What is a nuclear stress test? Cardiology Basics
Usual stress test for the evaluation of coronary artery disease is a treadmill exercise ECG. It is commonly part of general health check-up and is widely available. But there are certain situations when the exercise ECG is not interpretable as in a person with left bundle branch block. Then a nuclear stress test will be useful. While exercise ECG tells you that there is a probability of obstructions in coronary arteries, it most often does not identify the region of myocardium supplied by the obstructed vessel. Nuclear stress test will tell you which is the region of myocardium that is affected. If there is already signif...
Source: Cardiophile MD - October 9, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Wellens' syndrome: to stent or not? IVUS negative, Symptoms persist, Stress Testing, Instantaneous Wave Free Ratio, and Fractional Flow Reserve.
A 55 y.o. male with no cardiac PMHX presented for 2 weeks of exertional chest pain, worsened on the day prior to presentation.  On the day of presentation, the chest discomfort was particularly intense, and associated with diaphoresis and nausea.  It was resolved (pain free) when the ECG was recorded:This ECG was read as " nonspecific " by the providers.  What do you think?These is classic Wellens ' pattern A (biphasic, terminal T-wave inversion), and it isWellens 'syndrome (Angina, resolved -- pain free -- with preserved R-waves and Wellens ' pattern A T-waves).  The morphology of these T-wav...
Source: Dr. Smith's ECG Blog - January 28, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs

Test yourself: how many hours between your diagnosis of OMI and positive STEMI criteria?
Written by Pendell Meyers, with edits by Steve SmithA male in his early 40s presented with intermittent chest/abdominal pain. He admitted to several episodes over the past two days, including one episode several hours prior to presentation, described as severe (8/10), substernal " burning, " non-radiating, associated with diaphoresis, described as " feeling food stuck in my throat, " or " like I ate too fast, " but not associated with eating, relieved by belching and flatulence, relieved by lying flat. The episode on the day of presentation was similar except he had the additional new features of " burning ears " and " blu...
Source: Dr. Smith's ECG Blog - July 8, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

Another day, another EHR outage: MEDSTAR EHR goes dark for days
At my March 2, 2015 post "Rideout Hospital, California: CEO Pinocchio on quality of patient care during hospital computer crash" (http://hcrenewal.blogspot.com/2015/03/rideout-hospital-california-ceo.html) I highlighted a stunning example of when the light shone through the corporate B.S. about health IT outages, thanks to a letter to the editor by a family member of an affected patient:Letter: Re: Rideout Hospital computer problemshttp://www.appeal-democrat.com/opinion/letter-re-rideout-computer-problems/article_4a408cc0-be47-11e4-9b7b-93c22da930d4.html Friday, February 27, 2015 I am writing in regard to commen...
Source: Health Care Renewal - May 6, 2015 Category: Health Management Tags: healthcare IT crash healthcare IT outage MedStar Health Patient care has not been compromised Politico Source Type: blogs

Rideout Hospital, California: CEO Pinocchio on quality of patient care during hospital computer crash
EHRs and other clinical IT are touted as essential to improving safety, among many other benefits.Yet when hospital systems crash, the common refrain by hospital executives to the press, when such stories are reported, is "...but quality of care was not compromised."  In fact, I've made an indexing term for this refrain.  The following query link retrieves the posts so indexed, numbering almost 30 at present:  http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromisedOne hospital in California 40 minutes north of Sacramento had a crash and its CEO made exactly that claim....
Source: Health Care Renewal - March 2, 2015 Category: Health Management Tags: Appeal-Democrat healthcare IT crash healthcare IT risk Patient care has not been compromised Rideout Hospital Robert Chason Source Type: blogs

Regadenoson for vasodilator myocardial stress – selective A2A receptor agonist
Regadenoson, adenosine and dipyridamole are the three vasodilators which can be used during radionuclide myocardial perfusion imaging. Their response is mediated through adenosine receptors: A1, A2A, A2B and A3. A2A receptor activation leads to coronary vasodilation and some peripheral vasodilation. A1, A2B and A3 activation are responsible for bronchospasm and high grade AV block. Regadenoson is a selective A2A receptor agonist while adenosine binds to all of them non selectively. Dipyridamole acts by reducing the metabolic degradation of adenosine and has an effect on all the adenosine receptors. (Source: Cardiophile MD)
Source: Cardiophile MD - July 2, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Head On Motor Vehicle Collision. ST depression. Myocardial Contusion?
A woman in her 40's was involved in a head-on motor vehicle collision.  EMS noted a facial droop. On arrival she was hypertensive but other vitals were normal.  She did complain of back and neck pain, chest pain, and SOB.  She also had a facial droop as noted by medics.  This droop was apparently new.An ECG was recorded:This shows diffuse ST depression (diffuse subendocardial ischemia) in leads I, II, aVF an V3 to V6, with reciprocal ST elevation in aVR and V1.  This is diagnostic of subendocardial ischemia or injury.  The ECG was repeated 36 minutes later:The findings are improvingIs this:1. ...
Source: Dr. Smith's ECG Blog - July 1, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Strengthened FDA warnings for Lexiscan and Adenoscan
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - December 12, 2013 Category: Internists and Doctors of Medicine Tags: cardiovascular Source Type: blogs

Top stories in health and medicine, September 30, 2013
From MedPage Today: Stress Test Agents Equal for Predicting CAD Risk. Stress tests done with the newer vasodilator regadenoson (Lexiscan) have the same predictive power for coronary artery disease as conventional adenosine (Adenoscan). Opioid Tx Improves RLS Symptoms. Treatment with long-acting oxycodone and naloxone in fixed combination was effective at reducing restless legs syndrome (RLS) symptom severity among patients not effectively managed on other treatments. Simplicity Key to ED Angina Management. For relatively low-risk angina patients in the emergency department, reserving myocardial perfusion imaging for sele...
Source: Kevin, M.D. - Medical Weblog - September 30, 2013 Category: Family Physicians Tags: News Cancer Heart Source Type: blogs