General examination – hands and feet
General examination – hands and feet
Cyanosis and pallor can be noted in the tips of the digits in both central and peripheral cyanosis. Severe jaundice may be visible in the palms and soles, especially in small infants.
Clubbing of digits may be noted in cyanotic heart diseases as well many other non cardiac conditions. In clubbing, initially there is fluctuation of nail bed (Grade 1) followed by obliteration of angle between nail and adjacent skin fold (Lovibond angle – Grade 2). Later there is curvature of the nails (parrot beaking – Grade 3). Grade 4 or hypertrophic osteoarthropathy is not common in cardiova...
Source: Cardiophile MD - September 22, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Heberden’s nodes Janeway lesions Lovibond angle Osler’s nodes Pitting edema Polydactyly Source Type: blogs
EchoNous KOSMOS 3-in-1 Ultrasound, Electronic Stethoscope, and ECG Helps with COVID-19
EchoNous, a developer of novel ultrasounds, has found a way to leverage multiple critical clinical technologies within a single device. The result is KOSMOS, a handheld 3-in-1 device consisting of an ultrasound, electronic stethoscope, and an ECG, all linked via artificial technology.
When COVID-19 was hitting NYC earlier this year, EchoNous was able to use KOSMOS to help diagnose COVID patients and to inform on treatment strategies. We had a lovely chat with Dr. Richard Hoppmann, a key member of EchoNous, Clinical Professor of Internal Medicine at the University of South Carolina, and the Director of the Ultrasound I...
Source: Medgadget - September 21, 2020 Category: Medical Devices Authors: Alice Ferng Tags: Cardiology Critical Care Diagnostics Exclusive Informatics Medicine Public Health Source Type: blogs
McConnell' Sign: Pulmonary Embolism
McConnell ’s sign is a echocardiographic finding described in patients with acute Pulmonary embolism. There is a distinct regional pattern of right ventricular dysfunction, with akinesia of the mid free wall but normal motion at the apex.Famous Radiology Blog http://www.sumerdoc.blogspot.com
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Source: Sumer's Radiology Site - September 11, 2020 Category: Radiology Authors: Sumer Sethi Source Type: blogs
An 18 year old with chest pain and diffuse ST Elevation
An 18 year old complained of chest pain.Here is his ECG: What do you think?Comment on ECGMany immediately think this is pericarditis. But, in fact, this is the patient ' s baseline early repolarization, seen on a previous ECGs when he presented for a seizure (not chest pain). Most diffuse ST elevation is normal variant. --There isdiffuse ST Elevation. --There are well-formednotchesat the J-point in all leads with ST Elevation. The STE is called normal variant. The notching qualifies the ECG as true early repolarization (which is now defined as distinct from normal var...
Source: Dr. Smith's ECG Blog - September 10, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
21 year old woman with CP, SOB, then syncope, and with ST depression with T-wave inversion in V1-V3
In this study, except for troponin elevation,Gestalt was the best predictor.The article does not specify the QT correction methodWhy is right ventricular hypertrophy (RVH) not found in this large study of syncope? Probably because it is not common enough to be identified in a general syncope study. Not every high risk factor will be identified in such studies, but it is obvious that RVH is a dangerous condition and that, if identified on ECG, needs further workup. Why were so few ECG findings predictive?Because most abnormal ECG findings were considered adverse outcomes in their own right and not eva...
Source: Dr. Smith's ECG Blog - August 31, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Hypoxia and LV dysfunction: Let us learn more from “ COPD, COVID-19 and Tetralogy of Fallot ”
Superficially, tissue hypoxia might look similar to Ischemia but differs in one important aspect. Though the hypoxic myocardium is short of oxygen, the respiratory excreta from cells ie Co2, lactic acid, and free radicles are promptly cleared and flushed as blood flow is normal. Hence, generally acute Ischemia of tissues is more cell threatening than regional hypoxia at any organ level. How do you classify hypoxia? we need to go to physiology classes again.There are 4 types. Ischemic -Hypoxia, systemic hypoxia, Anemic hypoxia, Histo-toxic hypoxia.A good reference to read (Ošt’ádal B., Kolář F. (1999) Myocardial Hy...
Source: Dr.S.Venkatesan MD - August 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: metabolic support of heart failure anerobic cardiac metabolism copd and lv dysfunction covid heart disease hypoxia and covid lv dysfunction hypoxia vs iscehmia ketone bodies ato heart lv dysfunction in congenital cyanotic heart disease met Source Type: blogs
What ’ s the relationship between JVP and PCWP/LVEDP?
This study elegantly shows a correlation (or lack of it) in different subsets of heart failure. It tells us very clearly If JVP(RAP) is not correlating or disproportionate to PCWP, it implies RV dysfunction.
2. This paper suggests a really useful scheme to classify heart failure as concordant and discordant with reference to right and left heart.
It throws some interesting facts. I guess it will help us guide diuretic management and prognosticate chronic heart failure. (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - August 2, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Jugular venous pulse JVP -Jugualr venous pulse diastolic stress testing jjvp in hfref jvp cvp pcwp lvedp jvp in acute mr jvp in asd lutembacher syndrome jvp in bernheom effect jvp in isolated lv failure jvp in jfp Source Type: blogs
A Woman with New Dyspnea. Is the extreme left axis deviation, with negative T-wave in lead III, suggestive of RV strain?
