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How I overcame a heart attack and health challenges with the help of faith, family, and skilled doctors
I stood outside in my yard, which had been dormant during the winter season and was now awakening to the spring. Yard work was a familiar and enjoyable activity for me, one that I had been doing for years. But as I walked across the yard, I found myself out of breath and fatigued, to Read more… How I overcame a heart attack and health challenges with the help of faith, family, and skilled doctors originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - May 18, 2023 Category: General Medicine Authors: Tags: Conditions Cardiology Source Type: blogs

A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day
This was sent by a colleague.A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB.  She had one episode of pain the previous night and two additional episodes early on morning the morning she presented.  Deep breaths are painful and symptoms come and go.  She had one BP that was measured at 160/120, uncertain when and what the BP was at other moments.  Home meds were labetalol and nifedipine.  There are T-wave inversions in precordial leads.  The patient is pain free, so it is qu...
Source: Dr. Smith's ECG Blog - May 10, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

A man in his 70s with acute chest pain and paced rhythm.
Sent by Pete McKenna M.D.  Edits by Meyers and SmithA man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of  acute chest pain.Triage ECG:What do you think?This is diagnostic of proximal LAD occlusion.  This is a huge anterolateral OMI.  Deadly.  I cannot be anything else.Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessiv...
Source: Dr. Smith's ECG Blog - May 8, 2023 Category: Cardiology Authors: Pendell Source Type: blogs

Localisation of Ventricular Tachycardia by Surface ECG
Surface ECG can be used to identify the site of origin of ventricular tachycardia. QRS morphologic patterns and vectors are helpful in discerning the activation pattern of the myocardium. Chest wall deformity as well as metabolic and drug effects can cause limitations in analysis sometimes [1]. Identification of site of origin of VT is useful while planning catheter ablation. It is also useful in correlating with the clinical situation as in post myocardial infarction scar related VT. Another instance is for correlation with findings on imaging modalities like echocardiography and cardiac magnetic resonance imaging [2]. F...
Source: Cardiophile MD - April 23, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Myocardial Ischemia-Reperfusion Injury
Myocardial Ischemia-Reperfusion Injury is a paradoxical exacerbation of cellular dysfunction and cell death occurring after restoration of blood supply in previously ischemic tissues. Reperfusion of the myocardium after coronary occlusion in acute myocardial infarction can cause reperfusion arrhythmias like accelerated idioventricular rhythm. Myocardial ischemia-reperfusion injury can also occur after cardiac surgery and circulatory arrest [1].  Though reperfusion is essential for salvage of the myocardium it can sometimes cause paradoxical damage. Reperfusion injury can also affect distant organs occasionally leadin...
Source: Cardiophile MD - April 20, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Compare these two ECGs. Do either, neither, or both show anything important?
One case sent by Dr. Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve SmithTake a look at these two ECGs below from two patients in the ED, first without any clinical context. Full case details and outcomes are below.Case 1:Case 2: Case 1:What do you think?This was sent to Dr. Smith by SamGhali (@EM_RESUS) with zero other info.  Smith ' s response was: " OMI Mimic. "Later, this info was supplied by Sam:This ECG was recorded in a 23-year-old African American man with a history of psychiatric illness, acute alcohol/drug intoxication, brought in by police officers status post being ...
Source: Dr. Smith's ECG Blog - April 17, 2023 Category: Cardiology Authors: Pendell Source Type: blogs

A 40-something with 100 minutes of chest pain
I was reading ECGs on the system, and saw this one:What do you think?I knew that, if the patient had presented with chest discomfort, that this ECG is diagnostic of inferior posterior OMI, even though it is not a STEMI.However, it is difficult to recognize for an interpreter who is does not have special expertise in OMI ECG diagnosis. We taught an AI system fromPM Cardio to recognize patterns of subtle OMI (beware: this version of the app is not available to the public yet).  We named the AI app the " Queen of Hearts " This is what the Queen said about this ECG:" OMI with High Confid...
Source: Dr. Smith's ECG Blog - March 27, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

85 year old with chest pain, STEMI negative, then normal troponin but with relatively large delta: discharge?
Conclusion:This patient should NEVER have been ruled out by troponin.And the ECG findings, which are diagnostic of OMI, were also missed.Thus, this is the protocol Fred Apple and I developed for Hennepin for the Abbott Architect:==================================My Comment by KEN GRAUER, MD (3/24/2023):==================================I like this case by Dr. McLaren — because it allows us to highlight a very important fault of the outdated STEMI paradigm that is all-too-often forgotten — namely, Being sure to obtain and clinically correlate at least 2 serial ECGs&...
Source: Dr. Smith's ECG Blog - March 24, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs

A 50-Something Male with 2 hours of Chest discomfort
This ECG was texted to me in real time, but I did not notice the message until about an hour after it came. " 50 + yo. Concerning history, known CAD "Recorded 2 hours after pain onset:What do you think?This was my response:" This looks like a worrisome EKG. It looks like an Occlusion MI (OMI), but I am not 100% certain. But by now you must have a repeat ECG.  Can I see it? "Pendell Meyers had an identical response when I sent it to him.PM Cardio AI algorithm said " OMI with high confidence "Explanation: There is subtle ST Elevation in inferior leads, with a hyperacute T-wave in III, reciprocal STD in aVL with an ...
Source: Dr. Smith's ECG Blog - March 19, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

A man in his 50s with chest pain
 Sent by anonymous, written by Pendell MeyersA man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. He had episodes of chest pain off and on all night, until about 1 hour prior to arrival when the pain became constant, crushing, 10/10 chest pain that radiated to both arms. He denied any lightheadedness, shortness of breath, vomiting, or abdominal pain. Vitals were within normal limits.Here is his triage ECG at 0343:What do you think?Meyers interpretation: Diagnostic of LAD OMI, with hyperacute T waves in a large LAD distribution including precord...
Source: Dr. Smith's ECG Blog - March 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs

What do you think of this ECG?? Is this during pain, or after pain resolution? Also, see the CT image of the heart.
If you saw this ECG only knowing that it is an acute chest pain patient, what would be your interpretation?This is a trick question, as you will see below.  But you can make a diagnosis here, and Pendell and I do this all the time when reading ECGs from databases. I sent this to Pendell without any information at all, and he replied " Postero-lateral Reperfusion. "The T-waves in V2-V4appear hyperacute, suggesting LAD occlusion,BUT there is also T-wave inversion that is typical morphology forreperfusion in V5 and V6.Thus, one must think of reperfusion.  When there is reperfusion and there are large T-waves in...
Source: Dr. Smith's ECG Blog - March 6, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

Our OMI Toolbox Application is out now !
We are happy to announce that our " OMI Toolbox " application has just released and ready for your use. As myocardial infarction (MI) and many other diagnoses (for example left ventricular hypertrophy, prior MI etc.) can cause ST-segment elevation (STE) on electrocardiogram (ECG), the distinction between them may be hard and complicated. Furthermore, some ECGs may not meet the STEMI criteria but may still be diagnostic for acute coronary occlusion (ACO). For this purpose, only one set of diagnostic or differentiating criteria (STEMI criteria) is not enough, therefore a bunch of different tools are needed to make a&nbs...
Source: Dr. Smith's ECG Blog - March 3, 2023 Category: Cardiology Authors: Emre Aslanger Source Type: blogs

COVID-19 myocarditis illusions: A new cardiac MRI study raises questions about the diagnosis
BY ANISH KOKA One of the hallmarks of the last two years has been the distance that frequently exists between published research and reality. I’m a cardiologist, and the first disconnect that became glaringly obvious very quickly was the impact COVID was having on the heart. As I walked through COVID rooms in the Spring of 2020 trying to hold my breath, I waited for a COVID cardiac tsunami. After all social media had been full of videos from Wuhan and Iran of people suddenly dropping in the streets. My hyperventilating colleagues made me hyperventilate. Could it be that Sars-COV2 had some predilection for heart...
Source: The Health Care Blog - February 7, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Anish Koka COVID-19 Misinformation myocarditis Vaccine Source Type: blogs

Primary PCI and its silent encounter with “ myocardial neutrophilia ”
Myocardial infarction,  a gross pathological entity renamed now as STEMI for clinical purposes, is the most famous medical emergency that triggers a series of calls. Right from 911/First medical contact, the ER, that ends up in CCU or a 24/7 cath lab. The heart, can’t wait for all these external responses when it is challenged with a vascular accident. The moment ATO occurs, two things happen. The endogenous fibrinolytic led by native tissue PA (Tpa) tries to get rid of the thrombotic plug by all its means. It succeeds in 15%. We call it spontaneous lysis or aborted MI. Many lives are lost in the remaining before th...
Source: Dr.S.Venkatesan MD - February 1, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized myocardial neutrophilia Source Type: blogs

Chest pain, and Cardiology didn ' t take the hint from the ICD
Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and GrauerA 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The screening physician ordered an EKG and noted his ashen appearance and moderate distress. Triage EKG:What do you think?Triage physician interpretation: -sinus bradycardia-lateral ST depressionsWhile there are lateral ST depressions (V5, V6) the deepest ST depressions are in V4. Additionally, lead V3 has ST depressions, which are always abnormal (recall that lead V3 will haveST elevation under nor...
Source: Dr. Smith's ECG Blog - January 23, 2023 Category: Cardiology Authors: Bracey Source Type: blogs