Wide Complex Tachycardia -- VT, SVT, or A Fib with RVR? If SVT, is it AVNRT or AVRT?
A 69 y.o. male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Per EMS report, patient believes he has been in atrial fibrillation for 5 days, since coming down with flu-like illness with rhinorrhea, productive cough, SOB. Patient is on rivaroxaben, carvedilol, and dofetilide (to suppress atrial fib -- rhythm control). He states that he maybe missed a dose or two during recent illness. On EMS arrival, patient ' s oxygen sat...
Source: Dr. Smith's ECG Blog - March 28, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 50s with shortness of breath
Sent by Tom Fiero, written by Pendell Meyers A man in his 50s presented with acute shortness of breath. Unfortunately we do not have access to the patients presenting vital signs.Here is his ECG:Original image, suboptimal qualityQuality improved with PM Cardio digitizationThe ECG is highly suggestive of acute right heart strain, with sinus tachycardia, S1Q3T3, and T wave inversions in anterior and inferior with morphology consistent with acute right heart strain. There is also STE in lead III with reciprocal depression in aVL and I, as well as some subendocardial ischemia pattern with STD in V5-V6 and STE in aVR. Thus...
Source: Dr. Smith's ECG Blog - March 26, 2024 Category: Cardiology Authors: Pendell 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
Pigtail Catheter and Modifications
Transcript of the video: Pigtail catheter, as the name implies, has a curve at its tip, resembling the tail of the pig. Typically it is a left heart cathter, used for angiography, but there are other uses as well. There are several modifications of pigtail catheter, also used sometimes. Other than angiography, pigtail catheter is used in cardiology for drainage of pericardial effusion. Similar shaped catheters are used for drainage of pneumothorax, pleural effusion and ascites. Even for nephrostomy, a similar catheter is used. But it is of higer diameter, unlike the cardiology pigtail catheter.
This is the curved region of...
Source: Cardiophile MD - March 20, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Two patients with chest pain, with QRS obscured: which was STEMI positive, and which had Occlusion MI?
Written by Jesse McLaren Two patients
presented with acute chest pain, and below are the precordial leads V1-6 for
each. Patient 1 (ECG on the left) was a 45 year-old male, and patient 2 (ECG is
on the right) was a 70 year-old male. The limb leads have been removed because
there was no ST elevation in those leads, the QRS complexes have been
obscured because this is irrelevant to STEMI criteria, and red lines have been added to measure ST segment elevation. Using the
current paradigm, can you tell which patient had an acute coronary occlusion? Using
T wave amplitude, can you tell which ECG has hyperacute T waves?...
Source: Dr. Smith's ECG Blog - January 17, 2024 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
What do you suspect from this ECG in this 40-something with SOB and Chest pain?
I was reviewing ECGs for a study, and came across this one, and was able to get all the clinical information:What do you think?The Queen diagnosed " OMI with high confidence " due to the ST Elevation in V1-V3.Smith interpretation: This is highly likely to be due to extreme right heart strain and is nearly diagnostic of pulmonary embolism. Let me tell you about her hospitalization, discharged 1 day prior, but it was at another hospital (I wish I had the ECG from that hospitalization):The patient is 40 years old and presented to another hospital with chest pain and SOB. She had been sitting doing work when sh...
Source: Dr. Smith's ECG Blog - January 8, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?
Written by Pendell MeyersA woman in her 20s with connective tissue disorder and history of aortic root and valve repair presented with palpitations. Here is her triage ECG: What do you think?Atrial flutter with 2:1 conduction. The atrial flutter rate is approximately 200 bpm, with 2:1 AV conduction resulting in ventricular rate almost exactly 100 bpm. The fact that the atrial flutter rate is 200 bpm (rather than more typical adult rate of ~300 bpm) suggests that the patient must have one or both of the following:1) enlarged atria ( " bigger race track " )2) sodium channel blockade ( " slower race car "...
Source: Dr. Smith's ECG Blog - December 24, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Acute Dyspnea and Right Bundle Branch Block
I was texted this ECG just as I was getting into bed.It is of an elderly woman who complained of shortness of breath and had a recent stent placed.I was told that the Queen of Hearts had called it OMI with high confidence.What do you think? Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema.Here is my interpretation:There is sinus rhythm with RBBB. If you jump to looking at ST segments, you see " coved " ST in V3, V4, V5, with subtle ST Elevation. This is HIGHLY ...
