A man in his 50s with fever and shortness of breath
Written by Pendell MeyersA man in his 50s with HTN, HLD, obesity, and restrictive lung disease presented with shortness of breath worsening over the past 3 days. He also had a cough and subjective fevers. He denied chest pain. His vitals were within normal limits.Here is his triage ECG (no baseline available):What do you think?Findings: - sinus rhythm at about 100 bpm - STE in I and aVL (meets STEMI criteria) - hint of STD in III and aVF - STD in V1 and V2 - hyperacute T-waves in I and aVL (with reciprocal negative hyperacute T in III)Interpretation:This is definitive evidence of acute transmural i...
Source: Dr. Smith's ECG Blog - May 10, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Hypertension induced by tyrosine kinase inhibitor
Well known adverse effect of chemotherapeutic agents are cardiomyopathy and myocarditis leading to heart failure and arrhythmias. Hypertension induced by tyrosine kinase inhibitor (TKI) is an important adverse effect and has specific mechanisms. Hypertension is noted with vascular endothelial growth factor (VEGF) and vascular signalling pathway (VSP) inhibitors [1].
The incidence ranges from 5% to 80% among VEGF inhibitors and is dose dependent. Incidence of hypertension is lower in new generation small molecule TKI [1]. Mechanism of hypertension is through vascular signally pathway inhibition which causes decrease in nit...
Source: Cardiophile MD - April 27, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardio Oncology Source Type: blogs
How does cardiovascular disease increase the risk of severe illness and death from COVID-19?
Based on reports from China, we know that most COVID-19 patients (about 80%) will develop mild flulike symptoms, including fever, dry cough, and body aches that can be managed at home. 20% will develop more serious symptoms, such as pneumonia requiring hospitalization, with about a quarter of these requiring ICU-level care.
Initial reports focused on the respiratory effects of COVID-19, such as pneumonia and difficulty breathing. But more recent literature has described serious cardiovascular complications occurring in about 10% to 20% of hospitalized patients.
Someone with pre-existing heart disease who becomes ill with C...
Source: Harvard Health Blog - April 2, 2020 Category: Consumer Health News Authors: Dara K. Lee Lewis, MD Tags: Health Heart Health Hypertension and Stroke Infectious diseases Source Type: blogs
A 40-something with chest pain. Is this inferior MI?
This was sent by a Saleh Hatem, an avid reader of the blog.The patient presented with chest pain:There is a narrow complex tachycardia.Is there inferior ST Elevation?Here was my interpretation:What appears to be ST Elevation in inferior leads is really a P-wave that is contiguous with the QRS. (The next bump over is a T-wave that looks like a P-wave!).Since the P-wave is not inverted, it is NOT retrograde, and therefore it is a native sinus beat. This sinus beat does conduct, but there is severely prolonged PR interval (severe first degree AV block), with a PR interval of over 400 ms.So: Sinus tachycardia with severe...
Source: Dr. Smith's ECG Blog - March 3, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 53 yo woman with cardiogenic shock. Believe me, this is not what you think.
This was sent by a reader.A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock.pH was 6.9 and K was normal.Here was the ECG:There is sinus tachycardia.This is " Shark Fin " morphology.Shark Fin has also been called:"Giant R-wave""Triangular QRS-ST-T waveform"Usually shark fin is in one coronary distribution and represents massive ST elevation that is as high as the peak of the R-wave and thereforefuses the R-wave and ST segment.So Shark Fin really is just a dramatic representation of STEMI, and can be in any coronary distribution.It is often confused with a wide QRS due to condition...
Source: Dr. Smith's ECG Blog - February 15, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Test yourself: Which of the following 6 ECGs of patients with chest pain represent inferior OMI?
Which of the following 6 ECGs of patients with chest pain represent inferior OMI?The answer could be 1 or more than 1.1.2.3.4.https://hqmeded-ecg.blogspot.com/2011/10/inferior-st-elevation-what-is-diagnosis.html5.https://hqmeded-ecg.blogspot.com/2018/05/is-there-delayed-activation-wave.html6.https://hqmeded-ecg.blogspot.com/2013/04/a-40-year-old-male-with-several-chronic.htmlAnswer:3. and 5. are inferior OMI1., 2., 4., and 6. are limb lead early repolarizationIs it really possible to differentiate these?Yes. Pendell did it easily getting 6/6 correct.I put this post up because I just received number 3 from a former gr...
Source: Dr. Smith's ECG Blog - February 1, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 40-something with sharp chest pain, worse with lying down, better leaning forward
p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Helvetica; background-color: #fefefe}A 40-something y.o. male with only PMH of DM and tobacco use presented with chest pain. Patient complained of 2 days of sharp, constant, sternal chest pain, 10/10, waxing and waning, worse with laying down and improved with leaning forward or walking. He has not had pain like this before.Here is his ED ECG:Diffuse ST Elevation.The only reciprocal depression is in aVRThere is a lot of PR depression.The inferolateral T/ST ratio is low (i.e., T-waves are not large in spite of STE)What do you think?This ...
