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What are these ST elevations, ST depressions, and tall T waves diagnostic of?
Written by Pendell MeyersLet ' s see this presentation ECG without any context first (no baseline ECG was available)What do you think? What will you do?The ECG is diagnostic of severe hyperkalemia. There is sinus tachycardia, the beginning of QRS widening, tall pointy peaked T waves with little area compared to their height. There is STE in V1-V3, aVR, and aVL, with STD in II, III, aVF, V4-V6. The appearance in V1 is similar to the Brugada morphology (as is often the case in hyperkalemia and Na channel blocker effects causing STE). Together these ST elevations in the right precordial leads and aVL are classic pseudoS...
Source: Dr. Smith's ECG Blog - May 14, 2021 Category: Cardiology Authors: Pendell 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
VITAL trial on vitamin D
Role of vitamin D in cardiovascular disease has been suggested by observational studies. Low blood levels of vitamin D was found to be associated with higher risks of heart disease, stroke, hypertension and diabetes mellitus [1]. But the 2011 Institute of Medicine (United States) guidance concluded that the evidence is inconsistent and inconclusive, not meeting the criteria for a cause effect relationship [2].
VITAL study was a randomized placebo controlled trial of vitamin D3 (cholecalciferol) at a dose of 2000 IU per day and omega-3 fatty acids at a dose of 1 g per day for prevention of cancer and cardiovascular diseas...
Source: Cardiophile MD - April 18, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
The Paradigm Shift That Wasn ’ t: The ISCHEMIA Trial
By ANISH KOKA
A recent email that arrived in my in-box a few weeks ago from an academic hailed the latest “paradigm shift” in cardiology as it relates to the management of stable angina. (Stable angina refers to chronic,non-accelerating chest pain with a moderate level of exertion). The points made in the email were as follows (the order of the points made are preserved):
The financial burden of stress testing was significant ( 11 billion dollars per annum in the USA!)For stable CAD, medical treatment is critical. We now have better medical treatments than all prior trials including ischemia. th...
Source: The Health Care Blog - February 26, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Anish Koka cardiology ISCHEMIA trial Source Type: blogs
Discordant grading of severity of aortic stenosis
Discordance between various measures of severity of aortic stenosis (AS) is considered as discordant grading of severity of aortic stenosis or simply discordant AS. Severe aortic stenosis has aortic Vmax ≥4.0 m/s, mean gradient ≥40 mm Hg and effective orifice area (EOA) ≤1.0 sq. cm. Peak aortic velocity and mean gradient are flow dependent measurements, while effective orifice area and Doppler velocity index are relatively flow independent.
About 20-30% of patients may have discordant measures of severity of aortic stenosis on echocardiography [1]. Discordance is mostly between effective orifice area and Vmax/Doppl...
Source: Cardiophile MD - February 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography discordant aortic stenosis discordant AS hybrid imaging hybrid imaging to assess LVOT measurement pseudo severe aortic stenosis pseudo severe AS Source Type: blogs
Wellens ' syndrome: to stent or not? IVUS negative, Symptoms persist, Stress Testing, Instantaneous Wave Free Ratio, and Fractional Flow Reserve.
A 55 y.o. male with no cardiac PMHX presented for 2 weeks of exertional chest pain, worsened on the day prior to presentation. On the day of presentation, the chest discomfort was particularly intense, and associated with diaphoresis and nausea. It was resolved (pain free) when the ECG was recorded:This ECG was read as " nonspecific " by the providers. What do you think?These is classic Wellens ' pattern A (biphasic, terminal T-wave inversion), and it isWellens 'syndrome (Angina, resolved -- pain free -- with preserved R-waves and Wellens ' pattern A T-waves). The morphology of these T-wav...
Source: Dr. Smith's ECG Blog - January 28, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
ST Depression Maximal in V1-V4 and Angio shows 3 Vessel Disease. Is it posterior? Which is the culprit?
A 70-something woman had acute chest pain.The ECG was texted to me with the words: " Acute chest pain. Could this be posterior MI? What do you make of the ST depression in V4-V6? "What do you think?My response: " The ST depression is maximal in V1-V4. This is most consistent with a posterior MI. If it sounds clinically like acute MI then this is good for activating the cath lab. "Her response: " Yeah, I did activate. But the cardiology fellow told me he was sure it would not be a posterior MI because of diffuse ST depression. He suggested that we should have consulted cardiology rather than activati...
Source: Dr. Smith's ECG Blog - December 23, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
A woman with near-syncope, bradycardia, and hypotension
Written by Pendell MeyersA 59-year-old woman with diabetes, hypertension, prior stroke, and peripheral vascular disease presented with multiple near-syncopal events over the past 2 days, as well as ongoing back pain. EMS found her bradycardic in the 40s and administered atropine with no response. She was mentating and had a reasonable blood pressure (around 90s systolic), so they decided not to pace prehospital. On arrival the patients blood pressure was 79/50 mm Hg. She was still awake and alert. Here is her first ECG (no baseline available):What do you think?Findings: - junctional bradycardia (no P waves,...
