Palpitations and presyncope in a 40-something
Discussion: Putting all of the information together this patient is most likely suffering from arrhythmogenic cardiomyopathy (AC) better known as ARVC. The medical hx is typical, with sudden onset tachydysrhythmia during physical exertion. It is not uncommon for the initial presentation to be sudden cardiac death (SCD). In fact it is one of the leading causes of SCD in people age less than 40 years. Thus it is very important to identify this disorder. AC is a disease in which myocardium is replaced by fibrofatty tissue. This usually and predominantly affects the RV free wall and apical regions, but it can affect the left v...
Source: Dr. Smith's ECG Blog - March 24, 2024 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
Why ICDs are less effective in Non Ischemic DCM ?
We wish, our understanding about cardiac contractile physiology is deep and nearly complete. Heart is an irreversibly coupled electro-mechanical organ , right from the fetal days until the final heart beat. In myocardial pathology, the genesis and sustainability of ventricular arrhythmia are intricately related to the degree of LV dysfunction of any cause.
SCD is the leading cause of mortality in heart failure. Tackling SCD was in God’s domain, until the brilliance of Dr. Michel Mirowski shrunk the defibrillator and implanted it under the chest in 1980. (Dr. MM’s s a unique and inspiring story, from Poland a...
Source: Dr.S.Venkatesan MD - February 20, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized crt device crt-p vs crt-d danish trial ischemic dcm madit trial non ischemic dcm Source Type: blogs
What kind of AV block is this? And why does she develop Ventricular Tachycardia?
Discussion: The initial ECG in today ' s case is pathological for any patient, especially for a 50-year old previously heathy female. Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). Usually the medical history will provide clues to the cause. Even though the primary suspicion was not ischemic heart disease, a CT angiogram was performed, and it revealed normal coronary arteries. This ruled out coronary disease as the cause of conduction system disease. When assessing patients with early onset high grade conduction disorders and ventricular tachydysrhythmi...
Source: Dr. Smith's ECG Blog - January 23, 2024 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
Heart disease in the shadows: a closer look at cardiac sarcoidosis
My new internist began my annual checkup with a nervous confession: “You are my first patient with cardiac sarcoidosis.” Even during an urgent care visit for potential cellulitis, I was met with raised eyebrows from the treating physician who reviewed my chart: “Very interesting, I’ve never seen a case of this heart disease.” With over
Read more…
Heart disease in the shadows: a closer look at cardiac sarcoidosis originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - August 14, 2023 Category: General Medicine Authors: Kamal Bharucha, MD, PhD Tags: Conditions Rheumatology Source Type: blogs
This was texted to me in real time. The patient has acute chest pain.
This was texted to me in real time. The patient has acute chest pain.What do you think?Here was my answer:" Not ischemia. Chronic. Maybe HOCM or another form of LVH. I would not activate cath lab. Get serial troponins "It is a scary ECG, with a lot of ST Elevation and what appear to be hyperacute T-waves in inferior leads, and profound reciprocal ST Depression in aVL. There are Q-waves in V4-V6, with what appear to be hyperacute T-waves. Any objective, rule-based analysis of this ECG would scream " STEMI " or " OMI " . But, alas, ECGs are like faces. No measurements can t...
Source: Dr. Smith's ECG Blog - July 5, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A young lady with wide complex tachycardia. My first time actually making this diagnosis de novo in real life in the ED!
Written by Pendell MeyersA woman in her 30s with minimal past medical history presented simply stating she was " feeling unwell. " Her symptoms started suddenly about 48 hours ago, but had continued to worsen, including epigastric discomfort, nausea, cough, and dyspnea and lightheadedness on exertion. She denied chest pain and denied feeling any palpitations, even during her triage ECG:What do you think?Despite otherwise normal vital signs, she was appropriately triaged to the critical care area of the ED.She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for ...
Source: Dr. Smith's ECG Blog - June 3, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Is this Myo-pericarditis? Or OMI with subsequent pericarditis? Does the angiogram always explain the ECG findings?
Conclusion: Although at 1st glance, it looked like the ECG picture in Figure-1 might be suggestive of acute pericarditis — on further inspection, there are significant ECG features against the diagnosis of acute uncomplicated pericarditis.As per the superb discussion above by Dr. Smith — evolution of this case (including the ECG picture on serial tracings) — are consistent with what probably occurred in today ' s case, namely the combination of acute OMI from LCx occlusion, followed by development of post-infarction regional per...
Source: Dr. Smith's ECG Blog - June 11, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Morning Distort
By MARTIN A. SAMUELS
A 35 year old woman complains of weakness of the right side of her face and pain behind the right ear. She lives in an urban environment and denies any recent illnesses. She is not vaccinated against COVID-19 but is COVID negative.
What do you think, I was asked at our Morning Report? Well, I said, it sounds like a straightforward Bell palsy. The pain around the ear suggests swelling of the VIIth cranial nerve in the facial canal and the stylomastoid foramen, a very common historical point, I opined; so much so that its absence would make me doubt the diagnosis and m...
