Chest pain, Ventricular Paced Rhythm, and a Completely Normal Angiogram 3 Months Prior.
One of our graduates, Rochelle Zarzar, who is now an education fellow, sent me this from one of the hospitals she works at now:An elderly woman presented with chest pain. She had been nauseous the night before and did not feel well, then awoke 2 hours prior with chest pain.She had had a completely normal angiogram 3 months prior.Here is that angiogram report:The left main coronary artery is normal.Left anterior descending is a type 3 vessel and is normal.Left circumflex is nondominant and normal.The right coronary artery is dominant and normal.The nurses immediately recorded an ECG. This was 2 hours after the o...
Source: Dr. Smith's ECG Blog - May 29, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Most common cause of acquired heart disease in children in developed countries – Cardiology MCQ
Most common cause of acquired heart disease in children in developed countries:
a) Rheumatic heart disease
b) Viral myocarditis
c) Kawasaki disease
d) Lyme disease
Click here for the correct answer.
(Source: Cardiophile MD)
Source: Cardiophile MD - May 28, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Lake Louise criteria – Cardiology MCQ -Answer
Lake Louise criteria is for the diagnosis of:
Correct answer c) Myocarditis on cardiac magnetic resonance imaging
Lake Louise criteria are based on those for detection of myocardial edema, hyperemia and capillary leakage (myocardial early gadolinium enhancement), necrosis and fibrosis (late gadolinium enhancement/LGE). 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 i...
Source: Cardiophile MD - May 19, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Lake Louise criteria – Cardiology MCQ
Lake Louise criteria is for the diagnosis of:
a) Myocardial infarction on echocardiography
b) Endocarditis on blood culture
c) Myocarditis on cardiac magnetic resonance imaging
d) None of the above
Please post your answer as a comment below. Correct answer will be published on: May 19, 2018 @ 18:18
The post Lake Louise criteria – Cardiology MCQ appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - May 17, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Most important cardiotoxicity of immune checkpoint inhibitors – Cardiology MCQ – Answer
Most important cardiotoxicity of immune checkpoint inhibitors – Answer
Interactive Kindle Edition: Check here for more Cardiology MCQs!
Cardiotoxicity of immune checkpoint inhibitors – Correct answer: 1. Fulminant myocarditis
Immunotherapy 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 fulminan...
Source: Cardiophile MD - March 25, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Most important cardiotoxicity of immune checkpoint inhibitors – Cardiology MCQ – Answer
Most important cardiotoxicity of immune checkpoint inhibitors – Answer
Interactive Kindle Edition: Check here for more Cardiology MCQs!
Correct answer: 1. Fulminant myocarditis
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 treated with immune checkpoint inhibitors [2]. It is associated with profound hemodynamic compromise progressing to circulato...
Source: Cardiophile MD - March 25, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Most important cardiotoxicity of immune checkpoint inhibitors – Cardiology MCQ
Most important cardiotoxicity of immune checkpoint inhibitors – Cardiology MCQ
Interactive Kindle Edition: Check here for more Cardiology MCQs!
Cardiotoxicity of antineoplastic drugs like adriamycin is well known. In fact regular monitoring and management of cardiotoxicity of antineoplastic drugs have given rise to a new subspeciality known as Onco Cardiology [1]. Immune checkpoint inhibitors are novel anti cancer drugs targeting immune checkpoint molecules: cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), programmed cell death 1 (PD-1) and its ligand (PD-L1) [2]. They are highly useful in a large number of so...
Source: Cardiophile MD - March 23, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Most important cardiotoxicity of immune checkpoint inhibitors – Cardiology MCQ
Most important cardiotoxicity of immune checkpoint inhibitors – Cardiology MCQ
Interactive Kindle Edition: Check here for more Cardiology MCQs!
Immune checkpoint inhibitors are novel anti cancer drugs targeting immune checkpoint molecules: cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), programmed cell death 1 (PD-1) and its ligand (PD-L1) [1]. They are highly useful in a large number of solid and hematological tumours. The most important recently highlighted cardiovascular adverse effect of immune checkpoint inhibitors is:
Fulminant myocarditis
Acute myocardial infarction
QT prolongation
Venous thromboemboli...
