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A Middle Aged Male diagnosed with Gastroesophageal Reflux
This middle aged male with h/o GERD but also h/o stents presented to the ED with chest pain. He had been at a clinic that day where he had complained of worsening GERD. An EKG was recorded and interpreted as normal by the computer, the clinician, and by the overreading cardiologist.He had an ECG recorded in triage (I am not certain whether the patient had active pain at this time; I believe he didnot):What do you think?Here is the patient ' s ECG from several hours ago (which was essentially the same):This shows minimal inferior ST Elevation that is howeverall but diagnostic of inferior ischemia. There is the o...
Source: Dr. Smith's ECG Blog - July 16, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
New skills in ACS : Lessons from an Immature resident and an Intelligent consultant !
A brief conversation between an elite consultant and his fellow. (Caution: Grade 2 harsh language)
Hey Doc, why is this guy’s name not found in today’s angiogram list? Any Insurance issues?
No sir, he has every requirement. Thrombolysis was very successful, ST has regressed well and it is nearly isoelectric and only T is inverted. His LV function is normal. In fact, I am not able to pick up any WMA.
Aren’t you aware, that being fine is never a contraindication for a PCI ? Which book teach you like that?
No sir, It’s already beyond 48 hrs sir. What is the purpose of know...
Source: Dr.S.Venkatesan MD - July 12, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acs management acute coronary syndrome stemi nstemi Source Type: blogs
New skills in ACS : Lessons from a foolish resident and an Intelligent consultant !
A brief conversation between an elite consultant and his fellow. (Caution: Grade 2 harsh language)
Hey Doc, why is this guy’s name not found in today’s angiogram list? Any Insurance issues?
No sir, he has every requirement. Thrombolysis was very successful, ST has regressed well and it is nearly isoelectric and only T is inverted. His LV function is normal. In fact, I am not able to pick up any WMA.
Aren’t you aware, that being fine is never a contraindication for a PCI ? Which book teach you like that?
No sir, It’s already beyond 48 hrs sir. What is the pur...
Source: Dr.S.Venkatesan MD - July 12, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acs management acute coronary syndrome stemi nstemi Source Type: blogs
The ECG must be recorded at the right time, or the Occlusion (OMI) will be missed.
This was sent by one of our faculty, Steven Souchtchenko, who trained under me and works at another hospital most of the time, and with us at Hennepin some of the time.Case:53yoF with stuttering CP for 2 days, suddenly acutely worse tonight, now 10/10 pressing radiating to L arm. What do you think?Steven wrote: " I called it " OMI " based on hyperacute T-waves. " (Dr. Souchtchenko understands that a hyperacute T-wave is not at all defined by its height, nor even by its size and bulk (though these are " bulky, " but by its sizein proportionto the QRS)." Cardiology didn ’t believe me. I recorded...
Source: Dr. Smith's ECG Blog - July 4, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Acute chest pain and a difficult ECG
Conclusion: Whereas I did not feel we could rule out an OMI from the initial tracing shown in Figure-1 — none of the subsequent tracings in today ' s case were suggestive of an acute event. I suspect that IF the initial ECG would have beenimmediately repeated withaccurate chest lead electrode placement — that there maynot have been any need for concern about a possible acute event from the initial ECG.Learning Point: When clinical decision-making hangs in the balance and you strongly suspect an error in lead placement — it is best toimmediately repeat the ECG —&nbs...
Source: Dr. Smith's ECG Blog - June 25, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
How IoT Medical Devices Save and Improve Lives
The following is a guest article by Erik Kling, Interim Head of IoT Americas at Vodafone Business.
IoT, or the Internet of Things, has transformed our homes with connected lights and smart appliances. It’s also revolutionized all areas of business, including manufacturing. Sensors connected to the internet can track goods throughout the supply chain — from sourcing materials to delivering completed products to consumers.
IoT technology has improved the way we live, but its most profound impact may be in healthcare, where it’s saving lives and improving health.
Before IoT revolutionized healthcare, doctors and care pr...
Source: EMR and HIPAA - June 23, 2022 Category: Information Technology Authors: Guest Author Tags: AI/Machine Learning Clinical Health IT Company Healthcare IT IT Infrastructure and Dev Ops AED American College of Cardiology Connected Defibrillators Continuous Glucose Monitors CPAP Dr. Ami Bhatt Elliot Erik Kling Healthcare AI Source Type: blogs
Acute Chest pain with LBBB. What is going on?
This history and ECG were texted to me from a far away ED on a Friday night:" Very elderly make with history of coronary disease on an angiogram 1 year prior presents with 2 hours of chest pain, sternal, pressure, and mild diaphoresis. "What do you think?There is sinus tachycardia with LBBB. There is concordant ST depression (STD) in lead V2, and excessively proportionally discordant STD in all of leads V3-V6. Thus, there is one lead (V2) that meets the Sgarbossa criteria and the Smith modified criteria, and 4 other leads (V3-V6) that meet the alternative Smith modified criteria (proportionally excessively disc...
