Compare these two ECGs. Do either, neither, or both show anything important?
One case sent by Dr. Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve SmithTake a look at these two ECGs below from two patients in the ED, first without any clinical context. Full case details and outcomes are below.Case 1:Case 2: Case 1:What do you think?This was sent to Dr. Smith by SamGhali (@EM_RESUS) with zero other info. Smith ' s response was: " OMI Mimic. "Later, this info was supplied by Sam:This
ECG was recorded in a 23-year-old African American man with a history
of psychiatric illness, acute alcohol/drug intoxication, brought in by
police officers status post being ...
Source: Dr. Smith's ECG Blog - April 17, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A 40-something woman with acute pulmonary edema -- see the Speckle Tracking echocardiogram.
A 49 year old woman with h/o COPD only presented with sudden dyspnea. She had acute pulmonary edema on exam. PrehospitalConventional algorithm interpretation: ANTERIOR INFARCT, STEMITransformed ECG by PM Cardio:PM Cardio AI Bot interpretation:OMI with High ConfidenceWhat do you think?There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD.This is proximal LAD Occlusion until proven otherwise.On arrival, lung ultrasound confirmed pulmonary edema (B lines). An ECG was recorded:ED ECG 1:The findings are still present but not nearly as profound now...
Source: Dr. Smith's ECG Blog - April 12, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Severe Chest Pain on ED Arrival, after Wellens' waves Seen on Prehospital ECG
A 40-something woman called 911 in the middle of the night for Chest pain that was intermittent. On arrival, she complained of severe pain.The medics had recorded this ECG and were uncertain whether it was recorded during chest pain:Let ' s get a better image with use of thePM Cardio app:What do you think?There is deep T-wave inversion in proximal LAD territory (V2-V4, I, aVL) that is all but diagnostic of Wellens ' . This is acute ACS, but it almost always seen in a pain free state. Since the patient has active pain now, if this is indeed Wellens, ' she must be re-occluded at this moment. An ED...
Source: Dr. Smith's ECG Blog - March 13, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?
Conclusions.The efficacy of transthoracic cardioversion for converting atrial fibrillation to sinus rhythm was enhanced by pretreatment with ibutilide. However, use of this drug should be avoided in patients with very low ejection fractions. (N Engl J Med 1999;340:1849-54.) Smith comments from the full text: They included patients who had had a fib for less than 48 hours They excluded patients with a fib for longer than 48 hours unless they proved, by TE echo, to not have an atrial thrombus OR unless they anti-coagulated them for 3 weeks first *Therefore, our patients who have been in afib< 48 hours, or who h...
Source: Dr. Smith's ECG Blog - March 13, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fight Aging! Newsletter, February 6th 2023
In conclusion, our study reveals that aging enhances atherosclerosis via increased inflammation of visceral fat. Our study suggests that future therapies targeting the visceral fat may reduce atherosclerosis diseaseburden in the expanding older population.
Is the Gut a Significant Source of Amyloid-β in Alzheimer's Disease?
https://www.fightaging.org/archives/2023/02/is-the-gut-a-significant-source-of-amyloid-%ce%b2-in-alzheimers-disease/
The early stages of Alzheimer's disease are characterized by rising levels of amyloid-β in the brain and the formation of misfolded amyloid aggregates. It is present...
Source: Fight Aging! - February 5, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Does Mitochondrial Dysfunction Meaningfully Contribute to the Development of Atherosclerosis?
Mitochondria are the power plants of the cell, producing the chemical energy store molecule ATP, but are also integrated into a wide range of fundamental cellular processes. Mitochondrial function declines with age, likely an important contribution to age-related declines in energy-hungry tissues such as the brain and muscles. It is also known that mitochondrial dysfunction can provoke chronic inflammation via the mislocation of mitochondrial DNA into parts of the cell where it will act as a damage-associated molecular pattern. This upregulation of inflammatory signaling is a reasonable proposal for the way in which mitoch...
Source: Fight Aging! - January 30, 2023 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Ultrasound Tornado Rapidly Disrupts Blood Clots
A team of researchers at North Carolina State University have developed an ultrasound transducer that can disrupt blood clots in the brain quickly by creating an ultrasound vortex or ‘tornado’. The transducer is designed to be housed in a catheter that can be advanced through the vasculature until it reaches the site of a blood clot in the brain, such as those that occur in cases of cerebral venous sinus thrombosis. The technique can disrupt clots more quickly than conventional forward-facing ultrasounds, as the vortex wave creates shear stress that helps to break the clot into pieces. The approach has the potential to...
Source: Medgadget - January 30, 2023 Category: Medical Devices Authors: Conn Hastings Tags: Neurology Neurosurgery Radiology NCState Source Type: blogs
Fight Aging! Newsletter, January 23rd 2023
This study explored the association between tap drinking water and longevity in Cilento, Italy, to understand whether trace elements in local drinking water may have an influence on old, nonagenarian, and centenarian people and promote their health and longevity.
