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DM / DNB Cardiology Entrance Mock Test 14
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 14. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - February 7, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 9
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 9. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - January 27, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

"How could I convince my interventionalist to come do a cath in the middle of the night?"
I just received this email today.  I receive these fairly frequently:Dear Dr. Smith:I am an Emergency physician working in an outlying hospital in _________. We have an interventional hospital to which we refer cath lab patients.  I had a 31 year old with typical chest pain and vomiting and the attached ECG. I was sure he was infarcting but couldn’t convince the interventionalist to take him (after emailing him the ECG).I treated the patient aggressively with medical management and transfered him to the tertiary center.  They did not take him to the cath lab emergently.  When he went to the cath lab t...
Source: Dr. Smith's ECG Blog - August 27, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

The Digital Doctor: Is Natural Language Processing the Breakthrough We’ve Been Waiting For?
By BOB WACHTER, MD Natural language processing might seem a bit arcane andtechnical – the type of thing that software engineers talk about deep into the night, but of limited usefulness for practicing docs and their patients. Yet software that can “read” physicians’ and nurses’ notes may prove to be one of the seminal breakthroughs in digital medicine. Exhibit A, from the world of medical research: a recent studylinked the use of proton pump inhibitors to subsequent heart attacks. It did this by plowing through 16 million notes in electronic health records. While legitimate epidemiologic questions can be raised a...
Source: The Health Care Blog - June 23, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Research and Reviews in the Fastlane 081
This article reviewed 17,583 adult ED intubations over 10 years at 13 different centers. The study found 95% of intubations were performed by ED physicians with good results: 99% of intubations were successful within 3 attempts.Orotracheal intubation with RSI was, of course, the most common technique, with 85% first pass success rate with this technique. And first pass success rates increased over time during the 10 year period, showing that we are continuing to get better!Interestingly, senior residents had 85% first pass rate, compared to just 72% for attendings.For drugs, etomidate was overwhelmingly the most commonly u...
Source: Life in the Fast Lane - April 30, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: R&R in the FASTLANE critical care Education Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs

From Scott Weingart EMCrit Interview: Who needs the Cath Lab now??
Who Needs the Cath Lab/Cards Consult?Here is the podcast of Scott's Interview with me . (some of this gets distorted in MS internet explorer)FirstActivate the Lab for unambiguous STEMI (only clear STEMIs have a 90 minute CMS mandate)Get Cardiology or Interventional Consultation for more complicated cases: difficult ECGs, subtle ST elevation, ST depression with ongoing symptoms, STEMI "Equivalents.This requires a systematic approach, with buy-in from Cardiology, that they will respond immmediately to such requests for help.  What do they get out of it?  Fewer false positive activations and more activatio...
Source: Dr. Smith's ECG Blog - March 29, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Medications After a Heart Attack
From: www.secondscount.orgYour heart attack recovery will include medications. Taking these medications exactly as prescribed is one of the best tools at your disposal for avoiding death in the months following a heart attack. According to an article published in Circulation, the journal of the American Heart Association, heart attack patients who had not filled any of their prescriptions within 120 days of being discharged from the hospital had 80 percent greater odds of death than those who filled all of their prescriptions.Medications you are likely to be prescribed after a heart attack fall int...
Source: Dr Portnay - January 23, 2015 Category: Cardiology Authors: Dr Portnay Source Type: blogs

