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A Treacherous Twist on ECG
The patient is a 61-year-old female with a history of well-controlled hypothyroidism on levothyroxine supplementation and prior suspected cardioembolic stroke on chronic anticoagulation who previously underwent surgical mitral valve repair 1 year previously due to symptoms of severe fatigue with a baseline left ventricular ejection fraction of 55-60% and non-obstructive coronary artery disease. Immediately following surgery, her left ventricular ejection fraction declined to 40%. Postoperatively, she continued to experience fatigue with gradual worsening of her left ventricular ejection fraction to 30%.
Source: The American Journal of Medicine - October 26, 2021 Category: General Medicine Authors: Tyler J. Bonkowski, Christopher M. Madison, Sanjay Dandamudi, David A. McNamara Tags: ECG Image of the Month Source Type: research

Non-Vitamin K Antagonists versus Warfarin in Patients with Atrial Fibrillation and Bioprosthetic Valves: a Systematic Review and Meta-Analysis
Patients with bioprosthetic heart valves and valve repair with concomitant atrial fibrillation are at an increased risk of thromboembolic events.1-5 Until recently, there was a paucity of randomized data to guide the optimal anticoagulation strategy in this patient population. In a prior meta-analysis of 4 randomized studies in patients with atrial fibrillation and valvular heart disease, excluding significant mitral stenosis and mechanical valves, there was a significant reduction in the risk of stroke or systemic embolism with non-vitamin K antagonist oral anticoagulants (NOACs) vs.
Source: The American Journal of Medicine - October 7, 2021 Category: General Medicine Authors: Rhanderson Cardoso, Caique M.P. Ternes, Gustavo B. Justino, Amanda Fernandes, Ana Vitoria Rocha, Leonardo Knijnik, Andre d'Avila, Renato D. Lopes Tags: Clinical Research Study Source Type: research

The case of the furtive finding: atypical atrial flutter
A patient’s arrhythmia was identified only after an electrocardiogram (ECG) lead was attached directly to an atrial epicardial lead. The 87-year-old man had a history of paroxysmal atrial fibrillation, coronary artery disease, and severe mitral and tricuspid regurgitation and was admitted for corrective cardiac surgery. His history included a cardioembolic stroke 10 months prior to admission, hypertension, and hyperlipidemia. He underwent coronary artery bypass grafting (CABG) to the right coronary artery, bioprosthetic mitral valve replacement, tricuspid annulus repair, and a maze cryoablation or cryomaze procedure.
Source: The American Journal of Medicine - July 31, 2014 Category: Journals (General) Authors: Jeffrey Paulsen, Gagan Singh, Uma Srivatsa, Ezra A. Amsterdam Source Type: research

The Case of the Furtive Flutter: Atypical Atrial Flutter
A patient's arrhythmia was identified only after an electrocardiogram (ECG) lead was attached directly to an atrial epicardial lead. The 87-year-old man had a history of paroxysmal atrial fibrillation, coronary artery disease, and severe mitral and tricuspid regurgitation; he was admitted for corrective cardiac surgery. His history included a cardioembolic stroke 10 months prior to admission, hypertension, and hyperlipidemia. He underwent coronary artery bypass grafting (CABG) to the right coronary artery, bioprosthetic mitral valve replacement, tricuspid annulus repair, and a maze cryoablation or cryomaze procedure.
Source: The American Journal of Medicine - July 31, 2014 Category: Journals (General) Authors: Jeffrey Paulsen, Gagan Singh, Uma Srivatsa, Ezra A. Amsterdam Tags: ECG image of the month Source Type: research