A young healthy male with epigastric pain and tachycardia
A young previously healthy man with no past medical history presented with a complaint of epigastric pain for a few days. He had no other complaints. He appeared well. Vitals were HR 107, BP 140/70, sats 98%, RR 20, Temp 36.7. He had a normal exam except for the mild tachycardia.The physician was planning on discharging the patient except for the tachycardia, which prompted him to obtain an ECG. He was startled by the result. He showed it to me:QRS 105 ms. Sinus tach. RV conduction delay (R'-wave in V1)Diffuse ST depression, diagnostic of ischemia.Not knowing anything else about t...
Source: Dr. Smith's ECG Blog - August 14, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Terminal QRS Distortion: Diagnostic of LAD Occlusion. Or is it Pericarditis?
A middle-aged woman presented with what is described as a burning feeling in her chest which the physician said was "very atypical." It did occur during exercise and radiated to both wrists.Here is the first ECG:Sinus rhythm. Computerized QTc is 437. There is some ST Elevation in II and aVF but without reciprocal ST depression in aVL. Precordial leads also have ST Elevation: Is this normal variant or is it Ischemic ST Elevation? There is upward concavity in all leads, suggesting normality. But upward concavity is seen in all of leads V2-V6 in almost 50% of LAD occlusion. There is n...
Source: Dr. Smith's ECG Blog - July 16, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Kawasaki disease – Cardiology MCQ
Cardiovascular features of Kawasaki disease:
a) Coronary aneurysms
b) Myocarditis
c) Aneurysms of medium sized non coronary arteries
d) All of the above
Correct answer: d) All of the above
In addition to these pericarditis and endocardial involvement in the form of valvular regurgitation can occur Kawasaki disease. Congestive heart failure can occur in severe cases. Raynaud’s phenomenon and peripheral gangrene can be noted in some cases.
Kawasaki disease is also known as mucocutaneous lymph node syndrome, originally described from Japan. But now it is known to occur in many other geographic regions, and it has become...
Source: Cardiophile MD - May 29, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: SCD in young athletes
Commonest cause of sudden cardiac death (SCD) in young athletes:
a) Coronary anomalies
b) Aortic rupture
c) Hypertrophic cardiomyopathy
d) Congenital heart disease
Correct answer: c) Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy accounts for about thirty five percent of sudden cardiac death in young athletes and coronary anomalies contribute about seventeen percent. Myocarditis can be there in about six percent, aortic rupture in three percent and congenital heart disease in one percent.
Reference:
Maron BJ, Olivotto I, Spirito P, Casey SA, Bellone P, Gohman TG, et al. Epidemiology of hypertrophic cardiomyopath...
Source: Cardiophile MD - April 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Maleficent Troponins
We physicians are obsessed with classifying, sorting, and differentiating in a quest for never-ending precision. We gather all manner of “facts” from our patients. Sights, smells, reactions to pushing or pulling. We divine sounds with antiquated stethoscopes or peer underneath the skin with ultrasound. We subject them to tests of blood, urine, and fluids from any place our needles can reach.
All of this is to arrive at an exact diagnosis that is often frustrated by the secondary nature of the data. Our disappointment has driven us mad, but the promise of exactness from biomarkers leaves us giddy. We have convi...
Source: Spontaneous Circulation - February 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Maleficent Troponins
We physicians are obsessed with classifying, sorting, and differentiating in a quest for never-ending precision. We gather all manner of “facts” from our patients. Sights, smells, reactions to pushing or pulling. We divine sounds with antiquated stethoscopes or peer underneath the skin with ultrasound. We subject them to tests of blood, urine, and fluids from any place our needles can reach.
All of this is to arrive at an exact diagnosis that is often frustrated by the secondary nature of the data. Our disappointment has driven us mad, but the promise of exactness from biomarkers leaves us giddy. We have convince...
Source: Spontaneous Circulation - January 30, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Young Woman with Chest Pressure and Subtle, Focal ST Elevation/Depression
A very healthy woman in her 20's (who, however, is a heavy smoker) presented with 4 days of waxing and waning substernal chest pressure radiating to the throat and both shoulders. It was not sharp, not pleuritic. There were no myalgias, no viral symptoms, no F/C/S.Looking at her, she was the picture of health, and I thought to myself: "Is there any possible way she could have an MI?". My answer, of course was yes. I've seen it too often before in young women, as for instance:in this case, and in this case, and others.So we ordered an ECG, of course:I found this very interesting and worriso...
