75 year old dialysis patient with nausea, vomiting and lightheadedness
Written by Jesse McLaren A 75 year-old patient with diabetes and end stage renal
disease was sent to the ED after dialysis for three days of nausea, vomiting,
loose stool, lightheadedness and fatigue. RR18 sat 99% HR 90 BP 90/60, afebrile. Below is the 15 lead ECG. What do you think? There ’s normal sinus rhythm, normal conduction, normal axis,
normal R wave progression and normal voltages. There’s subtle inferior ST
elevation with straightening of the ST segment, reciprocal ST depression and T
wave inversion in aVL, and ST depression in V2. This is diagnostic of
infero-posterior OMI, but it is falsely n...
Source: Dr. Smith's ECG Blog - August 19, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Stress Cardiovascular Magnetic Resonance Imaging for Stable Chest Pain
Stress cardiovascular magnetic resonance imaging is not as commonly used for evaluation of persons with stable chest pain as other modalities of non-invasive evaluation. Ricci and colleageus have reported a systematic review and meta-analysis on this aspect in JAMA Cardiology [1]. They evaluated 33 diagnostic studies including 7814 persons and 31 prognostic studies including 67,080 persons. The included studies were between 2002 and 2021.
The authors concluded that stress CMR had high diagnostic accuracy and had robust prognostication, especially when 3 Tesla MRI scanners were used. Myocardial ischemia and late gadoliniu...
Source: Cardiophile MD - June 12, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
A man in his late 30s with acute chest pain and ST elevation
Sent by Dan Singer MD, written by Meyers, edits by SmithA man in his late 30s presented with acute chest pain and normal vitals except tachycardia at about 115 bpm. Here is his triage ECG:What do you think?Dr. Singer sent this to me with just the information: " ~40 year old with acute chest pain " . I immediately responded: " cool fake! Not OMI. Do you have a prior? There is a reasonable chance of pericarditis in this case, or this could be a baseline. " It could easily be mistaken for a South African flag pattern anterolateral OMI, with STE in I, aVL, V2. But importantly there is no reciprocal STD in III (which would...
Source: Dr. Smith's ECG Blog - May 16, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A 20-something with intermittent then acute chest pain
This was sent to me by a partner:" Curious what you think of this one we had overnight. Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. He had another episode the day before after exerting himself. No pericardial effusion on ultrasound. "What do you think?First, many on Twitter said " Pericarditis " . This is NOT pericarditis, which virtually NEVER has ST depression any where except aVR. When there is ST depression (as in aVL, V2, V3), then top on the differential is OMI or myocarditis.See our publication: ST depression in ...
Source: Dr. Smith's ECG Blog - April 25, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 40-something woman with acute pulmonary edema -- see the Speckle Tracking echocardiogram.
A 49 year old woman with h/o COPD only presented with sudden dyspnea. She had acute pulmonary edema on exam. PrehospitalConventional algorithm interpretation: ANTERIOR INFARCT, STEMITransformed ECG by PM Cardio:PM Cardio AI Bot interpretation:OMI with High ConfidenceWhat do you think?There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD.This is proximal LAD Occlusion until proven otherwise.On arrival, lung ultrasound confirmed pulmonary edema (B lines). An ECG was recorded:ED ECG 1:The findings are still present but not nearly as profound now...
Source: Dr. Smith's ECG Blog - April 12, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Myocarditis update from Sweden
BY ANISH KOKA
The COVID19/vaccine myocarditis debate continues in large part because our public health institutions are grossly mischaracterizing the risks and benefits of vaccines to young people.
A snapshot of what the establishment says as it relates to the particular area of concern: college vaccine mandates:
Dr. Arthur Reingold, an epidemiology professor at UC-Berkeley, notes that UC also requires immunizations for measles and chickenpox, and people still are dying from COVID at rates that exceed those for influenza. As of Feb. 1, there were more than 400 COVID deaths a day across the U.S.
“The arg...
Source: The Health Care Blog - February 27, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Anish Koka covid19 myocarditis Sweden Source Type: blogs
A COVID-19 vaccine exemption letter
BY ANISH KOKA
I recently saw a young man who came to see me because his place of future employment, a large health system was requiring him to complete the 1º series of his COVID-19 vaccination. He was concerned because he had chest pain after his first mRNA vaccine and was uncomfortable with the risks of a second mRNA dose. He attempted to get a Johnson and Johnson vaccine and was told by pharmacists he was not allowed to mix and match this particular vaccine as he had already received an mRNA dose. With no other option, he came to ask me whether I thought a vaccine exemption was reasonable in his case. He already had...
Source: The Health Care Blog - February 24, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Anish Koka COVID-19 vaccine exemption vaccines Source Type: blogs
COVID-19 myocarditis illusions: A new cardiac MRI study raises questions about the diagnosis
BY ANISH KOKA
One of the hallmarks of the last two years has been the distance that frequently exists between published research and reality. I’m a cardiologist, and the first disconnect that became glaringly obvious very quickly was the impact COVID was having on the heart. As I walked through COVID rooms in the Spring of 2020 trying to hold my breath, I waited for a COVID cardiac tsunami. After all social media had been full of videos from Wuhan and Iran of people suddenly dropping in the streets. My hyperventilating colleagues made me hyperventilate. Could it be that Sars-COV2 had some predilection for heart...
