Inferior ST elevation with reciprocal change: which of these 4 patients has Occlusion MI?
Written by Jesse McLaren, with comments by Smith and Grauer Four patients presented with cardiorespiratory symptoms, with inferior ST elevation and reciprocal change on their ECG. Which patient had occlusion MI? Note: according to the STEMI paradigm these ECGs are easy, but in reality they are difficult. First let ’s start with each ECG without clinical context. What do you think of each ECG? ECG 1: ECG 2:ECG 3:ECG 4:Now let ’s introduce some clinical context. How would this change management? Patient 1: 30 year old previously healthy, presenting with syncope, now asymptomatic with n...
Source: Dr. Smith's ECG Blog - May 23, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Chest pain, shortness of breath, T wave inversion, and rising troponin in a young healthy runner.
In this study, 40 presumably healthy male marathon runners had their cardiac troponin and other findings measured before and after running a marathon. 39 pts (97.5%) had baseline cTnT values below the reference limit (less than 14 ng/L). 38 pts (95%) of participants had post-marathon cTnT concentration rise above this reference limit. The median post-marathon cTnT was 41 ng/L, and the 95th percentile concentration was 90 ng/L. None reported " cardiac symptoms " after the race.See this single post for many examples of BTWI:Understanding this pathognomonic ECG would have greatly benefitted the patient.More cases involving BT...
Source: Dr. Smith's ECG Blog - May 19, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
On the declining prestige of expertise
Yeah, it ' s something of a hobby horse. But it ' s important.Sean Illig interviews Michael Lewis about why people don ' t trust experts. I don ' t think Lewis gives anything like a full explanation, but he does make a point I ' d like to pick up on. Much of what experts say about the world is probabilistic, and people just don ' t understand probability and statistics, either in a philosophical or a technical sense.Actually, probability is difficult to understand philosophically. I ' ll stay out of those weeds for now but most predictions, at least the interesting ones, come with a degree of likelihood, they aren ' ...
Source: Stayin' Alive - April 29, 2022 Category: American Health Source Type: blogs
TWiV 889: COVID-19 clinical update #110 with Dr. Daniel Griffin
outbreaks, viral load in vaccinated and unvaccinated individuals, predictive capacity of symptoms in children, comparison of antigen tests, incidence of myocarditis after vaccination, steroids during replication phase, Paxlovid efficacy and safety, fluvoxamine, sabizabutin, colchicine, and prevalence of infection in Africa. (Source: virology blog)
Source: virology blog - April 16, 2022 Category: Virology Authors: Vincent Racaniello Tags: This Week in Virology antiviral coronavirus COVID-19 delta inflammation Long Covid monoclonal antibody pandemic SARS-CoV-2 vaccine vaccine booster variant of concern viruses Source Type: blogs
RBBB with STE in I and aVL. Will the angiogram tell you if this ECG represents Occlusion MI or not?
A middle aged male with history of STEMI and stents presented with one hour of chest pain.Here is his ED ECG:What do you think?Analysis: There is sinus rhythm with RBBB. There is ST Elevation in I and aVL which is discordant to the wide S-wave (a wide S-wave in lateral leads is a feature of RBBB). There is also some ST depression in lead V3 (inferoposterior OMI is suggested). There is no R ' -wave in V2 and so one would not expect the typical discordant ST depression and TW inversion that one often sees in V2. However, V3 does have an R ' -wave, and STD, but the T-wave isconcordantly positive, which...
Source: Dr. Smith's ECG Blog - April 11, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
The (sort of, partial) Father mRNA Vaccines Who Now Spreads Vaccine Misinformation (Part 1)
By DAVID WARMFLASH, MD
Robert W. Malone, MD MS, is a physician-scientist who will live in infamy, thanks to the Joe Rogan Experience Podcast boosting his visibility this past December regarding his criticism of COVID-19 vaccines, particularly the mRNA vaccines (Moderna and Pfizer-BioNTech). Subsequently, Malone was banned from Twitter, which further boosted his celebrity status. Describing himself as the inventor of mRNA vaccine technology, he has been reaching a growing number of people with a narrative that makes COVID-19 vaccination sound scary. We cannot embed clips from the Rogan interview, which lasted about three...
Source: The Health Care Blog - March 17, 2022 Category: Consumer Health News Authors: matthew holt Tags: COVID-19 Health Policy antivaxxer COVID-19 vaccine David Warmflash Joe Rogan Robert Malone Source Type: blogs
False cath lab activation or false cancellation?
Written by Jesse McLarenA 40 year old developed sudden chest pain radiating to the jaw, with diaphoresis and vomiting. What do you think?What do you think? There ’s normal sinus rhythm with normal conduction, normal axis, normal R wave progression and normal voltages. There are hyperacute T wave in I/aVL and possibly V5-6, with reciprocal change in III. There’s also ST depression in V1-3. The computer interpretation labeled this ECG as “nonspecific”, and it does not meet STEMI criteria. But there are ischemic abnormalities in the majority of leads that add up to an ECG diagnostic of posterolateral Occlusion MI...
Source: Dr. Smith's ECG Blog - March 16, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A 40-something woman with severe chest pain and ST Elevation
This 40-something woman presented with severe anterior chest pain.Theprehospital ECG looked the same and the medics were worried about the ST Elevation and about STEMI/OMI.What do you think?There is ST Elevation thatmeets STEMI criteria in 3 consecutive leads V2-V4. The T-waves in V2-V4 appear hyperacute. The heart rate is 125!!But, as we have discussed often, when there istachycardia, you must doubt the diagnosis of acute OMI. Unless the OMI is resulting in decreased stroke volume, or there is an additional disorder, there should not be tachycardia. There must be another etiology or an addition...
