What is secondary AF?
Secondary AF has been defined as self limited atrial fibrillation caused by a reversible etiology. Conditions which cause secondary AF are myocardial infarction, myocarditis, pericarditis, acute pulmonary disease, hyperthyroidism, ethanol intoxication, sepsis and postoperative state. It is well known that postoperative AF can increase the morbidity and ICU/hospital stay after cardiac and non cardiac surgery.
Reference
Quon MJ, Behlouli H, Pilote L. Anticoagulant Use and Risk of Ischemic Stroke and Bleeding in Patients With Secondary Atrial Fibrillation Associated With Acute Coronary Syndromes, Acute Pulmonary Disease, or...
Source: Cardiophile MD - December 1, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said " Nothing too exciting. "
This article fails to specify whether it was troponin I or T, but I contacted the institution and they used exclusively troponin I during that time period.Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. The impact of ST-segment elevation on the prognosis of patients with Takotsubo cardiomyopathy. J Electrocardiol [Internet] 2022;Available from: http://dx.doi.org/10.1016/j.jelectrocard.2022.09.009Cardiology opinion: Takotsubo Cardiomyopathy (EF 30-35%)V Fib Cardiac arrestProlonged QTCNSTEMI (Smith comment: is it NSTEMI or is it Takotsubo? -- these are entirely different)Moderate sin...
Source: Dr. Smith's ECG Blog - November 30, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Lake Louise criteria is for the diagnosis of myocarditis on CMR
Lake Louise criteria are based on those for detection of myocardial edema, hyperemia and capillary leakage, necrosis and fibrosis. Myocardial early gadolinium enhancement suggests hyperemia and capillary leakage. Edema is indicated by an area of high intensity signal in T2 weighted images. It can be global in some cases. In the absence of late gadolinium enhancement which would indicate necrosis or fibrosis, edema is suggestive of potentially reversible myocardial injury. Global myocardial edema may be difficult to identify visually and needs software support which compares myocardial T2 weighted images with that of skele...
Source: Cardiophile MD - November 19, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Rheumatic heart disease – Cardiology Basics
Rheumatic heart disease – Cardiology Basics
Rheumatic heart disease is a group diseases which occur secondary to heart valve damage from rheumatic fever. Rheumatic fever is a disease in which antibodies produced by the body against streptococci cross react with different tissues in the body, especially the heart.
Group A beta hemolytic streptococci causing sore throat are involved in the pathogenesis of rheumatic fever. Most of the long term damage following rheumatic fever is caused by damage to heart valves . Initial manifestation of rheumatic fever is with polyarthritis, usually of the large joints.
But it does no...
Source: Cardiophile MD - October 22, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is cardiogenic shock? Cardiology Basics
When the heart is not able to pump enough blood for perfusing the vital organs and the blood pressure falls, it is known as cardiogenic shock. Most important cause of cardiogenic shock is an acute myocardial infarction. Cardiogenic shock can also occur in other conditions like a fulminant myocarditis. In case of myocardial infarction, it is more likely to occur in those who are older, having multivessel coronary artery disease, and in those with a previous myocardial infarction. Cardiogenic shock is a potentially life threatening condition and needs urgent treatment. Even with treatment about half of those with cardiogeni...
Source: Cardiophile MD - October 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is complete heart block? Cardiology Basics
When natural pacemaker impulses from the sinoatrial node fails to reach the ventricles and activate them, it is known as complete heart block. The block could be at the level of the atrioventricular (AV) node or below that.
Sinus node is a subepicardial structure located in the upper part of right atrium near the orifice of the superior vena cava. Signals from sinus node travel to the AV node through three internodal pathways. They are Wenckebach, Thorel and Bachmann bundles. Bachmann bundle gives a branch to the left atrium also.
AV node is located near the atrioventricular junction in the lower part of right atrium. It ...
Source: Cardiophile MD - October 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Is first degree heart block dangerous? Cardiology Basics
PR interval is measured from the onset of P wave to the onset of QRS complex. It includes the P wave and the PR segment. Normal PR interval is from 120 to 200 ms. If it is prolonged, it is called as first degree atrioventricular (AV) block.
PR interval is the time taken for activation of the atria and conduction of the impulses down to the ventricles and initiate activation of the ventricles. This includes the physiological delay in conduction at the AV node. The delay allows complete emptying of the atria before the ventricles start contracting. The atrial help to ventricular filling acts like an atrial booster at the en...
Source: Cardiophile MD - October 14, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Athlete ’s heart – Cardiology Basics
Athlete’s heart – Cardiology Basics
Athlete’s heart is thickening of the heart muscle due to constant training in response to increased circulatory demand. Athlete’s heart is not dangerous, it is a physiological adaptation of the heart to training and increased load. It is associated with a slow heart rate, called athlete’s bradycardia.
The slower resting heart rate is a protective mechanism to prevent undue rise with exercise as normally heart rate increases with intensity of exercise. There is an increase in the size of the chambers of the heart and increased efficacy of pumping to meet the high demand duri...