Source: Dr. Smith's ECG Blog - June 23, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fight Aging! Newsletter, June 20th 2022
This study showed a negative relationship between the gaps and the number of senescence cells. Moreover, we found a similar reduction in 30-month-old naturally and 7-month-old D-gal-induced aging rats. Given these consistent data from different eukaryotic organisms, it suggests that the Youth-DNA-GAP is a marker of phenotype-related aging degree
Towards Scaffold-Based Regeneration of Dental Pulp
https://www.fightaging.org/archives/2022/06/towards-scaffold-based-regeneration-of-dental-pulp/
Researchers are working towards the ability to regenerate the dental pulp inside teeth. Full regeneration of teeth h...
Source: Fight Aging! - June 19, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Eko DUO Digital ECG + Stethoscope: Exclusive Interview and Review
In the latest advancements of AI and med tech, the Eko DUO stands out as a smart and reliable product with FDA-cleared artificial intelligence (AI) algorithms being used to detect leading indicators of heart disease. More significantly, this is a sma...
Source: Medgadget - June 8, 2022 Category: Medical Devices Authors: Alice Ferng Tags: Cardiology Exclusive Medicine Pediatrics Telemedicine Eko_Health stethoscope Source Type: blogs
ST elevation after gunshot to the chest
Conclusion: The ECG in Figure-1 would not be typical for non-traumatic acute pericarditis. However, it could be consistent with traumatic pericarditis (because ECG findings are so variable in traumatic pericarditis).NOTE: The ECG features of acute myocarditis may differ substantially from those of a " pure " pericarditis. There may be a resemblance between these 2 entities — but ST segment deviations (elevation and depression) with myocarditis may not follow the timing seen with pericarditis. In addition, Q waves may develop — so at times it may...
Source: Dr. Smith's ECG Blog - June 8, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Quiz post - which of these, if any, are OMI? What is the South African Flag Sign? Will you activate the cath lab? Can you tell the difference on ECG?
Written by Pendell Meyers, additions and edits by Grauer, Smith, McLarenBelow we have 5 cases of adults (ranging from 40-70 years old) who all presented to the ED with acute nontraumatic chest pain that sounded at least somewhat like potential ACS to the provider. You should look at each ECG and decide if it is OMI, not OMI, or something else.Our goal in this post is to compare and contrast OMIs with false positives that mimic them. In this post we will examine the anterolateral distribution that has been described as the " South African Flag Sign. " (SAFS)It is very hard to describe why an ECG expert can easily...
Source: Dr. Smith's ECG Blog - May 11, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?
Submitted and written byDestiny Folk MD, peer reviewed by Meyers, Smith, Grauer, McLarenA man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. He complained of generalized weakness and left lower extremity numbness. He reported that 12 hours prior to arrival he used fentanyl and cocaine. He reported difficulty walking and felt as if his left leg was “asleep.” He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. On arrival in the ED, he wa...
Source: Dr. Smith's ECG Blog - May 5, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 40s who really needs you to understand his ECG
Written by Pendell MeyersA man in his 40s presented for " left sided chest pain sudden onset yesterday when sneezing and coughing that is worsened with inspiration. " He also complained of associated SOB, dizziness, jaw pain, and back pain, which he described as " muscle spasms. " He has also had rhinorrhea and cough for 1 week. Also, left hand numbness today. He went to urgent care for evaluation. An ECG was performed there (unavailable) which reportedly was abnormal, so EMS was called to urgent care to take him to the ED.On EMS arrival, they noted the patient vomited then became unresponsive. He was reportedly...
Source: Dr. Smith's ECG Blog - May 1, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 40s with RUQ abdominal pain
Conclusion:In hemodynamically stable patients with chest pain, sinus tachycardia aids in the identification of patients unlikely to have type I MI, especially in those with HR greater than 120 bpm.===================================MY Comment by KEN GRAUER, MD (4/28/2020):===================================Insightful case presented by Drs. Goss and Meyers highlighting the importance of recognizing the ECG signs of acute PE. I focus my comments on further dissecting some of these " tell-tale " ECG features.The " theme " of today ' s case was "pattern recognition". Like the ECG diagnos...
Source: Dr. Smith's ECG Blog - April 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Chest pain, a ‘normal’ ECG, a ' normal trop ' , and low HEART and EDACS scores: Discharge home? Stress test? Many errors here.
Written by Jesse McLaren, with comments from Smith and GrauerA 60 year old presented with three weeks of intermittent non-exertional chest pain without associated symptoms. ECG was labeled ‘normal’ by the computer (confirmed by the overreading cardiologist) and the high-sensitivity Troponin I was normal at a value of 11 ng/L (Abbott Alinity assay, where normal is<26 in males,<16 in females; this assay is nearly identical to the Abbott Architect high sensitivity assay). So the patient was low risk according to HEART and EDACS scores. Should this patient be discharged home? How about a stress test? ...
Source: Dr. Smith's ECG Blog - April 22, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
