A 12 year old with Wide Complex Tachycardia
A previously healthy 12 year old presented to the ED with a "fast heart rate" that had started about 1.5 hours prior to presentation. She was reportedly a healthy child and active in several sports. She had a fairly active day and had been swimming off of a boat when her symptoms started. Her mother thought that she was just anxious, so took her home and had her try some deep breathing exercises. When this didn't help she presented to the ED and had this ECG recorded: Here is a higher resolution image, but missing V4-V6:There is regular monomorphic tachycardia with RR interval of about 0.285 ...
Source: Dr. Smith's ECG Blog - July 19, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 3
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Source: Cardiophile MD - July 9, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
AV block and DCM – Cardiology MCQ
AV block in the presence of features of dilated cardiomyopathy (DCM), may indicate:
a) Sarcoidosis
b) Lyme disease
c) Myotonic dystrophy
d) All of the above
e) None of the above
Correct answer: d) All of the above
Other conditions associated with this combination are lamin A/C mutation and giant cell myocarditis.
Reference
Japp AG et al.The Diagnosis and Evaluation of Dilated Cardiomyopathy. J Am Coll Cardiol. 2016;67(25):2996-3010. (Source: Cardiophile MD)
Source: Cardiophile MD - June 30, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
When Children are Harmed by Vaccine Refusal
The recent diphtheria death of a child, those with serious illness/admissions and the need for active health surveillance of many others is of grave concern. It appears we are reversing all our health gains in our country. The majority of our population have little memory of the horrific nature of diseases that we have prevented using vaccines. Those of us who have worked in the health system for many decades have experienced the devastating effects of diphtheria, pertussis (whooping cough), tetanus, polio, measles, Hib meningitis, etc. I remember going through two diphtheria epidemics in different parts of the country whe...
Source: Malaysian Medical Resources - June 24, 2016 Category: Global & Universal Authors: palmdoc Tags: - Education - Ethics - Guest diphtheria pertussis vaccination vaccines Source Type: blogs
A Middle-Aged Woman with 3 days of Chest pain and Posterolateral Injury on the ECG
A middle-aged woman called 911 for burning chest pain and dyspnea. Here is her prehospital ECG:There is clearly acute myocardial injury with ST elevation in high lateral leads.The computer did not read STEMI, but medics were very suspicious and brought the patient to the critical care area.An ED ECG was immediately recorded:There is sinus tachycardia. There is clear high lateral and posterior injury.The cath lab was activated.History:The patient states she has had 3 days of burning chest pain and SOB. She thinks she has the flu and states that she is currently pain free.These are her first vital signs:101...
Source: Dr. Smith's ECG Blog - March 18, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 21
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Source: Cardiophile MD - March 8, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
A 30 year old with Chest Pain, Anterior ST Elevation, Terminal QRS distortion, and a High Troponin
This was contributed by Brooks Walsh, who has contributed many interesting cases and articles to this blog. I edited and added comments, of course.The CaseA 30 year-old man presented to the ED with chest pain. It had started 2 days ago, was constant, and radiated down his left arm. It was only mild, but he also endorsed mild dyspnea. He had no medical problems. He denied cocaine or other stimulants. Vital signs were normal, and the exam was notable only for a thin body habitus.Here is his ED ECG:There is significant anterior ST segment elevation (STE). However, the tall R waves and T waves suggest early...
Source: Dr. Smith's ECG Blog - March 7, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Wheat Belly: Self-Directed Health?
Director chair, film slate and load horn.
Here’s a proposal for you: If, by following the Wheat Belly lifestyle, a long list of conditions are reduced or reversed at no risk, almost no cost, reversing even chronic and potentially fatal conditions . . . does that mean that the notion of self-directed health might be on the horizon, i.e., putting control over health back in our own hands?
I think it does. No, we will never implant our own defibrillators or take out our own gallbladders. But so many chronic health conditions afflicting modern humans recede that I believe that it is entirely reasonable to start talking a...
Source: Wheat Belly Blog - February 16, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle arthritis autoimmune diabetes eating disorder gluten grains Inflammation joint Weight Loss Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 9
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Source: Cardiophile MD - January 27, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 6
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Source: Cardiophile MD - January 22, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Pediatric electrocardiography
Tips for ECG recording in children
Limb electrodes may be placed more proximally on the limbs than the conventional distal placement. This will produce less movement artefacts in children who are less likely to stay quiet during the entire period of record. V3R and V4R should be recorded in addition to the standard 12 leads. Standard paper speed (25 mm/s) and gain (10 mm / mV) are used for paediatric recordings also. Half gain (5 mm / mV) recordings are done if the complexes are large. Recording can be done under sedation or during natural sleep or sometimes even by distraction techniques to keep the child quiet.
Indicatio...
Source: Cardiophile MD - December 11, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs
Is this STEMI? Pattern Recognition is Key
This was sent to me, asking what I thought of it:A very elderly woman presented with weakness and diarrhea. There was no chest pain or dyspnea. An ECG was recorded because weakness is a common symptom of MI, especially in elderly women. What is your interpretation?I was told the computer interpretation was "Acute STEMI".My response was: "LVH only. No STEMI." How do I know?It is hard for me to explain exactly how I know this except that I have seen it so often and recognize the pattern. But I'll try. Features suggesting STEMI: One could easily believe this is inferior-...
Source: Dr. Smith's ECG Blog - October 28, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Dengue circulatory shock : What is the mechanism ?
Dengue is a global infectious disease caused by Flavivirus (RNA) transmitted by day biting mosquitoes Ades aegypti .It is primarily a tropical or sub tropical disease , India is marked among the epicentre . 75% of dengue infections are asymptomatic. Among the remaining 25 % only 5 % develop severe dengue and a fraction of them go for a dreaded circulatory and bleeding complication leading to a likely fatality.Severe hypotension is the hall-mark in dengue shock .
The mechanism of shock
The sine-qua non of dengue shock is the capillary leak syndrome .This is due to some unknown vascular toxins acting in micro cir...
Source: Dr.S.Venkatesan MD - October 1, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions dengue myocarditis mechanism of dengue shock myocardial involvement in dengue Source Type: blogs
A 21 year old with Chest pain
A 21 year old presented with typical chest pain. Here is his ECG:There is inferior and lateral ST elevation. Pericarditis, right?The key to this being STEMI is the ST depression in V2, and perhaps a touch in aVL. This is very nearly a de Winter's T-wave. ST depression is not seen in pericarditis, though it can be seen in myocarditis. Due to this ST elevation, one must assume that this is ischemic ST elevation.There is saddleback, but the saddleback is in V3 and V4, not V2. More important is that there is ST depression, in which case saddleback morphology is NOT reassuring.The emergency p...
Source: Dr. Smith's ECG Blog - September 2, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
