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What is the Diagnosis in this 70-something with Chest Pain?
This is a very commonly missed ECG of a terrible condition.  In this case, it was almost dismissed.  I present many other similar ECGs at the bottom that were indeed missed or dismissed.CaseI was texted this ECG from a physician assistant who works by himself in several small Emergency Departments.He is a particularly smart and well trained emergency medicine PA (because he trained at Hennepin).He added the words:" What do you think?  70-something male with DM, HTN, no previous MI, with Chest pain "What doyouthink?Here was my response:" Definite Huge Occlusion MI (OMI). STEMI! This is a bad one.  There ...
Source: Dr. Smith's ECG Blog - July 27, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs

A Text Message in the Middle of the night. Do you give thrombolytics?
I awoke in the morning and discovered a text with this ECG that was sent 6 hours prior by a former resident:" 60 year old with classic chest pain.  The cath lab is occupied for the next 90 minutes.  Cards says " not a STEMI " .  Thinking of giving lytics. "What do you think?What do you do?I texted back: " Sorry for delay!  Was sleeping.  This is OMI!!  Did you give lytics?  Proximal LAD.  Great catch! "There is 0.5 mm of ST Elevation in V3-V6.  The T-wave in V4 is far too large for the QRS.  The LAD occlusion formula would be very high due to the extremely small R-wave in V...
Source: Dr. Smith's ECG Blog - July 16, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs

A female in her 60s with sudden chest pressure
Written by Pendell MeyersA female in her mid 60s with history of SVT and HTN presented with sudden onset 3/10 chest tightness while lying in bed in the early morning. She had nausea and diaphoresis with this event, as well as tightness between her scapula, and a loose bowel movement.Here is her initial ECG at presentation to the ED at time zero (no prior available):What do you think?Sinus rhythm with significant downsloping STD in V1-V3, maximal in V1-V2. There is also subtle STE in V6 with large-area T-wave with straight/convex ST segment morphology. The T-waves in the inferior leads could be large if a prior ECG wer...
Source: Dr. Smith's ECG Blog - July 14, 2019 Category: Cardiology Authors: Pendell Source Type: blogs

Would you have given thrombolytics to this NSTEMI patient?
Case submitted by Dr. James AlvaA middle aged male called EMS for chest pain. EMS arrived and confirmed that the patient was complaining of chest pain and shortness of breath.They recorded this prehospital ECG:What do you think?Normal QRS complex rhythm with hyperacute T-waves in V2-V6, I and aVL. Slight STE in V2 only, with significant STD and thus de-Winter pattern in V4-V6. Leads II and III show reciprocal depression of the ST segment (II) and T-wave (III). This is diagnostic of acute myocardial infarction of the anterolateral walls, with the most likely etiology being Occlusion of the LAD. In other words, this ECG show...
Source: Dr. Smith's ECG Blog - July 6, 2019 Category: Cardiology Authors: Pendell Source Type: blogs

Master health musings : Where did Alexander the Great, checked his LDL and Chenghis khan recorded his BP ?
A middle-aged man a Biotech engineer, who is just back from his annual health check, sitting in front of me with a deeply anguished face and said “Doctor my LDL is 130mg, and my diastolic BP is 90 mmHg and fasting sugar is 120 mg .I am very much worried about my future” Wait , let me go through your file, I said , Isn’t a serious Issue doctor? No, its not , But , doctor, I have read about ASCOT, SPRINT and HOPE-3 trials. I guess they tell us to keep the LDL, blood sugar and diastolic BP all these three parameters around 80. Isn’t doctor? He went on to add, that his old fashioned family physician ha...
Source: Dr.S.Venkatesan MD - June 2, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized master health check up in cardiology preventive health care Source Type: blogs

Ultrasound Case 094
Dr James Rippey Ultrasound Case 094 A 68 year old male presents 2 weeks post coronary artery bypass grafting. He describes continuing chest wall pain, increasing shortness of breath and poor exercise tolerance. You wonder whether this is a pericardial effusion have a look.
Source: Life in the Fast Lane - May 29, 2019 Category: Emergency Medicine Authors: Dr James Rippey Tags: Cardiology TOP 100 Ultrasound echocardiography Pericardial effusion Post CABG Effusion spine sign Top 100 ultrasounds Source Type: blogs

Diabetes: What price comfort and habit?
I was in suburban Chicago recently one morning, hoping to get something to eat for breakfast. I’d heard that the Panera chain was now serving breakfast that you could order any way you wanted. It’s called “Panera Bread,” but I thought I’d give it a try, as I’ve safely consumed their salads in past. At the counter, I placed my order for 3 eggs over easy, sausage, and bacon—not perfect, given our inability to scrutinize foods and ingredients in such places, but I was willing to try. Obviously, I turned down the breads/toasts that were included. The middle-aged Hispanic woman behind t...
Source: Wheat Belly Blog - May 15, 2019 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly diabetes grain-free grains Inflammation sugar undoctored Source Type: blogs

TAVR: Aortic valve replacement without open-heart surgery
There has been a flurry of news recently about a procedure called trans-catheter aortic valve replacement (TAVR) for the treatment of the common heart condition aortic stenosis (AS). You may even know people who have had this procedure performed. What exactly is TAVR? And what’s all the excitement about? What is aortic stenosis? First, it’s important to understand the condition that TAVR is designed to treat, aortic stenosis. The aortic valve is the last structure of the heart through which blood passes before entering the aorta and circulating throughout the body. The aortic valve has three flaps, called leaflets, tha...
Source: Harvard Health Blog - April 29, 2019 Category: Consumer Health News Authors: Pinak B. Shah, MD Tags: Health Heart Health Surgery Source Type: blogs

