A man in his 60s with chest pain and LBBB
Sent by Ali Khan MD, written by Pendell MeyersA man in his 60s with HTN, HLD, known prior LBBB, presented with episodes of chest pain radiating to the left shoulder, with diaphoresis and dyspnea. Episodes started yesterday after starting to exercise, came and went throughout the day, and he decided to present to the ED the next morning after the one of these episodes failed to resolve like the others.Here is his ECG at triage with ongoing pain (prior unavailable):Same image optimized by PM Cardio appWhat do you think?I sent this to Drs. Smith, McLaren, and Grauer all of whom immediately diagnosed LAD occlusion based ...
Source: Dr. Smith's ECG Blog - September 11, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Vitamin K antagonist superior to DOAC in RHD with AF – INVICTUS study
Vitamin K antagonist superior to DOAC in RHD with AF – INVICTUS study
The INVICTUS program (INVestIgation of rheumatiC AF Treatment Using VKA) was designed as an open label parallel group trial comparing treatment with vitamin K antagonists or rivaroxaban, in rheumatic heart disease with atrial fibrillation [1]. It was an international multicentre randomized study. A registry of 17,000 patients was also planned to document the contemporary clinical course of patients with RHD, including a focused sub-study on pregnant women with RHD within the registry. RHD is considered as a neglected disease affecting 33 million pe...
Source: Cardiophile MD - September 10, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
OCT is not “ Obsessive compulsive tomography ”
This is the story of PCI to LAD from the customary bifurcation workshop for the budding experts, which ended up with a compulsive final OCT run-through, triggering a debate on what to do with the side branch.
What shall we do next?
Just balloon dilate the distal strut
Would consider a second stent. Maybe a TAP depending upon LCX morphology
At this stage, I would like to know the FFR or iFR across LCX Jail.
Get rid of this OCT, Let me have look at regular CAG. I bet I can make a better decision.
Leave it alone if the clinical status & profile is good
Leave it alone? Is it not an incomplete Job?
Def...
Source: Dr.S.Venkatesan MD - September 8, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coronary Imaging ILUMEN study oct opitical coherence tomography Source Type: blogs
Pneumatic Assistive Device for People with Disabilities
Researchers at Rice University have developed a pneumatic assistive device for people with disabilities. The technology includes an air pump that is mounted in the wearer’s shoe, providing pneumatic power with each step. This power is stored in a wearable belt that includes an “arm” that can reach out and grip items when activated. The device may be very practical for people with arm weakness who struggle to lift objects.
The research team also developed a shirt with a bellows mechanism in the armpit that lets a wearer pick up an object that weighs 10 pounds. The researchers are exploring the possibility of u...
Source: Medgadget - September 6, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Rehab riceuniversity Source Type: blogs
60 year old with vomiting, diarrhea, and syncope: is this Wellens? Is this type 2 MI?
Written by Jesse McLaren, with edits/comments by Smith and Grauer A 60 year-old patient with diabetes and ESRD presented with 24 hours of vomiting, diarrhea, weakness and then a syncopal episode. Vitals: RR 18, sat 98%, HR 103, BP 124/71 and temp 38.0. Here ’s their ECG: is this Wellens? There ’s borderline sinus tach, normal conduction, normal axis, and low voltages in the limb leads. The anterior leads have loss of R waves, mild convex ST segments and primary T wave inversion. In the context of QS waves, T wave inversion indicates old or subacute infarct, or reperfusion after signif icant infarc...
Source: Dr. Smith's ECG Blog - August 19, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A woman in her 30s with several days of chest pain and an episode of altered mental status.
Written by Pendell Meyers, reviewed by Smith, Grauer, McLarenA woman in her early 30s with history of diabetes had 2-3 days of gradual onset nonradiating chest pain with associated nausea, malaise, and shortness of breath. Then she had an " abrupt change in her mental status and became more somnolent and less responsive " at home in front of her family. Her family called EMS, who found the patient awake and alert complaining of worsening chest pain compared to the prior few days.En route to the ED, they recorded this ECG and transmitted it, asking whether the cath lab should be activated:What do you think?There is sinus rh...
Source: Dr. Smith's ECG Blog - August 15, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 60s with dizziness, nausea, chest pain, and LBBB
Submitted and written by Parker Hambright MD, peer reviewed by Meyers, McLaren, Grauer, SmithA man in his late 60s called EMS for acute dizziness, nausea, vomiting, and chest pain shortly after beginning his morning exercise. The symptoms lasted for only about 15 minutes and then resolved spontaneously. He was brought to the ED and evaluated in less than one hour from onset of symptoms. His history included known CAD, HTN, HLD, prior MI with LAD stent, AAA repair, and reported dizziness/vertigo.Here are his EMS and ED triage ECGs (unclear whether symptoms still present or resolved at time of these ECGs, but it seems that s...
