Antiarrhythmic drug classification
The popular Vaughan Williams classification was published in 1975 [1]. It is still being used by most of us. The Sicilian Gambit published in 1991 [2] has not been so popular because of its complexity. Vaughan Williams classification is approximately as follows:  Class I: Sodium channel blockers ◦a: Moderate Na channel block. e.g. Quinidine, Disopyramide ◦b: Weak Na channel block. e.g. Lignocaine, Mexiletine ◦c: Marked Na channel block. e.g. Flecainide, Propafenone  Class II: Beta blockers  Class III: Potassium channel blockers: Amiodarone, Sotalol, Ibutilide  Class IV: Calcium channel blockers I...
Source: Cardiophile MD - October 13, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs

Cardiac arrest with anterior-inferior STEMI: Guess the value of the initial ED high sensitivity Abbott troponin I
A ~40 year old woman started having chest discomfort.  She called 911 after an uncertain amount of time.  EMS arrived and recorded thisprehospital ECG:Obvious Anterior and Inferior STEMI, consistent with LAD occlusionAfter recording this ECG, the patient went intoventricular fibrillation.She was rapidly defibrillated.The cath lab was activated by the paramedics.She arrived complaining of chest pain, with a BP of 110/70.An ED ECG was recorded:It looks worse stillAside: Should the patient receive antidysrhythmics to prevent recurrent VT/VF?  See discussion below on both beta blockers and other anti-dysrhythmic...
Source: Dr. Smith's ECG Blog - September 18, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs

A 31 year old with Diabetes and HTN complains of bilateral arm tingling and headache
This ECG was texted to me with the message " A 31 year old with Diabetes and HTN complains of bilateral arm tingling and headache. "There is high lateral ST Elevation and inferior reciprocal ST depression.There is also STE in V2.The computer calls it a STEMI.What do you think?STE in I, aVL and V2 is a pattern associated with "Mid-anterolateral OMI, " which is seen with OMI of the first Diagonal.  See more of Mid-anterolateral OMII wrote back: " I think this is a false positive due to LVH.  PseudoSTEMI.  I can't tell you exactly why.  It just looks like it.  ECGs are of...
Source: Dr. Smith's ECG Blog - August 29, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs

This middle-aged patient presented with SOB, weakness, and mild pulmonary edema.
She previously had Atrial fibrillation with LBBB.Here is her ED ECG:Does this reveal the etiology of her symptoms?This shows atrial fibrillation.  There is a regular, slow response.  The fact that the response is regular proves that the atrial fibrillation is NOT conducting.  When atrial fib conducts, the ventricular rate must always be irregular.This is atrial fibrillation with complete (3rd degree) AV block.The QRS morphology is RBBB with a vertical axis.  This suggests an LV escape rhythm, possibly from the left anterior fascicle.She previously had known LBBB, so she is lucky that her left sided esca...
Source: Dr. Smith's ECG Blog - January 21, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs

Wide-complex tachycardia that didn ’t follow the rules
ConclusionIt is well worth remembering that this was a rare case! In most middle-aged patients with a history of cardiomyopathy, a WCT will usually be VT. Furthermore, while specific criteria (e.g. precordial RS duration, aVR morphology) may not be perfectly sensitive, the are more likely to be helpful than suspecting 1:1 atrial flutter in patients not taking sodium-channel-blocking antiarrhythmics.Comparison of the old and WCT ECGsmight have suggested an SVT or atrial flutter at the time of presentation. However, it would not have been prudent for most clinicians to try e.g. a calcium-channel blocker as the first age...
Source: Dr. Smith's ECG Blog - December 22, 2019 Category: Cardiology Authors: Brooks Walsh Source Type: blogs

Prescription Drugs That Block Weight Loss
A number of drugs prescribed to treat common conditions, such as hypertension, allergies, depression, inflammation, and diabetes, block your ability to lose weight. Several of these drugs actually cause weight gain, and most doctors fail to inform their patients of such side effects. Among the drugs that block weight loss are: Beta-blockers: metoprolol, atenolol, carvedilol, and propranolol  Antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor), doxepin, paroxetine (Paxil), trazodone, and others Steroids: prednisone and hydrocortisone (but not inhaled or nasal steroids for allergies) Antihistamines: diphen...
Source: Wheat Belly Blog - May 7, 2019 Category: Cardiology Authors: Dr. Davis Tags: News & Updates blood sugar drugs failed weight loss fatigue weight loss hypertension insulin prescription drugs undoctored wheat belly Wheat Belly Total Health Source Type: blogs

