The VERDICT Trial
This study is unable to comment on whether patients with STEMI(-) Occlusion MI have benefit from emergent cath, because that is not the population studied and this subgroup is not commented on.This study is just the most recent in a long long line of similar literature. Context is everything for understanding this study. See below for an excerpt from theOMI Manifesto which summarizes the existing literature and provides details on each study:-------------------------------------------------------------------------------------------------------------- Counter-argument:“Haven’t there been RCTs showing no benefit for earl...
Source: Dr. Smith's ECG Blog - January 4, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
The computer calls this a “normal ECG”. We'll just keep making this point.
This case was contributed byBrooks Walsh, an emergency physician in Connecticut.A middle-aged woman had an acute onset of chest pain and dyspnea. The symptoms improved somewhat after the paramedic gave her nitroglycerin. The pain had almost resolved by the time an ECG was obtained in the ED:Here is the computer diagnosis What do you think?Perhaps you might think these changes are too subtle to immediately call for the cath lab. But do you think the ECG is “normal?” Well, the computer thought so!Note leadsIII and aVF. There is subtle ST segment elevation in those leads. Although it is not high in absolute term...
Source: Dr. Smith's ECG Blog - December 19, 2018 Category: Cardiology Authors: Brooks Walsh Source Type: blogs
Our residents are getting really good at this.
Conclusion:This patient was treated so fast that he had no actual infarction. Spontaneous reperfusion certainly helped.So this is really another case ofUnstable Angina. Here are more cases of Unstable Angina (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - October 27, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments
This study from Herzog et al (from our own Hennepin County Medical Center) included patients from a national registry and compared 3049 patients on dialysis admitted and eventually found to have acute MI compared with 534,395 patients not on dialysis admitted with an eventual diagnosis of acute MI. Of these groups, only 22% of dialysis patients had an admission diagnosis consistent with acute MI while 43.8% of nondialysis patients had the correct admission diagnosis of acute MI. Dialysis patients had double the rate of cardiac arrest (11% vs 5%), were less likely to receive reperfusion therapy when eligible (47% vs. ...
Source: Dr. Smith's ECG Blog - September 29, 2018 Category: Cardiology Authors: Daniel Lee Source Type: blogs
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without
Submitted by Nic Thompson, Written by Pendell Meyers, edits by Steve SmithThis is a long post, but well worth the read because it clearly delineates the difference in patient outcomes between advanced ECG interpretation and STEMI criteria!Dr. Thompson evaluated a male in his 40s with history of CAD s/p MI with PCI years ago, active smoking, HLD, HTN, who presented with chest discomfort and diaphoresis starting when the patient woke up a few hours prior to arrival. The pain waxed and waned until EMS arrived and gave him 325 mg aspirin en route, and had significant relief just prior to arrival. Here was his presentation...
Source: Dr. Smith's ECG Blog - September 2, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
It's over
He passed away Monday evening.Because he was on hospice care, I kept a log in their manual. I'll post what I wrote:7/169:55 am I called hospice. No one had called or come out since Friday night when we registered with them. We had requested pain meds and anti-anxiety meds. And this morning, we need to refill his nitroglycerin tabsHe got up and walked down the hall without oxygen to the kitchen. I fixed him breakfast. We sat at the table and chatted. He went to the bathroom, changed his shirt, brushed his teeth, shaved, took his meds and put his contacts in. I thought, "wow! we'r...
Source: Wife of a Diabetic - July 18, 2018 Category: Endocrinology Source Type: blogs
It's over
He passed away Monday evening.Because he was on hospice care, I kept a log in their manual. I ' ll post what I wrote:7/169:55 am I called hospice. No one had called or come out since Friday night when we registered with them. We had requested pain meds and anti-anxiety meds. And this morning, we need to refill his nitroglycerin tabsHe got up and walked down the hall without oxygen to the kitchen. I fixed him breakfast. We sat at the table and chatted. He went to the bathroom, changed his shirt, brushed his teeth, shaved, took his meds and put his contacts in. I thought, " wow! w...
Source: Wife of a Diabetic - July 18, 2018 Category: Endocrinology Source Type: blogs
It's over
He passed away Monday evening.Because he was on hospice care, I kept a log in their manual. I'll post what I wrote:7/169:55 am I called hospice. No one had called or come out since Friday night when we registered with them. We had requested pain meds and anti-anxiety meds. And this morning, we need to refill his nitroglycerin tabsHe got up and walked down the hall without oxygen to the kitchen. I fixed him breakfast. We sat at the table and chatted. He went to the bathroom, changed his shirt, brushed his teeth, shaved, took his meds and put his contacts in. I thought, "wow! we'r...