Source: Dr. Smith's ECG Blog - March 3, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 50s with " no reciprocal ST depression " and " diffuse " ST elevation. What does diffuse actually mean?
CONCLUSION: I completely agree with Dr. Meyers that ST-T wave changes in thisinitial ECG shown inFigure-1 are definitely not “diffuse”.The “beauty” of medicine — is that there is often more than a single appropriate answer or approach to any clinical situation. As a result — I choose to continue my use of the term“diffuse”for those selective situations that I describe above. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - February 12, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Hyperacute T-waves -- missed. Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) may be due to transient thrombotic Occlusion MI.
Coronary thrombosis (twice in the same patient!!) without a stenosis or even a culpritDo not miss the last image at the bottom that shows the series of T-waves in V4-V6I recently had a discussion with an incredibly smart and fantastic ECG and Cardiology expert. He was skeptical that you can have OMI with Wellens waves without having a major stenosis on angiogram.I told him I ' ve seen it on occasion and that this happens due to thrombosis of non-obstructive lesions that lead to complete occlusion but that thencompletely lyse and do not show stenosis by the time of the angiogram. I said that even if there is not...
Source: Dr. Smith's ECG Blog - December 29, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Godwin ’s Law and the Rise of Hyperbole on MedTwitter 🙄
By @roguerad
I first clashed with authority when I was eight. Every Saturday bunch of brown kids, children of Indian immigrants to Britain with an identity crisis who longed for the culture they left behind, attended a class in the temple about “our culture” taught by a joyless scholar of Hinduism – a pundit – whose major shtick was punctuality. When I turned up late, even by a minute, he’d make me stand outside, even if freezing. Some kids called him “Hitler,” or “Hitler uncle,” the qualifier “uncle” indicated that because he was as old as our fathers, he deserved respect.
Then, I believe...
Source: The Health Care Blog - October 28, 2021 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Public Health Godwin's Law Hyperbole MedTwitter Misinformation Saurabh Jha Source Type: blogs
Most important cardiotoxicity of immune checkpoint inhibitors – Cardiology MCQ – Answer
Most important cardiotoxicity of immune checkpoint inhibitors – Answer
Cardiotoxicity of immune checkpoint inhibitors – Correct answer: 1. Fulminant myocarditisImmunotherapy with immune checkpoint inhibitors is becoming standard of care for multiple types of malignancies. Important immune checkpoint inhibitors are ipilimumab which acts against cytotoxic T lymphocyte-associated antigen 4 (CTLA-4); nivolumab and pembrolizumab which act against programmed cell death 1 (PD-1) and atezolizumab which targets PD-1 ligand (PD-L1).
Autoimmune fulminant myocarditis has been described in persons treate...
Source: Cardiophile MD - October 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
D-Cube syndrome : DES-Dengue-DAPT
Background
A 52-year-old diabetic woman who had undergone recent PCI with a DES developed a febrile illness which was diagnosed as Dengue fever. She has been taking DAPT (Dual antiplatelet) meticulously to maintain her stent. Now, her platelet count has dropped from 1.5 and subsequently to 1 lakh. She is asking now, whether to stop DAPT or not? What is the risk of stent occlusion if she stops?
The D³ cube syndrome
Infectious diseases rarely bother a cardiologist (maybe a few IE, myocarditis, etc). Now, a unique situation is emerging.
*Dengue affects 50-100 million people worldwide every year and one billion are ...
Source: Dr.S.Venkatesan MD - September 9, 2021 Category: Cardiology Authors: dr s venkatesan Tags: anti platelet drug antiplatelet drugs in dengue clopidogrel prasugrel ticagrelol in dengue fever dapt in dengue fever therapeutic issues in dengue and cad warfarin heparin in dengue Source Type: blogs
Post #56 Back-to-School Advice for the COVID-19 Delta Surge
It is with a mix of frustration and hope that I am writing a second back-to-school blog about COVID-19. At this same time last year, there were so many unknowns about the pandemic and how to handle returning to school. The uncertainty led to fear, which in turn fueled a respect for the virus, which unfortunately is lacking in the current decision-making to ban mask mandates. The irony is we have so much more science and data than we did at this time last year that we could and should be smarter about our policies. Nonetheless, with some children vaccinated, and more to become eligible soon, this next school year...
Source: A Pediatrician's Blog - August 20, 2021 Category: Pediatrics Source Type: blogs
An Adolescent with dizziness and near syncope
Submitted by Maura Corbett, PA-C, written by Alex Bracey, with some comments by Smith and MeyersA teenage male presented to the emergency department with the complaint of dizziness with near-syncope. He was stable and able to provide a history and mentioned that he was asymptomatic while seated but dizzy and weak when attempting to stand. An ECG was recorded:What do you think? There iscomplete (third degree) heart block with wide complex bradycardicescape. The morphology is that of LBBB and so the escape is originating from the right bundle.The possible etiologies of this ECG are:- Structural/congenital heart di...
Source: Dr. Smith's ECG Blog - August 7, 2021 Category: Cardiology Authors: Bracey Source Type: blogs