Data on population and water sources were collected through the National Demographic Statistics, the Cilento Municipal Archives, and the Cilento Integrated Water Service. Ordinary least squares (OLS) regression and a geographically weight regression (GWR) model were used to study the spatial relationship between the explanatory and outcome variables of long...
Source: Fight Aging! - January 22, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
The Impact of Aging on Skin Healing
Skin heals poorly in old people, the consequence of mechanisms of aging such as the growing number of senescent cells present in aged tissues. Senescent cells are normally generated for a short period of time during wound healing and their pro-growth, pro-inflammatory signals help to coordinate the intricate dance of cell populations involved in regrowth following injury. The constant presence of senescent cells and their signals is disruptive to the healing process, however. As noted in this review paper, a number of other mechanisms are also relevant to the declining capacity for regeneration of skin in older people.
...
Source: Fight Aging! - January 17, 2023 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
A teenager with chest pain, a troponin below the limit of detection, and " benign early repolarization "
Sent by anonymous, written by Pendell MeyersA male in his teens presented with complaints of chest discomfort and dyspnea beginning while exercising but without obvious injury. He immediately stopped exercising and symptoms started to improve. Later that evening he felt recurrent central chest discomfort, shortness of breath, and vomited. Symptoms have been constant since this second episode, and are still present on arrival, which seems to have been less than 1 to 2 hours from onset of symptoms. No similar symptoms in the past. No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of...
Source: Dr. Smith's ECG Blog - January 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A woman in her 50s with acute chest pain
Submitted and written by Anonymous, edits by Meyers and SmithA 50s-year-old patient with no known cardiac history presented at 0045 with three hours of unrelenting central chest pain. The pain was heavy, radiated to her jaw with an associated headache.Triage VS: 135/65 mmHg, 95 bpm, 94% on room air, 16/min, 98.6 FTriage ECG:ECG Interpretation:Sinus rhythm with normal QRS. There is slight STE in V1, V2, and aVR, with STD in V3-V6, I, aVL, and II. There are T waves in lead III which are suspicious for hyperacute T waves, with reciprocal negative large T wave inversions in aVL. I do not think this ECG is by itself diagnostico...
Source: Dr. Smith's ECG Blog - January 6, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
An ECG which is obviously diagnostic of OMI can appear wholly non-specific to most interpreters. A comment on AI.
This was texted to me by a former resident, with no information:What do you think?Here Ken Grauer has used the PM Cardio app to improve the image:This was my immediate response:" Acute proximal LAD OMI " To me it is obvious and diagnostic.There are hyperacute T-waves in I, aVL, V2-V6. These are wide, bulky, with large area under the curve relative to the QRS size.Furthermore, there is a QS-wave in V3 and qrS in V4, both diagnostic of MI at some time (past or present). We have shownhere and validatedhere that old MI has relatively small T-wave (by amplitude). In this situation (QS-waves), ...
Source: Dr. Smith's ECG Blog - January 1, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Thrombus, tumor or vegetation?
This question is often faced by the echocardiographer while evaluating a mass detected on the heart valves or cardiac chambers. Usual method is to take it in the clinical context. There could also be non-infective vegetations of marantic endocarditis which are almost impossible to differentiate from infective vegetations. Marantic vegetations can be suspected in the presence of small and multiple vegetations changing from one examination to another, without associated abscess or valve destruction [1]. It may be noted that echocardiography is neither 100% specific nor 100% sensitive for the diagnosis of infective endocardi...
Source: Cardiophile MD - December 15, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
A man in his 50s with acute chest pain and LVH
Sent by Drew Williams, written by Pendell MeyersA man in his 50s with history of hypertension was standing at the bus stop when he developed sudden onset severe pressure-like chest pain radiating to his neck and right arm, associated with dyspnea, diaphoresis, and presyncope. EMS arrived and administered aspirin and nitroglycerin. He reported several weeks of intermittent chest pain similar to the active pain, worsening over the past 2-3 days, some of them as long as an hour, but all spontaneously resolved and were of less intensity than the current symptoms.There are 2 very instructive posts which we link to at the bottom...
Source: Dr. Smith's ECG Blog - December 14, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Deep vein thrombosis of upper limbs vs lower limbs
The chance of pulmonary embolism is 6% for upper extremities, while it ranges from 15 – 30% with lower limbs. Recurrence at one year is 2-5% for upper extremities while it is 10% for lower extremities. The incidence of post thrombotic syndrome is much higher for lower extremities than upper extremities. (Source: Cardiophile MD)
Source: Cardiophile MD - December 10, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
