All about alternans
Here is all you wanted to know about alternans: Traube’s pulse, total pulsus alternans, diastolic pulsus alternans, right ventricular pulsus alternans, biventricular pulsus alternans and electrical alternans!
Traube’s pulse – pulsus alternans
Pulsus alternans or Traube’s pulse was described by Ludwig Traube in 1872 [1]. Pulsus alternans is nothing but alternating pulses having different volumes and is a feature of left ventricular dysfunction. It is well known that pulsus alternans can be augmented by a premature ventricular contraction [2].
A rare case of pulsus alternans due to 2:1 left bundle branch...
Source: Cardiophile MD - January 25, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology biventricular pulsus alternans Brody's effect diastolic pulsus alternans electrical alternans right ventricular pulsus alternans total pulsus alternans Traube's pulse Source Type: blogs
The successes make the challenging cases more bearable
I first met her in the urgent care at the cancer center when I was on call one night. She was beautiful: 53 years old, four adult sons, and in incredible pain. She had stage 4 breast cancer, and unbeknownst to her, she had a metastatic lesion in her femoral neck, which she had fractured about four weeks ago. But she’d just had a spine operation for mets in her lumbar vertebral bodies a month before that, so she thought it was a complication of surgery. Like the pulmonary embolism she’d had.
She squirmed and winced on the bed, clearly uncomfortable, but she had it; as an intern, my chief resident called it spark...
Source: Kevin, M.D. - Medical Weblog - January 17, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/brooke-crawford" rel="tag" > Brooke Crawford, MD < /a > Tags: Physician Cancer Source Type: blogs
Research and Reviews in the Fastlane 168
Welcome to the 168th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check o...
Source: Life in the Fast Lane - January 11, 2017 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Education Emergency Medicine Intensive Care Neurology Neurosurgery Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation recommendations research and reviews Source Type: blogs
Case of Breathlessness: Medicine Unplugged Series
Here is video lecture discussing approach to a case pulmonary thromboembolism with discussion on Radiological findings.Famous Radiology Blog http://www.sumerdoc.blogspot.com
TeleRad Providers at www.teleradproviders.com Mail us at sales@teleradproviders.com (Source: Sumer's Radiology Site)
Source: Sumer's Radiology Site - January 5, 2017 Category: Radiology Authors: Sumer Sethi Source Type: blogs
Only the ECG Diagnoses Acute Coronary Occlusion. Do not be Fooled by a Negative High Sensitivity Troponin.
This case was sent by Peter Hammarlund, 2nd year Internal Medicine/Cardiology resident (and self-proclaimed ECG nerd) at Helsingborg Hospital, Sweden. Peter frequently sends me great cases like this, but I never post them because the Swedish standard, explained below, is very difficult to interpret.This time I could not resist.Especially interesting is the troponin data and the manipulated images seen below.Casep.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Calibri; color: #222222; -webkit-text-stroke: #000000; background-color: #ffffff} span.s1 {font-kerning: none}Hi Steve,I was involved in this highly...
Source: Dr. Smith's ECG Blog - December 28, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Quiz on deep vein thrombosis
Short quiz on DVT
Quiz on DVT
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Question 1Risk factor/s for upper limb venous thrombosis:AVigorous arm exerciseBCentral venous catheter...
Source: Cardiophile MD - December 27, 2016 Category: Cardiology Authors: Johnson Francis Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Coronary artery disease: Primary care and prevention – 2
Previous
Check for differential diagnosis
Some of the important differential diagnosis in the case of acute coronary syndrome are acute pulmonary embolism, aortic dissection, pneumothorax, esophageal disease, perforated peptic ulcer, cholecystitis, gastritis and sometimes even Herpes Zoster of left thoracic region in pre-eruptive phase. A good history, physical findings and sometimes time are needed for an accurate differential diagnosis. Checking for asymmetry of peripheral pulses is often resorted to for excluding aortic dissection, though it may still miss an aortic dissection sparing the branches as in descending thora...
Source: Cardiophile MD - December 18, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs
Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. At midnight.
A middle aged male presented at midnight after 14 hours of constant, severe substernal chest pain, radiating to his throat and to bilateral jaws, and associated with diaphoresis. It was not relieved by anything. The pain was not positional, pleuritic, or reproducible. He had no previous medical history. The blood pressure was 110/60. Physical exam was normal and there was no murmur.I delved into his reasons for arriving so late after onset, thinking that perhaps the pain had only recently increased, or that it had been intermittent until now, but he confirmed that it was 14 hours of constant pain a...
Source: Dr. Smith's ECG Blog - December 13, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Quiz on pulmonary embolism
Short quiz on pulmonary embolism
Quiz on pulmonary embolism
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Question 1Risk of intracranial bleed for tenecteplase in a...