Source: Dr. Smith's ECG Blog - December 18, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
Mitochondrial Transplantation to Treat Ischemia-Reperfusion Injury: Interview with Dr. Alexander Schueller, CEO of cellvie
The objective of cellvie’s approach is to rescue mitochondria function by the augmentation and replacement of mitochondria, which are damaged during ischemia. Specifically, viable mitochondria are transplanted during reperfusion into the affected c...
Source: Medgadget - December 11, 2020 Category: Medical Devices Authors: Conn Hastings Tags: Cardiac Surgery Cardiology Critical Care Exclusive Medicine Urology cellvie Source Type: blogs
Arrhythmia basics: How often we need to know the mechanism of arrhythmia ?
How many times you have treated cardiac arrhythmia in both emergency & non-emergency situations?
Infinite times.
How many times did you really bother to know the mechanism of a given arrhythmia before ordering medication or shocking?
Hmm,.. let me think. (Except for AVNRT/ AVRT, and few VTs, very rarely I have worried about the mechanism !)
Why is it so? because treatment takes priority and we are able to tame the arrhythmia even without knowing the real mechanism.
The following slide is a gross summary of the cardiac arrhythmia mechanism
Understanding cardiac arrhy...
Source: Dr.S.Venkatesan MD - November 2, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Basic science -Physiology Brugada syndrome cardiac electrophysiology cardiology -Therapeutics Cardiology-Arrhythmias brady dependent vt eads dads early and late after depolarisation enhanced automaticity vs triggerred activity vs reentry Source Type: blogs
Acute Aortic syndrome : Please mind the Length of “ Ascending Aorta ” as well !
Aorta probably is the most critical structure in the entire circulatory system. (apart from the heart of course !) It is a 1.5 to 2.5 mm thick tube, with a diameter of 2.5 cm/length of 30 -35 cm from the aortic valve to the iliac bifurcation.(Eric Borsero 2011) It handles about 7500 liters of blood every day. Understanding the Aortic pathology has vastly improved at the molecular level with deep gene sequencing that defines fibrillin phenotypes. Meanwhile, CT , 4D MRI and 3D prototyping have landed us in a new era where we can feel the exact models of a patient’s virtual aAorta for monitoring and treatment purp...
Source: Dr.S.Venkatesan MD - November 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized marfan aortic dissection aorta size new coconcepts in aortic dimension normal aorta size normal aortic root size what is normal length of ascending aorta Source Type: blogs
Acute Aortic syndrome : Please mind the length of “ Ascending Aorta ” as well.
Aorta probably is the most critical structure in the entire circulatory system. (apart from the heart of course !) It is a 1.5 to 2.5 mm thick tube, with a diameter of 2.5 cm/length of 30 -35 cm from the aortic valve to the iliac bifurcation.(Eric Borsero 2011) It handles about 7500 liters of blood every day. Understanding the Aortic pathology has vastly improved at the molecular level with deep gene sequencing that defines fibrillin phenotypes. Meanwhile, CT , 4D MRI and 3D prototyping have landed us in a new era where we can feel the exact models of a patient’s virtual aAorta for monitoring and treatment purp...
Source: Dr.S.Venkatesan MD - November 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: aortic aneurysm marfan aortic dissection aorta size new coconcepts in aortic dimension normal aorta size normal aortic root size what is normal length of ascending aorta Source Type: blogs
Antiarrhythmic drug classification
The popular Vaughan Williams classification was published in 1975 [1]. It is still being used by most of us. The Sicilian Gambit published in 1991 [2] has not been so popular because of its complexity.
Vaughan Williams classification is approximately as follows:
Class I: Sodium channel blockers
◦a: Moderate Na channel block. e.g. Quinidine, Disopyramide
◦b: Weak Na channel block. e.g. Lignocaine, Mexiletine
◦c: Marked Na channel block. e.g. Flecainide, Propafenone
Class II: Beta blockers
Class III: Potassium channel blockers: Amiodarone, Sotalol, Ibutilide
Class IV: Calcium channel blockers
In 2018, an exten...
Source: Cardiophile MD - October 13, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs
Body Sensors Printed Directly on Skin at Room Temperature
Biomedical sensors typically perform their best when they’re placed in close proximity to the body. While wearables, such as wrist-worn heart rate monitors, are common these days, they are very limited by where they can be placed on the body, h...
Source: Medgadget - October 12, 2020 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiology Geriatrics Informatics Materials Medicine Military Medicine Nanomedicine Neurology Space Medicine Sports Medicine Source Type: blogs
" It isn ' t a STEMI, " so cath lab refusal (again). Were they right?
Sent by Anonymous, written by Pendell MeyersAn elderly female called EMS for acute epigastric pain. EMS arrived and recorded this ECG on the way to the hospital:This case was sent to me with only the details above, and my response was: " It ' s posterolateral (and probably also inferior) OMI until proven otherwise. I ' d also give a little calcium because it ' s slow, wide, and a couple leads have almost pointy Ts. But I don ' t really think it ' s hyperK. This one is OMI. Either LCX or RCA, or perhaps an Obtuse Marginal that supplies those regions. "Interpretation: There is an absence of sinus activity, including an ...
Source: Dr. Smith's ECG Blog - September 27, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