Source: Dr. Smith's ECG Blog - November 2, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
AdDRESSing the Causes of Rash
Conclusion: DRESS syndrome is a rare but potentially life-threatening condition with an estimated mortality rate of 10 percent. Suspicion must be high because it may present as a spectrum of nonspecific clinical and laboratory findings.Tags: rash, tox cave, DRESS, DRESS syndrome, RegiSCAR, hepatitis, myocarditis, myositisPublished: 8/7/2014 2:50:00 PM (Source: The Tox Cave)
Source: The Tox Cave - August 7, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
AdDRESSing the Causes of Rash
Conclusion: DRESS syndrome is a rare but potentially life-threatening condition with an estimated mortality rate of 10 percent. Suspicion must be high because it may present as a spectrum of nonspecific clinical and laboratory findings.Tags: rash, tox cave, DRESS, DRESS syndrome, RegiSCAR, hepatitis, myocarditis, myositisPublished: 8/7/2014 2:50:00 PM (Source: The Tox Cave)
Source: The Tox Cave - August 7, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A 29 year old male with pleuritic chest pain for 6 hours
This case was sent to me by Taylor Sanders of the LSU- Baton Rouge Emergency Medicine residency.A 29 year old complained of 6 hours of pleuritic chest pain:QRS: There is rSR' in V1, consistent with RV conduction delay, but the QRS does not appear prolonged and there are no S-waves in lateral leads. However, this absence of lateral S-wave may be due to terminal QRS distortion from the ST Elevation. R-waves in Lateral leads: the R-waves in I and aVL are minimal, but are well formed in V5 and V6; this is somewhat unusual, and one must entertain the possibility of reversed limb lead placement. However, when t...
Source: Dr. Smith's ECG Blog - June 26, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
An 8 year old with diarrhea, abdominal pain, and syncope
This case was sent by:Maria PerezEmergency RegistrarMonash Medical CentreMelbourneShe obtained permission from the family to identify the location or origin of the case.CaseThis previously completely healthy 8 yo girl complained of diarrhea, vomiting, and upper abdominal pain radiating to the chest, for the past 3 days. There had been an episode of syncope 3 days prior for which she had been seen by her primary care provider, but there is no information from that visit. Her exam was normal except for an irregular heart rate at 78, with BP of 100/60. Lungs were clear.Because of the irregular hear...
Source: Dr. Smith's ECG Blog - May 20, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 16 year old girl has syncope while playing basketball.....
A 16 yo Female with no previous medical history had a syncopal event while playing basketball. She arrived to the ED in severe respiratory distress, awake but agitated. She was tachypneic in the 40s-50s. She was intubated shortly after arrival, and had an ECG recorded: Sinus tachycardia with massive ST elevation in I, aVL, V5 and V6, with extreme ST depression in V3 and V4, and reciprocal ST depression in II, III, aVF. This is diagnostic of a very acute posterolateral STEMI.The ECG was briefly inspected by a pediatric emergency physician unaccustomed to diagnosing acute MI. He did not ...
Source: Dr. Smith's ECG Blog - May 6, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Boston ER Physician Loses Malpractice Suit Over Rare Condition
A Boston physician has been successfully sued in a malpractice case after missing a rare diagnosis for an untreatable condition in the emergency room. The judgement against Dr.Liang was for $4.8 million after he failed to miss a case of viral myocarditis in a 23 year old man.
The post Boston ER Physician Loses Malpractice Suit Over Rare Condition appeared first on InsideSurgery Medical Information Blog. (Source: Inside Surgery)
Source: Inside Surgery - May 4, 2014 Category: Surgery Authors: Editor Tags: Cardiology Infectious Disease Medical News Wire Source Type: blogs
ST Elevation and a Positive Troponin: Is it Myopericarditis or STEMI?
In this study of 625 patients with presumed STEMI who had angiograms within 2 hours of the ECG, but not simultaneous with the ECG, 26 had completely normal angiograms. The final clinical diagnosis by 3 cardiologists (not by MRI or biopsy) was STEMI in 7 (1.2%) and myopericarditis in 5 (0.8%). Normal angiograms (no stenosis at all) seem to occur in about 4.5% of patients with Non-STE-ACS, but they still have substantial subsequent morbidity (2% death or MI at 1 year; TIMI score stratifies them well)Finally, there is this paper by Sarda et al. from JACC in which they studied 45 patients with apparent STEMI but with nor...
Source: Dr. Smith's ECG Blog - February 17, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Inferior and Lateral ST Elevation and A Positive Troponin
A young woman presented with substernal chest pain described as both crushing and stabbing, with radiation to the jaw and left arm and associated with dyspnea. It was not positional or pleuritic. She was otherwise healthy except for an unspecified "recent illness" and recent pyelonephritis. She denied tobacco or other drug use.Here is her initial ECG:There is sinus rhythm and normal, though low voltage, QRS. There is inferior and lateral ST elevation., with large T-waves very suggestive of hyperacute T-waves. Is this MI? Pericarditis? Early repolarization manifesting in inferior and late...
Source: Dr. Smith's ECG Blog - October 31, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
