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

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

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

Inferior ST elevation with reciprocal change: which of these 4 patients has Occlusion MI?
Written by Jesse McLaren, with comments by Smith and Grauer Four patients presented with cardiorespiratory symptoms, with inferior ST elevation and reciprocal change on their ECG. Which patient had occlusion MI?  Note: according to the STEMI paradigm these ECGs are easy, but in reality they are difficult. First let ’s start with each ECG without clinical context. What do you think of each ECG? ECG 1: ECG 2:ECG 3:ECG 4:Now let ’s introduce some clinical context. How would this change management? Patient 1: 30 year old previously healthy, presenting with syncope, now asymptomatic with n...
Source: Dr. Smith's ECG Blog - May 23, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?
Submitted and written byDestiny Folk MD, peer reviewed by Meyers, Smith, Grauer, McLarenA man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. He complained of generalized weakness and left lower extremity numbness. He reported that 12 hours prior to arrival he used fentanyl and cocaine. He reported difficulty walking and felt as if his left leg was “asleep.” He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. On arrival in the ED, he wa...
Source: Dr. Smith's ECG Blog - May 5, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

Fight Aging! Newsletter, March 7th 2022
This study estimates that prescreening with a 500 blood test could reduce by half both the cost and the time it takes to enroll patients in clinical trials that use PET scans. Screening with blood tests alone could be completed in less than six months and cut costs by tenfold or more, the study finds. Known as Precivity AD, the commercial version of the test is marketed by C2N Diagnostics. The current study shows that the blood test remains highly accurate, even when performed in different labs following different protocols, and in different cohorts across three continents. xCT Knockout Modestly Extends Life in M...
Source: Fight Aging! - March 6, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

xCT Knockout Modestly Extends Life in Mice
As a general rule, methods that produce 10-20% life extension in mice are unlikely to prove all that interesting in humans. But it depends on what is going on under the hood. In most cases interventions act on life span by upregulating cellular stress response mechanisms, and there is more than enough evidence to suggest that this category of approaches is far more effective at extending life in short-lived species than is the case in long-lived species such as our own. In this case, the mechanism of interest may be anti-inflammatory, a reduction of age-related chronic inflammation. There is not yet a body of evidence to t...
Source: Fight Aging! - March 2, 2022 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Hypothermia at 18 Celsius in V Fib arrest: CPR, then ECMO rewarming, for 3 hours, then Defib with ROSC. Interpret the ECG.
A middle-aged man was found outside in the cold in full arrest in ventricular fibrillation.Chest compressions and ventilation were begun.On arrival, CPR was continued and core temperature was measured at 18 ° C (64.4° F).The patient was put on Extracorporeal Life Support in the ED3 hours after initial resuscitation, the core temp was 30 ° C and the patient was defibrillated with a single attempt.A 12-lead ECG was recorded:There is sinus rhythm with RBBB and right axis deviation.  In all leads, there is a 2nd wave after the initial QRS.  This is an Osborn wave.  I have not found any previous report of...
Source: Dr. Smith's ECG Blog - February 8, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

What does LBBB look like in severe hypothermia? Is there a long QT? Is the QT appropriate for the temperature?
This patient was found down in a Minneapolis winter.  He was very cold with frostbitten fingers and toes.  He was alert but encephalopathic and delirious and very agitated and could not be adequately calmed with olanzapine and lorazepam, so we intubated him.  The first reliable temperature could only be obtained with a Foley thermistor, and it was 26.5 degrees C (79.7 F).His BP was 76/60.  K was 2.8 mEq/L.Here was his first ECG:There is sinus bradycardia with left bundle branch block (LBBB), with proportional ST-T, and VERY long QT and a PVC.  I measure the QT at 800 ms. Notice that there are ...
Source: Dr. Smith's ECG Blog - January 6, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

