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Total 287 results found since Jan 2013.
An Adolescent with dizziness and near syncope
Submitted by Maura Corbett, PA-C, written by Alex Bracey, with some comments by Smith and MeyersA teenage male presented to the emergency department with the complaint of dizziness with near-syncope. He was stable and able to provide a history and mentioned that he was asymptomatic while seated but dizzy and weak when attempting to stand. An ECG was recorded:What do you think? There iscomplete (third degree) heart block with wide complex bradycardicescape. The morphology is that of LBBB and so the escape is originating from the right bundle.The possible etiologies of this ECG are:- Structural/congenital heart di...
Source: Dr. Smith's ECG Blog - August 7, 2021 Category: Cardiology Authors: Bracey Source Type: blogs
What is this rhythm? Is there AV block?
Case written and submitted by Elzada Sercus M.D., peer reviewed by Pendell Meyers, Steve Smith, and Ken GrauerA 31-year-old female with a history of low blood pressure and episodes of lightheadedness developed near syncope on postpartum day one after an uncomplicated c-section. She has no other past medical history and does not take any medications. She has no family history of sudden cardiac death or premature coronary artery disease. Given the patient ' s near syncope, an ECG was obtained and when the patient was placed on continuous telemetry monitoring was found to have frequent PVCs. She did not experience any palpita...
Source: Dr. Smith's ECG Blog - July 16, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Cardiology MCQs
Which of the following is an innocent murmur?
Gibson’s murmur
Roger’s murmur
Still’s murmur
Dock’s murmur
Correct answer: 3. Still’s murmur
Still’s murmur was described by George Frederic Still in 1909. This is a low pitched murmur heard in the lower left sternal area. It is best heard with the bell of the stethoscope. Still’s murmur is a mid systolic murmur, loudest in supine position and diminishes in intensity on sitting and standing as venous return decreases [Doshi AR. Innocent Heart Murmur. Cureus. 2018 Dec 5;10(12):e3689]. Gibson’s murmur is the train-in-tunnel murmur or ma...
Source: Cardiophile MD - July 5, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Defining Hypertension : Why we remain in “ Status confusious ” despite 50 years of clinical trials ?
Next to the atmospheric pressure, the most curious pressure to understand is stored within human blood. Yes, it is the “blood pressure”, fondly referred to as BP by both physicians and patients. (When worried men & women visit us and say, that they are suffering from BP, please make it a point to clarify, BP is a sign of existence of life, rather than a dreaded pathology )
Why should blood have pressure?
BP is lateral pressure exerted by flowing blood on the vessel wall (or is it the propelling pressure head ? It is to be noted, cuff pressure doesn’t measure this !) BP is generated by the heart in...
Source: Dr.S.Venkatesan MD - May 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Hypertension 2013 STEMI AHA ACC Guidelines blood pressure lowering treatment trialist collaboration hypertension and dyslipidemia Hypertension current guidelines jnc 6 7 8 hypertesnion Lancet BP LTT trial LDL vs diastolic BP vs fasting blood Source Type: blogs
What is an Intermediate coronary lesion & What shall we do with it ?
This question might squeeze the collective coronary knowledge of any cardiologist. (At least, it does for me !)
What is an intermediate coronary lesion? (ICL)
Traditionally it is an “angio-ocular reflex” measurement of coronary arterial diameter stenosis that lies between 40 to 70% (Mind you, 70 diameter stenosis is 90% area. So,we must be clear what we really mean in any revascularisation debate).
Above one is the simplest expression of ICL. (* While 70% cutoff is fairly constant, the lower limit 40% is still not a settled issue. It can even be 30 %. I think we haven’t yet named th...
Source: Dr.S.Venkatesan MD - April 25, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized diameter vs area stenosis fame s fame study ffr ifr qfr intermediate coronary lesion minimal cad coronary erosion what is intermediate coronary lesion ? Source Type: blogs
A man in his 60s with diaphoresis, vomiting, and inferior STE
Written by Pendell MeyersA man in his 60s appeared altered and diaphoretic and vomiting to a bystander, who called EMS. EMS personnel agreed that he was altered, possibly intoxicated, and seemed to deny all complaints that EMS inquired about. Vital signs were within normal limits.EMS performed an ECG:What do you think?Raw findings: - Sinus rhythm - Normal QRS, axis straight down at lead aVF - STE in leads II (2.0 mm), III (1.5 mm), aVF (2.0 mm) - STD in aVL (1.0 mm) - STD in V1 (0.5 mm), STD in aVR (0.5 mm)Subjective interpretation of those findings:It is slightly tough to decide whether this is in...
Source: Dr. Smith's ECG Blog - April 16, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Getting It Right Despite the Wrong Paradigm
Written by Alex Bracey, edits by Meyers and SmithA 50 something year old male presented to the ED as a transfer from an outside hospital with chest pain. As EMS gave report I looked through the transfer packet for the initial ECG:Sinus bradycardia with loss of R-wave progression and hyperacute T-waves in V2-V5, slight STE in aVL and I without meeting STEMI criteria. There is a down-up T-wave in lead III, which is a very specific reciprocal finding in high lateral OMI. Very highly suspicious of OMI. Applying the 4-variable formula for detection of subtle anterior OMI would yield: STE60V3 = 2.5, QTc = 360, RV4 = 3, QRSV2 = 5...