Pre-existing Left Bundle Branch Block and Atrial Fib: what is alarming on this routine pre-procedure ECG?
An elderly patient had a pre-procedure ECG (ECG-1).  She was asymptomatic.  The patient had known Left Bundle Branch Block (LBBB) and atrial fibrillation (see ECG-2 below), and was rate controlled on metoprolol. ECG-1What is the problem?ECG-2 (previous for comparison):There are enormous U-waves, best seen in V1-V3, but also in V4 and V5.  This was seen by the overreading cardiologist.  The cardiologist called the The K was checked and it was 1.9 mEq/L.The patient was sent to the ED for hypokalemia.While being assessed and having potassium orally and IV, her heart rate dropped to 30 beats per minute...
Source: Dr. Smith's ECG Blog - January 20, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs

Dynamic, Reversible, Ischemic T-wave inversion mimics Wellens'. All trops negative.
A middle-aged man presented with 7-8/10 non-radiating chest tightness to the left chest wall, associated with nausea but no diaphoresis, that began while walking approximately 40 minutes prior to arrival at the ED. The pain resolved as he arrived to the emergency department. He had 2 episodes over the past 2 days of similar chest tightness. He had a history of hypertension but stopped taking his medication several years ago.  The patient is pretty sure that this discomfort was his reflux.BP was 200/100.Here was his triage ECG.  It is uncertain if the patient was pain free at this time or not, or, if pai...
Source: Dr. Smith's ECG Blog - December 14, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Anterior STEMI and multiform PVCs with Narrow Coupling Interval. When to give beta blockers in acute MI?
Conclusion of first report:In patients with anterior Killip class II or less ST-segment –elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI.Conclusion of 2nd report: In patients with anterior Killip class  ≤II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fe...
Source: Dr. Smith's ECG Blog - October 19, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Tachycardia and ST Elevation.
This Case was sent from Anonymous.A middle-aged patient was sent to the ED with tachycardia. He denied any sensation of palpitations, but his heart rate was consistently 150 bpm. The other vitals were normal. He had JVD and swollen legs, but clear lungs and a normal room air oxygen saturation.He denied all typical and atypical ischemic symptoms. He noted, however, that he had had marked fatigue starting about 5 days ago, but that he was actually feeling much better today.The initial ECG:The rhythm appeared to be atrial flutter, but also concerning were the ST segment elevations in I, aVL, V2, and V3, as well as ST depressi...
Source: Dr. Smith's ECG Blog - September 24, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

MKSAP: 57-year-old man with type 2 diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between 8.0% and 9.0% before implementing significant lifestyle changes and transitioning to insulin therapy from metformin therapy 2 years ago. His medical history includes coronary artery disease, first-degree atrioventricular block, nonprolife...
Source: Kevin, M.D. - Medical Weblog - August 11, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Neurology Source Type: blogs

Depression: Common medication side effect?
This study is especially thought-provoking, given that more and more people are taking medications with depression or suicidal thoughts as possible side effects. The CDC just released updated data showing a troubling recent rise in suicide rates, and that 54% of those who die from suicide do not have a known mental health disorder, so this is an important public health issue. That said, it is important to note: in this study, people who used these medications were more likely to be widowed and have chronic health problems, both of which are associated with a higher risk of depression. And many (but not all) of these medica...
Source: Harvard Health Blog - July 16, 2018 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Anxiety and Depression Drugs and Supplements Health Source Type: blogs

Chest pressure during exertion, evolution of inverted T-waves and Troponins. Surprise Angiogram.
I was texted this ED ECG with the words: " 40-something with chest pressure during exertion. "  It is unclear whether the pain was gone at this time, but it was certainly better after receiving some sublingual nitro.Presentation ECG 1What do you think?My response was:" Definitely ischemia. Probable high lateral MI.  If patient still has chest pain and you cannot relieve it with nitro, needs cath lab. "This is because there is ST depression in II, III, aVF, and also in V4-V6, with STE and T-wave inversion in aVL.  It looks as if there had been an occlusion resulting in STE in aVL (and reci...
Source: Dr. Smith's ECG Blog - July 1, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Might Depression Be Linked to One of These Popular Medications?
If you’re taking beta blockers, certain kinds of anxiety drugs, certain types of painkillers (including ibuprofen), proton pump inhibitors (PPIs) (used to treat acid reflux), ACE inhibitors (used to treat high blood pressure), or anti-convulsant drugs, you may be at greater risk for depression. That’s according to a new, large-scale study published earlier this week in JAMA. However, this was a correlational study, so it can’t say that these medications actually cause depression or not. It may be that people with greater health problems are more likely to take one of these medications and be depressed abo...
Source: World of Psychology - June 15, 2018 Category: Psychiatry & Psychology Authors: John M. Grohol, Psy.D. Tags: Depression General Medications Psychiatry Research Drugs cause depression popular medications Source Type: blogs

An elderly woman found down with bradycardia and hypotension
Submitted by Alex Bracey, with edits by Pendell Meyers and Steve SmithA female in her 70s with PMH of hypertension, coronary artery disease, and a remote history of an aortic valve replacement was brought into the ED after being found down by her son. On arrival she was confused. Her initial ECG isshownbelow.What do you think? - Sinus bradycardia with HR of ~50 BPM (plus artifact that mimics PVCs) - Peaked T waves particularly visible in leadsV1-V3, I, and aVL - RBBB with QRS duration 152 ms (comparison to prior shows similar RBBB morphology but with QRS duration of 116 ms)In addition to being bradycardic as seen on this E...
Source: Dr. Smith's ECG Blog - June 6, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

Zero tolerance for low blood pressure
Just as we have zero tolerance for hypoglycemia in the Wheat Belly lifestyle, we also have zero tolerance for hypotension, or low blood pressure (BP). Follow the Wheat Belly lifestyle free of ciabattas, penne pasta, and tortellini, and blood sugars plummet. If you are injecting insulin or taking other diabetes drugs, hypoglycemia is a risk and can be dangerous, resulting in loss of consciousness and injury. We therefore urge everyone to talk to their doctor about discontinuing or reducing insulin and diabetes drugs immediately upon starting the Wheat Belly lifestyle. Unfortunately, the majority of doctors don’t under...
Source: Wheat Belly Blog - May 8, 2018 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle blood pressure blood sugar BP gluten-free grain-free grains health hypertension hypertensive Source Type: blogs

Propranolol found superior to Metoprolol for electrical storm
Propranolol found superior to Metoprolol for electrical storm: Use of propranolol has gone down with the availability of newer beta blockers. Here is one study which suggests that we may have to go back to propranolol in certain situations. The study by Chatzidou S et al [1] has found that propranolol is superior to metoprolol in the treatment of electrical storm along with intravenous amiodarone. Propranolol has a membrane stabilizing effect (local anaesthetic effect), which is not there for metoprolol. Of course metoprolol is beta one specific and has other advantages which propranolol does not have, being a non se...
Source: Cardiophile MD - April 30, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs

Beta blocker in HOCM – Cardiology MCQ
Which of the following beta blockers is not an ideal choice in the treatment of hypertrophic obstructive cardiomyopathy? a) Metoprolol b) Propranolol c) Sotalol d) Carvedilol Post your answer as a comment below. Correct answer will be published on: Apr 24, 2018 @ 19:32 The post Beta blocker in HOCM – Cardiology MCQ appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - April 23, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

MKSAP: 62-year-old man is evaluated during a routine visit
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin. On physical examination, the patient is afebrile, blood pressure is 130/66 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. BMI is 29. Cardiac examination reveals a grade 2/6 early-peaking syst...
Source: Kevin, M.D. - Medical Weblog - April 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology Diabetes Source Type: blogs

MKSAP: 26-year-old woman with a mechanical mitral valve prosthesis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old woman with a mechanical mitral valve prosthesis visits to discuss anticoagulation management during pregnancy. Her last menstrual period was 6 weeks ago and her pregnancy was confirmed by laboratory testing in the office. Her mitral valve was replaced 5 years ago. Her medications are low-dose aspirin, metoprolol, and warfarin (4 mg/d). On physical examination, vital signs are normal. Cardiac auscultation demonstrates a normal mechanical S1. There are no murmurs or added sounds. Her INR is 2...
Source: Kevin, M.D. - Medical Weblog - February 24, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology OB/GYN Source Type: blogs

Altered Mental Status, Bradycardia
911 was called for an elderly woman who fell and was confused.  Medics found her unresponsive, with " convulsive " movements.  They could not find a pulse.  They performed CPR, gave epinephrine, and intubated the patient and regained a pulse, at which time she became responsive and had this prehospital ECG:On arrival, heart rate was 87 and she was hypotensive at 52/21, with a palpable pulse and cardiac function present on echo.  She was intubated (by medics), but awake and alert and nodding to questions, shaking her head " no " to chest pain, headache, or SOB.  Repeat pulse was ...
Source: Dr. Smith's ECG Blog - February 19, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

A fire, thick socks, and prebiotics to keep you warm
Here’s an interesting speculation: The microbes in bowel flora are metabolically active, generating heat. There are so many microbes inhabiting the human intestine that it is estimated that up to 70% of human heat (at rest) is generated by bowel flora. In support of this argument, antibiotics have been found to reduce body temperature. Animals raised to have sterile intestines free of microorganisms also have lower body temperature. The pound or so of human bowel flora is therefore a virtual heat factory. We know that feelings of being cold can be produced by common health conditions such as iodine deficiency, hypoth...
Source: Wheat Belly Blog - December 11, 2017 Category: Cardiology Authors: Dr. Davis Tags: Undoctored Wheat Belly Lifestyle bowel flora cold feeling cold Inflammation microbiota prebiotic probiotic Weight Loss Wheat Belly Total Health Source Type: blogs

Are there any good doctors?
Are doctors who follow “consensus guidelines,” rank high on quality standards set by hospitals, and adhere to rules set by the drug and medical device industries really providing “health”? Would you call a regimen of Lipitor, hydrochlorothiazide, aspirin, metoprolol, Prilosec, and Naprosyn “healthy” because it was prescribed by a “good” doctor? Health is not provided by doctors; revenue-generating healthcare is provided by doctors–there’s a difference, a big difference. Health is something you achieve on your own with results that are SUPERIOR to the results doc...
Source: Wheat Belly Blog - June 1, 2017 Category: Cardiology Authors: Dr. Davis Tags: Undoctored Wheat Belly Lifestyle diy healthcare prescriptions sick care Source Type: blogs

Chest Pain Diagnosed as Gastroesophageal Reflux
p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Helvetica; background-color: #fefefe}A 50-something male presented to a clinic for one day of intermittent substernal chest and jaw pain. He had had several episodes of pain since onset; it was described as pressure-like and lasts about 5-15 minutes and resolves spontaneously. He had been pain free for about an hour.  He had some " pre-diabetes, " but no h/o hypertension, no known family history of heart disease, and he smokes about 1-2 cigarettes per day. An ECG was recorded:The computer read:Normal ECGWhat do you think?Smith ...
Source: Dr. Smith's ECG Blog - May 29, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs

MKSAP: 57-year-old man is seen after results of a carotid ultrasound
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is seen for follow-up evaluation after results of a carotid ultrasound obtained to investigate a left neck bruit show a mixed density plaque at the origin of the left internal carotid artery. Stenosis is estimated to be 60% to 80%. He has had no focal neurologic symptoms or visual loss. The patient has coronary artery disease (CAD) with stable angina, hypertension, dyslipidemia, type 2 diabetes mellitus, and mild kidney failure. He has a 30-pack-year smoking history but stopped smoking ...
Source: Kevin, M.D. - Medical Weblog - May 6, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs

MKSAP: 68-year-old man with new-onset ascites
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, and metoprolol. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 122/84 mm Hg, pulse rate is 64/min, and respirati...
Source: Kevin, M.D. - Medical Weblog - April 22, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions GI Source Type: blogs

An unstable wide complex tachycardia resistant to electrical cardioversion
CONCLUSIONS:p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.9px Arial; -webkit-text-stroke: #000000; background-color: #ffffff} p.p2 {margin: 0.0px 0.0px 0.0px 0.0px; font: 17.2px Arial; -webkit-text-stroke: #000000; background-color: #ffffff} p.p3 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.9px Arial; color: #660066; -webkit-text-stroke: #660066; background-color: #ffffff} p.p4 {margin: 0.0px 0.0px 0.0px 0.0px; font: 14.0px Arial; color: #660066; -webkit-text-stroke: #660066} p.p5 {margin: 0.0px 0.0px 0.0px 0.0px; font: 14.0px Arial; color: #660066; -webkit-text-stroke: #660066; min-height: 16.0px} p.p6 {margin: 0.0px 0.0p...
Source: Dr. Smith's ECG Blog - February 22, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs

A Young Man with Recurrent Chest Pain and Dyspnea with Exertion
CaseThis is a young man who has had chest pain and dyspnea with exertion for years. He presented to the ED with these symptoms again. On this occasion, the CP was associated with stress and accompanied by some SOB, 7/10 at it's worse and made worse with activity, with radiation up into the left side of his neck and face.No h/o hypertension.Here is the ECG:Probable Diagnosis?I was shown this ECG and gave my opinion, as below.Here is an ED bedside echo, parasternal long axis:Look at the small the end-systolic LV chamber sizeParasternal short axis:Again, look at the end-systolic chamber size!What is the Diagnosis?Th...
Source: Dr. Smith's ECG Blog - November 29, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

Drug names need to be simplified for our patients ’ safety
The patient’s heart was beating dangerously slowly, and his EKG showed third-degree AV block: His heart’s electrical system had completely shut down in the middle.  If this were TV, the doctors would have started shouting “Epi!” and “Get the pads!” immediately.  This was real life, though, so his team decided to briefly sit down with him to try to determine why his heartbeat had slowed so dramatically.  Was it something that could be reversed without the need to surgically implant a pacemaker? Yes, as it turns out, the patient had been taking metoprolol for years, a blood-...
Source: Kevin, M.D. - Medical Weblog - November 29, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/rahul-banerjee" rel="tag" > Rahul Banerjee, MD < /a > Tags: Meds Medications Source Type: blogs

Are these prescription drugs preventing your weight loss?
A number of drugs prescribed to treat common conditions, such as hypertension, allergies, depression, inflammation, and diabetes, block your ability to lose weight. Several of these drugs actually cause weight gain, and most doctors fail to inform their patients of such side effects. Among the drugs that block weight loss are: Beta-blockers: metoprolol, atenolol, carvedilol, and propranolol  Antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor), doxepin, paroxetine (Paxil), trazodone, and others Steroids: prednisone and hydrocortisone (but not inhaled or nasal steroids for allergies) Antihistamines: diphen...
Source: Wheat Belly Blog - September 13, 2016 Category: Cardiology Authors: Dr. Davis Tags: Depression Dr. Davis Drugs and wheat Nutritional supplements Weight loss Wheat Belly Wheat Belly Lifestyle Wheat Belly Total Health Wheat-Free Lifestyle anxiety Source Type: blogs

Oh So Quietly, Evidence of Bad Health Care Corporate Leadership Accumulates - Three AstraZeneca Settlements
While the news media is distracted by seemingly more spectacular issues, we hear the steady drip, drip, drip oflegal cases suggesting just how systemically bad the leadership of big health care organizations is.  From February 2015 to now, for example, there have been three cases involving multinational pharmaceutical giant AstraZeneca.Settlement of Allegations of Kickbacks to Give AZ Drugs Preferred Status in FormulariesFirst, in February 2015, reported in most detail by Ed Silvermanin the Wall Street Journal,AstraZeneca has agreed to pay the federal government $7.9 million to settle allegations the drug maker paid k...
Source: Health Care Renewal - September 8, 2016 Category: Health Management Tags: AstraZeneca bribery deception impunity kickbacks legal settlements Source Type: blogs

MKSAP: 57-year-old man with substernal chest pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, hypertension, and hyperlipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin. His other medications are aspirin, metoprolol, atorvastatin, and sublingual nitroglycerin as needed. His inpatient plasma glucose values are 170 to 210 mg/dL (9.4-11.6 mmol/L). Results of all other laboratory studies are ...
Source: Kevin, M.D. - Medical Weblog - August 27, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Source Type: blogs

An Unusual Tachycardia
This Case was sent by Atif Farooq and Scott Weingart, from Stony Brook.This is a 70-something with history of CABG who presented with 30 minutes of SOB and palpitations.Here is his ECG:What is it?Atif wrote this:" My first thought was perhaps a bidirectional V Tach, though the pt is not on digoxin and otherwise has no discernable reason to be in BVT. Scott was considering maybe an intermittent aberrant conduction, though we thought it odd for it to be strictly alternating beats.Here is my answer:Atif,Interesting EKG!I think it is SVT with every-other-beat-aberrancy. --Every QRS comes right on time, perfectly...
Source: Dr. Smith's ECG Blog - August 24, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

Welcome to my World: Perpetual Alarm Fatigue
By HANS DUVEFELT, MD Part of a series on primary care challenges and their solutions. I missed a drug interaction warning the other day when I prescribed a sulfa antibiotic to Barton, a COPD patient who is also taking dofetilide, an uncommon antiarrhythmic. The pharmacy called me to question the prescription, and I quickly changed it to a cephalosporin. The big red warning had popped up on my computer screen, but I x-ed it away with my right thumb on the trackball without reading the warning. Quite honestly, I am so used to getting irrelevant warnings that it has become a reflex to bring the cursor to the spot where I can ...
Source: The Health Care Blog - August 15, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Welcome to My World: Med Wreck
By HANS DEUVEFELT, MD Part of a series on primary care challenges and their solutions. Medication reconciliation is something we do every day, in the clinic and in the hospital. It shouldn’t be as hard as it is. A patient with multiple medical problems returns for a fifteen minute quarterly visit. He saw his cardiologist three weeks ago and was told to double his metoprolol. There are two ways to catch this change: when the cardiologist’s office note comes in, or as we check the patient in for his visit. The cardiologist’s office note, generated by one of the leading EMRs, runs seven pages and contains e...
Source: The Health Care Blog - August 10, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

DM / DNB Cardiology Entrance New Test Series 5
Time limit: 0 Quiz-summary 0 of 30 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Information This new test series requires ...
Source: Cardiophile MD - August 6, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

Beta-Blockers for Cocaine and other Stimulant Toxicity
Dogma: “a belief or set of beliefs that is accepted by the members of a group without being questioned or doubted; a point of view or tenet put forth as authoritative without adequate grounds.” Years ago I treated a university student who presented to the emergency department (ED) after drinking several cans of a popular caffeinated energy drink to “pull an all-nighter” during final exam week. He was tremulous, agitated, and pale, with sinus tachycardia ranging from 140 to 160 bpm and normal blood pressure (BP). The house officer (registrar) working with me that night proposed treating him with a be...
Source: Life in the Fast Lane - July 4, 2016 Category: Emergency Medicine Authors: John Richards Tags: Toxicology and Toxinology alpha stimulation amphetamines Beta Blockers cocaine dogma John Richards Stimulant Toxicity Stimulants Source Type: blogs

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes
A late middle-aged man presented with one hour of chest pain.  He had significant history of CAD with CABG x5, and repeat CABG x 2 as well as a subsequent PCI of the graft to the RCA (twice) and of the graft to the Diagonal.   Most recent echo showed EF of 60%.  He also had a history of chronic kidney disease, stage III.He had recently had a NonSTEMI. Angio had shown some acute disease in the saphenous vein graft to the posterior descending artery off of the RCA.  He was managed medically with Clopidogrel.  Medics stated that he had not been taking his clopidogrel for 2 weeks.He appeared to be in s...
Source: Dr. Smith's ECG Blog - April 7, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

Melinda loses weight despite metoprolol
I’ve talked previously about how some drugs, both prescription and over-the-counter, can block weight loss. Metoprolol, a beta blocker prescribed to treat heart rhythm disorders, hypertension, coronary disease, migraine headaches, and other conditions, is on that list. But Melinda succeeded in losing an impressive amount of weight despite taking this drug. “I have lost a 110 pounds over the last two and a half years. I still need to lose another 90 pounds. I just found an article written by you saying that metoprolol may prevent weight loss. This is very disheartening, as I have worked hard to lose weight and t...
Source: Wheat Belly Blog - April 1, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Success Stories gluten grains metoprolol Weight Loss Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 19
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 19. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - February 25, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

