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31 Year Old Male with RUQ Pain and a History of Pericarditis. Submitted by a Med Student, with Great Commentary on Bias!
This was submitted by a fantastic medical student who wished to remain anonymous: A 31 year old male with a history of viral pericarditis one year ago presented with right upper quadrant pain. Here is his initial ED ECG:The R-wave in V4 extends to 33 mm, the computerized QTc is 372 msThe only available previous ECG is from one year ago, during the admission when he was diagnosed with pericarditis:1 year ago ECG, with clinician and computer interpretatioin of pericarditis What do you think? What do these EKGs show? What is your plan for this patient?Here was the story from my perspective, prospectively:I was shown this ECG ...
Source: Dr. Smith's ECG Blog - December 20, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs

Philips Introduces IQon, World’s First Spectral Detector CT
At RSNA, Philips is introducing its IQon Spectral CT system, the world’s first spectral-detector CT scanner. Spectral CT provides information about tissue composition by determining energy levels of detected X-ray photons. The information provi...
Source: Medgadget - December 5, 2013 Category: Technology Consultants Authors: Wouter Stomp Tags: Cardiology Radiology Urology Vascular Surgery Source Type: blogs

You MUST recognize this pattern, even if it is not common
Disclaimer: I never state from where I get a case.  They come from all over the world.   Any case may or may not be from my own institution.  Do not make any assumptions.Case: A non-English speaking woman in her 60's with h/o HTN, type II DM, hyperlipidemia, CAD s/p CABG 16 years prior, and end stage renal disease on dialysis  presented to the ED at time 0.  She had awoken 7 hours prior with severe headache followed by upper chest heaviness and vomited x 2.   EMS placed an 18 gauge IV, gave 2 NTG, and aspirin.  She stated the pain was not similar to a previous MI.  BP was 200 systoli...
Source: Dr. Smith's ECG Blog - November 22, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs

Now It's the Cardiologists' Turn
People like to rag on psychiatry: we've got our own anti-psychiatry movement, and one of the biggest issues for these groups is that "psychiatry" (whoever our singular voice might be) misrepresented itself by saying there are chemical imbalances responsible for mental illness, when no precise imbalance has yet been identified.  We're not like internal medicine and it's sub-specialties where there are numbers and a cut-off for when you have diabetes, and when your cholesterol raises your risk of heart disease.  Those numbers are reportedly precise science, but, actually, those illnesses are defined like psychiatri...
Source: Shrink Rap - November 20, 2013 Category: Psychiatrists and Psychologists Authors: Dinah Source Type: blogs

Critical Care Compendium update
LITFL’s Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care. Currently there are almost 1,500 entries with more in the works… Some pages are more developed than others, and all the pages are being constantly revised and improved. Links to new references and online resources are added daily, with an emphasis on those that are free and open access (FOAM!). These pages originated from the FCICM exam study notes created by Dr Jeremy Fernando in 2011, and have been updated, modified and added to since. As such will be particularly us...
Source: Life in the Fast Lane - November 17, 2013 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Critical Care Compendium Education eLearning Emergency Medicine Featured CCC LITFL collection Source Type: blogs

A Sweet Wide Complex Tachycardia
A 29-year-old man with history of type 1 diabetes mellitus presents with two weeks of feeling ill that became worse over the previous two days. This included a productive cough, subjective fevers, and frequent vomiting. He reports no headache, chest pain, or abdominal pain. He has had financial problems after losing his job about a month earlier, and is currently living in a local motel. His brother brought him to the emergency department for evaluation after finding him in bed confused, with vomit on the floor.   He appeared ill, and was oriented only to self. Vital signs were blood pressure 78/43 mm Hg, pulse 146 bpm, r...
Source: Spontaneous Circulation - November 12, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Is RF ablation possible in Rheumatic Atrial fibrillation ? ?
No procedure is  impossible in medicine    . . . but it should be useful for the patient ! Where will you ablate ? What is the purpose ? The much  hyped*  ablation of pulmonary vein  is never going to help in rheumatic heart since  arrhythmia focus occurs at  random . How can you  locate a   focus of AF over a  huge , scarred  left atrium  ? ( which looks like a lunar surface  sprinkled with a rocky terrain ! )                                       Note the huge , scarred LA .It would                                       be a w...
Source: Dr.S.Venkatesan MD - September 30, 2013 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation Cardiology - Electrophysiology -Pacemaker rheumatic heart disease maangement of af maze corridor surgery in af and rhd ptmc plus rf ablation of atria pulmonary vien isolation rheumatic af is useless rf ablation in rhd R Source Type: blogs

Two interrupted sinus beats. What is the etiology?
In this study of 35 patients with sick sinus syndrome, as diagnosed by (1) age at least 45 years; (2) mean sinus rate at rest less than 45 beats/min, and/or intermittent sinoatrial block in at least 1 standard electrocardiogram recorded during diurnal hours on different days; (3) symptoms attributable to sinus node dysfunction, such as syncope or dizziness, and/or easy fatigue or effort dyspnea, the patients were followed up for up to 4 years (mean 17 ± 15 months). During follow-up, 20 patients (57%) had cardiovascular events that required treatment: 8 had syncope (23%); 6 had overt heart failure (17%); 4 patients had chr...
Source: Dr. Smith's ECG Blog - September 10, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs

Biomarkers in acute coronary syndrome
Creatine (CK) and Isoenzymes Three CK isoenzymes described are the MM, MB and BB fractions. In 1970’s, MB fraction was shown to be elevated in and highly specific for acute myocardial infarction. Later it was shown that CK-MB can be released from skeletal muscles as well, especially regenerating skeletal muscles. This lead to a search for better more specific markers of acute myocardial necrosis. CK-MB level begins to rise 4-6 hours after myocardial infarction and it takes up to 12 hours for it to be elevated in all patients with myocardial infarction. CK-MB levels return to baseline within 36-48 hours. Hence it is the m...
Source: Cardiophile MD - August 17, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Source Type: blogs

The George W Bush stent case: An incredible teaching opportunity on the basics of heart disease
The wrist artery hardly had time to seal. (Surely it was a radial.) The controversy came that fast. The drumbeat of naysayers seemed to start only minutes after a prideful press release announced that George W Bush had undergone successful cardiac stent placement. The ever-quotable cardiologist from Cleveland Clinic, Dr. Steven Nissen, said, “This is really American medicine at its worst.” Dr. David L Brown, from Stony Brook University, and author of an important 2012 study on stents, added that GWB was “now the poster child for the inappropriate use of stenting.” How could this be? It must be a good thing to uncov...
Source: Dr John M - August 11, 2013 Category: Cardiology Authors: Dr John Source Type: blogs

Vernakalant
All of the following statements about Vernakalant are true except: a) Useful in the treatment of recent onset atrial fibrillation b) Rapidly acting drug c) Atrial selective agent d) Acts on the calcium channel Correct answer: d) Acts on the calcium channel Its actions are mainly on potassium channels. It has action on Kv1.5 channel conducting IKur current and Kir3.1/3.4 channel which conducts IKAch current. It has actions on Ito (transient outward current), late sodium current and mild effect on the rapid component of the delayed rectifying current IKr.  
Source: Cardiophile MD - August 2, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Electrophysiology Source Type: blogs

Ivabradine
is a: a) Beta blocker b) Calcium channel blocker c) Potassium channel activator d) Pacemaker current inhibitor Correct answer: d) Pacemaker current inhibitor Ivabradine is a selective inhibitor of the Funny Current (If) or the pacemaker current in the sinoatrial (SA) node. This results in pure heart rate reduction. Read more…
Source: Cardiophile MD - August 1, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ Test 6
Cardiology MCQ Online 6 Time limit: 0 Quiz-summary 0 of 25 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 You are welcome to try this MCQ set and share it among your friends. Answer key with explanation appears after you complete the test and submit it and press on the view questions button. W...
Source: Cardiophile MD - July 16, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

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