It is Far too Early for a Requiem for Unstable Angina
Dr. Braunwald declared that high sensitivity troponins will make Unstable Angina a thing of the past.  That very well may be true, but in the United States we are not yet in the era of high sensitivity troponins.  And we do not know what their effect will be.Here are many more cases of Unstable Angina.Unstable AnginaA male in his 50's with no past history presented with new intermittent burning left chest pain, lasting 10 minutes at a time, radiating to the left arm, for 24 hours.  He had chest pain just prior to arrival in the ED, but it resolved prior to physician evaluation.  He did use cocaine a few...
Source: Dr. Smith's ECG Blog - December 15, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Transient ST elevation, rules out for MI, what is it?
A 70 year old diabetic complained of 6/10 epigastric pain.  Here is his initial ECG:There is diffuse ST elevation: II, III, aVF and V3-V6.  There is reciprocal ST depression in aVL.  This is diagnostic of inferolateral STEMIThe emergency physician activated the cath lab and gave appropriate antiplatelet and antithrombotic therapy.The PCI team came to talk to the patient, and while they were talking, the patient vomited and was pain free thereafter and said he felt much better.  They recorded another ECG:The ST elevation is resolved. There can be no other explanation than the patient spontaneously reperf...
Source: Dr. Smith's ECG Blog - December 5, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Dual antiplatelet therapy: More the better?
Dual antiplatelet therapy with aspirin and a thienopyridine (clopidogrel, prasugrel etc) is currently recommended for at least 12 months after implantation of a drug eluting stent (DES) following a percutaneous coronary intervention (PCI). But there have been instances of late stent thrombosis and very late stent thrombosis after DES implantation. Hence the DAPT study (Dual Antiplatelet Therapy) sponsored by the Harvard Clinical Research Institute sought to look at benefits of dual antiplatelet study at 30 months after implantation of a drug eluting stent and bare metal stent. The study results were presented at the Ameri...
Source: Cardiophile MD - November 30, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

What happened after the PCI?
A middle-aged male with h/o CABG x 3, previous stents, and aortic valve and aortic root replacement presented primarily with headache, but also told the medics that he had chest pain (for 6 hours) because he "knew they would respond faster than if he said headaches."  The chest pain was right sided rib and shoulder pain, worse with inspiration, sharp, and sometimes 7-8/10.  But the headache was much worse.   Chest pain was not relieved by sublingual NTG.He has noticed worsening exertional dyspnea, such that he feels he can only walk about a block before experiencing "chest tightness. Here is his ED ECG ...
Source: Dr. Smith's ECG Blog - October 30, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

18 hours of intermittent chest pressure
A male in his 60's with no previous cardiac history complained of substernal chest pain intermittently for 18 hours.  It has more recently become constant.  He was diaphoretic.  He called 911 and had this prehospital ECG recorded:I saw this when he arrived, and was worried about the slight ST depression in V2 and the size of the T-waves in V5 and V6, as well as the minimal terminal T-wave inversion in aVL and a bit of ST depression there.We recorded this immediately:The same findings are here, without any evolution.BP was 140/80.His pain continued and would be relieved from 8/10 to 6/10 with sublingual nitro...
Source: Dr. Smith's ECG Blog - October 28, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Research and Reviews in the Fastlane 054
Conclusions Wrong? (emlitofnote) Critical Care, CardiologyGuyton AC. Regulation of cardiac output. Anesthesiology. 1968; 29(2): 314-26. PMID: 5635884 The modern emphasis on echo might make you think that the heart determines cardiac output. This classic paper by Guyton shows that unless the heart is failing, it has a permissive role in determining cardiac output. The real determinants are (1) the degree of vasodilation of the peripheral vasculature, especially veins, and (2) the filling of the circulatory system, indicated by the mean systemic filling pressure. Gotta love those Guyton curves! Recommended by: Chris Nick...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Clinical Research Education Emergency Medicine Infectious Disease Intensive Care Neurology Neurosurgery Obstetrics / Gynecology Orthopedics Pediatrics Trauma critical care literature R&R in the FASTLANE recommendat Source Type: blogs

Prolonged (63 minutes) Ventricular Fibrillation, Followed by Unusual Cardiogenic Shock
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases.  On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely.  When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA.        
Source: Dr. Smith's ECG Blog - September 19, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Poor Microvascular Reperfusion ("No Reflow"): Best Diagnosed by ECG
This study demonstrates the importance of frequent static ECG’s and the insensitivity of using only 2 static ECG’s to detect reperfusion.  In 58% of patients, ST segments were unstable, rising and falling, before final resolution.Infrequent static ECG’sCaliff RM et al., Failure of simple clinical measurements to predict perfusion status after intravenous thrombolysis, 1988.  Methods:  Califf et al. (339) performed angiography on 386 TAMI patients at 60 and 90 minutes post-administration of tissue plasminogen activator (tPA).  They recorded a baseline ECG and another at 90 minutes post-tPA, before ...
Source: Dr. Smith's ECG Blog - August 9, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs