An Ischemic ECG and Bedside Echo shows diffuse dysfunction but with Apical Sparing
An approximately 40 y.o. male was in jail when he reported dyspnea. He was brought to a small local ED where a chest x-ray showed pulmonary infiltrates. He was hypotensive and hypoxic, and a provisional diagnosis of sepsis from pneumonia was made. He had CT pulmonary angiogram which was read as " no PE. " His lactate was 4.6 mEq/L and WBC count 20,000. He was given levofloxacin, thentransferred to a tertiary care center.Upon arrival, his vitals were HR 115, BP 87/53, RR 30, T 37.3, and O2 sat 91% on room air. Breathing was labored, tachypneic. He had cool extremities. ...
Source: Dr. Smith's ECG Blog - September 4, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fight Aging! Newsletter, September 3rd 2018
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more.
This content is...
Source: Fight Aging! - September 2, 2018 Category: Research Authors: Reason Tags: Newsletters 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
Cellular Senescence is One of the Causes of Age-Related Decline of Liver Regeneration
Tissue regeneration falters with age throughout the body, and there are numerous contributing factors to this decline. It is uncertain as to exactly how these factors layer in terms of cause and effect, however. One can point to the loss of stem cell activity, for example, and then ponder the degree to which that is secondary to rising levels of chronic inflammation. That chronic inflammation is in part inherent disarray and misconfiguration in the immune system stemming from exposure to persistent pathogens, but also arises from the accumulation of senescent cells that secrete strongly inflammatory signals. Now consider t...
Source: Fight Aging! - August 31, 2018 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
A False Appearance of Fine
Like a million times before, the tech thrust an ECG in front of you. This one, however, grabbed every neuron's attention. Who was this?The tech says the patient is a 70ish-year-old diabetic, hypertensive man brought to the emergency department because he has been feeling weak from a couple days of diarrhea.Where was he? Was he talking? What was his blood pressure?The tech pointed at one of the back rooms, and said, "Oh, his blood pressure is good—138/71, and he is talking to his family."He did look pretty good. His heart rate was 37 bpm as he chatted with his family. Staring back at the ECG, I think maybe...
Source: Lions and Tigers and Bears - August 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Fight Aging! Newsletter, July 30th 2018
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more.
This content is...
Source: Fight Aging! - July 29, 2018 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
New Evidence for Diminished Drainage of Cerebrospinal Fluid to be Important in Neurodegenerative Conditions
A number of research groups are building convincing evidence to show that reduced drainage of cerebrospinal fluid is an important contributing factor in the development of neurodegenerative diseases. A sizable fraction of these conditions are characterized by the aggregation of forms of altered or misfolded proteins, such as amyloid-β, tau, and α-synuclein. They precipitate to form solid deposits surrounded by a complex halo of biochemistry that harms and eventually kills brain cells. From what is known of amyloid-β, levels are quite dynamic, which all along has suggested that rising amounts in older brains are the resu...
Source: Fight Aging! - July 27, 2018 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Doctor . . , What about “ Pharmaco-Non Invasive ” approach for my husband ?
A young man aged around 40 years, had a STEMI was promptly thrombolysed in a small hospital located about 40 KM away in the suburbs of my city Chennai. They did an awesome job of saving the patient life and salvaging the myocardium.
Now begins the story . . . one of the non-medical person who is the owner of the hospital has an unfortunate working business relationship with a frighteningly big nearby hospital which had signed a memorandum of irresponsible understanding . It demanded any patient who arrives in the small hospital with MI should be transferred at earliest opportunity to them.
So, an ambulance was arr...
Source: Dr.S.Venkatesan MD - July 21, 2018 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Interventional -PCI Cardiology -Therapeutic dilemma Cardiology -unresolved questions Primary -PCI newer concepts in acute coronary syndrome pharmaco non invasive approach pharmaco-invasive approach rescue pci Source Type: blogs
Tropical Travel Trouble 010 Fever, Arthralgia and Rash
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 010
Peer Reviewer: Dr Jennifer Ho, ID physician QLD, Australia
You are an ED doc working in Perth over schoolies week. An 18 yo man comes into ED complaining of fever, rash a “cracking headache” and body aches. He has just hopped off the plane from Bali where he spent the last 2 weeks partying, boozing and running amok. He got bitten by “loads” of mosquitoes because he forgot to take insect repellent.
On examination he looks miserable,...
Source: Life in the Fast Lane - July 16, 2018 Category: Emergency Medicine Authors: Amanda McConnell Tags: Clinical Cases Tropical Medicine arthralgia dengue fever rash Source Type: blogs
What is the blood supply for coronary artery ?
One may recall some stunningly simple facts from our high school biology classes that every living cell needs energy on a moment to moment basis. Blood vessels which take care of the vital organ’s energy supply also need the same blood (Nutrients /Oxygen) for its own survival.
Coronary arteries carry about 250 ml of blood every minute , 24/7 supplying ATP enriched fuel to the heart.
Who is feeding these delicate vessels which carry on this life-sustaining work ?
It is easier to assume the three layers of the blood vessels which are bathed with blood would never suffer from Ischemia. Reality is differen...
Source: Dr.S.Venkatesan MD - July 10, 2018 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
What is the blood supply for the coronary artery ?
One may recall some stunningly simple facts from our high school biology classes that every living cell needs energy on a moment to moment basis.
Blood vessels which take care of the vital organ’s energy supply also need the same blood (Nutrients /Oxygen) for its own survival.
Coronary arteries carry about 250 ml of blood every minute , 24/7 supplying ATP enriched fuel to the heart.
Who is feeding these delicate vessels which carry on this life-sustaining work ?
It is easier to assume the three layers of the blood vessels which are bathed with blood would never suffer from Ischemia. Reality is different .Blood ves...
Source: Dr.S.Venkatesan MD - July 10, 2018 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 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
FDA Approves Zephyr Endobronchial Valve, a Minimally Invasive Implant for Severe Emphysema
The FDA approved a new medical device for patients suffering from severe emphysema. The Pulmonx Zephyr Endobronchial Valve is a one-way valve system to be implanted through the airways using a traditional bronchoscope. The valve is integrated into a stent that expands against a bronchiole to block off air flowing in and only allow it to flow out. As the trapped air flows out, ventilation/perfusion mismatch is improved, and the device relieves pressure on the healthy lung to allow for better breathing.
The available data is from a multi-center study of 190 patients with severe emphysema (the LIBERATE trial), comparing Zephy...
Source: Medgadget - July 2, 2018 Category: Medical Devices Authors: Ben Ouyang Tags: Medicine Thoracic Surgery Source Type: blogs
Lung ventilation-perfusion scintigraphy – Cardiology MCQ – Answer
Lung ventilation-perfusion scintigraphy has a negative predictive value of nearly — percent for excluding thromboembolic pulmonary hypertension:
Correct answer: a) 100%
Because of the nearly 100% negative predictive value, a normal lung ventilation-perfusion scintigraphy (V/Q scan) virtually excludes the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). V/Q scanning has a high sensitivity of 96 – 97.4% for detecting perfusion abnormalities.
But V/Q scan being not very specific, its diagnostic utility is low. It can only be used as an initial screening test. Any abnormal test requires additio...
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
Fight Aging! Newsletter, May 28th 2018
This study indicates that frailty and other age-related diseases could be prevented and significantly reduced in older adults. Getting our heart risk factors under control could lead to much healthier old ages. Unfortunately, the current obesity epidemic is moving the older population in the wrong direction, however our study underlines how even small reductions in risk are worthwhile." The study analysed data from more than 421,000 people aged 60-69 in both GP medical records and in the UK Biobank research study. Participants were followed up over ten years.
The researchers analysed six factors that could impact on...
Source: Fight Aging! - May 27, 2018 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
