Vaccine associated myocarditis revisited with COVID-19 mRNA vaccines
When I had reviewed the topic of vaccine associated myocarditis for an editorial in the BMH Medical Journal in 2017, most of the cases were associated with small pox vaccination [1]. There were also reports of streptococcal pneumonia vaccine and influenza vaccine associated myocarditis. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) used in the vaccine were also implicated in some cases [2,3].
While the large scale vaccination for small pox in an attempt to prepare for potential bioterrorism was the association in 2003 [4], COVID-19 mRNA vaccines are currently in the limelight for vaccine induced myocarditis...
Source: Cardiophile MD - July 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
I'm for it . . .
but it isn ' t going to happen, at least not this year. I got the following from the Drug Policy Alliance:Today, on the 50th anniversary of Nixon declaring the “war on drugs,” Reps. Bonnie Watson Coleman and Cori Bush haveofficially introduced the Drug Policy Reform Act, a bill to federally decriminalize ALL drugs that they unveiled earlier this week at the press conference the Drug Policy Alliance hosted. DPA has been a strategic partner on the development of this legislation and will be actively advocating for its passage in Congress. DPA ’s Executive Director, who is currentlytestifying before the House...
Source: Stayin' Alive - June 17, 2021 Category: American Health Source Type: blogs
Athlete ’ s heart
Athlete’s heart
Athlete’s heart denotes structural, functional and electrical remodeling seen in trained athletes. It is a physiological adaptation helping athletes perform physical tasks better than non-athletes [1]. Though most of the findings in athlete’s heart are related to the left ventricle, changes do occur in the right ventricle as well.
Effect of exercise on the left ventricle
During aerobic exercise which is isotonic, the heart rate and stroke volume increases. Systemic vascular resistance falls, but slight to moderate increase in blood pressure can occur due to the increased cardiac output. As...
Source: Cardiophile MD - June 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
COVID-19 and the heart: What have we learned?
Early in the pandemic, epidemiologists made a striking observation. Compared to the general population, people with cardiovascular disease (CVD) were more than twice as likely to contract severe forms of COVID-19. In the last six months, death rates from COVID-19 have dropped significantly, but CVD remains a major predictor of poor outcome. What have we learned about heart disease and COVID-19 in that time?
Pre-existing heart conditions and poor metabolic health increase risk of severe COVID-19
As I described in a blog post back in April, some health conditions, like diabetes, increase risk of severe COVID-19 by suppressin...
Source: Harvard Health Blog - January 6, 2021 Category: Consumer Health News Authors: Dara K. Lee Lewis, MD Tags: Coronavirus and COVID-19 Heart Health Source Type: blogs
Extreme shock and cardiac arrest in COVID patient
This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED. He was moderately hypoxic. He had the following EKG recorded:Low voltage, suggests effusion.(see Ken ' s discussion of low voltage below)There is a QS-wave in V2.There is minimal, probably normal STE in V2-V6.A bedside cardiac ultrasound was normal, with no effusion. He had troponins ordered, and the first returned at 72 ng/L (Abbott Architect hs cTnI; URL for males = 34 ng/L). An elevated troponin in a COVID patient confers about 4x the risk of mortality than a normal one.He was admitted on oxygen and was&...
Source: Dr. Smith's ECG Blog - November 12, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Doctors Urge Caution in Interpretation of Research in Times of COVID-19
September 9, 2020
To:
American College of Cardiology
American College of Chest Physicians
American College of Physicians
American College of Radiology
American Heart Association
American Society of Echocardiography
American Thoracic Society
European Association of Cardiovascular Imaging
European Society of Cardiology
European Society of Radiology
Heart Rhythm Society
Infectious Disease Society of America
North American Society of Cardiovascular Imaging
Radiologic Society of North America
Society of Cardiovascular Magnetic Resonance
Soci...
Source: The Health Care Blog - September 17, 2020 Category: Consumer Health News Authors: Christina Liu Tags: COVID-19 Medical Practice Patients Physicians myocarditis Saurabh Jha Source Type: blogs
A man in his 50s with 2 hours of chest pressure
Case submitted by Anonymous, written by Pendell MeyersA man in his 50s with history only smoking presented to the ED with chest pressure for the past 2 hours. His vitals were within normal limits except BP 163/109. No prior ECG was available. Here is his triage ECG:What do you think?This is probably obvious to regular readers of this blog, but it is NOT obvious to most emergency providers and cardiologists.Findings include: - Sinus rhythm - Normal QRS complex - Hyperacute T waves in leads II, III, and aVF - reciprocal STD and T wave inversion in aVL - STD in V2-V4 (max in V3) - Like...
Source: Dr. Smith's ECG Blog - September 12, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
This is double plus ungood news
It ' s one study, and it isn ' t very long follow-up, just two or three months, butthis is a very ugly result. German researchers did magnetic resonance imaging of the hearts of 100 people who had recovered from Covid-19. Two thirds of them had not been hospitalized. It turned out that 78% of them had abnormal results indicating inflammation of the heart muscle, and/or reduced cardiac functioning, regardless of the severity of their illness. They don ' t fully explain how the sample of patients was obtained but they describe them as " unselected, " in other words they are assumed to be representative of all patients ...
