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Palpitations and presyncope in a 40-something
Discussion: Putting all of the information together this patient is most likely suffering from arrhythmogenic cardiomyopathy (AC) better known as ARVC. The medical hx is typical, with sudden onset tachydysrhythmia during physical exertion. It is not uncommon for the initial presentation to be sudden cardiac death (SCD). In fact it is one of the leading causes of SCD in people age less than 40 years. Thus it is very important to identify this disorder. AC is a disease in which myocardium is replaced by fibrofatty tissue. This usually and predominantly affects the RV free wall and apical regions, but it can affect the left v...
Source: Dr. Smith's ECG Blog - March 24, 2024 Category: Cardiology Authors: Magnus Nossen Source Type: blogs

Topoisomerase inhibitors and chronic pain
Topoisomerase inhibitors emerged in the American medical landscape in 1971, thanks to the discovery by Dr. Jim Wang of the E. coli omega protein. Topoisomerase I, an enzyme identified by Dr. Wang, plays a crucial role in DNA unwrapping from supercoiling. Supercoiling involves tightly wrapping DNA for storage and protection, requiring unwrapping for reading, a Read more… Topoisomerase inhibitors and chronic pain originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 23, 2024 Category: General Medicine Authors: Tags: Meds Medications Pain Management Source Type: blogs

A 50-something with chest pain. Is there OMI? And what is the rhythm?
Written by Willy FrickA man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. His ECG is shown:What do you think?The history thus far is highly suggestive of OMI, so we must study the ECG very closely to see if we can confirm this. Looking at the rhythm strip, we see there is more going on than simple sinus rhythm, and in fact there are two different morphologies of QRS complexes. Take a closer look at the rhythm by itself and see if you can figure out what ' s going on before scrolling further....
Source: Dr. Smith's ECG Blog - March 22, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs

Women of color face biases in endometriosis diagnosis and surgical treatment
March is endometriosis awareness month. Endometriosis, a disease in which tissue similar to the lining of the uterus grows outside of the uterus, affects 1 in 10 women, or 190 million individuals worldwide. Although endometriosis leads to chronic pain and fertility issues and can impact bowel, urinary, and sexual function, it may take up to Read more… Women of color face biases in endometriosis diagnosis and surgical treatment originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 21, 2024 Category: General Medicine Authors: Tags: Conditions OB/GYN Source Type: blogs

Beyond the workout: the hidden struggle of diabetic gastroparesis
The final three minutes of my hour-long elliptical workout were not easy. Pain spread across my stomach, causing me to row in a half-sitting motion, and my chest vacillated between violent coughs and the sorts of deep breaths people take when they think they’ve seen a ghost. Perspiration fell from my shirtless torso to the Read more… Beyond the workout: the hidden struggle of diabetic gastroparesis originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 21, 2024 Category: General Medicine Authors: Tags: Conditions Endocrinology Gastroenterology Source Type: blogs

Evaluation of JVP
Transcript of the video: Now we will discuss the basic principles of evaluation of jugular venous pressure and jugular venous pulse. These are assessed in the internal jugular vein and not in the external jugular vein. To revise the anatomy lessons, this is the external jugular vein and this is the internal jugular vein. Now, why we should not be looking at external jugual vein, though it is much easier to find out is that, in lower portion, it may be kinked so that it may not reflect the true right atrial pressure. The whole purpose of assessing the jugular venous pressure and pulse is that it reflects the right atrial pr...
Source: Cardiophile MD - March 21, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Opioid prescribing, pain management, and patient advocacy [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! We delve into the complexities of opioid prescribing, pain management, and the opioid crisis with our guest, Richard A. Lawhern. As a patient advocate, Richard brings a unique perspective to the table. Join us as we discuss the discrepancies in data Read more… Opioid prescribing, pain management, and patient advocacy [PODCAST] originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 19, 2024 Category: General Medicine Authors: Tags: Podcast Pain Management Source Type: blogs

An 80 year old woman with Left Bundle Branch Block (LBBB) and pleuritic chest pain
This case was sent by Amandeep (Deep) Singh at Highland Hospital, part of Alameda Health System.The patient presented to an outside hospitalAn 80yo female per triage “patient presents with chest pain, also hurts to breathe”PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB.HPI: Abrupt onset of substernal chest pain associated with nausea/vomiting 30 min PTA.  She reports associated SOB but no dizziness or LOC.  She was given NTG at home before coming to the hospital. This was the ECG obtained at triage.This ECG was recorded and was reviewed remotely by a...
Source: Dr. Smith's ECG Blog - March 19, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs

