Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?
ConclusionAmong inferior STEMI, the presence of any ST depression in lead I does not help to diagnose RVMI. ST elevation ≥0.5 mm in lead V1 is specific for RVMI, and moderately sensitive only if concomitant STD ≥ 0.5 mm in V2 is not present. Although STE in V1 is quite specific, overall the diagnostic characteristics of the standard 12‑lead ECG are inadequate to definitively diagnose, or exclude, RVMI, a s defined angiographically.____________________________Kosuge M, Ishikawa T, Morita S, Ebina T, Hibi K, Maejima N, Umemura S, Kimura K.Posterior wall involvement attenuates predictive value of ST-segment elev...
Source: Dr. Smith's ECG Blog - May 30, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his early 40s with chest pain a " normal ECG " by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?
This study looked at less than 1000 cases, which is not nearly enough (see below for analysis) and they used cardiologists as the gold standard (a very poor gold standard), NOT presence or absence of Occlusion MI (which we have done in all of our ECG studies, and must be ascertained by 1) TIMI 0/2 flow on angiogram or 2) culprit + TIMI 3 flow and very high troponin. So this study is worthless and must be ignored. I have here 38 cases of " Computer Normal " ECGs which were critically abnormal and the vast majority are missed acute coronary occlusions (Missed Acute OMI) and most were recognized ...
Source: Dr. Smith's ECG Blog - May 23, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Off and on chest pain for 24 hours in a 50s year old man
Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell MeyersA man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath. His pain was initially mild, then became severely worse several hours prior to presentation, but then eased off again and was minimal on arrival. There was no associated diaphoresis, nausea, vomiting, arm pain, jaw pain, syncope, lightheadedness or other acute symptoms.Initial vitals: Temp 36.7 C, BP 161/79, RR...
Source: Dr. Smith's ECG Blog - April 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Is this Rhythm Puzzling to You?
==================================My Comment by KEN GRAUER, MD (3/30/2023):==================================The ECG in Figure-1 was sent to me without the benefit of any history. I thought the rhythm illustrated a number of essential concepts for clinicians dedicated to Emergency Care.Do YOU know what the rhythm is?IF this arrhythmia is puzzling to you — READ ON! I illustrate how to make the diagnosis within less than 15 seconds.Figure-1: The initial ECG in today ' s case. This tracing was sent to me without the benefit of any history. ...
Source: Dr. Smith's ECG Blog - March 30, 2023 Category: Cardiology Authors: ECG Interpretation Source Type: blogs
Severe Chest Pain on ED Arrival, after Wellens' waves Seen on Prehospital ECG
A 40-something woman called 911 in the middle of the night for Chest pain that was intermittent. On arrival, she complained of severe pain.The medics had recorded this ECG and were uncertain whether it was recorded during chest pain:Let ' s get a better image with use of thePM Cardio app:What do you think?There is deep T-wave inversion in proximal LAD territory (V2-V4, I, aVL) that is all but diagnostic of Wellens ' . This is acute ACS, but it almost always seen in a pain free state. Since the patient has active pain now, if this is indeed Wellens, ' she must be re-occluded at this moment. An ED...
Source: Dr. Smith's ECG Blog - March 13, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
What do you think of this ECG?? Is this during pain, or after pain resolution? Also, see the CT image of the heart.
If you saw this ECG only knowing that it is an acute chest pain patient, what would be your interpretation?This is a trick question, as you will see below. But you can make a diagnosis here, and Pendell and I do this all the time when reading ECGs from databases. I sent this to Pendell without any information at all, and he replied " Postero-lateral Reperfusion. "The T-waves in V2-V4appear hyperacute, suggesting LAD occlusion,BUT there is also T-wave inversion that is typical morphology forreperfusion in V5 and V6.Thus, one must think of reperfusion. When there is reperfusion and there are large T-waves in...
Source: Dr. Smith's ECG Blog - March 6, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest pain, and Cardiology didn't take the hint from the ICD
Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and GrauerA 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The screening physician ordered an EKG and noted his ashen appearance and moderate distress. Triage EKG:What do you think?Triage physician interpretation: -sinus bradycardia-lateral ST depressionsWhile there are lateral ST depressions (V5, V6) the deepest ST depressions are in V4. Additionally, lead V3 has ST depressions, which are always abnormal (recall that lead V3 will haveST elevation under nor...
Source: Dr. Smith's ECG Blog - January 23, 2023 Category: Cardiology Authors: Bracey Source Type: blogs
Fight Aging! Newsletter, December 19th 2022
In conclusion, p16 deletion or p16 positive cell clearance could be a novel strategy preventing long term HFD-induced skin aging.
