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
Chest pain, trop > 50,000 but only 30% LAD stenosis on angiogram: what's the diagnosis?
Conclusion: Correlation of the recurrence of this patient ' s chest pain with evolving ECG changes (loss of anterior R waves, waxing and waning of Q waves — and dynamic change in shape and relative amount of ST segment deviation) — was enough to justify the determination of an " acute STEMI " despite no more than borderline ECG criteria for this diagnosis and non-obstructive coronary disease on 2 catheterizations. Clinically — Stenting of the non-obstructive 60% mid-LAD lesion effectively prevented further infarction. Dependence on mill...
Source: Dr. Smith's ECG Blog - June 5, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Does a Single Troponin below the 99th percentile URL Rule out Acute MI if the Chest pain is very prolonged?
A 66 y.o. male who presented for chest pain that started this AM when he woke up, and has persisted throughout the day prompting him to call 911. He says the pain is dull in nature and located across the chest, does not radiate, that it isworse with exhalation. He denies worsening with activity or positioning. He endorses SOB and requested to sit up. He says this has not happened to him before. He endorses cough productive of yellow sputum. He denies any edema. Denies history of venous thromboembolism. He endorses a 50 pack year history of smoking. He denies recent illness or recent s...
Source: Dr. Smith's ECG Blog - May 26, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Unstable Angina Still Exists in Era of high sensitivity troponin, with a short lesson on troponin interpretation
42 y.o. male with no past medical history presented for chest pain of onset 2 weeks prior. It is not constant, but lasts only a couple minutes. It is substernal without radiation, and is associated with SOB. Onset of chest pain was 2 weeks. States it is not constant. He has PMH of HTN, hyperlidemia, DM2, 1/3 ppd smoking (4 risk factors).A few days prior, his chest pain was intense and lasted about 10 minutes and it made him sweat. On the day of presentation, he was walking to the ED from the parking lot and the chest pain recurred and lasted about 2 minutes. Here is his ED ECG:T...
Source: Dr. Smith's ECG Blog - May 8, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 40s who really needs you to understand his ECG
Written by Pendell MeyersA man in his 40s presented for " left sided chest pain sudden onset yesterday when sneezing and coughing that is worsened with inspiration. " He also complained of associated SOB, dizziness, jaw pain, and back pain, which he described as " muscle spasms. " He has also had rhinorrhea and cough for 1 week. Also, left hand numbness today. He went to urgent care for evaluation. An ECG was performed there (unavailable) which reportedly was abnormal, so EMS was called to urgent care to take him to the ED.On EMS arrival, they noted the patient vomited then became unresponsive. He was reportedly...
Source: Dr. Smith's ECG Blog - May 1, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 40s with RUQ abdominal pain
Conclusion:In hemodynamically stable patients with chest pain, sinus tachycardia aids in the identification of patients unlikely to have type I MI, especially in those with HR greater than 120 bpm.===================================MY Comment by KEN GRAUER, MD (4/28/2020):===================================Insightful case presented by Drs. Goss and Meyers highlighting the importance of recognizing the ECG signs of acute PE. I focus my comments on further dissecting some of these " tell-tale " ECG features.The " theme " of today ' s case was "pattern recognition". Like the ECG diagnos...
Source: Dr. Smith's ECG Blog - April 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 50s with acute chest pain and history of prior MI
Written by Pendell MeyersA man in his 50s with prior history of anterior MI with LAD stent presented with acute chest pain similar but more intense than his last MI. He presented around midnight with pain that had started around 9pm the night before. He had taken NTG at home with no improvement, and immediately received morphine on arrival at the ED for severe chest pain (a very bad idea if your accuracy for finding OMI on ECG is low, since ongoing pain will be your last chance to identify those with ongoing untreated OMI).Here is his triage ECG at 0012:What do you think? What is the differential of this ECG?There is sinus...
Source: Dr. Smith's ECG Blog - April 13, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
RBBB with STE in I and aVL. Will the angiogram tell you if this ECG represents Occlusion MI or not?
A middle aged male with history of STEMI and stents presented with one hour of chest pain.Here is his ED ECG:What do you think?Analysis: There is sinus rhythm with RBBB. There is ST Elevation in I and aVL which is discordant to the wide S-wave (a wide S-wave in lateral leads is a feature of RBBB). There is also some ST depression in lead V3 (inferoposterior OMI is suggested). There is no R ' -wave in V2 and so one would not expect the typical discordant ST depression and TW inversion that one often sees in V2. However, V3 does have an R ' -wave, and STD, but the T-wave isconcordantly positive, which...
Source: Dr. Smith's ECG Blog - April 11, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Welcome To The Virtual Ward!