Source: Dr. Smith's ECG Blog - August 1, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Fight Aging! Newsletter, August 1st 2022
In this study, we used the recently released Infinium Mouse Methylation BeadChip to compare such epigenetic modifications in C57BL/6 (B6) and DBA/2J (DBA) mice. We observed marked differences in age-associated DNA methylation in these commonly used inbred mouse strains, indicating that epigenetic clocks for one strain cannot be simply applied to other strains without further verification. Interestingly, the CpGs with highest age-correlation were still overlapping in B6 and DBA mice and included the genes Hsf4, Prima1, Aspa, and Wnt3a. Furthermore, Hsf4, Aspa, and Wnt3a revealed highly significant age-associated DNA methyla...
Source: Fight Aging! - July 31, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
An Omics View of the Inflammation of Aging
Aging is characterized by chronic inflammation, disruptive of cell and tissue function, a sizable contribution to the onset and progression of all of the common age-related conditions. The causes of this inflammation are known at the high level, such as the increasing presence of senescent cells and damage-associated molecular patterns, such as DNA debris from dead and dying cells. At the detail level, the real of genomics, transcriptomics, proteomics, and the other omics, much remains to be cataloged. There is the hope that a full map of inflammation in aging would point out more and better regulatory or signal molecules ...
Source: Fight Aging! - July 26, 2022 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
A man in his 50s with hypoxemic respiratory failure from COVID pneumonia develops chest pain
Submitted by anonymous, written by Parker Hambright, MD, peer reviewed by Meyers, Smith, McLarenA man in his 50s with a past medical history of hypertension and tobacco use disorder, who tested COVID positive 11 days prior, presented to the emergency department with worsening shortness of breath over several days. He was tachypneic and hypoxemic down to as low as 44% with reportedly good SpO2 waveform before EMS applied noninvasive ventilation with improvement to 85-89%. Although history was limited by extremis, the report is that there was no chest pain at initial presentation, only shortness of breath.Here is his ECG on ...
Source: Dr. Smith's ECG Blog - July 25, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Fight Aging! Newsletter, July 25th 2022
This study further demonstrates that AMD is not a single condition or an isolated disease, but is often a signal of systemic malfunction which could benefit from targeted medical evaluation in addition to localized eye care."
Microglia in the Aging Brain, Both Protective and Harmful
https://www.fightaging.org/archives/2022/07/microglia-in-the-aging-brain-both-protective-and-harmful/
A growing body of evidence implicates the changing behavior of microglia in the aging of the brain and onset of neurodegeneration. Microglia are analogous to macrophages, innate immune cells unique to the central nervous sys...
Source: Fight Aging! - July 24, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
The Complexities of Vascular Aging
We are as old as our arteries, as the saying goes. The aging of the vasculature impacts all of the tissues in the body, and there are many distinct mechanisms by which this happens. The loss of capillary density reduces the supply of oxygen and nutrients to energy-hungry tissues such as muscles and the brain. The stiffening of vessels leads to hypertension and pressure damage to delicate tissues throughout the body. The leakage of the blood-brain barrier allows unwanted molecules and cells to provoke chronic inflammation in the brain. The fatty deposits of atherosclerosis narrow and weaken blood vessels, further reducing b...
Source: Fight Aging! - July 19, 2022 Category: Research Authors: Reason Tags: Medicine, Biotech, Research 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
When Normal is only Pseudo-Normal, it can deceive the caregivers.
An Aussie friend down under sent me this case. A 70-something male presented with sharp stabbing central CP. Here is the initial ECG with 7/10 CP:NormalThe pain was resolving, and another ECG was recorded with 3/10 CP:Normal, but compared to the first, the T-waves in V2 and V3 are not as tall. Hmm.......The pain completely resolved:What do you think?Now there is an all-but-diagnostic terminal T-wave inversion in V2. This is very subtle Wellens ' .The patient then developed 8/10 stabbing CP again:The T-wave in V2 is again upright, indicating re-occlusion of the LAD. There is also less T-wave inv...
Source: Dr. Smith's ECG Blog - June 29, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 30s with chest pain and a normal bedside echo, without wall motion abnormality
In conclusion — our THANKS to Drs. Nicacio and Meyers for presenting today ' s case. As interesting as I found the initial ECG to be — the KEY point in today ' s case is that identification of suspicious (albeit indefinite) ECG findings in this patient with typical unrelieved chest pain merited timely cath (which was done within 15 minutes of ED presentation) — and this confirmed the need for prompt revascularization. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - June 17, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
