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40-something male in a head-on Motor Vehicle Collision and Splenic Injury
A 40-something male presents to the stabilization room for evaluation following head on motor vehicle collision (MVC).  Pt was reported restrained driver, hit at city speeds,  with + airbag deployment.The MVC was unquestionably caused by the other car, not by this driver.The patient complained to EMS of chest pain and a prehospital EKG en route was concerning for STEMI.The patient was at all times hemodynamically stable, without evidence of any profuse bleeding.He had an ECG recorded on arrival to the ED:Anterior and Inferior STEMI with diffuse hyperacute T-waves. This ECG really can ' t be anything else.&nb...
Source: Dr. Smith's ECG Blog - October 26, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs

Antiplatelet agent given only after angiography – Cardiology MCQ
Antiplatelet agent given only after angiography – Cardiology MCQ Which of the following agents is given only after assessing coronary anatomy by angiography in acute coronary syndrome? Ticlopidine Clopidogrel Prasugrel Ticagrelor Post your answer as a comment below.
Source: Cardiophile MD - September 3, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Antibiotic effect of ticagrelor
Ticagrelor is a reversible platelet adenosine diphosphate P2Y12 receptor (P2Y12) inhibitor and is quite effective as an antiplatelet agent. New research suggests an antibiotic effect for ticagrelor and the researchers suggest that further research may lead to development of a new class of antibiotics [1]. In fact there is a global need for new antibiotics, which are conspicuous by their absence in the current scenario of multidrug resistant organisms. The study published as a Research Letter in JAMA Cardiology reports on the ‘Antibacterial Activity of Ticagrelor in Conventional Antiplatelet Dosages Against Antibi...
Source: Cardiophile MD - May 20, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Ticagrelor vs other P2Y12 inhibitors
Ticagrelor is a reversible P2Y12 receptor inhibitor whereas clopidogrel and prasugrel are irreversible inhibitors. Ticagrelor does not require metabolic activation, absorption is rapid and half life is between 7-12 hours; while clopidogrel and prasugrel requires metabolic activation P2Y12 receptor inhibition by ticagrelor is more rapid and achieves a markedly higher degree of inhibition of adenosine diphosphate (ADP) mediated platelet aggregation. This is possibly a reason for higher degree of bleeding with ticagrelor than clopidogrel. Lower rates of fatal bleeds with ticagrelor compared to prasugrel is thought to be du...
Source: Cardiophile MD - May 17, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Over-the-counter cold and flu medicines can affect your heart
As the cold and flu season continues this year, it is important to be aware that many of the most commonly used over-the-counter (OTC) remedies for congestion, aches, pains, and low-grade fevers contain medicines that can have harmful effects on the cardiovascular system. Chief among these medications are nonsteroidal anti-inflammatory drugs (NSAIDs) and decongestants. NSAIDs and your heart Certain NSAIDs are associated with a small increase in the relative risk for developing a heart attack, stroke, heart failure, atrial fibrillation, increased blood pressure, and blood clots. NSAIDs relieve pain and inflammation by inhib...
Source: Harvard Health Blog - March 20, 2019 Category: Consumer Health News Authors: Mark Benson, MD, PhD Tags: Cold and Flu Drugs and Supplements Health Heart Health Source Type: blogs

Reversal of ticagrelor – phase 1 trial of a new agent
Reversal of ticagrelor – phase 1 trial of a new agent Platelet transfusion may be ineffective in reversing the effects of the P2Y12 inhibitor ticagrelor [1]. This is because the free drug binds to fresh platelets [2]. Small reversal effect has been noted with platelet transfusion for the effect of clopidogrel [2]. Phase 1 trial of an antibody capable of reversing the antiplatelet effect of ticagrelor has been presented at the American College of Cardiology Annual Conference 2019, New Orleans, LA. PB2452, ticagrelor reversal agent, is a monoclonal antibody fragment that binds ticagrelor with high affinity. It was a p...
Source: Cardiophile MD - March 18, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology 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

The VERDICT Trial
This study is unable to comment on whether patients with STEMI(-) Occlusion MI have benefit from emergent cath, because that is not the population studied and this subgroup is not commented on.This study is just the most recent in a long long line of similar literature. Context is everything for understanding this study. See below for an excerpt from theOMI Manifesto which summarizes the existing literature and provides details on each study:-------------------------------------------------------------------------------------------------------------- Counter-argument:“Haven’t there been RCTs showing no benefit for earl...
Source: Dr. Smith's ECG Blog - January 4, 2019 Category: Cardiology Authors: Pendell 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

