Interesting things about traveling
He had a very hard time adjusting to altitude changes. I thought that was interesting. The higher the altitude, the more nitroglycerin he took and the more difficulty he had breathing. I don't think either of us were prepared for that.Temperature changes affected him as well. If he got cold, he put on gloves....and I'd be so hot I'd have the AC on blast!Almost a comedy of errors. He worried constantly about having enough insulin. I reassured him that we were never more than 3 or 4 days from home and could start back any time he wanted.We were gone almost a month. I loved every moment of ...
Source: Wife of a Diabetic - March 9, 2018 Category: Endocrinology Source Type: blogs
Day 23 of traveling with Diabetes.
There have been great days, good days, bad days and horribly awful days. Just the same as when we are at home. But I am living in a 17' travel trailer and all the utter nastiness of diabetes is in my face 24/7. Thankfully, I can go outside a lot as we are in southern Arizona and the weather has been amazing!We extended our time here by 10 days. I am having so much fun visiting with my sister and exploring the area. My brother-in-law comes by every day to have a chat with hubby. They have their RV about a mile from the "resort" we are staying in.I suppose we are not really on the road as we set...
Source: Wife of a Diabetic - February 14, 2018 Category: Endocrinology 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
Orbiting ORBITA
By ANISH KOKA, MD
I’m sitting amidst a number of cardiologists to go over the most recent trials presented at the interventional cardiology conference in Denver. The cardiology fellow presenting goes quickly through the hors de oeuvres until finally getting to the main course – ORBITA.
ORBITA sought to test the very foundations interventional cardiology was built on – the simple idea that opening a stenosed coronary artery was good for patients. The trial was a double blind randomized control trial of patients with tightly stenosed arteries who either had a stent placed or had a sham procedure. Before the resul...
Source: The Health Care Blog - December 4, 2017 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Anish Koka cardiology Orbita Source Type: blogs
A 50-something with h/o coronary bypass has chest pain and a ventricular paced rhythm
Conclusions: ACO in VPR is an uncommon condition. The MSC showed good Sens for diagnosis of ACO in the presence of VPR, especially among patients with high peak cTn, and Spec was excellent. These methods and results are consistent with studies that have used the MSC to diagnose ACO in LBBB. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - December 3, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Middle-Aged Man with crescendo angina
A middle-aged male with several comorbidities including DM presented with chest pain. It had been on and off all day, then constant for 2.5 hours. It was central without radiation, sharp but also tight, and was 9/10. There was some cough, but no SOB; he reports COPD and has been using his inhalers without improvement. He also reports diaphoresis and tingling of his hands since the worsening of pain at 1700.His BP was 160/90.He was given aspirin and nitro via EMS with good improvement in his chest pain.First ED ECG at 2:40 after chest pain became severe.Sinus rhythm.Slight left axis deviation (mostly...
Source: Dr. Smith's ECG Blog - November 1, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Cardiology MCQ Test 5
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Source: Cardiophile MD - October 22, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
MKSAP: 60-year-old woman with substernal chest pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old woman is evaluated for a 3-week history of substernal chest pain. The pain is dull, nonradiating, and unrelated to activities. Sometimes the pain is worse after eating spicy foods and can be occasionally triggered by emotional stress. She has not had shortness of breath or weakness. She is moderately active, walking a mile each day. She generally eats a “healthy heart” diet but has never had her lipid levels evaluated. She has never smoked cigarettes. There is no family history of heart disease...
Source: Kevin, M.D. - Medical Weblog - July 8, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
Chest Pain Diagnosed as Gastroesophageal Reflux
p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Helvetica; background-color: #fefefe}A 50-something male presented to a clinic for one day of intermittent substernal chest and jaw pain. He had had several episodes of pain since onset; it was described as pressure-like and lasts about 5-15 minutes and resolves spontaneously. He had been pain free for about an hour. He had some " pre-diabetes, " but no h/o hypertension, no known family history of heart disease, and he smokes about 1-2 cigarettes per day. An ECG was recorded:The computer read:Normal ECGWhat do you think?Smith Comment:Th...
Source: Dr. Smith's ECG Blog - May 29, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Refractory V FIb Arrest, put on ECMO, regains an organized rhythm, and a 12-lead is recorded.
I received this case from:Dominic Larose MD CCFP(EM) FACEPAlain Vadeboncoeur MD CSPQMontreal Heart InstituteHi Steve,Here is a case I had a while ago. The patient was seen on the street, with sudden LOC. An off duty fireman was a bystander, so the cardiac arrest was recognised and immediate CPR was begun at 11:58. First responders arrived afterwards, and the patient was shocked twice with an AED. ALS crew arrived 6 minutes later, and ACLS protocol was performed. The patient was in recurrent VF with wide complex PEA in between. Epinephrine and amiodarone were given. Seven shocks were given. The patient was transported ...
Source: Dr. Smith's ECG Blog - May 22, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 57-year-old man is seen after results of a carotid ultrasound
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man is seen for follow-up evaluation after results of a carotid ultrasound obtained to investigate a left neck bruit show a mixed density plaque at the origin of the left internal carotid artery. Stenosis is estimated to be 60% to 80%. He has had no focal neurologic symptoms or visual loss. The patient has coronary artery disease (CAD) with stable angina, hypertension, dyslipidemia, type 2 diabetes mellitus, and mild kidney failure. He has a 30-pack-year smoking history but stopped smoking 7 years ...
Source: Kevin, M.D. - Medical Weblog - May 6, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
What is the culprit artery? Not what you think.
p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Helvetica}An elderly woman who was quite healthy except for some chronic renal insufficiency and hypertension had 3 days of classic angina lasting only 10-15 minutes at a time, but which became more constant on the day of presentation.She called 911. Medics palpated a pulse of 80 and a BP of 140 systolic, and recorded this prehospital ECG (day 1):Atrial Fibrillation at a rate of about 120.Profound ST depression: leads I, II, III, aVF, V3-V6.There is STE in aVR (reciprocal ST elevation, reciprocal to the ST depression)This is classic diffuse subendocardial ischemia.Sh...
Source: Dr. Smith's ECG Blog - April 14, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