Cold Cap Therapy for Chemo Patients: Interview with Kate Dilligan, CEO of Cooler Heads Care
Cooler Heads Care, a medtech company based in San Diego, created Amma, a cold cap therapy device that aims to help chemotherapy patients to preserve their hair. Hair loss is a very common side-effect of chemo, and poses a significant psychological challenge for patients who are already struggling with their diagnosis and treatment. Simply cooling the scalp during chemotherapy can dramatically reduce the amount of drug absorbed by the hair follicles, leading to reduced hair loss. However, current technology to achieve this comes with a hefty price tag, and may cost the patient as much as $8,000. This is out of reach for ...
Source: Medgadget - November 16, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Exclusive Medicine Oncology Source Type: blogs

Triboelectric pacemaker
Usually modern pacemakers are powered by built-in batteries and you need to replace the pulse generator when the battery reaches end of life. What if the device gets charged itself using energy of cardiac contractions? That is exactly what a triboelectric pacemaker powered by cardiac contractions aims to achieve. Triboelectric effect is typically the static electricity which is generated when a plastic comb is used on dry hair. Researchers have tested a symbiotic cardiac pacemaker which uses an implantable triboelectric nanogenerator (iTENG) which harvests energy from cardiac contractions and stores in a capacitor [1]. T...
Source: Cardiophile MD - August 25, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQs
Which of the following is NOT a drug used for metabolic modulation in heart failure? Trimetazidine Ranolazine Perhexiline Sacubitril-valsartan Correct answer: 4. Sacubitril-valsartan Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI). Trimetazidine is a 3-ketoacyl coenzyme A thiolase inhibitor, while ranolazine inhibits the late sodium current. Perhexiline inhibits carnitine palmitoyl transferase. Latter three are metabolic modulators while sacubitril-valsartan is a hemodynamic modulator in heart failure [Ashrafian H, Neubauer S. Metabolic modulation in heart failure: high time for a definitive ...
Source: Cardiophile MD - July 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Management of aortic dissection
Aortic dissection is the most common aortic emergency. It is one of the three acute aortic syndromes, the others being aortic intramural hematoma and penetrating aortic ulcer. It has a grave prognosis with 20% pre hospital and 30% in hospital mortality. Aortic dissection is generally considered as acute when diagnosis is made within 14 days of onset and chronic after that. An intimal and medial tear in the aorta causes blood to seep into the media and the false lumen usually progresses along a variable extend of the aorta. Important risk factors for aortic dissection are hypertension, Marfan syndrome and bicuspid aortic ...
Source: Cardiophile MD - May 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Cardiac Surgery Source Type: blogs

J wave syndrome
Discussion and ECG Quiz 17. References Antzelevitch C, Yan GX. J wave syndromes. Heart Rhythm. 2010 Apr;7(4):549-58. Osborn JJ. Experimental hypothermia; respiratory and blood pH changes in relation to cardiac function. Am J Physiol. 1953 Dec;175(3):389-98. Sethi KK, Sethi K, Chutani SK. J Wave Syndrome: Clinical Diagnosis, Risk Stratification and Treatment. J Atr Fibrillation. 2014 Dec 31;7(4):1173. Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, Pasquié JL, Nogami A, Babuty D, Yli-Mayry S, De Chillou C, Scanu P, Mabo P, Matsuo S, Probst V, Le Scouarnec S, Defaye P, Schlaepfer J, Rostock T, Lacroi...
Source: Cardiophile MD - April 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs

Electrical storm – Management
Electrical storm – Management Electrical storm: Recurrent unstable ventricular tachycardia (VT)/ventricular fibrillation (VF) requiring more than three direct current (DC) shocks per day. Beta blocker is the single most effective therapy for recurrent VT unless the person is in shock. A combination of intravenous amiodarone with oral propranolol has been found to be superior to intravenous amiodarone with oral metoprolol [1]. Stellate ganglion block / ablation is being increasingly used as a modality for treatment of drug refractory ventricular tachycardia. Temporary blockage of stellate ganglion can be obtained by...
Source: Cardiophile MD - December 18, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Ablation of stellate ganglion Stellate ganglion block Temporary blockage of stellate ganglion Source Type: blogs