Acute aphasia. What is the likely etiology?
A 60-something man without significant past history presented after sudden onset of aphasia 45 minutes prior. There was also a report of a few days of abdominal pain, nausea and vomiting, and of not being himself.BP was 165/80, pulse 110. He had profound expressive aphasia but his motor exam was intact.A stroke code was called and the patient underwent a CT stroke series. Non-contrast scan showed no bleed and no evidence of infarct. Cerebral CT angiography did not show a large vessel occlusion.He was rapidly given tPA (alteplase).An ECG was obtained (ECG-1):What does it show? Is this...
Source: Dr. Smith's ECG Blog - January 25, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fight Aging! Newsletter, January 24th 2022
In conclusion, senolytic drugs have shown promising results in the elimination of senescent cells and in alleviating various diseases in animal models. However, in patients, there is a paucity in data on the efficacy and safety of senotherapeutics from clinical trials, including systemic effects and side-effects. In this regard it is important to assess the specificity of senolytics in killing targeted senescent cells and their cytotoxic effects, to identify reliable markers for intervention responses, to elucidate interactions with comorbidities and other drugs, and to standardise administration protocols.
FOXO3...
Source: Fight Aging! - January 23, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Chronic Stress Accelerates Atherosclerosis
Sustained psychological stress is shown to accelerate the progression of atherosclerosis. The most plausible biological explanations involve the effects of stress on (a) the immune system, resulting in raised inflammatory signaling, and on (b) blood pressure. Raised blood pressure can accelerate atherosclerosis, as well as raise the risk of rupture of atherosclerotic lesions. The relationship between stress and atherosclerosis may well have as much to do with the lifestyle effects of stress and their downstream effects on cardiovascular health over the long term, however.
Although the specific biological mechanism...
Source: Fight Aging! - January 20, 2022 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Wide Complex Tachycardia with Huge ST Elevation. What is going on?
This 70-something woman with no significant past history (no previous ECGs or cardiac history) presented by EMS with fairly acute chest pressure and shortness of breath, with nausea and diaphoresis. " Like an elephant sitting on my chest. " She had no history of atrial fibrillation and was not on any anticoagulants.She stated that she had had a similar episode a couple weeks earlier, lasting 24 hours, with rapid heart beat but without chest pain, that spontaneously resolved. She thought she was having a panic attack. Since then she has had " little spurts " of the same thing lasting 1-2 hours.E...
Source: Dr. Smith's ECG Blog - January 12, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
7 steps to missing posterior Occlusion MI, and how to avoid them
This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by SmithCaseYou ’re shown an ECG from a patient in the waiting room with chest pain. What do you think?Sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. There ’s primary ST depression in the precordial leads maximal in V3-4, and an inverted T wave in V2. There’s also a down-up T wave in aVL with a tiny bit of ST depression (which suggests inferior MI), but without associated inferior findings. Step 1 to missing posterior MI is relying on the STEMI criteria. A prospective valid...
Source: Dr. Smith's ECG Blog - January 3, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Hyperacute T-waves -- missed. Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) may be due to transient thrombotic Occlusion MI.
Coronary thrombosis (twice in the same patient!!) without a stenosis or even a culpritDo not miss the last image at the bottom that shows the series of T-waves in V4-V6I recently had a discussion with an incredibly smart and fantastic ECG and Cardiology expert. He was skeptical that you can have OMI with Wellens waves without having a major stenosis on angiogram.I told him I ' ve seen it on occasion and that this happens due to thrombosis of non-obstructive lesions that lead to complete occlusion but that thencompletely lyse and do not show stenosis by the time of the angiogram. I said that even if there is not...
Source: Dr. Smith's ECG Blog - December 29, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Did the posterior leads help here? Why not just get good at STDmaxV1-V4?
Written by Pendell MeyersA middle aged woman presented with chest pain and dyspnea. Her exam and vitals were within normal limits. Here is her triage ECG:What do you think?There is sinus rhythm with a relatively normal QRS (except for the substantial positive QRS component in V2). There is STD in V2-V4, with no QRS explanation, and downsloping ST morphology in V2 and horizontal morphology in V3-4. Thus, there is posterior OMI until proven otherwise, because of STD maximal in V1-V4. There is also subtle evidence of inferior OMI, with slight STD and TWI in aVL with suspiciously full upright T waves in the III and ...
Source: Dr. Smith's ECG Blog - December 27, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
A presentation on atrial fibrillation : Old wine in Old bottle
Caution: 2008 Presentation
This one is from the archive, a presentation on Atrial fibrillation done 14 years ago at KG.hospital, Coimbatore.
Link to PDF download
Good news: Nothing much has changed since 2008
Recognizing the clinical importance of AF and the need to rule out a systemic cause is the key, Further, a genuine bedside debate about the pros and cons of simple vs aggressive treatment discussion is welcome.
The nomenclature issue of valvular vs non-valvular has finally seemed to have settled. The latter is banished for good reason. (Funny to note Aortic valve was conside...
