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: diphenhydr...
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 fewer h...
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, nonproliferative d...
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 reciprocal inferior STD)...
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 select...
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
