A 40 year old with nonspecific symptoms including dizziness
.What do you notice about the ECG?There is a very short QT interval. This is often found in hypercalcemia. See Ken Grauer ' s comments below for detail.Thus, the patient ' s chemistry was done and revealed ionized hypercalcemia of 6.3 mg/dL (normal 4.4 - 5.2)Followup: he was found to have hyperparathyroidism===================================MY Comment, by KEN GRAUER, MD (9/12/2023):===================================Today ' s ECG is remarkable for an uncommon but important finding that we periodically review, because it otherwise is all-too-easy to overlook. For example — Did YO...
Source: Dr. Smith's ECG Blog - September 12, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest pain, among other symptoms. What do you see?
This patient had many complaints including chest pain.The computer called this ***Acute STEMI***What do you think?STEMI never has a very short QT. This QT interval is 320 ms, with a QTc of around 350, depending on which correction formula you use. (There is Bazett, Fridericia, Hodges, Framingham and Rautaharju -- see here at mdcalc: https://www.mdcalc.com/calc/48/corrected-qt-interval-qtcIf the ST Elevation here were due to STEMI, it would be an LAD Occlusion. You can use myLAD Occlusion/Normal Variant STE formula on this. I did, and the result was the lowest value I have ever obtained (1...
Source: Dr. Smith's ECG Blog - February 17, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
February 2021: Clinical Presentation Provides Clue to Toxicity
A 43-year-old man with a history of bipolar disorder, hypertension, and asthma presented with altered mental status and a tremor. He reported increasing fatigue and hand tremors for one day. He said he and his family recently had food poisoning with vomiting and diarrhea for several days. Those symptoms had resolved. He continued to take all of his prescribed medications, which included lithium carbonate (Lithobid) 800 mg BID and amlodipine 10 mg daily.His initial vital signs were a heart rate of 104 bpm, a blood pressure of 136/82 mm Hg, a respiratory rate of 16 bpm, an oxygen saturation of 99% on room air, and a temperat...
Source: The Tox Cave - January 29, 2021 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Fatigue and Weakness and a computer interpretation of STEMI
This case was sent by David Carroll, a 2nd year EM resident, and his attending physician Brad Caloia.A 60-something male presented to the ED with weakness and fatigue. He was diagnosed with a viral syndrome anddischarged. He returned later and had a lab and ECG workup. He had no cardiac history. There was no chest pain or shortness of breath.Here is his ECG:The computer interpretation:Rate: 93 | PR 146 | QRSD 112 | QT/QTc(Bazett) 353/439Normal sinus rhythmAnterolateral infarct, acute / ***ACUTE MI*** What do you think?Dr. Carroll astutely realized something was amiss: what is it?There...
Source: Dr. Smith's ECG Blog - October 30, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Part One: Tapping the Wrist
The wrist is not commonly aspirated in the emergency department, but emergent arthrocentesis may be indicated for extreme or concerning cases, and tapping the wrist to determine the underlying pathology or relieve pain may be of great value. The synovial fluid from the joint space can be analyzed for crystals, infection, and blood. This information may help determine the overall plan and aid in decision-making and consultation. The ultimate treatment plan may include admission, intravenous antibiotics, multiple aspirations, and even surgical washout.A swollen, painful wrist that is hot to the touch is concerning for sep...
Source: The Procedural Pause - April 1, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Clinical Depth: The Power of Knowing More than the Minimum
By HANS DUVEFELT, MD
In medicine, contrary to common belief, it is not usually enough to know the diagnosis and its best treatment or procedure. Guidelines, checklists and protocols only go so far when you are treating real people with diverse constitutions for multiple problems under a variety of circumstances.
The more you know about unusual presentations of common diseases, the more likely you are to make the correct diagnosis, I think everyone would agree. Also, the more you know about the rare diseases that can look like the common one you think you’re seeing in front if you, rather than having just a memorize...
Source: The Health Care Blog - November 6, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care Hans Duvefelt primary care physicians Source Type: blogs
What causes kidney stones (and what to do)
Stone disease has plagued humanity since ancient times. Kidney stones have been identified in Egyptian mummies. The Hippocratic oath describes their treatment: “I will not use the knife, not even verily, on sufferers from stone, but I will give place to such as are craftsmen therein.”
Who gets kidney stones and why?
The lifetime risk of kidney stones among adults in the US is approximately 9%, and it appears that global warming may be increasing that risk. (As the climate warms, human beings are more likely to get dehydrated, which increases the risk of stone formation.) There are four major types of kidney stones: cal...