What Accounts For The Lower Growth In Health Care Spending?
Several recent studies have examined the factors accounting for the recent slowdown in growth in real per capita health care spending. The most recent entrant to this literature is the newly published work of Dunn, Rittmueller, and Whitmire. Earlier work has identified two large categories of change as contributors to slower growth: the 2007-2009 recession, and other structural changes in the delivery and payment of health care. Understanding the relative role of these two factors is important in determining whether the slowdown is temporary or will be sustained. The new paper by Dunn and colleagues builds on a framework t...
Source: Health Affairs Blog - February 18, 2016 Category: Health Management Authors: Kenneth Thorpe Tags: Costs and Spending Drugs and Medical Technology Featured Organization and Delivery Diabetes hyertension off patent drugs Prescription Drugs Source Type: blogs

Things of which I will never tire, part three thousand and forty-six:
1. The look on an attending's face when the nursing staff in the NCCU actually knows something. We read our patients' charts before the shift begins, we review lab results, we read EKGs and check out the results on CT scans and EEGs. Yet, for some reason, the attendings will never get over that first, pure shock of a simple nurse knowing something he (usually "he") doesn't about a patient.(Nota bene: this is not all attendings, just a couple. Dr. Vizzini and Dr. Manbags come to mind.)2. Pure thankfulness from a resident when we solve a problem or save them from a hideous fate. Dude/ette, that's what we're here fo...
Source: Head Nurse - February 14, 2016 Category: Nursing Authors: Jo Source Type: blogs

The Electrocardiographically Silent Circumflex Artery
A 39 yo otherwise healthy man with no risk factors was walking at the mall when he developed chest pressure.  He presented to the ED after 30 minutes, now also feeling weak.  He was diaphoretic.  Here was his initial ECG:There is sinus rhythm.  There is abnormal T-wave inversion in V2 which is abnormal and very suspicious There is minimal, nondiagnostic ST elevation in inferior leads with possibly a suggestion of reciprocal ST depression in aVL.  There are thin and normal inferior Q-waves. Thus, there are some suspicious abnormalities, but no definite signs of ischemia.   There is also mi...
Source: Dr. Smith's ECG Blog - January 31, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

The Electrocardiographically Circumflex Artery
A 39 yo otherwise healthy man with no risk factors was walking at the mall when he developed chest pressure.  He presented to the ED after 30 minutes, now also feeling weak.  He was diaphoretic.  Here was his initial ECG:There is sinus rhythm.  There is abnormal T-wave inversion in V2 which is abnormal and very suspicious There is minimal, nondiagnostic ST elevation in inferior leads with possibly a suggestion of reciprocal ST depression in aVL.  There are thin and normal inferior Q-waves. Thus, there are some suspicious abnormalities, but no definite signs of ischemia.   There is also mi...
Source: Dr. Smith's ECG Blog - January 31, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

MKSAP: 59-year-old woman with continued substernal chest pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old woman is evaluated for continued substernal chest pain. She presented with exertional chest pain 6 months ago that occurred with minimal ambulation. She was evaluated with a stress nuclear medicine myocardial perfusion study that showed no ST-segment changes but a small area of inducible ischemia in the lateral area of the left ventricle and an ejection fraction of 45%. She was initially treated medically but has continued to have chest pain with exertion despite the addition of multiple an...
Source: Kevin, M.D. - Medical Weblog - January 30, 2016 Category: Journals (General) Authors: Tags: Conditions Heart Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 7
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 7. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - January 23, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 6
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 6. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - January 22, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 5
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 5. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated ...
Source: Cardiophile MD - January 20, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

Test your medicine knowledge: 62-year-old man is evaluated during a routine visit
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin. On physical examination, the patient is afebrile, blood pressure is 130/66 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. BMI is 29. Cardiac examination reveals a grade 2/6 early-peaking syst...
Source: Kevin, M.D. - Medical Weblog - November 14, 2015 Category: Journals (General) Authors: Tags: Conditions Heart Source Type: blogs