Source: Dr.S.Venkatesan MD - December 12, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation ACC AHA Atrial fibrillation affirm race af guidelines affirm trial atrial fibrillation Approach to atrial fibrillation a ppt presntation Source Type: blogs
A man in his 50s with acute chest pain, now resolved, has 2 undetectable troponins. CT Coronary Angiogram?
Written by Pendell MeyersA man in his 50s presented to the ED with chest pain described as pressure, without radiation, acute onset about three hours prior to arrival. He had had stuttering less severe versions of this pain all week that usually went away after a few minutes. He also had diaphoresis and dyspnea. He had extensive family history of CAD with CABG ' s in the mid 50s for multiple relatives, but he had no personal known history of CAD. It is unclear whether he had pain at the time of triage, but notes describe that his pain had subsided by the time of EM physician evaluation:Triage at approximately 21...
Source: Dr. Smith's ECG Blog - December 6, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Even when the story is obvious, with intractable pain, the STEMI paradigm can cause preventable delays
Written by Pendell MeyersA man in his early 60s presented with acute chest pain rated 10/10 with associated nausea and vomiting with known history of multivessel CAD. He presented at 2300 with onset of symptoms at 2230. He was awoken from sleep by the symptoms, which were identical to prior MI for which he received a stent years ago. On arrival his heart rate was 43 bpm and blood pressure 91/62. Atropine and IV fluid was given.Here was his triage ECG:What do you think? Baseline below for comparison, but try first without it.His baseline ECG was available on file:The presentation ECG shows diagnostic evidence of poste...
Source: Dr. Smith's ECG Blog - December 1, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
EINSTEIN-Jr clinical trials of Rivaroxaban in children
Rivaroxaban is useful for treatment of venous thromboembolism in adults and is associated with lower risk of bleeding compared to standard anticoagulants. EINSTEIN-Jr phase 2 used bodyweight adjusted rivaroxaban for children with venous thromboembolism [1]. It was a single arm multicenter study three age groups – children younger than 6 months, those in age group 6 months to 5 years and in children and adolescents between 6-17 years. Studies were done at 54 sites across Australia, Europe, Israel, Japan and North America. The study was in children with confirmed venous thromboembolism who have been treated for at lea...
Source: Cardiophile MD - November 25, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
Drug coated balloons in coronary artery disease
Drug coated balloons are a novel therapeutic option in certain situations of coronary artery disease. An established use of drug coated balloon is for in-stent restenosis of both bare metal and drug eluting stents [1]. Drug coated balloon transfers antiproliferative drugs into the vessel wall during single balloon inflation. This is done by means of a lipophilic matrix. The advantage over drug eluting stent is that there is no permanent implant. Drug eluting stents have the disadvantages of neo-atherosclerosis and stent thrombosis. Even temporary implants like bioresorbable scaffolds have elevated thrombotic risk.
Drug co...
Source: Cardiophile MD - November 18, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Coronary Interventions Source Type: blogs
3 strategies to lower the risk of fragmented medical care
After a minor bike accident, you go to the emergency room with a broken wrist. While you ’re being triaged, you tell the nurse you take blood thinners because you had deep vein thrombosis a few years ago. The doctor treating you says he’s read your medical records, so you assume he knows what medications youRead more …3 strategies to lower the risk of fragmented medical care originally appeared inKevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 12, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/miles-j-varn" rel="tag" > Miles J. Varn, MD < /a > < /span > Tags: Physician Emergency Medicine Primary Care Source Type: blogs
An elderly man who dies 12 hours later - could he have been saved?
Sent by Anonymous, written by Pendell Meyers and Steve SmithAn elderly man with good neurologic baseline but history of CABG presented to the ED with acute lightheadedness, shortness of breath, and chest pressure radiating to both arms. He had just recently been admitted for similar symptoms which had been diagnosed as an NSTEMI, and he received a stent to the ostial LCX one week ago. At that time his EF was 30%. He returned to the same hospital where he had just received his LCX stent.Here is his first ECG at triage, with chest pain temporarily resolved:He then had spontaneous return of chest pain while in the ED, wi...
Source: Dr. Smith's ECG Blog - October 22, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
The syndrome of vanishing ACS : Who activates spontaneous thrombolysis doctor ?
Background
“Your husband was really lucky, his heart attack got spontaneously aborted. His ECG is near normal now. The angiogram is normal.No stent, no lysis. He secreted his own Tpa and got rid of the clot. We will discharge him to tomorrow.”
Thank you very much, Doctor. How did this happen, doctor?
Don’t thank me. Definitely, I don’t have an answer. Spontaneous successful thrombolysis (Ref 4) happens up to 15 % of ACS. All I can say is he has a very disciplined mast cell network and fibrinolytic system.
Vascular events: Pathobiology
Vascular highway accidents that happen with sudden freezing...
Source: Dr.S.Venkatesan MD - October 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized anti fibrinolytic system thrombolysis Source Type: blogs