The expression ‘virtual ward’ is trending. But is it just the expression we hear about more often, or is there a real trend? And by the way: what is a virtual ward? And what is it good for?
It is yet difficult to find one, generally accepted definition for the new phenomenon. The same phrase is used for a number of quite different solutions. For the sake of understanding, here is what we think about when we speak of virtual wards.
“A virtual ward is a solution that supports patients who would otherwise be in hospital to get the acute care, remote monitoring and treatment in their own homes, with the use o...
Source: The Medical Futurist - April 5, 2022 Category: Information Technology Authors: Andrea Koncz Tags: TMF Artificial Intelligence in Medicine Digital Health Research E-Patients Future of Medicine Health Sensors & Trackers Healthcare Policy Telemedicine & Smartphones virtual ward Source Type: blogs
Intermittent Chest pain with Nausea and Vomiting, resolved at this moment
This is fromAmandeep ( " Deep " ) Singh. Dept Emergency Medicine, Highland Hospital, Oakland.Case51 yo male who walked to a parked fire engine complaining of nausea and vomiting. Per patient, he started feeling nauseous when he woke up, and shortly after, vomited. On arrival at the emergency department, he reports that he has had intermittent episodes of chest pain associated with nausea and shortness of breath over the past 3 days. These episodes last about 20 minutes before spontaneous resolution. He states that he is no longer having any chest pain, difficulty breathing, or na...
Source: Dr. Smith's ECG Blog - March 23, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Understanding this pathognomonic ECG would have greatly benefitted the patient.
Written by Pendell MeyersInterpret this ECG first without context. You don ' t need context yet because this ECG is nearly pathognomonic.After having learned about benign T wave inversion pattern years ago on this blog, and having seen many cases on this blog and in my practice since then, I instantly recognize this as BTWI, a fairly common normal variant. I see maybe one of these ECGs each month in my practice. There is no ischemia, certainly no concern at all for OMI. It meets basically all of the criteria that Dr. Smith has consistently described over the years, after reviewing a large cohort of patients by W...
Source: Dr. Smith's ECG Blog - March 22, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Fight Aging! Newsletter, March 21st 2022
This study was the first to examine how these networks interact with physical activity and fitness to impact how the brain functions.
"This paper is exciting because it gives us some evidence that when people whose brain networks aren't functioning optimally engage in physical activity, we see improvement in their executive function and their independence. Maybe just take the stairs on the way to work. Stand up and walk around a little bit more. That's where you get the most bang for your buck, not crazy, high-intensity exercise."
Variations in Biological Age Across Organs in Younger Individuals
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Source: Fight Aging! - March 20, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Elastin Fragmentation and the Elastin Receptor Complex in Aging Blood Vessels
Elastin is a vital component of the complex structure of the extracellular matrix in flexible, elastic tissues, such as skin and blood vessel walls. It is the extracellular matrix that determines physical tissue properties, such as strength, elasticity, and so forth. This structure becomes disarrayed with age for a variety of reasons: photoaging that breaks down molecules or encourages alterations; cross-linking between molecules that restricts their range of motion; changes in the behavior of cells that maintain the structure.
Today's open access paper looks at a different aspect of this issue. The researchers disc...
Source: Fight Aging! - March 14, 2022 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Missing ECG signs of OMI is associated with early death
Written by Sean Trostel MD, with edits by Smith and MeyersA man in his 80s with history of CAD, MI s/p PCI, HTN, HLD, Afib, and HFrEF, presented with sudden onset, aching, central chest pain radiating to the left arm and shortness of breath that began in the morning, 1 hour prior to arrival to the ED. This was his initial triage ECG, recorded one hour after onset of symptoms, and a baseline ECG below for comparison:What do you think?Baseline on file: This ECG was interpreted as sinus bradycardia with no acute ST or T wave changes compared to prior. Despite the very poor quality and wanderin...
Source: Dr. Smith's ECG Blog - February 25, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Cerebral Venous Thrombosis: NCCT
History: A 32 yr female c/o sudden headache followed by loss of consciousness. Post partum statusFindings:Multiple ill-defined hypodense lesions are seen in the brain parenchyma bilaterallyNot confined to single arterial teritoryMost of the lesions show hemorrhagic transformationMild surrounding edema is seenHypderdense superior saggital sinus - thrombosisThe findings are typical of Hemorrhagic venous infarctsDiagnosis:Hemorrhagic venous infarctsExtra EdgeEtiologyGenetic prothrombotic conditions, dehydration, trauma, brain surgery, post partum state, OC pills, mastoiditisHow to differentiate arterial from venous...
Source: Sumer's Radiology Site - February 19, 2022 Category: Radiology Authors: Sumer Sethi Source Type: blogs
