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Total 378 results found since Jan 2013.

Inferior STEMI with AV Block, Cardiogenic Shock and ST elevation in V1
This is a case I had with one of our superb internal medicine/emergency medicine residents, Marco Salmen, MD.  He wrote it up for this blog, with some help from me.CaseAn elderly woman called 911 for acute onset of nausea and chest pain of 30 minutes duration.  A prehospital ECG was identical to this first ED ECG:  Rhythm: There is a regular, narrow complex bradycardia, with ventricular rate of ~43 bpm. There appear to be P-waves at irregular intervals, but without relationship to the QRS.  Thus, there is third degree (complete) AV block.  The escape is narrow, thus junctional or from the bund...
Source: Dr. Smith's ECG Blog - January 20, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 3
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 3. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%% Your answers are hi...
Source: Cardiophile MD - January 17, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

Some Come To Bury The Stethoscope, Some To Praise It
Is the stethoscope still an essential tool of modern medicine or is it an obsolete low-tech vestige of an antiquated era? There is, to say the least, a wide variety of opinions on the topic. On the one hand, technology enthusiasts argue that the stethoscope should be replaced by portable ultrasound devices. “The stethoscope’s 200th birthday should...Click here to continue reading...
Source: CardioBrief - January 15, 2016 Category: Cardiology Authors: Larry Husten Tags: People, Places & Events Policy & Ethics Cardiology medical education stethoscope technology ultrasound Source Type: blogs

Rupture of Aneurysm of the Sinus of Valsalva Presenting as Cardiogenic Shock and Severe Ischemia
This was sent by Nick Jubert, MD, one of our fine EM residency graduates who works at a facility without a cath lab, so has to transfer patients who need a cardiac cath:Steve, Really interesting case I saw this morning, thought I’d send it your way. CaseA 60 year old female with a history of HTN, DM, hyperlipidemia presented via EMS with crushing central chest pain radiating to her neck, 7/10. Here is the EMS EKG: There is RBBB, with ST elevation in aVR and V1, and diffuse, marked, ST depression in I, II, aVF, aVL and V3-V6. This is severe subendocardial ischemia.I immediately activated the cath lab given c...
Source: Dr. Smith's ECG Blog - January 11, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

LITFL R&R – Best of 2015
This article is one more piece of the mounting evidence demonstrating a clear call to change what is the usual care in many  institutions in the U.S. Stop the madness! Chest pain is tough — it’s the second most ED common chief complaint, and it scares the heck out of us and our patients – partially because missed MI is one one of the top causes of litigation. But we also see a ton of resources spent on a terribly low yield from chest pain workups. This new study in JAMA-IM including Mike Weinstock (of Bounceback fame), Scott Weingart and David Newman looked at the bad outcomes of patients with normal ECG...
Source: Life in the Fast Lane - January 9, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Trauma critical care examination research and reviews Source Type: blogs

Research and Reviews in the Fastlane 116
This article raises the question of how important MIC is and whether we should be developing and testing alternate ways to assess antibiotic efficacy. Recommended by: Anand Swaminathan Emergency Medicine Piazza G et al. A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. JACC Cardiovasc Interv 2015; 24;8(10):1382-92. PMID: 26315743 This is simple prospective data on a highly selected group of patients with massive or sub massive PEs. There were almost as many authors as patients here...
Source: Life in the Fast Lane - January 6, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Infectious Disease Intensive Care Pediatrics Radiology Respiratory critical care examination R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs

ASD with right to left shunt on colour Doppler echocardiography
Subcostal view on echocardiography showing atrial septal defect (ASD) with right to left shunt Classically atrial septal defect (ASD) is best imaged from the subcostal view on echocardiography as the septum is perpendicular to the ultrasound beam in this view. The ASD is marked with stars in the left image panel. Right image panel shows the colour Doppler flow pattern across the ASD. Blue colour indicates that the flow is away from the transducer. In this case a downward flow across the ASD in this view is from right atrium to left atrium (right to left shunt). When right to left shunt across the atrial septum is noted in ...
Source: Cardiophile MD - December 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

A Fascinating Demonstration of ST/S Ratio in LBBB and Resolving LAD Ischemia
This case was contributed by one of my talented colleagues, Johanna Moore, MD.  She is our research director and is doing some great research on cardiac arrest.  Check out her research on Head-up CPR!There is more interesting stuff on Head up CPR here.  And here.CaseA patient with a history of CABG in 1998, with subsequent ischemic cardiomyopathy, called his clinic to report he had a few minutes of burning chest and epigastric pain, associated with walking, that was now gone.  They told him to call 911.  Medics arrived and recorded this ECG (pain free) about 15 minutes after the resolution of ...
Source: Dr. Smith's ECG Blog - December 16, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Research and Reviews in the Fastlane 112
Welcome to the 112th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check ou...
Source: Life in the Fast Lane - December 9, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Emergency Medicine Infectious Disease Orthopedics Pediatrics Pre-hospital / Retrieval critical care Education Intensive Care literature R&R in the FASTLANE recommendations Research and Review Source Type: blogs