Source: Dr. Smith's ECG Blog - April 12, 2021 Category: Cardiology Authors: Bracey Source Type: blogs
Role of Valsalva maneuver in cardiology
The initial description of Valsalva maneuver was published by Antonio Maria Valsalva in 1704. It was forced expiratory effort against the closed glottis, nose and mouth, lasting for a few seconds. The maneuver was employed with the aim of expelling foreign bodies or exudates from the middle ear [1]. Even today otolaryngologists use variations of the maneuver very often. Edward Weber in 1851 detailed the cardiovascular changes associated with maneuver, making it useful for diagnostic purpose. Hence some authors prefer to call it as Valsalva-Weber maneuver [2].
The classical four phases of Valsalva maneuver and its hemodyn...
Source: Cardiophile MD - April 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
When there is less than 1 mm of ST depression, can you make the diagnosis of posterior OMI?
DiscussionApproximately 10% of OMIs will involve the posterior wall, most of which also have concomitant involvement of the lateral and/or inferior walls (though usually not meeting STEMI criteria). Isolated posterior OMI, however, manifests as STD without associated STE since the subepicardial myocardial ischemia that would normally generate STE on overlying leads is occurring in the opposing or negative vector compared to the recording ECG leads. The majority of isolated posterior OMIs will be due to occlusion of the LCX, RCA, or a variety of their posterior branches.The 4th Universal Definition of Myocardial Infarc...
Source: Dr. Smith's ECG Blog - February 27, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
A 47-year-old man with abdominal pain and heart rates approaching 300 bpm
Written by Pendell MeyersA 47-year-old man with known WPW syndrome presented to the ED complaining of left abdominal pain, diarrhea, and chills. He denied palpitations, but is found to have a heart rate of 170 bpm at triage. He states that he occasionally has episodes of tachycardia which usually lasts about 1 hour, which he was instructed to " ride out at home unless they persist. " Other than his heart rate, his other vitals were within normal limits, and the patient did not show any signs of compromised cardiac output or distress.Here is his initial ECG:What do you think?The ECG shows an irregularly irregula...
Source: Dr. Smith's ECG Blog - January 13, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
EchoNous KOSMOS 3-in-1 Ultrasound, Electronic Stethoscope, and ECG Helps with COVID-19
EchoNous, a developer of novel ultrasounds, has found a way to leverage multiple critical clinical technologies within a single device. The result is KOSMOS, a handheld 3-in-1 device consisting of an ultrasound, electronic stethoscope, and an ECG, al...
Source: Medgadget - September 21, 2020 Category: Medical Devices Authors: Alice Ferng Tags: Cardiology Critical Care Diagnostics Exclusive Informatics Medicine Public Health Source Type: blogs
Thinklabs One Electronic Stethoscope Helps Physicians Stop Spread of COVID-19
The COVID-19 pandemic has led to the implementation and use of telemedicine and telehealth platforms and devices as part of current day-to-day standards of care in many hospital and healthcare systems. In this era of social distancing, doctors on our...
Source: Medgadget - July 13, 2020 Category: Medical Devices Authors: Alice Ferng Tags: Anesthesiology Cardiology Critical Care Diagnostics Education Emergency Medicine Exclusive Geriatrics Informatics Pediatrics Public Health Source Type: blogs
A young woman in her early 20s with syncope
Written by Pendell MeyersA 20 year old female with an episode of syncope was triage to my low acuity zone one morning. Her vitals were within normal limits except for her heart rate of 109 bpm.I immediately went to evaluate her, without looking in the chart first. I found a well appearing young lady in the room with her parents who witnessed the event. She stated that she was sitting on a shallow ledge in a pool when she became lightheaded, so she got up out of the pool and then briefly syncopized next to the pool in front of her parents, who were able to catch her preventing any trauma. She returned to normal within 30 se...
Source: Dr. Smith's ECG Blog - July 11, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
What do you think of this elderly man with " possible seizure " ?
Written by Pendell Meyers(with really great and thorough explanation of this finding by Ken Grauer).At my hospital, patients with any symptoms which could be vaguely interpreted as a possible stroke during the triage process are brought to the high acuity area and a provider is asked to do a " neuro check " , which involves a quick H and P and exam to determine if we should activate our stroke protocol.A man in his 70s was brought to me for a neuro check, and the triage providers commented that they were worried about a possible seizure as well. The patient was alert and oriented with normal vitals at triage. He stated tha...
Source: Dr. Smith's ECG Blog - May 23, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Aortic valve anatomy : A complete exploration
Found a wonderful anatomy teaching resource. A succinct yet comprehensive lecture on Aortic valve .A must-read for anyone who deals with valvular Interventions. For the cardiology fellows , I can tell you can’t find anything better than this. Thanks to Prof Gregory M Scalia and the structural heart disease Australia. It starts with this one master diagram of Aorta in the center with all surrounding structures and goes on to ensure we watch this 25-minute lecture nonstop.
At the end of the lecture, you should be able to learn about.
The complex fusion points of LVOT with Aorta. Understanding them is critical as we d...
Source: Dr.S.Venkatesan MD - April 25, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized aortic annulus virtual Best lecture on anatomy of aorta prof greg scalia structural heart disease australia Source Type: blogs