Source: The Health Care Blog - February 7, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Anish Koka COVID-19 Misinformation myocarditis Vaccine Source Type: blogs
Fight Aging! Newsletter, February 6th 2023
In conclusion, our study reveals that aging enhances atherosclerosis via increased inflammation of visceral fat. Our study suggests that future therapies targeting the visceral fat may reduce atherosclerosis diseaseburden in the expanding older population.
Is the Gut a Significant Source of Amyloid-β in Alzheimer's Disease?
https://www.fightaging.org/archives/2023/02/is-the-gut-a-significant-source-of-amyloid-%ce%b2-in-alzheimers-disease/
The early stages of Alzheimer's disease are characterized by rising levels of amyloid-β in the brain and the formation of misfolded amyloid aggregates. It is present...
Source: Fight Aging! - February 5, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
A Discussion of the Biochemistry of Cardiac Fibrosis
Fibrosis is a malfunction of tissue maintenance, in which excessive amounts of extracellular matrix structure are created, forming scar-like features that disrupt normal tissue function. Fibrosis is a feature of aging and can rise to the level of life-threatening issue in organs such as the lung, liver, kidneys, and heart. This is particularly the case because there are no truly effective therapies to treat fibrosis; it is an inexorable condition that leads towards organ failure. Progress towards the reversal of fibrosis has been slow, unfortunately, despite the comparatively recent discovery that senescent cells appear to...
Source: Fight Aging! - January 31, 2023 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Cardiology update: Should mRNA vaccine myocarditis be a contraindication to future COVID-19 vaccinations ?
BY ANISH KOKA
Myopericarditis is a now a well reported complication associated with Sars-Cov-2 (COVID-19) vaccinations. This has been particularly common with the messenger RNA (mRNA) vaccines (BNT162b2 and mrna-1273), with a particular predilection for young males.
Current guidance by the Australian government “technical advisory groups” as well as the Australian Cardiology Society suggest patients who have experienced myocarditis after an mRNA vaccine may consider a non-mRNA vaccine once “symptom free for at least 6 weeks”.
A just published report of 2 cases from Australia that document myopericarditi...
Source: The Health Care Blog - January 26, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Anish Koka mRNA vaccine myocarditis Source Type: blogs
Unconscious + STEMI criteria: activate the cath lab?
Case submitted and written by Dr. Mazen El-Baba and Dr. Evelyn Dell, with edits from Jesse McLarenEMS brought a John Doe, in his 30s, who was found in an urban forest near a homeless encampment on a cool fall day. There were no signs of trauma on scene or on the patient. EMS reported an initial GCS of 8 with pupils equal and reactive. The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4.Vitals: HR 45; systolic BP was 110-120; irregular respiratory rate; oxygen saturation was normal; tympanic temperature 30; glucose was 6. In the resuscitation room, the patient had another seizure that stopped after...
Source: Dr. Smith's ECG Blog - January 21, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A teenager with chest pain, a troponin below the limit of detection, and " benign early repolarization "
Sent by anonymous, written by Pendell MeyersA male in his teens presented with complaints of chest discomfort and dyspnea beginning while exercising but without obvious injury. He immediately stopped exercising and symptoms started to improve. Later that evening he felt recurrent central chest discomfort, shortness of breath, and vomited. Symptoms have been constant since this second episode, and are still present on arrival, which seems to have been less than 1 to 2 hours from onset of symptoms. No similar symptoms in the past. No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of...
Source: Dr. Smith's ECG Blog - January 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Xish
Earlier I discussed the insane excesses of Xi Jinping ' s " zero Covid " policy. The economic and social costs of the draconian, and doomed, effort to end transmission of the virus in China were unsustainable. The policy provoked the first mass protests of his rule, at great peril to the protesters, created supply chain shortages around the world, and severely damaged the Chinese economy. So yeah, not a good idea. But . . .He suddenly turned 180 on a dime and eliminated all mitigations measures. The result has been equally catastrophic. Eric Fiegl-Ding is an epidemiologist who became well known as an early Cassandra about ...
Source: Stayin' Alive - December 20, 2022 Category: American Health Source Type: blogs
A woman in her 70s with chest pain
Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, SmithA woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. She felt nauseous and lightheaded with no neurologic deficits. EMS noted prehospital vitals for heart rates in the 60s, SPO2 of 98% on room air, initially hypotensive to 66/34 with improvement to 100/70 after 800 mL of IV fluids by EMS. Here is her ECG on arrival to the ED: What is your differential? What are your next steps?The ECG is quickly reviewed and shows si...
Source: Dr. Smith's ECG Blog - December 18, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