Source: Wife of a Diabetic - July 18, 2018 Category: Endocrinology Source Type: blogs
Is there a Right Ventricular MI in addition to Infero-postero-lateral MI?
A 40-something woman had sudden chest pain. She called 911. This prehospital ECG was recorded:Here are limb leads:Here are precordial leads:Diagnosis?This is of course diagnostic of an acute coronary occlusion MI (OMI) that also meets STEMI criteria.But which myocardial walls are affected?InferiorPosterior (as manifested with T-wave inversion)Lateral (subtle ST elevation)Is there also RV MI? Can you tell from this ECG? (hint: no, you can ' t tell from this ECG)When this was shown to me, I said " Activate the Cath Lab. "The providers had been uncertain until I gave my opinion, but then went ahead and...
Source: Dr. Smith's ECG Blog - July 11, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Test yourself: how many hours between your diagnosis of OMI and positive STEMI criteria?
Written by Pendell Meyers, with edits by Steve SmithA male in his early 40s presented with intermittent chest/abdominal pain. He admitted to several episodes over the past two days, including one episode several hours prior to presentation, described as severe (8/10), substernal " burning, " non-radiating, associated with diaphoresis, described as " feeling food stuck in my throat, " or " like I ate too fast, " but not associated with eating, relieved by belching and flatulence, relieved by lying flat. The episode on the day of presentation was similar except he had the additional new features of " burning ears " and " blu...
Source: Dr. Smith's ECG Blog - July 8, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
I want to go dancing.....
Managing wrote:What really sucks is that no matter how many things you do to keep yourself busy you are still kind of forced to be alone as the spouse of a chronically ill person. I want so badly to go dancing with a man. To go on little adventures together instead of just sitting in the house with a blaring TV in order be with him. . . and him dozing in and out of sleep anyway. I am very lonely. Friends just don't fill the spouse gap. I think I will always be mad at him for not caring enough about my quality of life to even TRY to take care of his health so he can do things with me. He has given up on life. And in do...
Source: Wife of a Diabetic - July 7, 2018 Category: Endocrinology Tags: congestive heart failure dancing dementia diabetes ketoacidosis Source Type: blogs
Watch what happens when " pericarditis " and morphine cloud your judgment
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve SmithCaseA 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain “similar to his prior MI, but worse.” The pain initially started the daypriorto presentation. The pain roused him from sleep but subsided without intervention. Around 19 hours later, he experienced the same pain, which prompted his presentation to the ED. By this time, three hours had passed from the onset of the pain but it was no longer present. Here is his initial ECG:00:04What do you think? - Sinus rhythm at ~70 bpmSTE in...
Source: Dr. Smith's ECG Blog - July 3, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Wellens syndrome – Cardiology MCQ – Answer
New !!!
Cardiology MCQs from Cardiophile MD – Volume 3: Interactive Kindle Edition
Cardiology MCQs from Cardiophile MD – Volume 3 Paperback
Wellens syndrome is characterized by all of the following except:
Correct answer (wrong statement): a) Critical stenosis of left circumflex coronary artery
Original description from Wellens group date back to 1982 [1], though the eponym came later. They noted the pattern in 18% of their 145 patients with unstable angina. In spite of symptom control with nitroglycerin and beta blocker therapy, they noted that 12 of the 16 patients who did not undergo revascularization (surg...
Source: Cardiophile MD - May 13, 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
labs and kidney ultrasound
A lot of my posts here are just to keep a journal of what's going on. His labs are declining. The nephrologist called and wants to schedule an ultrasound of his kidneys as he thinks there might be a tumor.My best guess - it's his heart. Here's why I say that.His last labs were 1/18. Current labs were 4/13.BUN jumped from 26 to 36. Normal is 7 - 23. It's been as high as 63 in the past! It's the test for blood in the urine and normally means either there is something blocking the kidneys, you are exercising too much, or your heart is not pumping enough blood through the kidneys.His A1c is 8...
Source: Wife of a Diabetic - April 21, 2018 Category: Endocrinology Source Type: blogs