Source: Dr. Smith's ECG Blog - November 18, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
The Ins and Outs of Healthcare Communication Platforms
Communication is the key to making anything work – including your organization. But when dealing with all of the many things that providers do and the highly important health information about patients, something as simple as selecting a communication platform becomes a very tricky situation. What’s the best way for providers to coordinate the many different areas and people they have to handle? How many communication platforms do you even need to accomplish the goals of your organization without making it overcomplicated? How do you maintain the security and privacy of your patient’s health information a...
Source: EMR and HIPAA - November 8, 2023 Category: Information Technology Authors: Grayson Miller Tags: C-Suite Leadership Communication and Patient Experience Health IT Company Healthcare IT Hospital - Health System IT Infrastructure and Dev Ops Security and Privacy Abhi Sharma Ali Davis Amit Phadnis Care Coordination Communication Pl Source Type: blogs
Brugada Syndrome: Diagnosis and Risk Stratification
Hello friends, this is the modified version of my talk at Indian Heart Rhythm Society Conference, New Delhi, 2023, on Brugada Syndrome. Hope you will enjoy this session.
Initial description of Brugada syndrome in 1992 was that of syncopal episodes and/or sudden death in persons with structurally normal heart and a characteristic ECG pattern of right bundle branch block with ST segment elevation in leads V1 to V3. Sometimes individuals with a diagnostic ECG may be totally asymptomatic and may be having a family history of sudden death. Genetic nature of the disorder and mutation in sodium channel gene was described in 1998...
Source: Cardiophile MD - October 27, 2023 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology General Cardiology Source Type: blogs
Bonus Features – October 1, 2023 – 45 Percent of patients prefer telehealth for minor but urgent issues and much more
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.
Surveys and Research
Nearly 30% of telehealth visits result in an in-person follow-up within three weeks, and nearly half of patients who used telehealth only did it once, according to Trilliant Health’s latest report on t...
Source: EMR and HIPAA - October 1, 2023 Category: Information Technology Authors: Brian Eastwood Tags: Healthcare IT Aaron Tendler Accelecom AccYouRate AdvancedMD Affirm Aiberry Akasa Amwell Apollo MD AvaSure Cedar Christine Davis Costco DAX Copilot Evidium Foresite Capital Google Cloud Gozio Health GrayMatters Health Source Type: blogs
What does the ECG show in this patient with chest pain, hypotension, dyspnea, and hypoxemia?
Written by Pendell Meyers, with some edits by SmithA man in his 40s with many comorbidities presented to the ED with chest pain, hypotension, dyspnea, and hypoxemia.The bedside echo showed a large RV (Does this mean there is a pulmonary embolism as the etiology?)Here is his triage ECG:What do you think? Lots of info here.The rhythm is 2:1 atrial flutter. The flutter waves can conceal or mimic ischemic repolarization findings, but here I don ' t see any obvious findings of OMI or subendocardial ischemia.The QRS is around 100 msec wide (narrow), but with very abnormal morphology including a large R-wave in V1, dee...
Source: Dr. Smith's ECG Blog - August 14, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Profound ST depression in II, III, aVF
Conclusion:Type II MI probable due to hypoxia and tachycardia from resp arrest and amphetamine use. Whether the ST Depression on the ECG represents ischemia or not is uncertain, but it does not represent acute coronary syndrome.===================================MY Comment, by KEN GRAUER, MD (7/26/2023):===================================The most interesting aspects of today ’s case are: i) The tale told by the 6 ECGs; and, ii) The surprise finding of positive troponins! The Sum is More than Each of its Parts:If we look back at the initial ECG&nb...
Source: Dr. Smith's ECG Blog - July 27, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Blood Pressure Meds vs Blood Thinners: What ’ s The Difference?
Conclusion
In conclusion, while blood pressure medicines and blood thinners are both crucial to heart health, their roles and mechanisms of action are notably distinct. Blood pressure medication works primarily on the vascular system, aiding in reducing blood pressure by relaxing blood vessels or altering the heart’s function. On the other hand, blood thinners target the blood itself, working to prevent the formation of potentially dangerous blood clots.
Throughout this article, one thing becomes undeniably clear: the importance of regular consultations with your healthcare provider. When it comes to managing m...
Source: The EMT Spot - July 20, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs
27 Dangers And Risks Of High Blood Pressure
Conclusion
Despite its silent nature, high blood pressure gradually damages organs over time. The interconnectedness of the circulatory system means that all organs reachable by blood are at risk.
Hypertension can lead to critical complications such as heart enlargement, coronary artery disease, stroke, cognitive decline, erectile dysfunction, kidney disease, proteinuria, vision problems, and vascular damage.
The importance of proactive measures to manage and prevent these adverse effects is emphasized.
Regular blood pressure monitoring, adopting a healthy lifestyle, and working with healthcare professionals ar...
Source: The EMT Spot - June 1, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs
