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Total 177 results found since Jan 2013.

ECG changes in hypocalcemia: Mechanism
Prolongation of ST segment contributing to prolonged QT interval and corrected QT interval (QTc) is the hallmark ECG change in hypocalcemia. Hypocalcemia prolongs phase 2 of the myocardial action potential, thereby prolonging the ST segment. T waves are not generally affected in hypocalcemia because phase 3 of the myocardial action potential is not affected by calcium ions. Calcium channels close at the end of phase 2, with phase 3 being mostly related to potassium channel activity. Cases are on record in which severe hypocalcemia has mimicked ST elevation myocardial infarction in the emergency department. Coronary angiog...
Source: Cardiophile MD - December 2, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ: Angiotensin II receptor
Angiotensin II receptor 1 (AT1) is involved in: a) Vasoconstriction b) Proliferation c) Aldosterone secretion d) All of the above Correct answer: d) All of the above Angiotensin II is one of the most potent vasoconstrictors. It is also involved in the stimulation of aldosterone release from the zona glomerulosa of the adrenal cortex. Angiotensin receptors are G-protein coupled receptors. The important angiotensin receptors described are: AT 1, 2, 3 and 4. AT 1 is the most important and is involved in vasoconstriction, proliferation, matrix formation and aldosterone secretion. Losartan is a selective antagonist of AT1 rece...
Source: Cardiophile MD - November 27, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

LITFL Review 152
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. Welcome to the 152nd edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR] Kane Guthrie [KG] Mat Goebel [MG] Segun Olusany...
Source: Life in the Fast Lane - October 14, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Review LITFL R/V Source Type: blogs

Cardiology MCQ 344: Vernakalant
Vernakalant acts on: a) Sodium channel b) Potassium channel c) Sodium channel and potassium channel d) Potassium channel and calcium channel ["Click here for the answer with explanation", "Correct Answer:"] c) Sodium channel and potassium channel Vernakalant hydrochloride is a novel atrial selective antiarrhythmic agent. It blocks the early activating potassium channel (IKur) and frequency dependent sodium channel. Read more… The post Cardiology MCQ 344: Vernakalant appeared first on Cardiophile MD.
Source: Cardiophile MD - October 13, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs

Cardiology MCQ 343: Mechanism of action of ranolazine
Anti-ischemic mechanism of action of ranolazine is by: a) Negative inotropic effect b) Positive inotropic effect c) Negative lusitropic effect d) Positive lusitropic effect ["Click here for the answer with explanation", "Correct Answer:"] d) Positive lusitropic effect Ranolazine is thought to have its antianginal action by preserving myocardial blood flow during ischemia by its effects on inhibition of late sodium current which in turn prevents cellular sodium overload and sequentially calcium overload. Prevention of calcium overload reduces compression of intramyocardial blood vessels by reducing diastolic myocardia...
Source: Cardiophile MD - October 12, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Research and Reviews in the Fastlane 050
This study compared bedside US by EPs vs radiology US vs CT as the INITIAL test in patients expected with nephrolithiasis. It found there was no difference in serious outcomes between the groups, but the rate of serious outcomes was overall very low. Obviously patients that got only an US had lower radiation exposure and lengths of stay. But what is interesting is that 40% of patients with an initial ED US went on to get a CT also. This study does not state that patients should ONLY undergo US, just that it should be the INITIAL test. If it cuts down on our CT ordering, it sounds like a good start. (Zack Repanshek) Recomme...
Source: Life in the Fast Lane - September 29, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Emergency Medicine Infectious Disease R&R in the FASTLANE Radiology Resuscitation critical care Education Intensive Care literature recommendations Research and Review Source Type: blogs

Pacemaker Panic #2
ECG Exigency 016 A 68-year old woman presents by ambulance to the Emergency Department. Per the ambulance crew, she was brought from home after experiencing 7 out of 10 chest discomfort and weakness. She has a history of hypertension that is well controlled with furosemide, and has a pacemaker because her “heart used to go funny.” The ambulance crew are basic life support only, so the patient has received 324mg of aspirin, and oxygen by nasal cannula. Upon arrival she is seated upright on the stretcher breathing rapidly, with the following vitals: heart rate 107, blood pressure 180/110, respirations 20 and slightly lab...
Source: Life in the Fast Lane - September 19, 2014 Category: Emergency Medicine Authors: Mat Goebel Tags: Cardiology Clinical Case ECG Education Emergency Medicine EKG failure hyperkalaemia hyperkalemia pacemaker pacer pacing ppm Source Type: blogs

Femoral artery calcification
– positive and negative images Incidentally detected femoral artery calcification on X-ray taken for some other purpose. Both positive and negative images are shown side by side. Negative images were obtained by digital processing of the positive image. Extensive calcification is seen extending from the common femoral artery into superficial femoral artery and profunda femoris artery. Arterial calcifications are more likely to be seen in the elderly and in those with altered calcium metabolism as in chronic kidney disease and hyperparathyroidism. Secondary hyperparathyroidism may occur in chronic kidney disease due ...
Source: Cardiophile MD - September 6, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology X-ray Source Type: blogs

Mitral annular calcification (MAC)
Mitral annular calcification (MAC) is more likely in those with chronic kidney disease because of the deranged calcium and phosphorus metabolism. Products of calcium and phosphorus metabolism cause soft tissue calcification. MAC is also a marker of atherosclerotic burden. Mitral annular calcification is associated with higher incidence of atrial arrhythmias, stroke and cardiovascular mortality. MAC is more common in females, elderly and in those with hypertension and diabetes. Mechanism of mitral regurgitation in MAC Mitral annular calcification is more likely to cause mitral regurgitation than stenosis. Three reasons cou...
Source: Cardiophile MD - August 13, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Mitral stenosis due to mitral annular calcification Source Type: blogs

Calcium scoring of coronary arteries
scoring can be done with EBCT, while the vessel assessment can be done only with MDCT. The calcium scoring scale is known as Agatston score. A score of 0 means that there is no identifiable calcium. If there is no calcium there is no obstuctive coronary artery disease (CAD); if calcium score is more than 100 , it predicts obstructive CAD. Calcium scoring is useful to differentiate ischemic dilated cardiomyopathy from the idiopathic variety. If the calcium score is negative, it is unlikely to be ischemic in origin.
Source: Cardiophile MD - July 27, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Agatston score Calcium score Calcium scoring of coronary arteries EBCT ischemic dilated cardiomyopathy MDCT obstructive CAD obstuctive coronary artery disease Source Type: blogs

Incredible Case Demonstrating the Value of Frequent Serial ECGs
This case is presented and written by Vince DiGiulio, (EMT-Critical Care and emergency department tech).  As his title shows, he is a tech.  Not a paramedic.  Not a nurse.  Not a doctor.  He is a wizard at reading ECGs and is entirely self-taught.  He was the ECG tech on this case, and his skills mean that he recognized the pathology on the ECG and could stand there and keep recording them.A 75 year old female presents with a chief complaint of “reflux.” Starting about five days ago, a couple of times each day she has experienced a burning sensation behind the lower third of her ...
Source: Dr. Smith's ECG Blog - April 18, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Interview with Dr. Szilard Voros, CEO and Co-Founder of Global Genomics Group
Dr. Szilard Voros, CEO and co-founder of Global Genomics Group (G3), is currently heading the international GLOBAL study, which will enroll up to 10,000 patients with coronary artery disease. The coronary atherosclerotic disease of each patient will ...
Source: Medgadget - February 27, 2014 Category: Technology Consultants Authors: Tom Fowler Tags: Genetics Medgadget Exclusive Source Type: blogs

Paroxysmal SVT (PSVT) that repeatedly recurs in spite of successful conversion with adenosine
An elderly male complained of dyspnea.  His pulse was regular at just under 150.  BP was 110/70.  There was no evidence of shock or pulmonary edema.  Here is his ED ECG:There is a very rapid, wide complex tachycardia (QRS = 150 ms).  There are no P-waves before the QRS's.  There is a definite Right Bundle Branch Block and Left Anterior Fascicular Block pattern, so this is not VT.  The bifascicular block was new.  It could be a new block, or a rate-related BBB  If you look closely, you can see the inverted (retrograde) P-waves. (See annotated ECG below, with arrows pointing ...
Source: Dr. Smith's ECG Blog - January 31, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Mitral annular calcification (MAC)
is more likely in those with chronic kidney disease because of the deranged calcium and phosphorus metabolism. Products of calcium and phosphorus metabolism cause soft tissue calcification. MAC is also a marker of atherosclerotic burden. Mitral annular calcification is associated with higher incidence of atrial arrhythmias, stroke and cardiovascular mortality. MAC is more common in females, elderly and in those with hypertension and diabetes. Mitral annular calcification is more likely to cause mitral regurgitation than stenosis. Two reasons could contribute to this. The normal sphincter like mechanism of mitral annular c...
Source: Cardiophile MD - December 27, 2013 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Mitral stenosis due to mitral annular calcification Source Type: blogs