Can you see through this paced rhythm?
Written by Pendell MeyersAn elderly female with known CAD and multiple stents, pacemaker, stroke, and COPD presented with 2 hours of midsternal, nonradiating chest pain at rest. Apparently on arrival to the ED the patient described her pain more as " crampy " abdominal pain, but also chest discomfort.Here is her initial ECG during active symptoms:What do you think?There is dual chamber paced rhythm (atrial and ventricular pacer spikes) with resulting LBBB-like morphology. There is massive excessively discordant STE in II, III, aVF, as well as V4-V6. There is reciprocal excessively discordant STD in I and aVL. Additionally,...
Source: Dr. Smith's ECG Blog - April 24, 2019 Category: Cardiology Authors: Pendell Source Type: blogs

How long would you like to wait for your Occlusion MI to show a STEMI? Sometimes serial ECGs minimizes the delay.
Written by Pendell MeyersAn elderly woman presented with acute onset chest pain and shortness of breath. EMS showed us their ECG on arrival at her house:What do you think?There is sinus rhythm with minimal STE in V1-V3, not meeting STEMI criteria. However, this STE is definitively abnormal in the setting of a normal QRS complex and hyperacute T-wave morphology in V2. There is a small amount of reciprocal STD in V6 with a negative T-wave.This is subtle but diagnostic for anterior Occlusion MI. V2 never has this appearance in the absence of full thickness ischemia.We called for emergent cath lab activation.The cardiolog...
Source: Dr. Smith's ECG Blog - April 19, 2019 Category: Cardiology Authors: Pendell Source Type: blogs

Out of Hospital Cardiac Arrest third leading cause of DALY
Disability Adjusted Life Years (DALY) following adult nontraumatic Out of Hospital Cardiac Arrest (OHCA) treated by Emergency Medical in the United States of America has been shown to be the third leading cause of DALY lost in the year 2016 [1]. DALY is a standardized public health measure for estimating and comparing the burden of disease to the society at large. Coute RA and associates used the data from US national Cardiac Arrest Registry to Enhance Survival database for 2016. Years of life lost was calculated from this data and the remaining life expectancy at the age of death. Cerebral performance category scores fr...
Source: Cardiophile MD - April 10, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

An elderly woman transferred to you for chest pain, shortness of breath, and positive troponin - does she need the cath lab now?
Written by Alex Bracey, with edits by Smith and MeyersA female in her 70s presented to the ED at sign out while working in our acute zone (medium acuity). I picked up the chart and the triage note indicated that the patient was transferred from another hospital, with " EKG changes " and elevated troponin, for cardiology evaluation of NSTEMI. Symptoms were ongoing.Interest now piqued, I looked at the EKG and saw the following:What do you think? Baseline for comparison below.This is nearly pathognomonic! Of what?Baseline on file from outside hospital:This is her first ECG at our hospital:Meyers ECG interpretation: ...
Source: Dr. Smith's ECG Blog - April 4, 2019 Category: Cardiology Authors: Pendell Source Type: blogs

How To Go Beyond The Airline Medical Kit To Keep Passengers Healthy In The Future?
Humanity has come a long way from treating patients who have fallen off cliffs after having tried to fly, dressed like birds: parallel to the development of flying, the practice of how to keep people alive during flights has also greatly evolved. How can digital health add to the practice of aviation medicine in the future and make sure that passengers step off the plane as healthy as they got in? From Icarus through hot air balloons to mid-air meditation The human desire to conquer the sky is a thousand-year-old story, with tales such as the Greek myth about Daedalus and Icarus. The duo wanted to escape from Crete,...
Source: The Medical Futurist - March 21, 2019 Category: Information Technology Authors: nora Tags: Future of Medicine Health Sensors & Trackers aero aeronautics aviation emergency emergency medicine flight flight medicine Healthcare portable portable diagnostics predictive prevention technology wearables Source Type: blogs

What will you do for this patient transferred to you who is now asymptomatic?
A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chest pain and shortness of breath.This ECG was recorded on arrival:What do you think?This is technically a STEMI, with 1.5 mm STE in V1 and 1.5-2.0 mm in V2. The current criteria only require 1mm in V1 and 1.5mm in V2 for a female. However, I think many practitioners might not see this as a clear STEMI, and would instead call this " borderline. " The normal QRS complex with STE and large volume underneath the T-waves in V1-V3 confirm Occlusion MI (OMI). There is not technically STD in V6 and I, however the m...
Source: Dr. Smith's ECG Blog - March 5, 2019 Category: Cardiology Authors: Pendell Source Type: blogs

Some thoughts about Origin , Genesis and Mechanism of palpitation !
Not every one feels the palpitation during tachycardia / Bradycardia /VPDs , Why ? Palpitation is awareness of one’s own heart beat. It is a complex perception of sensation at cortical level (like dyspnea) . It can occur during physical and mental exertion.However , if it occurs without any physiological reasons , it becomes abnormal. It can mean an abnormally heart in terms of  heart rate , rhythm or  raise in stroke volume. The first rule of palpitation is both tachycardia and bradycardia can cause it. Tachycardic palpitation is due to valve motion and braducardic palpitation is due to both motion and increased...
Source: Dr.S.Venkatesan MD - February 24, 2019 Category: Cardiology Authors: dr s venkatesan Tags: cardinal symptom in cardiology Cardiology - Clinical Cardiology -Clinical signs Clinical cardiology Palpation mechansim of palpitation receptors for palpitation sensation of palpitation Source Type: blogs