Source: The Health Care Blog - August 12, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Martin A. Samuels morning report neurology Source Type: blogs
Positron Emission Tomography (PET) in Cardiology
Positron emission tomography (PET) imaging is useful in assessment of myocardial perfusion and viability, atherosclerotic plaque activity as well as cardiac innervation in heart failure. PET is also useful in prosthetic valve endocarditis, endocarditis associated with cardiac implantable electronic devices (CIED), infiltrative cardiomyopathy, aortic stenosis and cardio oncology [1].
PET imaging has superior diagnostic accuracy compared to SPECT (Single Photon Emission Computed Tomography). It has improved spatial and temporal resolution and can measure regional blood flow and has less radiation. In PET, high energy gamma...
Source: Cardiophile MD - April 20, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Positron emission tomography Source Type: blogs
Are early detection and treatment always best?
Throughout my medical career, I’ve heard statements like these:
Early detection offers the best chance of cure.
If you wait for symptoms, you’ve waited too long.
Knowledge is power, and the sooner you have the information, the better.
Over time, I’ve realized they are often untrue. Many health conditions go away on their own. In such cases, early testing may amount to wasted effort, time, and medical cost. Some testing is invasive and has a significant risk of complications. And minor abnormalities may lead to more testing. There’s also the anxiety of waiting for results, or learning you have an abnormality of unce...
Source: Harvard Health Blog - January 28, 2021 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Back Pain Heart Health Managing your health care Prevention Screening Tests and procedures Source Type: blogs
Artificial Intelligence vs. Tuberculosis, Part 1
By SAURABH JHA, MD
Slumdog TB
No one knows who gave Rahul Roy
tuberculosis. Roy’s charmed life as a successful trader involved traveling in his
Mercedes C class between his apartment on the plush Nepean Sea Road in South
Mumbai and offices in Bombay Stock Exchange. He cared little for Mumbai’s weather.
He seldom rolled down his car windows – his ambient atmosphere, optimized for
his comfort, rarely changed.
Historically TB, or
“consumption” as it was known, was a Bohemian malady; the chronic suffering produced
a rhapsody which produced fine art. TB was fashionable in Victorian Britain, in
part, because c...
Source: The Health Care Blog - December 5, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Artificial Intelligence Health Tech Saurabh Jha TB tuberculosis Source Type: blogs
Syncope evaluation from ECG: A check list and a focused review.
In the evaluation of syncope, history is most important to arrive at a diagnosis.The first step is to confirm whether its truly a syncope or (Metabolic/TIA or seizure. We are easily carried away by the urge to order a Holter monitoring routimely. In reality, the yield is too low (<15%) .Even the utility value of Head up tilt (HUT) is being downgraded.
Paradoxically, resting ECG might give important clue in many. One need to specifically look into a set pattern of ECG. It generally falls in one the following in any patient with syncope.
This post specifically may not be exclusive but stresses the importance of resting EC...
Source: Dr.S.Venkatesan MD - June 10, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Sclerosing orbital lesions: broadening the differential diagnosis of " idiopathic sclerosing pseudotumor "
Sclerosing orbital lesion(the biopsy revealed it to be Erdheim-Chester disease)Sclerosing lesions of the orbit can present a diagnostic conundrum. Often submitted with a differential diagnosis that includes idiopathic sclerosing pseudotumor, it is incumbent upon the pathologist to rule out other diagnostic possibilities before designating the lesion as idiopathic. In order to survey the range of diagnoses for such specimens, we searched over a 10-year period for specimens submitted to the University of Colorado pathology department which either clinically or pathologically raised the possibility of idiopathic sclerosing ps...
Source: neuropathology blog - April 19, 2019 Category: Radiology Tags: ophthalmic pathology Source Type: blogs
Trocar during Times of Trauma
Seventy-five percent of trauma injuries involve some kind of thoracic insult, a quarter of which need a procedural intervention like a chest tube. (Surg Clin North Am 2007;87[1]:95; http://bit.ly/2HaoX90.) Long-term illness, lung disease, and post-operative complications may cause pleural effusions or a pneumothorax, so treating these conditions quickly can significantly decrease patient morbidity and mortality. Other indications for chest tube placement include:Trauma: Pneumothorax, hemopneumothorax, or tension pneumothoraxLong-term illness: Pleural effusion (cancer, pneumonia)Infection: Em...
Source: The Procedural Pause - April 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
China Is Building The Ultimate Technological Health Paradise. Or Is It?
How could a country keep around 1.4 billion
people healthy when the system struggles with corruption, lack of resources and
an aging population? China, the emerging giant with a strong central leadership
fostering technology and innovation, places its bets on artificial
intelligence, telemedicine, cloud-based hospitals, and WeChat. While that could sound like
an ultimate technological paradise, the question is, what are they going to do
with the vast amount of data or to what interests are they going to leverage
their state of the art A.I. systems? Generally, how will we speak about digital
health in China: a healthcare dy...
Source: The Medical Futurist - February 19, 2019 Category: Information Technology Authors: nora Tags: Artificial Intelligence in Medicine Bioethics Future of Medicine Medical Professionals Patients Policy Makers AI chatbot china digital digital health Healthcare Innovation smartphone technology telehealth telemedicine Source Type: blogs