Source: Harvard Health Blog - May 17, 2019 Category: Consumer Health News Authors: Kevin R. Loughlin, MD, MBA Tags: Health Healthy Aging Kidney and urinary tract Source Type: blogs
Fight Aging! Newsletter, April 22nd 2019
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more.
This content is...
Source: Fight Aging! - April 21, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Even Early Stage Kidney Disease Causes Cognitive Impairment
The link between age-related kidney dysfunction and cognitive impairment is an interesting one, particularly in the context of research into klotho, which has functions in both the kidney and the brain, and has been shown to extend life and improve cognitive function in animal studies. It isn't completely clear as to which of these areas of the body is most important to the noted benefits to cognitive function in animal models, produced via various strategies for klotho overexpression. The most recent research on this topic tends to suggest that the mechanisms are indirect, involving many organ systems, rather than being a...
Source: Fight Aging! - April 16, 2019 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Is cardiac valves really (a)vascular structures ?
Though heart is known primarily as a pump, it is the four cardiac valves that ensures the critical , non-stop unidirectional flow that sustain the circulation . It is to be recalled these valves originate in the very early days of cardiac development when the primitive heart tube loops , even as the chambers expand from primitive ventricle. Mesenchymal differentiation controlled by various genes that cleaves the valve from myocardial tissue.
While heart by itself is the supreme vascular organ , its surprising few structures inside the heart , like the valves are quiet avascular ( or is it really so ?)
The valves that...
Source: Dr.S.Venkatesan MD - October 18, 2018 Category: Cardiology Authors: dr s venkatesan Tags: cardiac embryology Embryology : Heart valve development Infective endocarditis : Pathology valvular heart disease blood supply to heart valves hematogenous spread of infective endocarditis how bacteria reach mitral valve in infective endocardi Source Type: blogs
My exit ramp from medicine
One day, I was full of moderate despair, overworked, befuddled by the EHR with a tinge of burnout, staring at my computer, I treated myself to something I’ve not done before. It was my 62nd birthday that day, and I gave myself a birthday present. Before rising from that swivel chair, I had written down on a sticky pad the day that would be my retirement date, exactly one year after the expiration of my contract which I would be willing to extend no more than another year.
We try to keep ourselves productive in life because it is finite. Having my professional years identifiably finite would keep the remaining time focuse...
Source: Kevin, M.D. - Medical Weblog - July 11, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/richard-plotzker" rel="tag" > Richard Plotzker, MD < /a > Tags: Physician Endocrinology Practice Management Source Type: blogs
Hyperparathyroidism
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - April 17, 2018 Category: Internal Medicine Tags: endocrinology Source Type: blogs
Fight Aging! Newsletter, October 23rd 2017
In this study, we demonstrate that irrespective of the derivation of CD8+ CD45RA+CD27- T cells, these primed cells exhibit a unique highly inflammatory secretory profile characteristic of the SASP, and we also provide evidence that ADAM28 can be used as a functional marker of senescence in CD8+ T cells. Furthermore, we show that the secretory phenotype in CD8+ CD45RA+CD27- T cells is controlled through p38 MAPK signalling, which contributes to age-associated inflammation.
Patient Paid Clinical Studies are a Good Plan for Rejuvenation Therapies
https://www.fightaging.org/archives/2017/10/patient-paid-clinical-s...
Source: Fight Aging! - October 22, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Considering Common Mechanisms in Alzheimer's Disease and Osteoporosis
It has been observed that Alzheimer's disease and osteoporosis appear to be correlated to a larger degree than one would expect simply because both emerge, after a long chain of cause and effect, from the root causes of aging. That they are correlated in this way suggests that they share in common some parts of the middle of that long chain. Given that osteoporosis is a condition of the bones, a disruption of the balance between cells that create bone and cells that destroy bone, and Alzheimer's is a condition of the brain, in which aggregated proteins overwhelm cells, what could these two very different outcomes of aging ...
Source: Fight Aging! - October 16, 2017 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
MKSAP: 34-year-old man with episodic palpitations
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 34-year-old man is evaluated for episodic palpitations of 8 months’ duration. The palpitations last 5 to 10 minutes and then resolve spontaneously. They are usually associated with sweating and anxiety. Medical history is significant for thyroidectomy for medullary thyroid carcinoma diagnosed at 12 years of age. His father has also undergone thyroidectomy for medullary thyroid cancer. His only medication is levothyroxine.
On physical examination, blood pressure is 164/92 mm Hg, pulse rate is 106/min, and...
Source: Kevin, M.D. - Medical Weblog - July 29, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Endocrinology Source Type: blogs