Source: Cardiophile MD - March 23, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Our patients deserve better than the " STEMI criteria "
Written by Pendell Meyers,of the Stony Brook class of 2019, with edits by Steve SmithTwo CasesImagine that two patients present simultaneously to your Emergency Department with moderately concerning chest pain and the following ECGs (no priors available).The first patient has this ECG:The second patient has this ECG:Do either of them, neither of them, or both, require emergent reperfusion therapy?STEMI guidelines (and therefore most clinicians) provide you with a clear answer. Clear and yet perfectly wrong in these two cases.Let ' s take them one at a time.Case #1A woman in her 50s presented with 2 weeks of fatigue and che...
Source: Dr. Smith's ECG Blog - January 26, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
High ST Elevation in a Patient with Acute Chest Pain
ConclusionThe ECG findings could be due to either dynamic early repolarization (normal variant ST elevation), or to pericarditis, or to acombination of the 2 entities.Yes, normal variant ST elevation can be dynamic:Increasing ST elevation. STEMI vs. dynamic early repolarization vs. pericarditis.ST elevation of early repolarization may vary with the rateChest pain, Dynamic ST Elevation and T-waves, and High VoltageAlternatively, the ECG could represent pericarditis superimposed on early repol. There certainly was pericarditis, but that does not mean the ECG findings were due to pericarditis.This paradox is extremely w...
Source: Dr. Smith's ECG Blog - January 8, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Study Shows That Male Triathletes Should Take a Breather
Male triathletes should be concerned about their heart health. According to areport presented at the recent Radiological Society of North America (RSNA) conference, extensive exercise involved in triathlon training can result in myocardial fibrosis, a dire heart condition. However, females are not susceptible to the same risk. Although exercise is generally considered a good way to maintain a healthy heart, excessive exercise can be detrimental to the organ. Myocardial fibrosis can be a precursor to heart failure. The condition affects the ventricles, and can damage tissue which provokes fibrotic scarring. Jitka Starekova,...
Source: radRounds - December 22, 2017 Category: Radiology Authors: Julie Morse Source Type: blogs
LITFL Review 308
LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 308th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
This week’s ERCast chats with Ashley Liebig about 3 things we can do to improve our overall...
Source: Life in the Fast Lane - November 19, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs
MINOCA – Myocardial infarction with non obstructive coronary arteries
Myocardial infarction with non obstructive coronary arteries (MINOCA) [1] had a prevalence of 6% among myocardial infarctions noted in a recent systematic review [2]. They are more likely to be younger and female, but less often have dyslipidemia as a risk factor. Other risk factors were found to be similar. Total mortality at one year with MINOCA is about 4.7% compared to 6.7% with myocardial infarction associated with obstructive coronary artery disease. Typical myocardial infarction as demonstrated by cardiac magnetic resonance imaging (CMR) was noted only in about one fourth of cases. One third had myocarditis while ab...
Source: Cardiophile MD - November 14, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Anterior ST Elevation with Elevated Troponin, but with low T/ST ratio, 2 Cases
Case 1This case was sent by Michael Masias (EMCurious, Twitter handle: @EMedCurious), an ultrasound fellow in the Department of Emergency Medicine at UC San Diego.He sent this ECG with the following inquiry: "What do you think about this? 21 year old with chest pain. I am getting a result of " STEMI " by using the 3-variable formula, and " no STEMI " with the 4-variable. "Computerized QTc = 418Here was my immediate answer:" Tough one! There is a very low T/ST ratio. That is to say, the J-point is very elevated in V3 and V4 but without a tall T-wave. That is unusual for both early repol and LAD occlusion, and sug...
Source: Dr. Smith's ECG Blog - November 8, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
12 Cases of Use of 3- and 4-variable formulas to differentiate normal STE from subtle LAD occlusion
Here are 12 Cases using the 3- and 4-variable formulas, which help to distinguish normal ST elevation in leads V2-V4 from that of subtle LAD occlusion.Instructions for using free subtleSTEMI iPhone app for the 3-variable formula. 4-variable version still to come.Here is a video lecture of subtle LAD occlusion: One hour lecture on Subtle ECG Findings of Coronary OcclusionThe 3-variable formula comes from this paper:Smith SW et al. Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation Myocardial Infarction. Annals of Emergency Medicine 2012;60:45-56....
Source: Dr. Smith's ECG Blog - November 3, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
