out Acute MI if the Chest pain is very prolonged?
A 66 y.o. male who presented for chest pain that started this AM when he woke up, and has persisted throughout the day prompting him to call 911. He says the pain is dull in nature and located across the chest, does not radiate, that it isworse with exhalation. He denies worsening with activity or positioning. He endorses SOB and requested to sit up. He says this has not happened to him before. He endorses cough productive of yellow sputum. He denies any edema. Denies history of venous thromboembolism. He endorses a 50 pack year history of smoking. He denies recent illness or recent s...
Source: Dr. Smith's ECG Blog - May 26, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