A " normal ECG " on a busy night
Written by Pendell MeyersWe walked in to an overnight shift with approximately 70 patients in the waiting room and a room full of sign-outs at midnight. At 3:55 AM during that kind of a night shift, this ECG (among many others) was brought from triage for review by my team.We knew only that the ECG belonged to a man in his 50s with chest pain and normal vitals. No prior available.Here is the computer interpretation:So we have a triage-computer-normal ECG.Don ' t bother me with this, right?I ' m sure you can imagine the cognitive burden we had during this type of night. On first review from triage, my attending and I waffle...
Source: Dr. Smith's ECG Blog - October 6, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

A completely healthy 30-something woman with acute chest pain -- this post is loaded with info !!!
p.p1 {margin: 0.1px 0.0px 0.1px 0.2px; font: 11.0px Helvetica}A previously healthy young woman presented to the ED with one hour of acute onset right sided chest pain and pressure, very severe, radiating down the right arm.  Here is her initial ED ECG (time 0):What do you think?My impression:without any other information, I looked at this ECG and 2 features stood out: 1) the T-wave in lead I is hyperacute.  It is far too large for that QRS.  2) The T-wave in V6 is far too large; it is almost as tall as the R-wave, which is distinctly abnormal.  3) there is slight downsloping ST depression in V2 whi...
Source: Dr. Smith's ECG Blog - September 15, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Watch what happens when " pericarditis " and morphine cloud your judgment
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve SmithCaseA 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain “similar to his prior MI, but worse.” The pain initially started the daypriorto presentation. The pain roused him from sleep but subsided without intervention. Around 19 hours later, he experienced the same pain, which prompted his presentation to the ED. By this time, three hours had passed from the onset of the pain but it was no longer present. Here is his initial ECG:00:04What do you think? - Sinus rhythm at ~70 bpmSTE in...
Source: Dr. Smith's ECG Blog - July 3, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

Palpitations and Chest Tightness: Should You Activate the Cath Lab (or Give Thrombolytics)?
This case was sent by Jessica Carmichael, and Emergency Physician  on active duty at Irwin Army Community Hospital in Fort Riley, Kansas.  She trained at Brooke Army Medical Center.ECG and CaseI was sent this ECG with some information, but I looked only at the ECG before reading the text:What do you think?My response was this:" I have not read the text of your email yet, but I would say that this is benign normal variant STE. "(There is also atrial fibrillation without a rapid ventricular response.)" Now I will read your text: "Here is the text:" The following ECG was sent to me by a former resident yesterday and...
Source: Dr. Smith's ECG Blog - June 26, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Benefit vs. social responsibility: a profound ethical dilemma in medicine today
Brilinta, at $6.50 per pill, twice a day, reduces cardiovascular events more than generic Plavix, which costs 50 cents per pill, once a day. But only a little: 20% relative or 2% absolute risk reduction. The event risk was 10% with the more expensive drug and 12% with the one that costs 82% less. Put differently, if 100 patients were treated with Brilinta for a year, at a cost of $4,680 for each patient, ten patients would still have an event. With clopidogrel, 100 patients, each one at a cost of $180, 12 events would occur. That means two fewer events would happen per 100 patients on Brilinta at an extra cost of $450,000...
Source: Kevin, M.D. - Medical Weblog - April 22, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Policy Cardiology Public Health & Source Type: blogs

Critical Issues in PCI : ” Left ” main cries foul . . . calls for “ Right ” thinkers ?
Conquering  left main disease is considered as crowning glory for the Interventional cardiologists. For over three decades , CABG has remained the undisputed modality which is being challenged  today. Fortunately, the Incidence of true isolated  left main disease is  low .(If Medina bifurcation subset is excluded)   With growing expertise , advanced hardware and Imaging ( like a 360 degree OCT fly through view ) one can virtually sit inside the left main and complete a PCI . Still , coronary care is much . . . much  . . . more than a technology in transit ! Most importantly, these complex PCIs require rigorous...
Source: Dr.S.Venkatesan MD - February 10, 2018 Category: Cardiology Authors: dr s venkatesan Tags: CABG Indications cardiac surgery Cardiology -Interventional -PCI cardiology -Therapeutics Cardiology -unresolved questions cardiology wisdom cath lab tips and tricks best option for left main disease left main pci or cabg precombat synta Source Type: blogs

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