Coconut atrium
is the term coined for complete calcification of the left atrium in chronic rheumatic valvular heart disease [1]. The stimulus for calcification could be the chronic inflammatory process of rheumatic fever as well as the strain due to atrial overload. Reduced left atrial compliance leads to elevation in pressures which gets transmitted to the pulmonary venous system, pulmonary arteries and sequentially to the right heart. Chest X-ray will show the calcified outline of the left atrium [2], which can be further confirmed by computerized tomographic (CT) scan. Coconut atrium has also been called as ‘porcelain atrium...
Source: Cardiophile MD - December 6, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac CT scan Cardiology X-ray Coconut atrium Coconut left atrium mold-like atrial calcification porcelain atrium Source Type: blogs

Atrial septal defect (ASD)
Illustrated Review with ECG, CXR, Echo Video, Cath Images X-ray chest in atrial septal defect X-ray chest PA view in atrial septal defect with pulmonary hypertension (Click on the image for an enlarged view) The main pulmonary artery (MPA) is grossly dilated. The right pulmonary artery (RPA) is also quite enlarged. Right atrial enlargement is seen as a shift of the cardiac contour to the right of the spine. Pulmonary vascularity is increased and prominent end on vessels (End on) are also seen. Apex is upwards, suggesting a right ventricular configuration. All features suggest a large secundum atrial septal defect with a l...
Source: Cardiophile MD - November 16, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology X-ray ECG / Electrophysiology Echocardiography Structural Heart Disease Interventions ASD Crochetage Sign ASD ECG ASD echo ASD Echo Video ASD X-Ray Chest PA Colour Doppler Echo in ASD ECG in A Source Type: blogs

New hardware in thrombus capture : Megavac appear promising !
If thrombus is the chief culprit in any vascular emergency  there can be  no second thoughts as it needs immediate  arrest without warrant! (STEMI,Acute pulmonary embolism , DVT, Acute limb ischemia etc) Since pharmacological lysis of thrombus is easy and  be done immediately  it will continue to play a major role still , in many clinical situations that critically compromise organ function . However , large  thrombus burden  (or in which medical therapy fails to do a good job )  we must  intervene mechanically  to change the course of event.Though vascular surgery is a definitive option its always better we try ...
Source: Dr.S.Venkatesan MD - November 16, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Hadwares in cardiology Hardware techniques tips Newer hardwares in cardiology Technology Emerging coronary hardware distal protection device Thrombus capture megavac thrombus suction in pulmonary embolism Source Type: blogs

Pleural effusion in heart failure – on which side is it more common?
Brief Review Conventionally it is considered that pleural effusion in heart failure is more common on the right side. If it is bilateral, it is likely to be more severe on the right side. In fact if it is more on the left side, the conventional teaching is that a cause other than heart failure is to be looked for. There have been several discussions on the sidedness of pleural effusion in heart failure one view is that the larger surface area of right lung permits more transudation into the right pleural cavity. Another technical aspect is that an enlarged heart on the left side may prevent the detection of minimal effusio...
Source: Cardiophile MD - November 14, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology heart failure pleural effusion pleural effusion in heart failure Source Type: blogs

Possible clot issue on replacement aortic valves slows momentum of TAVR
The next frontier in cardiology is the replacement of cardiac valves via catheters rather than open-chest surgery. This new branch of cardiology is called “structural” cardiology. Trainees do entire “structural” fellowships in which they learn to do things with catheters that surgeons once did with open chest techniques. You may have heard about TAVR–or transcatheter aortic valve replacement. This procedure was pioneered in Europe, and now more than 200,000 cases have been done worldwide. We have a nascent but successful TAVR program at my hospital. In the US, TAVR is approved only for patient...
Source: Dr John M - October 10, 2015 Category: Cardiology Authors: Dr John Source Type: blogs

Think twice before having carotid artery surgery
Hundreds of thousands of people have undergone surgery or stents to “fix” blockages in their carotid arteries. (The left and right carotids are the main arteries to the brain.) Most of the these people (about 90%) reported no complaints. We say they are asymptomatic. The blockages were discovered on exam or by ultrasound of the neck. The idea is that major blockages can progress to full blockages and cause stroke. Since it’s best to prevent stroke, patients with blockages get referred to surgeons and surgeons operate. The fix entails cleaning out the blockage, which we call endarterectomy. More recently, ...
Source: Dr John M - October 1, 2015 Category: Cardiology Authors: Dr John Source Type: blogs