Source: Stayin' Alive - August 17, 2020 Category: American Health Source Type: blogs
Hypoxia and LV dysfunction: Let us learn more from “ COPD, COVID-19 and Tetralogy of Fallot ”
Superficially, tissue hypoxia might look similar to Ischemia but differs in one important aspect. Though the hypoxic myocardium is short of oxygen, the respiratory excreta from cells ie Co2, lactic acid, and free radicles are promptly cleared and flushed as blood flow is normal. Hence, generally acute Ischemia of tissues is more cell threatening than regional hypoxia at any organ level. How do you classify hypoxia? we need to go to physiology classes again.There are 4 types. Ischemic -Hypoxia, systemic hypoxia, Anemic hypoxia, Histo-toxic hypoxia.A good reference to read (Ošt’ádal B., Kolář F. (1999) Myocardial Hy...
Source: Dr.S.Venkatesan MD - August 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: metabolic support of heart failure anerobic cardiac metabolism copd and lv dysfunction covid heart disease hypoxia and covid lv dysfunction hypoxia vs iscehmia ketone bodies ato heart lv dysfunction in congenital cyanotic heart disease met Source Type: blogs
A middle aged female with " heartburn " and a " normal ECG " per the computer
This is a re-posting of a Tweet by Robert Jones (@RJonesSonoEM), reproduced with permission, written by Pendell MeyersA middle aged female with history of smoking presented to the ED with " bad heartburn. "Here is her prior baseline ECG (first), and her ED ECG (second):Baseline:ED ECG:What do you think? Do you agree with the computer ' s interpretation of " Normal ECG " ?This was posted on Twitter and Dr. Smith (and several others) replied that it shows OMI. Dr. Smith said " No " (meaning " No, I do not agree with the computer " ). " New ST elevation in V4-V6. New distortion of S wave in V4 - OMI - distal LAD likely. "The ...
Source: Dr. Smith's ECG Blog - August 7, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
A case of misinterpreted troponins, in spite of a very suspicious ECG....
This 50-something male with previous history of MI presented for intermittent CP and SOB for 2 days. CP lasted for hours at a time, was described as pleuritic, without radiation, but relieved by nitro. He was given nitro and full dose aspirin by EMS. Prehospital ECG was similar to first ED ECG.Here is the ED ECG for ED visit #1:It is very abnormal, with potentially ischemic downsloping ST depressionThere were 3 ECGs during an ED visit for chest pain one month earlier. Let ' s call that ED visit zero.Here is the last EKG from ED visit zero:There is minimal ST depression without the downsloping.Her...
Source: Dr. Smith's ECG Blog - July 20, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
What is a useful next step in the evaluation of this patient with Chest pain and this ECG?
Written by Pendell Meyers, submitted by Daryl Williams, edits by Steve SmithA man in his sixties with prior CAD and CABG experienced chest pain and pressure off and on for three days. He saw his primary doctor during this time who had suspected GI related symptoms and increased his PPI medication. On the third day it became more intense and had associated radiation to his neck and left arm, and this reminded the patient of his prior MI symptoms, so he presented to the Emergency Department. It is unclear how long he had constant symptoms during those three days.Here is his triage ECG (no prior was available in our system):W...
Source: Dr. Smith's ECG Blog - July 18, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
A young woman in her early 20s with syncope
Written by Pendell MeyersA 20 year old female with an episode of syncope was triage to my low acuity zone one morning. Her vitals were within normal limits except for her heart rate of 109 bpm.I immediately went to evaluate her, without looking in the chart first. I found a well appearing young lady in the room with her parents who witnessed the event. She stated that she was sitting on a shallow ledge in a pool when she became lightheaded, so she got up out of the pool and then briefly syncopized next to the pool in front of her parents, who were able to catch her preventing any trauma. She returned to normal within 30 se...
Source: Dr. Smith's ECG Blog - July 11, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
What do you think of this elderly man with " possible seizure " ?
Written by Pendell Meyers(with really great and thorough explanation of this finding by Ken Grauer).At my hospital, patients with any symptoms which could be vaguely interpreted as a possible stroke during the triage process are brought to the high acuity area and a provider is asked to do a " neuro check " , which involves a quick H and P and exam to determine if we should activate our stroke protocol.A man in his 70s was brought to me for a neuro check, and the triage providers commented that they were worried about a possible seizure as well. The patient was alert and oriented with normal vitals at triage. He stated tha...
Source: Dr. Smith's ECG Blog - May 23, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
1 hour of CPR, then ECMO circulation, then successful defibrillation....
An elderly woman had sudden ventricular fibrillation.She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). ECMO Flow was achieved after approximately 1 hour of high quality CPR.After good ECMO flow was established, she was successfully defibrillated.Here is her monitor rhythm:Notice the " Shark Fin " morphology in lead I monitor rhythm.Also notice that the arterial line mean arterial pressure is 63 mmHg, but there is no waveform (and SpO2 says " no pulse " ), as the flow is continuous on ECMO and the LV function at this point was ext...
Source: Dr. Smith's ECG Blog - May 18, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