The Latest AI Craze: Ambient Scribing
By MATTHEW HOLT Okay, I can’t do it any longer. As much as I tried to resist, it is time to write about ambient scribing. But I’m going to do it in a slightly odd way If you have met me, you know that I have a strange English-American accent, and I speak in a garbled manner. Yet I’m using the inbuilt voice recognition that Google supplies to write this story now. Side note: I dictated this whole thing on my phone while watching my kids water polo game, which has a fair amount of background noise. And I think you’ll be modestly amused about how terrible the original transcript was. But then...
Source: The Health Care Blog - March 18, 2024 Category: Consumer Health News Authors: matthew holt Tags: Health Tech Matthew Holt abridge AI Ambient Scribing Anthropic clinical care Coding Google Microsoft Nabla Nuance OpenAI Suki Source Type: blogs

Wound Care Education for Medical Doctors: Filling the Gap
Whenever I ask a group of doctors, “How many of you have had any training in care and treatment of chronic wounds?” it is the rare person who raises their hand. Despite the urgent need for medical doctors to know how to assess and treat pressure injuries and chronic wounds, there is no formal medical or surgical specialty in wound care. This has resulted in a gap in education, training, and research, with extensive variation in clinical practice. The medical education establishment has simply not caught up to the realities of care for the chronically ill patient. Filling the education gap in wound care is one of my pro...
Source: Jeffrey M. Levine MD | Geriatric Specialist | Wound Care | Pressure Ulcers - March 18, 2024 Category: Geriatrics Authors: Jeffrey M Levine Tags: An Aging World Geriatric Medicine Long-Term Care Pressure Injuries & Wound Care Risk Management aging skin bedsore bedsores decubiti decubitus ulcer end-of-life care geriatrics Healthcare Quality Improving Medical Care Jeff Lev Source Type: blogs

Why is the angiogram normal?
Written byWilly FrickA man in his 50s with a 15 pack-year smoking history presented to his primary care physician ' s office complaining of intermittent headache. He also complained of intermittent mild chest pain radiating into into both shoulders and his back, as well as occasional unexplained sweating. (Although radiation into the left arm is most classic for coronary ischemia, radiation into both arms is actually modestly more predictive). The primary care physician ' s note indicates low suspicion for cardiac ischemia, but " for completion, check troponin and ECG. " If an ECG was obtained in the office,...
Source: Dr. Smith's ECG Blog - March 17, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs

Goodness!
The essential, first-order or pure concept of " public goods " is whatever we benefit from that is " non-excludable " and " non-rivalrous. " That means you can use it without paying for it, and if you use it, it ' s still there for others. An example, at least for the time being, is the oxygen in the air. Back in the good old paleolithic, there was a lot more of that. Basically, the land and the water and the plants and animals were there for the taking, and there was usually plenty so rivalry was uncommon. Of course, this only worked within your own tribe -- sometimes people of different tribes tried exclusion and rivalry...
Source: Stayin' Alive - March 14, 2024 Category: American Health Source Type: blogs

Doctor charged after treating a DEA agent
As I wait for the next patient to be brought in, I start reviewing their chart. Past medical records have been received and scanned in per protocol, I see. This won’t be the first time I’ve seen his chart as he had to submit medical records and be approved before he could get an appointment Read more… Doctor charged after treating a DEA agent originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 14, 2024 Category: General Medicine Authors: Tags: Physician Pain Management Source Type: blogs

Three patients with chest pain and “normal” ECGs: which had OMI? Which were normal? And how did the Queen of Hearts perform?
This study had such low risk patients that not a single patient was ultimately diagnosed with ACS.  It is well known that NOMI usually has a normal ECG or nonspecific ECG. The fact that not a single one of these patients had ACS shows that the population studied could not possibly support their conclusion. It should never have been published.According to this data a triage ECG labeled ‘normal’ rules out the possibility of acute coronary occlusion.This is obviously unreliable data, as Dr. Smith ’s Blog has published51 cases of OMI with ECGs labeled ‘normal’, 35 of which were identified by the Queen ...
Source: Dr. Smith's ECG Blog - March 14, 2024 Category: Cardiology Authors: Jesse McLaren Source Type: blogs

A man in his 40s with 3 days of stuttering chest pain
Written byWilly FrickA man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. It started while he was at rest after finishing a workout. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It woke him the next day and radiated into his back. He was only able to sleep while sitting in a chair. He went to urgent care and had an ECG (not available) which was interpreted as normal, and was sent home. His pain returned, and he went back to the urgent care but was sent to the ER. His ECG is shown:What do you...
Source: Dr. Smith's ECG Blog - March 13, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs