A man in his 40s with 3 days of stuttering chest pain
Written byWilly FrickA man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. It started while he was at rest after finishing a workout. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It woke him the next day and radiated into his back. He was only able to sleep while sitting in a chair. He went to urgent care and had an ECG (not available) which was interpreted as normal, and was sent home. His pain returned, and he went back to the urgent care but was sent to the ER. His ECG is shown:What do you...
Source: Dr. Smith's ECG Blog - March 13, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
An elderly patient with stuttering chest pain. Don't jump to conclusions.
I was reading ECGs on the system and saw this one, and instantly knew the probable ECG diagnosis:What do you think?I went to the patient ' s chart:Elderly woman with stuttering chest pain and SOB, and dizziness.What do you think now?This is a very typical ECG for Hypertrophic Cardiomyopathy. I sent it to our EKG Nerdz group and Jesse McLaren replied: " Apical HOCM "It reminded me of many other cases I have seen, such as this one: Left Bundle Branch Block with Less Than 1 mm of Concordant ST Elevation (in the Setting of Hypertrophic Cardiomyopathy)HOCM that mimicked LBBB with OMI (concordant STE in V5)Case continu...
Source: Dr. Smith's ECG Blog - December 26, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
" A patient just arrived as a transfer for NSTEMI. "
Conclusion: Our THANKS to Dr. Frick for his detailed and highly insightful presentation. CREDIT to him for masterful correlation of clinical events to each ECG — that thoroughly supports his explanation of the successful treatment received by this patient with evolving LAD OMI.QUESTION: Isn ' t it so much EASIER with the lead-to-lead comparison facilitated by Figure-1 — to see the subtle-but-important evolution of ST-T wave changes that so closely correspond to clinical events? (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - December 7, 2023 Category: Cardiology Authors: Willy Frick Source Type: blogs
Physician burnout reimagined
While preparing yet another talk about burnout, I had a brainstorm. I created a counterpoint PowerPoint (or tongue-in-cheek complementary model) to The Stanford Model of Professional Fulfillment. Perhaps it was a particularly irreverent or flippant stage of my own stuttering burnout. Maybe it was passive-aggressive pent-up frustration. Whatever it was, I came up with a “new
Read more…
Physician burnout reimagined originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 29, 2023 Category: General Medicine Authors: Claudia Finkelstein, MD Tags: Physician Psychiatry Source Type: blogs
A 20-something with intermittent then acute chest pain
This was sent to me by a partner:" Curious what you think of this one we had overnight. Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. He had another episode the day before after exerting himself. No pericardial effusion on ultrasound. "What do you think?First, many on Twitter said " Pericarditis " . This is NOT pericarditis, which virtually NEVER has ST depression any where except aVR. When there is ST depression (as in aVL, V2, V3), then top on the differential is OMI or myocarditis.See our publication: ST depression in ...
Source: Dr. Smith's ECG Blog - April 25, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Dueling OMI: does this 30 year old with chest pain have any signs of occlusion or reperfusion?
Written by Jesse McLaren, with edits from Smith A 30 year old with a history of diabetes presented with two days of intermittent chest pain and diaphoresis, which recurred two hours prior to presentation. Below is ECG #1 at triage. Are there any signs of occlusion or reperfusion?There ’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression and normal voltages. There’s mild inferior ST elevation in III that doesn’t meet STEMI criteria, but it’s associated with ST depression in aVL and V2 that makes itdiagnostic of infero-posterior Occlusion MI (from either RCA or circumflex) – accomp...
Source: Dr. Smith's ECG Blog - January 29, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
The Monster Study On Stuttering Was Unethical
The so-called 'Monster Study' on children's stuttering was dramatic, unethical and was never published. (Source: PsyBlog | Psychology Blog)
Source: PsyBlog | Psychology Blog - December 15, 2022 Category: Psychiatry & Psychology Authors: Jeremy Dean Tags: Child Psychology Source Type: blogs
Why The Monster Study On Stuttering Was Unethical
The so-called 'Monster Study' on children's stuttering was dramatic, unethical and was never published. (Source: PsyBlog | Psychology Blog)
Source: PsyBlog | Psychology Blog - December 15, 2022 Category: Psychiatry & Psychology Authors: Jeremy Dean Tags: Child Psychology Source Type: blogs
Aphasia: 10 Things You Should Know
Aphasia is a catch-all word that describes difficulty in speaking. Aphasia can range from mild difficulty in finding and expressing words or completing sentences to a complete inability to speak.. It is a significant finding in a physical assessment. The patient who presents with a new onset of aphasia has a concerning medical issue. Here are ten things to keep in mind the next time you encounter a patient who is having difficulty speaking.