Association of LDL-Cholesterol with Mortality
https://www.fightaging.org/archives/2022/12/association-of-ldl-cholesterol-with-mortality/
Researchers here report on a study of LDL-cholesterol and mortality risk in older people. As they note, data on this topic is conflicted once one moves beyond the matter of cardiovascular disease. Over a lifetime, higher LDL-cholesterol makes it easier to reach the tipping point at which cholesterol deposited in blood vessel walls produces e...
Source: Fight Aging! - December 18, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Inflammatory cGAS-STING Signaling in Age-Related Endothelial Dysfunction
Chronic, unresolved inflammatory signaling is a feature of aging, the result of lingering senescent cells, debris from stressed cells, and other processes. When persistent over time, inflammatory signaling is highly disruptive to cell and tissue function, altering behavior in ways that contribute to a wide variety of pathologies. In the vasculature, this includes atherosclerosis, calcification, loss of compliance in the vascular smooth muscle responsible for contraction and dilation of blood vessels, and a range of more subtle problems, lumped under the heading of endothelial dysfunction, at the inner surface of blood vess...
Source: Fight Aging! - December 15, 2022 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Senolytics May Improve Organ Transplantation
Senescent cells accumulate with age and negatively affect surrounding tissue with their pro-inflammatory secretions. Greater understanding of this contribution to degenerative aging has led to the development of senolytic therapies to selectively destroy these errant cells and thus improve tissue function. Cellular senescence may also occur in tissues undergoing transplantation, a result of the stresses involved, and cause loss of function and related issues following transplantation. Thus senolytics may find a use in the organ transplant industry as a way to improve success rates and patient outcomes following successful ...
Source: Fight Aging! - December 14, 2022 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Fight Aging! Newsletter, December 12th 2022
In conclusion, selective removal of senescent dermal fibroblasts can improve the skin aging phenotype, indicating that BPTES may be an effective novel therapeutic agent for skin aging.
Non-Dividing Neurons Do In Fact Become Senescent, Impairing Brain Function
https://www.fightaging.org/archives/2022/12/non-dividing-neurons-do-in-fact-become-senescent-impairing-brain-function/
Cellular senescence is generally thought of as a characteristic of replicating cells; it is an end state reached when telomeres, reduced in length with each cell division, become too short. This is followed by programmed cell death...
Source: Fight Aging! - December 11, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Intermittent Fasting is Protective Against the Effects of Vascular Aging in the Brain
In this study, we demonstrate for the first time that IF promotes neuroprotective effects in a model of VaD by maintaining the integrity of the neurovascular structures in the brain. We specifically show that IF attenuated vascular pathology by reducing microvascular leakage and blood-brain barrier dysfunction, while maintaining the expression of tight junction (TJ) proteins. IF was also effective in decreasing white matter lesion formation, hippocampal neuronal cell death and cell death markers, while maintaining myelin basic protein levels. Our data suggest that the effects of IF on the structural integrity of the neurov...
Source: Fight Aging! - December 6, 2022 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Syncope, hypotension, vomiting and diaphoresis in a 60-something male with Diabetes and Hypertension
I was texted this ECG by one of my partners, with the following history: A 60-something male with diabetes and HTN presented with syncope. Per EMS report, the patient had a syncopal episode at work. On medics arrival, patient noted to be pale and diaphoretic, SBPs 60-80s, complaining of nausea and had one episode of emesis en route, possible hematemesis. There was no chest discomfort, though the patient was non-English speaking and reportedly " stoic " .What do you think?This was my response, in quotes: " I have a sneaking suspicion that this is a mimic. Tough one! &n...
Source: Dr. Smith's ECG Blog - December 6, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex
Written by Pendell MeyersFamily of an elderly woman with many comorbidities called EMS when she suddenly experienced shortness of breath, nausea, vomiting, and near syncope. She was alert and oriented and hypotensive with initial BP 70/50. A 12 lead ECG was obtained by EMS and is shown below:What do you think?There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!) The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in mo...
Source: Dr. Smith's ECG Blog - November 11, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Post doctoral and doctoral opportunities at Basque Center on Cognition Brain and Language (San Sebasti án, Basque Country, Spain)
FUNDED POSTDOCTORAL CANDIDATE POSITION – Signal Processing in Neuroimaging group at the BCBL- Basque Center on Cognition Brain and Language (San Sebasti án, Basque Country, Spain) www.bcbl.euINFORMATION ABOUT THE POSITION Position: PostdoctoralResearcher Profile: R2, Recognised Researcher (PhD holders or equivalent who are not yet fully independent) / R3, Established Researcher(Researchers who have developed a level of independence)Number of vacancies: 1Project: OpenLocation: Spain> Donostia-San SebastianResearch Field: Cognitive NeuroscienceJob Statu...
Source: Talking Brains - November 9, 2022 Category: Neuroscience Authors: Greg Hickok Source Type: blogs
