Impaired Monocyte to Macrophage Transition Implicated in Cardiovascular Disease
The innate immune cells called macrophages are vitally important to the health and function of tissues. They help to coordinate the intricate dance of stem cells, somatic cells, and immune cells that produces tissue regrowth and tissue maintenance. They destroy errant cells and pathogens. They have a variety of other roles as well. But where do macrophages come from? While some macrophages are generated within tissues, it is generally the case that in damaged or diseased tissues, most macrophages were originally monocytes. Circulating monocytes in the bloodstream enter tissues in response to chemical cues and then transfor...
Source: Fight Aging! - July 29, 2019 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
What does this ECG with significant ST Elevation represent?
These 2 serial ECGs were texted to me recently. They were recorded 12 minutes apart:" Hey Steve, 30-something with one week of chest pain, mostly right-sided, better with sitting up. " :What do you think?QTc ' s were 330 ms and 373 msThis is what I texted back:These look like they are a very pronounced case ofBenign T-wave Inversion. I do not think this is acute occlusion myocardial infarction (OMI). Get an emergent contrast echocardiogram.p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica}These are reasons why it does not look like OMI: 1. flat ST segment in V42. huge R-wave in V43. ...
Source: Dr. Smith's ECG Blog - July 20, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 20-something male with acute chest pain
I was texted this ECG with the words " sudden onset CP in a 20-something " :What do you think?This was my response:" This is abnormal in lateral leads. It probably is a normal variant but I would get a stat echo.It is out of the bounds of the usual with normal variant because the ST Elevation is so focal to the lateral wall. Most normal variant has as much inferior STE as lateral (and of course without ST depression in aVL). This is myocarditis versus myocardial infarction. He should get an immediate echo. Problem is, even myocarditis will have a wall motion abnormality. And then the only way to tell ...
Source: Dr. Smith's ECG Blog - June 10, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Harm Reduction
Kishore and colleagues in NEJM, including Josiah Rich from a university well known to me, discuss the harm reduction approach to injection drug use (IDU). Basically, this means using evidence to guide practice so as to minimize as much as possible the adverse public health consequences of addiction. In addition to the risk of overdose, which is getting most of the attention nowadays, IDU is a means of transmission of Hepatitis C and HIV, and contaminated needles transmit other common infectious organisms that can result in abscesses, and very serious consequences such as myocarditis.So, assuring that users have access to s...
Source: Stayin' Alive - May 23, 2019 Category: American Health Source Type: blogs
Epigastric pain radiating to the chest for 18 hours. ECG makes the Dx. Troponin makes the Dx. CT makes the Dx!
I was shown this ECG with no other information:What do you think?Hint: try to see through the artifact!I answered immediately: " High lateral MI with posterior MI. OMI. " (Occlusion Myocardial Infarction)I asked, " Did the patient present with chest pain? "Here is the history:" A middle-aged male complained of about 18 hours of epigastric pain that radiated to the chest. He also had an apparently new facial droop of equal duration. A stroke code was called, NIH stroke scale was only 1, and attention was turned to the chest pain. " BP was 148/83.How did I make this ECG diagnosis?There is subtle STE in aVL ...
Source: Dr. Smith's ECG Blog - March 28, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest pain and Convex ST Elevation in Precordial Leads
A 30-something y.o. male with PMH significant for anxiety, asthma, and alcohol use disorder presented with chest pain x 1 week. Patient thinks he has an asthma flare, with wheezing. He subsequently developed fevers and chills, and then left-sided chest pain associated with a cough. His breathing and infectious sx then improved. Today, however, he developed constant chest pain radiating into left arm around 1345. He states the pain is improving now. He had associated " swimmy, head rush, " which is no longer present. He denies associated shortness of breath, sweating, numbness, tingling. Onset of pain was while sweepi...
Source: Dr. Smith's ECG Blog - February 18, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Anterior ST Elevation and a High Initial Troponin.
I was shown this ECG with the history that the patient had chest pain:What do you think?This is what I said: " This is not anterior STEMI; it is normal variant, though it is unusual in appearance. "If you wanted to use the formula, the computerized QTc on all ECGs was 360 ms - 370 ms4-variable formula value = 12.14 (this is VERY low).Then I was told that the first troponin I was 14.0 ng/mL (very high!)Here is the history:A 40-something male presented with pleuritic left-sided chest pain, radiating to the neck, on and off for 3 days. He has also noted some dull generalized chest pain which he locates more so on t...
Source: Dr. Smith's ECG Blog - January 22, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
A patient with chest pain and dynamic ST elevation
Written by Pendell MeyersA female in her late 40s presented with chest pain, waxing and waning over the past 24 hours. Her history included end stage renal disease on dialysis, HTN, and DM. Here is her initial ECG around 4:30pm:Sinus tachycardia.The QRS is characterized byhigh voltage andnonspecific intraventricular conduction delay.There is STE in V2-V4However, this STE appears to be" secondary " STE in V2-V3 (repolarization abnormalities may be " secondary to an abnormal QRS " , or " primary " in the context of a normal QRS), a result of the abnormal QRS complex.The STE in V4 is concordant, and one must enterta...
