A man in his 30s with 12 hours of chest pain; is the ECG consistent with 12 hours of occlusion?
Written by Pendell Meyers, submitted by Siva Vittozzi-WongA man in his 30s with history of hypertension, hyperlipidemia, and diabetes presented with chest pain which started 12 hours prior to presentation. The pain was described as pressure, constant for 12 hours, radiating to the jaw, with left arm numbness. Initial vitals were significant for bradycardia at 45 beats per minute.Here is his presenting ECG with active pain:What do you think?Here was the prior EKG on file:The emergency medicine resident (who has received lectures from me on hyperacute T-waves, suble OMI, etc) documented the following interpretation:" Initial...
Source: Dr. Smith's ECG Blog - November 19, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
A 41 year old with chest pain and a Nondiagnostic Triage ECG. Thrombolytics prior to transfer for PCI.
Conclusion:Transfer for PCI without thrombolytics is best if PCI at receiving facility can be done in less than 120 minutes from first medical contact, or less than 90 minutes from STEMI diagnosis in first ED.Thrombolytics prior to Transfer to a PCI capable facility, then rescue PCI if no reperfusion for STEMITRANSFER AMI(Cantor et al. 2009).High risk STEMI: BP less than 100, HR greater than 100 Killip class II, III, ST depression of at least 2 mm in precordial leads, ST elevation in right precordial leads (right ventricular MIAll patients get TNK-tPA.80-90% received clopidogrel 300 mg (75 mg for age over...
Source: Dr. Smith's ECG Blog - November 7, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 50s with witnessed arrest and ST elevation in aVR
Written by Meyers, edits by SmithA 50-ish year old man was working construction when he suddenly collapsed. Coworkers started CPR within 1 minute of collapse. EMS arrived within 10 minutes and continued CPR and ACLS, noting alternating asystole and sinus bradycardia during rhythm checks. He received various ACLS medications and arrived at the ED with a perfusing rhythm.Initial vitals included heart rate around 100 bpm and BP 174/96. Here is his initial ECG, very soon after ROSC:What do you think?Sinus tachycardia. There is incomplete RBBB (QRS duration less than 120 ms). There is diffuse STD, maximal in V4-V5 a...
Source: Dr. Smith's ECG Blog - November 2, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
40-something male in a head-on Motor Vehicle Collision and Splenic Injury
A 40-something male presents to the stabilization room for evaluation following head on motor vehicle collision (MVC). Pt was reported restrained driver, hit at city speeds, with + airbag deployment.The MVC was unquestionably caused by the other car, not by this driver.The patient complained to EMS of chest pain and a prehospital EKG en route was concerning for STEMI.The patient was at all times hemodynamically stable, without evidence of any profuse bleeding.He had an ECG recorded on arrival to the ED:Anterior and Inferior STEMI with diffuse hyperacute T-waves. This ECG really can ' t be anything else.&nb...
Source: Dr. Smith's ECG Blog - October 26, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
A young peripartum woman with Chest Pain
This is written by Brooks Walsh.https://twitter.com/BrooksWalshA 30 year-old woman was brought to the ED with chest pain.It had started just after nursing her newborn, about an hour prior, and she described it as a severe non-pleuritic “pressure” radiating to the back.She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying " I ' m just an anxious person. "A CXR and a CTA for PE were normal.The ECGsAn initial ECG was obtained as the pain was rapidly resolving:Minimal upsloping ST Elevation in III, with a steeply biphasic T wave, and&nbs...
Source: Dr. Smith's ECG Blog - October 23, 2019 Category: Cardiology Authors: Brooks Walsh Source Type: blogs
CDK5 as a Target to Reduce Cell Death Following Ischemic Stroke
In this study, we synthesized a membrane-permeable peptide (Tat-CDK5-CTM) that specifically disrupts the binding of CDK5 and NR2B and then leads to the degradation of CDK5 by a lysosome-mediated pathway.
We found that the administration of Tat-CDK5-CTM not only retards calcium overload and neuronal death in oxygen and glucose deprivation (OGD)-treated neurons but also reduced the infarction area and neuronal loss and improved the neurological functions in MCAO (middle cerebral artery occlusion) mice. The peptide-directed lysosomal degradation of CDK5 is a promising therapeutic intervention for stroke.
Link:...
Source: Fight Aging! - October 18, 2019 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
FDA Clears geko Muscle Pump Activator to Prevent VTE
Venous thromboembolism (VTE) too often strikes bedridden patients in the hospital, and this is one of the main reasons that patients are put back on their feet as soon as possible. Inflatable wraps placed around the legs, which can raise the pressure, are a common way to prevent the condition. Now, a device called geko from Sky Medical Technology, a U.K. firm, has just been cleared by the FDA to stimulate the calf muscles, in turn increasing blood circulation, and helping to prevent VTE.