===================================MY Comment by KEN GRAUER, MD (7/26/2020):===================================The ECG in Figure-1 was obtained from a middle-aged woman who presented to the ED with new-onset shortness of breath.QUESTION: Is the inferior lead T wave inversion indicative of RV (Right Ventricular) Strain from acute PE (Pulmonary Embolism)?Figure-1: ECG obtained from a middle-aged woman who presented to the ED with new dyspnea (See text).MY THOUGHTS on ECG #1: As always — I favor a systematic approach to ECG interpretation. ...
Source: Dr. Smith's ECG Blog - July 27, 2020 Category: Cardiology Authors: ECG Interpretation Source Type: blogs
Chest Pain and Ischemic ST Depression — but there is no Cath Lab available. Thrombolytics?
===================================MY Comment by KEN GRAUER, MD (7/14/2020):===================================This middle-aged man with hypertension and hyperlipidemia presented to the ED with 2 hours of new-onset chest pain — and the ECG shown in Figure-1. The patient was hemodynamically stable. No prior tracing was available for comparison.HOW would you interpret the ECG shown in Figure-1?Immediate cath lab activation was not an option in this hospital. Should acute thrombolysis be used?Figure-1: The initial ECG in the ED (See text).My THOUGHTS on ECG #1...
Source: Dr. Smith's ECG Blog - July 14, 2020 Category: Cardiology Authors: ECG Interpretation Source Type: blogs
Can a bedside echocardiogram help rule out STEMI in patients with suspicious ECG ?
Can a bedside echocardiogram help rule out STEMI in patients with suspicious ECG?No, it can’t (Though, it may be tempting to use a rapid echo to look for wall motion defect to rule out ACS ) If your answer was No, probably you don’t need to read any further in this post. Diagnosis of STEMI* is based onClinicalECGBio-Markers
*Please note, two of the most popular investigations namely Echo and Coronary angiogram are missing in the list.Middle-aged man with chest pain. Can an echocardiogram help you confirm STEMI here? Most likely not. It may still be a evolving STEMI. But, observation, serial ECGs,...
Source: Dr.S.Venkatesan MD - July 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized diagnostic criteria for stemi gls in stemi role of echocardiography in diagnosis of acs stemi nstemi wall motion defect in stemi by echo Source Type: blogs
Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on?
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely. When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA. ===================================MY Comment by KEN ...
Source: Dr. Smith's ECG Blog - June 27, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Diffuse T-wave inversions and a very long QT
This ECG was texted to me and I read it while mountain biking. My response was " takotsubo " .ECG 1There is are diffuse T-wave inversions and a bizarre QT interval, very longThis is very typical of takotsubo.Aside: I classify takotsubo ECGs into 2 broad categories:1) ST Elevation which often mimics STEMI2) T-wave inversion: does not mimic STEMI, but rather mimics NonSTEMI or reperfused STEMIThe next day I texted back to ask what the clinical presentation was, what the echo showed, and what the outcome was.It turned out that this patient had severe alcoholism, alcohol withdrawal, and seemed to have had an alcohol ...
Source: Dr. Smith's ECG Blog - June 21, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his sixties with chest pain
Written by Pendell MeyersA man in his sixties with no prior history of CAD presented with fluctuating central chest pain that started the night before presentation, then went away, then woke him up from sleep the morning of presentation. The pain was 10/10 on arrival, with SOB. Although he also had some nasal drip and sore throat, he had no cough or fevers (this occurred during peak COVID).Here is his triage ECG:What do you think?Normal P-waves would have upright morphology in the inferior leads (especially lead II) and usually biphasic (up-down) morphology in V1. These p-waves are negative in almost all leads except for a...
Source: Dr. Smith's ECG Blog - June 2, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
What ’s a diagnosis about? COVID-19 and beyond
By MICHEL ACCAD
Last month marked the 400th anniversary of the birth of John Graunt, commonly regarded as the father of epidemiology. His major published work, Natural and Political Observations Made upon the Bills of Mortality, called attention to the death statistics published weekly in London beginning in the late 16th century. Graunt was skeptical of how causes of death were ascribed, especially in times of plagues. Evidently, 400 years of scientific advances have done little to lessen his doubts!
A few days ago, Fox News reported that Colorado governor Jared Polis had “pushed back against recen...
Source: The Health Care Blog - May 28, 2020 Category: Consumer Health News Authors: Christina Liu Tags: COVID-19 Medical Practice Physicians Diagnosis MICHEL ACCAD Source Type: blogs
1 hour of CPR, then ECMO circulation, then successful defibrillation....
An elderly woman had sudden ventricular fibrillation.She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). ECMO Flow was achieved after approximately 1 hour of high quality CPR.After good ECMO flow was established, she was successfully defibrillated.Here is her monitor rhythm:Notice the " Shark Fin " morphology in lead I monitor rhythm.Also notice that the arterial line mean arterial pressure is 63 mmHg, but there is no waveform (and SpO2 says " no pulse " ), as the flow is continuous on ECMO and the LV function at this point was ext...
Source: Dr. Smith's ECG Blog - May 18, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