Source: Dr. Smith's ECG Blog - January 13, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Viral symptoms, then acute chest pain and this ECG. What do you do?
A late 30 ' s male presented with fever, sore throat, headache, vomiting, and body aches ( " bones hurting " ) for 2 days.He presented to the ED because he developed sudden severe, sharp, pleuritic (but not positional), substernal and left mid to lower chest pain.He had this ECG at time 0What do you think?There was an old ECG for comparison:Very normalInterpretation:There is serious widespread ST elevation that could easily by due to a wraparound LAD with anterior and inferior MI. It could also be due to pericarditis or myocarditis, but I always say that " you diagnose pericarditis at your peril. "If you thought...
Source: Dr. Smith's ECG Blog - January 9, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Perimyocarditis vs Myopericarditis
Hearing the terms one may be tempted to think both are the same. But it is not so according to the 2015 ESC (European Society of Cardiology) Guidelines [1].
Myopericarditis: Pericarditis with known or clinically suspected concomitant myocardial involvement.
Perimyocarditis: Predominant myocarditis with pericardial involvement.
So the stress is on the second part of the name.
Reference
Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristic AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W; ESC Scientific Document Group. 2...
Source: Cardiophile MD - January 7, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
" Pericarditis " strikes again
Written by Pendell MeyersA man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. Several hours prior to presentation, while driving his truck, he started experiencing new central chest pain, without radiation, aggravating/alleviating factors, or other associated symptoms. On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. On exam the patient was well appearing, with normal vitals signs other than BP 155/82, no murmurs or rubs, normal pulses, no reproducible chest pain.Here is his triage ECG:Wha...
Source: Dr. Smith's ECG Blog - December 12, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
Teenager with chest pain and slightly elevated troponin. What happens then?
This is a previously healthy male teenager who was awoken by chest pain. He was seen at another hospital and found to have a slightly elevated troponin, then underwent a CT pulmonary angiogram (PE) protocol which revealed a right sided pneumonia. He was treated with Ceftriaxone and azithromycin.p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Calibri; background-color: #fefefe}The pain is described as located in the midsternal area, radiating to the right arm, described as 8-9/10 and worse with deep inspirations. He endorsed cough, fever, and body aches in the previous day...
Source: Dr. Smith's ECG Blog - December 9, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
MINOCA vs TpNOCA
TpNOCA: Troponin-positive nonobstructive coronary arteries
Apparent myocardial infarction in the absence of obstructive coronary artery disease
MINOCA: Myocardial Infarction With Nonobstructive Coronary Arteries
Term reserved for only those who have evidence of ischemia related myocardial necrosis
MINOCA included only coronary disorders like coronary dissection, plaque disruption, coronary spasm, microvascular dysfunction, coronary thrombus and embolism (recanalized).
TpNOCA includes in addition to MINOCA, myocardial disorders like myocarditis, takotsubo cardiomyopathy and other cardiomyopathies as well as non cardia...
Source: Cardiophile MD - September 10, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
The ECG was correct. The angiogram was not.
In this study, approximately 10% of Transient STEMI had no culprit found:Early or late intervention in patients with transient ST ‐segment elevation acute coronary syndrome: Subgroup analysis of the ELISA‐3 trialOne must use all available data, including the ECG, to determine what happened.Final Diagnosis?If the troponin remained under the 99% reference, then it would be unstable angina. If it rose above that level before falling, it would be acute myocardial injury due to ischemia, which is, by definition, acute MI. If that is a result of plaque rupture, then it is a type I MI. The clinical presentat...
Source: Dr. Smith's ECG Blog - August 12, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Even Low Levels of Infection Can Cause Cardiac Dysfunction in Older Individuals
We examined how mycobacterial infection and inflammaging catalyze the decline in cardiovascular function in the elderly. Young (3 months) and old (18 month) female C57BL/6 mice were infected with a sub-lethal dose of Mycobacterium avium (M. avium), an NTM. We observed no differences in the M. avium bacterial numbers in the lung, liver, or spleen between young and old M. avium infected mice. However, through the course of M. avium infection, old mice developed severe dysrhythmia and developed pericarditis. Moreover, the hearts of M. avium infected old mice had increased cardiac hypertrophy, fibrosis, expression of pro-infla...
Source: Fight Aging! - August 9, 2019 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Fight Aging! Newsletter, August 5th 2019
In conclusion, with study of the frailty syndrome still in its infancy, frailty analysis remains a major challenge. It is a challenge that needs to be overcome in order to shed light on the multiple mechanisms involved in the pathogenesis of this syndrome. Although several mechanisms contribute to frailty, immune system alteration seems to play a central role: this syndrome is characterized by increased levels of pro-inflammatory markers and the resulting pro-inflammatory status can have negative effects on various organs. Future studies should aim to better clarify the immune system alteration in frailty, and seek to esta...
Source: Fight Aging! - August 4, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