Source: Cardiophile MD - December 11, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Acute Chest Pain: Computer reads " Nonspecific ST-T abnormalities "
A male in his 60 ' s had a history of previously stented infero-posterior-lateral STEMI due to an occluded dominant circumflex, which had been opened and stented.He called 911 for acute chest pain.Here is the first prehospital ECG at time zero. The computer read " Nonspecific ST-T abnormalities. "Time zero:The computerized QTc was 431 ms.The computer read " nonspecific ST-T abnormalities "What do you think?There is minimal ST elevation in V2 and V3.T-waves are large in V2 and V3.There are minimal down-up T-waves in III and aVF.This is LAD occlusion until proven otherwise. One must explain the minimal ST elevation...
Source: Dr. Smith's ECG Blog - December 9, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
The uncertain diagnosis is difficult for everyone involved
It is frustrating for patients to have unanswered questions, and it is equally frustrating for doctors to not have answers to their questions. In the past month, I have cared for three patients who have stood out to me because they have all presented under personally dire situations.
“I have had crushing 10/10 chest pain since this morning,” Ms. A tells me at the urgent episodic appointment she scheduled in my evening primary care clinic as she is bent over in her chair, grimacing in pain.
Ms. A came to the hospital because of worsening, disabling chest pain that frequently woke her up while she slept and prevented her...
Source: Kevin, M.D. - Medical Weblog - December 4, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/michael-nguyen" rel="tag" > Michael Nguyen < /a > Tags: Education Medical school Source Type: blogs
Blood-Monitoring Disposable Smart Patch Delivers Blood Thinners On-Demand
Thrombosis, the occlusion of vasculature by blood clots, is a precursor to debilitating conditions including stroke, pulmonary embolism, and heart attack. Blood thinners such as heparin or Coumadin are used to treat thrombosis, but necessitate ongoing blood tests for precise drug dosing. Researchers from the University of North Carolina at Chapel Hill and North Carolina State University have developed and tested a self-regulating drug eluting patch that monitors the level of thrombin (a clot initiating enzyme) in the blood, and releases appropriate amounts of heparin in response.
The microneedle patch is meant to stick to ...
Source: Medgadget - November 30, 2016 Category: Medical Equipment Authors: Iris Kulbatski Tags: Medicine Nanomedicine Source Type: blogs
Chest Pain and Cardiogenic Shock with Profound ST Depression & STE in aVR. Activate the Cath Lab?
A middle-aged woman with known severe coronary disease had onset of substernal chest pain while at dialysis. 911 was called. A prehospital ECG was similar to the first ED ECG, which is shown below. The patient arrived with a systolic blood pressure of 90 mm Hg, too low to administer nitroglycerine. An initial lactate was elevated at 5.5.She was given aspirin, heparin, and ticagrelor.Here is her initial ED 12-lead ECG:There is atrial fibrillation with a rate of approximately 114.There is extreme ST depression in multiple leads and ST elevation in aVR, suggesting left main and/or 3 vessel disease ischemia...
Source: Dr. Smith's ECG Blog - November 15, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
The Driverless Car Is a Great Opportunity for Healthcare
The latest developments in the car industry point towards the realization that within years we will travel by driverless cars everywhere. These automated vehicles also have a huge potential in revolutionizing healthcare. Let me show you how.
Will learning how to drive become an obsolete skill?
Heading home to his daughter’s fourth birthday celebration, 37-year-old attorney, Joshua Neally suffered a pulmonary embolism in his moving car on a highway in July. For his greatest luck, the car was a new Tesla Model X with an autopilot function. It enabled the car to drive to the nearest hospital, while he suffered in the drive...
Source: The Medical Futurist - November 8, 2016 Category: Information Technology Authors: nora Tags: imported autopilot car industry cars driverless car future Healthcare Innovation portable diagnostics technology tesla vehicles wearables Source Type: blogs
Deep T inversion
First few conditions which come to our mind when we see deep T wave inversions are coronary artery disease, hypertrophic cardiomyopathy, post cardiac arrest state and takotsubo cardiomyopathy. Other conditions in which deep T wave inversion have been reported are nonischemic cardiomyopathy [1], after cardioversion [2], acute pulmonary embolism [3] and acute pulmonary edema [4].
References
Ambhore A, Teo SG, Poh KK. Diabetes mellitus and heart disease. Singapore Med J. 2013 Jul;54(7):370-5; quiz 376.
Sovari AA, Farokhi F. When the heart remembers. Am J Emerg Med. 2007 Sep;25(7):831-3.
Punukollu G, Gowda RM, Khan IA, Wilbur...
Source: Cardiophile MD - November 6, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology ECG / Electrophysiology ECG Library Source Type: blogs