Source: Dr. Smith's ECG Blog - January 9, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
Spodick ’ s sign – Cardiology MCQ
Spodick’s sign – Cardiology MCQ
Spodick’s sign is:
ST segment elevation in acute myocarditis
PR segment depression in acute pericarditis
ST segment elevation in acute myocardial infarction
Downsloping TP segment in acute pericarditis
Post your answer as a comment below.
The post Spodick’s sign – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - December 12, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
AAP Bronchiolitis Guidelines a Mismatch with Clinical Practice
I recently met with a group from our children's hospital to standardize the hospital management of bronchiolitis according to the latest American Academy of Pediatrics guidelines. (Pediatrics 2014;134[5]:e1474; http://bit.ly/2QIGbMX.) Unfortunately, these guidelines seem to cause confusion for experienced and inexperienced emergency physicians alike.This confusion comes from the guidelines raising unaddressed issues and new questions, most importantly not tackling important aspects of frontline clinical practice. These guidelines were developed with the best evidence currently available, and their application mo...
Source: M2E Too! Mellick's Multimedia EduBlog - December 4, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Ignorance based cardiology : How common is “ myocardial congestion ” in cardiac failure ?
We learn from basic physiology lessons that human body is made up of 60 % water. What about heart ? There is no reason for the heart should behave differently from rest of the body . If my assumptions are correct when the normal heart weighs 300g , 180g of which should be be water. The same thing could be applicable for LV mass( * Reference requested)
Is there myocardial congestion in cardiac failure ?
Genesis of edema in any tissue depends on local hydrostatic pressures, tissue resistive forces, osmotic balance, and cell membrane permeability. In the myocardium individual contribution of above factors are not ...
Source: Dr.S.Venkatesan MD - November 27, 2018 Category: Cardiology Authors: dr s venkatesan Tags: cardiac failure Cardiac MRI Cardio Nephrology effect of dialysis on myocardial water content lv amss and myocardial edema myocardial edema and ckd chronic kidney failure myocardial interstitial edema myocardial water imaging water logging Source Type: blogs
12 Year Old Asthmatic with Intermittent Dyspnea Unresponsive to Albuterol---What is it, and Why Now?
This case was written by one of ourgreat Hennepin 2nd year residents, Aaron Robinson, with lots of comments and edits by Smith.Thanks to Dr. Smith and Dr. Travis Olives for being part of this case. A 12 year old girl with a history of mild intermittent asthma presented to the emergency department with worsening shortness of breath over the past couple of days. She is up to date on her vaccinations and has no PMHx besides asthma and a noncontributory family history. She does not identify any specific triggers for her asthma. Initial screen in triage revealed normal vitals signs and a normal temperature. Upon interviewi...
Source: Dr. Smith's ECG Blog - August 7, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Tropical Travel Trouble 011 Tonsillitis and the Bull
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 011
Peer Reviewers: Dr Jennifer Ho, ID physician QLD, Australia and Dr Mark Little, ED physician QLD, Australia.
You are working in far North Queensland and encounter a 20 year old Indigenous man with tonsillitis on your ED short stay ward round. He has been receiving IV penicillin and metronidazole overnight but is deteriorating and now cannot open his mouth beyond 1.5cm, and has a swollen neck (some might say ‘Bull neck’). In add...
Source: Life in the Fast Lane - July 25, 2018 Category: Emergency Medicine Authors: Amanda McConnell Tags: Clinical Cases Tropical Medicine antitoxin bull neck c. diphtheriae c.ulcerans DAT pseudomembrane vaccine Source Type: blogs
Tropical Travel Trouble 011 Tonsillitis and the Bull
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 011
Peer Reviewers: Dr Jennifer Ho, ID physician QLD, Australia and Dr Mark Little, ED physician QLD, Australia.
You are working in far North Queensland and encounter a 20 year old Indigenous man with tonsillitis on your ED short stay ward round. He has been receiving IV penicillin and metronidazole overnight but is deteriorating and now cannot open his mouth beyond 1.5cm, and has a swollen neck (some might say ‘Bull neck’). In add...
Source: Life in the Fast Lane - July 25, 2018 Category: Emergency Medicine Authors: Amanda McConnell Tags: Clinical Cases Tropical Medicine antitoxin bull neck c. diphtheriae c.ulcerans DAT pseudomembrane vaccine Source Type: blogs
You Diagnose Pericarditis at your Peril (at the Patient's Peril!)
The source of this case is anonymous.A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chest pain radiating to " both axilla " as well as the upper back. She was reportedly " pacing in her room while holding her chest " .The initial tracing (EKG 1) was obtained.Clinician and EKG machine read of acute pericarditis.What do you think?There is sinus rhythm. There is diffuse ST elevation in II, III, aVF and V3-V6. One might agree with the computer and the clinician because there is inferolateral ST elevation without any recip...
Source: Dr. Smith's ECG Blog - June 20, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