Source: Cardiophile MD - October 8, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Why mandating boosters for college kids is a no good, very bad, dumb idea 
This study reinforced prior research that measured these responses up to 12 months. The stimulation of an immune response after a mild infection can even be demonstrated in the absence of actual seroconversion (detectable prior infection by antibodies) at the level of T-cells. The presence of effective immune memory, both humoral (antibody) and cellular components, after even a mild SARS-CoV-2 infection is no longer a matter of debate. One might be tempted to argue that repeated boosting can permanently suppress infection. Unfortunately, all available evidence suggests that this increased protection from infection is ...
Source: The Health Care Blog - September 14, 2022 Category: Consumer Health News Authors: Christina Liu Tags: COVID-19 Health Policy Anish Koka COVID-19 vaccine Viral Myalgia Source Type: blogs
Vaccine Myocarditis Update
BY ANISH KOKA
The European Medicines Agency decided on July 19, 2021 that myocarditis and pericarditis be added to the list of adverse effects of both messenger RNA (mRNA) based vaccines (BNT162b2 [Pfizer-BioNTech] and mrna-1273 [Moderna]) against COVID-19. This advice was based on numerous reports of myocarditis that followed a clinical pattern that strongly suggested a causal link between these particular vaccines and myocarditis/pericarditis. The adverse events that appeared to be predominantly in young men typically occurred within a week after injection, and were clustered after the second dose of the vaccine serie...
Source: The Health Care Blog - September 7, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: COVID-19 Health Policy Uncategorized Anish Koka cardiology Source Type: blogs
CNN myocarditis fact check by a Cardiologist (me)
BY ANISH KOKA
A recent CNN article discusses approval of the Moderna Covid-19 vaccine for people ages 6-17. The CDC director acted after its vaccine advisers on the Advisory Committee on Immunization Practices voted unanimously to support the two dose Moderna COVID-19 vaccine for kids in this age group. The goal per CDC director Walensky was to “protect our children and teens from the complications of severe COVID-19 disease”
The elephant in the room that the CDC advisory group addressed is the risk of myocarditis from the vaccines that has been widely reported since April of 2021 by multipl...
Source: The Health Care Blog - August 10, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Public Health CNN myocarditis Source Type: blogs
A man in his 50s with hypoxemic respiratory failure from COVID pneumonia develops chest pain
Submitted by anonymous, written by Parker Hambright, MD, peer reviewed by Meyers, Smith, McLarenA man in his 50s with a past medical history of hypertension and tobacco use disorder, who tested COVID positive 11 days prior, presented to the emergency department with worsening shortness of breath over several days. He was tachypneic and hypoxemic down to as low as 44% with reportedly good SpO2 waveform before EMS applied noninvasive ventilation with improvement to 85-89%. Although history was limited by extremis, the report is that there was no chest pain at initial presentation, only shortness of breath.Here is his ECG on ...
Source: Dr. Smith's ECG Blog - July 25, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Is this Myo-pericarditis? Or OMI with subsequent pericarditis? Does the angiogram always explain the ECG findings?
Conclusion: Although at 1st glance, it looked like the ECG picture in Figure-1 might be suggestive of acute pericarditis — on further inspection, there are significant ECG features against the diagnosis of acute uncomplicated pericarditis.As per the superb discussion above by Dr. Smith — evolution of this case (including the ECG picture on serial tracings) — are consistent with what probably occurred in today ' s case, namely the combination of acute OMI from LCx occlusion, followed by development of post-infarction regional per...
Source: Dr. Smith's ECG Blog - June 11, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
ST elevation after gunshot to the chest
Conclusion: The ECG in Figure-1 would not be typical for non-traumatic acute pericarditis. However, it could be consistent with traumatic pericarditis (because ECG findings are so variable in traumatic pericarditis).NOTE: The ECG features of acute myocarditis may differ substantially from those of a " pure " pericarditis. There may be a resemblance between these 2 entities — but ST segment deviations (elevation and depression) with myocarditis may not follow the timing seen with pericarditis. In addition, Q waves may develop — so at times it may...
Source: Dr. Smith's ECG Blog - June 8, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
A 30-something with Chest pain, elevated troponin, with Subtle ST Elevation and hyperacute T-waves.
A 30-something male presented in the middle of the night with several hours of sharp, non-radiating, left sided chest pain. It was there earlier, went away, and then returned approximately 1 hour prior to arrival. He is a smoker and has some family history of early MI. Exam and vital signs were normal.Here was the triage ECG:There appears to be diffuse ST Elevation (II, III, aVF with reciprocal STD in aVL, V3-V6, and lead I, with T-waves that appear to be hyperacute (broad and fat, but on the other hand they have no straightening of the ST segment). ST depression and T-wave inversion in V2 sugge...
Source: Dr. Smith's ECG Blog - May 24, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