1) Aphasia can be both receptive or expressive. If someone is having difficulty speaking they are said to be experiencing expressive aphasia. Receptive aphasia is a difficulty in und...
Source: The EMT Spot - November 7, 2022 Category: Emergency Medicine Authors: Steve Whitehead Tags: EMT Source Type: blogs
Individual Differences in Attentional Control Predict Working Memory Capacity in Adults who Stutter - ScienceDirect
Attentional control (Gwm-AC) strikes again as a key cognitive ability. Individual Differences in Attentional Control Predict Working Memory Capacity in Adults who Stutter - ScienceDirect https://www.sciencedirect.com/science/article/abs/pii/S0021992422000910HIGHLIGHTS•Attentional control predicts working memory capacity in adults who stutter•Activating simple linguistic stimuli may be more difficult for adults who stutter as a group•Adults who stutter who have higher executive control may be less susceptible to dual-task effects****************************************** Kevin S. McGrew, PhD Educational&...
Source: Intelligent Insights on Intelligence Theories and Tests (aka IQ's Corner) - October 18, 2022 Category: Neuroscience Source Type: blogs
Bonus Features – October 9, 2022 – Optum completes Change Healthcare acquisition, interest in flu shots is declining, and 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.
News
UnitedHealth Group subsidiary Optum closed its acquisition of Change Healthcare for $13 billion following an unsuccessful U.S. Department of Justice challenge of the deal. Optum first announced its intention to acquire Chan...
Source: EMR and HIPAA - October 9, 2022 Category: Information Technology Authors: Brian Eastwood Tags: C-Suite Leadership Health IT Company Healthcare IT Advata ahrq Alinea Ben Grabski BeneTalk Brigham and Women's Hospital Brightside Health CARIN Alliance Change Healthcare Communicare eClinicalWorks eCW FinThrive Forward Adv Source Type: blogs
The ECG must be recorded at the right time, or the Occlusion (OMI) will be missed.
This was sent by one of our faculty, Steven Souchtchenko, who trained under me and works at another hospital most of the time, and with us at Hennepin some of the time.Case:53yoF with stuttering CP for 2 days, suddenly acutely worse tonight, now 10/10 pressing radiating to L arm. What do you think?Steven wrote: " I called it " OMI " based on hyperacute T-waves. " (Dr. Souchtchenko understands that a hyperacute T-wave is not at all defined by its height, nor even by its size and bulk (though these are " bulky, " but by its sizein proportionto the QRS)." Cardiology didn ’t believe me. I recorded...
Source: Dr. Smith's ECG Blog - July 4, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Why do we NOT name Occlusion MI (OMI) after an EKG finding? (In contrast to STEMI, which is named after ST Elevation)
A 40-something male with no previous cardiac disease presented with chest pain.Here is his ECG:There is no clear evidence of OMI or ischemia. There is a tiny amount of STE in aVL, but it is NOT in the context of a tiny R-wave. There is a tiny amount of STD in lead III, with some non-specific T-wave flattening.I am glad that Ken Grauer (below) brings up the issue of whether the presence of " T-wave in V1 taller than T-wave in V6 " is evidence for OMI. I showed conclusively that this is a common finding in normal ECGs, though it is more common in LAD Occlusion than in norml variant STE. Moreover,...
Source: Dr. Smith's ECG Blog - June 1, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Coming back from the brink of burnout [PODCAST]
“I understand what it feels like to be in the depths of depression and hopelessness. I have had a lifelong battle with stuttering, obsessive-compulsive tendencies, depression, and suicide. I continually fight these battles and have learned to heal and recover through family, friends, and ultra-running. Since attempting to take my life on September 12, 2009,Read more …Coming back from the brink of burnout [PODCAST] originally appeared inKevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 10, 2022 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/post-author/the-podcast-by-kevinmd" rel="tag" > The Podcast by KevinMD < /a > < /span > Tags: Podcast Psychiatry Source Type: blogs
Monster Study On Stuttering
The so-called 'Monster Study' on children's stuttering was dramatic, had shaky ethics and was never published. (Source: PsyBlog | Psychology Blog)
Source: PsyBlog | Psychology Blog - February 18, 2022 Category: Psychiatry & Psychology Authors: Jeremy Dean Tags: Child Psychology Source Type: blogs