The device was previously only cleared to be used immediately after surgeries, but the geko muscle pump activator is now available for...
Source: Medgadget - October 15, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Critical Care Medicine Rehab Source Type: blogs
Fight Aging! Newsletter, September 30th 2019
In conclusion, older adults exhibited decreased markers of UPR activation and reduced coordination with autophagy and SC-associated gene transcripts following a single bout of unaccustomed resistance exercise. In contrast, young adults demonstrated strong coordination between UPR genes and key regulatory gene transcripts associated with autophagy and SC differentiation in skeletal muscle post-exercise. Taken together, the present findings suggest a potential age-related impairment in the post-exercise transcriptional response that supports activation of the UPR and coordination with other exercise responsive pathways (i.e....
Source: Fight Aging! - September 29, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Senescent Cells Implicated in Age-Related Changes in Blood Clotting
In this study, researchers validated the expression of some of the specific factors in cultured cells and in mice, which were treated with doxorubicin, a widely-used chemotherapy drug which induces widespread senescence. Those mice showed increased blood clotting, similar to what happens in humans who undergo chemotherapy. "Conversely, when we selectively removed senescent cells in specially bred transgenic mice, the increased clotting caused by doxorubicin went away."
SILAC Analysis Reveals Increased Secretion of Hemostasis-Related Factors by Senescent Cells
Cellular senescence irreversibly arrests cell...
Source: Fight Aging! - September 25, 2019 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Reviewing Changes in Platelet Function in Aging
Platelets are essentially structured chunks of cytoplasm shed by the megakaryocyte cells responsible for producing them, released into the blood stream. They are important in blood clotting and the innate immune response. Inappropriate blood clot formation known as thrombosis occurs more readily in later life, but it is unclear as to the degree to which age-related changes in platelets, versus other systems, are important to this process, or where platelets sit in the complex chains of cause and effect. The open access paper noted here reviews what is known of the aging of platelets and related mechanisms, a topic that is ...
Source: Fight Aging! - September 19, 2019 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Unusual: Troponin Trajectory to Help Determine Ongoing/Recurrent Infarction vs. Completed Infarction.
A 40-something male with no PMH of any kind presented to urgent care on a weekend (cath team is at home) with cough starting 2 weeks prior and SOB one week prior.He underwent a chest x-ray:As this was consistent with " pulmonary edema vs. viral infection, " and he was transferred to the EDThe faculty physician did an immediate cardiac and lung ultrasound:Many B lines (probable pulmonary edema)Parasternal short axis cardiac ultrasound:The anterior wall is closest to the transducer and shows an obvious wall motion abnormalityFurther history:The patient denied chest pain but stated that he had had about 3 epis...
Source: Dr. Smith's ECG Blog - September 16, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
MINOCA vs TpNOCA
TpNOCA: Troponin-positive nonobstructive coronary arteries
Apparent myocardial infarction in the absence of obstructive coronary artery disease
MINOCA: Myocardial Infarction With Nonobstructive Coronary Arteries
Term reserved for only those who have evidence of ischemia related myocardial necrosis
MINOCA included only coronary disorders like coronary dissection, plaque disruption, coronary spasm, microvascular dysfunction, coronary thrombus and embolism (recanalized).
TpNOCA includes in addition to MINOCA, myocardial disorders like myocarditis, takotsubo cardiomyopathy and other cardiomyopathies as well as non cardia...
Source: Cardiophile MD - September 10, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
The ECG was correct. The angiogram was not.
In this study, approximately 10% of Transient STEMI had no culprit found:Early or late intervention in patients with transient ST ‐segment elevation acute coronary syndrome: Subgroup analysis of the ELISA‐3 trialOne must use all available data, including the ECG, to determine what happened.Final Diagnosis?If the troponin remained under the 99% reference, then it would be unstable angina. If it rose above that level before falling, it would be acute myocardial injury due to ischemia, which is, by definition, acute MI. If that is a result of plaque rupture, then it is a type I MI. The clinical presentat...
Source: Dr. Smith's ECG Blog - August 12, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Localising “ Angina related artery ” ( ARA ) in UA/NSTEMI : Can we differentiate culprit artery from lesion ?
Identifying the culprit after a criminal event may be easy for the police.For cadiologists investigating the crime scne after a coronary event, It is a different story. (Of course, localization of IRA after a STEMI may not be really difficult.) But , when a patient is having UA and coronary artery shows multiple lesions, we do have real diagnostic issue. The general dictum could be tightest lesion or complex eccentric lesions with thrombus is likely to be the culprit. This has important therapeutic Impication as we are argued to address the active lesions first. The following study was done in 2009 trying to address ...
Source: Dr.S.Venkatesan MD - August 11, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
How does acute left main occlusion present on the ECG?
Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. In these ...
Source: Dr. Smith's ECG Blog - August 8, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
