Assessment of right ventricular diastolic function
Assessment of right ventricular diastolic function is often done by echocardiography, though not as commonly as for the left ventricle. An RV focussed apical four chamber view is used for the assessment of right ventricle. In RV focussed view, transducer is adjusted from the standard apical four chamber view to have right ventricle in the centre of the image than the usual image centered on the left ventricle. The left ventricular outflow tract should not come into the view and left ventricular apex should remain at the top of the image sector. In this adjusted view, the entire right ventricular free wall should be visibl...
Source: Cardiophile MD - September 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: Echocardiography Source Type: blogs

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

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?
Case written and submitted by Brandon Fetterolf MD, edits by MeyersA woman in her early 30s with multiple autoimmune disorders including vasculitis presented with 2-3 hours of mid-left side chest discomfort with radiation to neck and left arm and associated with nausea, diaphoresis and dizziness. Initial ECG on presentation at 1554 (no prior for comparison):What do you think is happening to his 30s woman? The ECG shows NSR with a normal QRS except for poor R wave progression and pathologic QS-waves in V2-3. There is STE and hyperacute T waves in V2, I, and aVL with reciprocal STD in II, III, and aVF. This is...
Source: Dr. Smith's ECG Blog - April 8, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

Podcasts for medical students on internal medicine
Today, we received two 3rd year medical students starting their IM rotation. I told them I would give them a list of podcasts that should help them get oriented to internal medicine. This is my podcast v1.0 list: From the Curbsiders: 142 Cirrhosis TIPS for Acute Complications 104: Renal tubular acidosis with Kidney Boy, Joel Topf MD 92: Pulmonary Embolism for the Internist 86: COPD: Diagnosis, treatment, PFTs, and nihilism 76: Pneumonia Pearls with Dr Robert Centor 61: Vasculitis and Giant-Cell Arteritis: ‘Rheum’ for improvement 52: Anemia: Tips, and tools for diagnosis and treatment 20: Hyp...
Source: DB's Medical Rants - April 29, 2019 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Snake Bite and Radiology
Discussion-Local manifestations of snake bite are soft-tissue swelling from edema, necrosis, and hemorrhage. Common long-term sequelae of envenomation is soft-tissue atrophy distal to the bite, particularly in the digits.-Systemic signs and symptoms after a venomous snake bite are due to anticoagulant/procoagulant activity or neurotoxicity. Cerebral hypoxia can occur due to hypotensive shock that may accompany some snake bite envenomations. Neuromuscular disorders with damage of the peripheral nervous system can with blockage of synaptic transmission, at either presynaptic or postsynaptic levels.Common neuro...
Source: Sumer's Radiology Site - March 21, 2019 Category: Radiology Authors: Sumer Sethi Source Type: blogs

MKSAP: 25-year-old man with dark-colored urine
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and swollen glands, but had otherwise felt well. Medical history is otherwise unremarkable, and he takes no medications. On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 180/90 mm Hg, pulse rate is 88/min, and respiration rate is 14/min. Cardiopulmonary...
Source: Kevin, M.D. - Medical Weblog - August 25, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Infectious Disease Nephrology Source Type: blogs

Guidelines, multiple specialists, and the science versus the art of medicine
My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a foreign toxic invader. Treatment, post kidney biopsy, involved administering large doses of corticosteroids followed by a chemotherapy agent called Cytoxan. Six days later it was clear that dialysis was required at least until the patient’s kidneys responded to the therapy and began working ...
Source: Kevin, M.D. - Medical Weblog - July 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/steven-reznick" rel="tag" > Steven Reznick, MD < /a > Tags: Physician Cardiology Hospital-Based Medicine Source Type: blogs

Cavernous Sinus Thrombosis: Case Report
Discussion by Dr MGK Murthy, Dr GA Prasad      Cavernous sinus is extradural venous plexus surrounded by a dural fold in the middle cranial fossa containing internal carotid artery with its periarterial sympathetic plexus, abducens nerve lateral to the internal carotid artery, but medial to the oculomotor and trochlear nerves and the ophthalmic and maxillary divisions of the trigeminal nerve, which run superior to inferior within the lateral dural border of the cavernous sinus.     Thrombosis of the cavernous sinus is usually caused by bacterial or fungal invasion comp...
Source: Sumer's Radiology Site - November 14, 2017 Category: Radiology Authors: Sumer Sethi Source Type: blogs

What patients can teach doctors about rare diseases
Having a chronic disease can be frustrating, especially when the patient seems to know more than the doctor. Unfortunately, this situation may be familiar to the millions of Americans suffering from a rare disease. In June, I had the unique experience of attending a convention for patients and health care providers to learn about one such rare disease category, vasculitis. Vasculitides (plural of vasculitis) are a family of autoimmune diseases characterized by inflammation of blood vessels, and often result in dysfunction of multiple organ systems.  The specific etiology of vasculitides is still largely unknown, and resea...
Source: Kevin, M.D. - Medical Weblog - July 19, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/aamir-hussain" rel="tag" > Aamir Hussain < /a > Tags: Conditions Rheumatology Source Type: blogs

How to be EPIC
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Let it never be said that we resist change. We, the consultants in my ED, have been reinvented. Previously our title was Duty Officer, which had a pleasantly communist, scratchy grey-overalled sound to it, but now we are the EPIC. An imperious title, in my opinion. This stands for Emergency Physician In Charge. Here’s where the duplicity begins. I’m hardly in charge of my own brain, so feigning tight command of the beast of the Emergency Department is a bit of a stret...
Source: Life in the Fast Lane - May 22, 2017 Category: Emergency Medicine Authors: Michelle Johnston Tags: Literary Medicine EPIC Source Type: blogs

How to be EPIC
LITFL: Life in the Fast Lane Medical Blog LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Let it never be said that we resist change. We, the consultants in my ED, have been reinvented. Previously our title was Duty Officer, which had a pleasantly communist, scratchy grey-overalled sound to it, but now we are the EPIC. An imperious title, in my opinion. This stands for Emergency Physician In Charge. Here’s where the duplicity begins. I’m hardly in charge of my own brain, so feigning tight command of the beast of the Emergency Department is a bit of a stretch. Bu...
Source: Life in the Fast Lane - May 22, 2017 Category: Emergency Medicine Authors: Michelle Johnston Tags: Literary Medicine EPIC Source Type: blogs

Retinal biopsy from an elderly woman with suspected ocular lymphoma
The patient had multiple foci of markedly thickened retina on exam. Ophthomologists were able to obtain a relatively large retinal biopsy. We did not find lymphoma in this case, and infections of many sorts were ruled out. But the ophthalmologists wanted an opinion as to whether retinal vasculitis was present. I wonder whether the threshold for calling vasculitis in the retina should be lower than in other tissues. Your input in the comments section would be greatly appreciated.Low power viewMedium power showing diffuse edemaArterioles with focus of intramural inflammatory infiltrate on right side of right vessel (Source: neuropathology blog)
Source: neuropathology blog - March 16, 2017 Category: Radiology Tags: ophthalmic pathology Source Type: blogs

LITFL Review 273
LITFL: Life in the Fast Lane Medical Blog LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 273rd LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Steve Mathieu from Portsmouth ICU shares his hot topics for the UK FFICM slides, from a great cours...
Source: Life in the Fast Lane - March 12, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs