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Procedure: Ultrasound
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Total 378 results found since Jan 2013.
RBBB with STE in I and aVL. Will the angiogram tell you if this ECG represents Occlusion MI or not?
A middle aged male with history of STEMI and stents presented with one hour of chest pain.Here is his ED ECG:What do you think?Analysis: There is sinus rhythm with RBBB. There is ST Elevation in I and aVL which is discordant to the wide S-wave (a wide S-wave in lateral leads is a feature of RBBB). There is also some ST depression in lead V3 (inferoposterior OMI is suggested). There is no R ' -wave in V2 and so one would not expect the typical discordant ST depression and TW inversion that one often sees in V2. However, V3 does have an R ' -wave, and STD, but the T-wave isconcordantly positive, which...
Source: Dr. Smith's ECG Blog - April 11, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
What Has A.I. In Medicine Ever Done For Us? At Least 50 Things!
Remember Monty Python’s brilliant Life of Brian movie scene where the Judean Jewish insurgent commando, planning the abduction of Pilate’s wife in return for all the horrors they had to endure from the Roman Empire, asks the rhetorical question: what have the Romans ever done for us? With the hype and overmarketing, not to speak about the fears around A.I, we asked the same question. What has A.I. in medicine ever done for us? Well, we found at least 50 things.
I have 50 responses to the pressing question on everyone’s mind who is interested in healthcare but tired of the hype or the doomsday scenarios around A.I....
Source: The Medical Futurist - March 1, 2022 Category: Information Technology Authors: berci.mesko Tags: Artificial Intelligence in Medicine Future of Medicine AI cancer diagnostics digital health Healthcare Innovation medical Radiology technology medical imaging treatment administration digital health technology Source Type: blogs
Wide Complex Tachycardia with Huge ST Elevation. What is going on?
This 70-something woman with no significant past history (no previous ECGs or cardiac history) presented by EMS with fairly acute chest pressure and shortness of breath, with nausea and diaphoresis. " Like an elephant sitting on my chest. " She had no history of atrial fibrillation and was not on any anticoagulants.She stated that she had had a similar episode a couple weeks earlier, lasting 24 hours, with rapid heart beat but without chest pain, that spontaneously resolved. She thought she was having a panic attack. Since then she has had " little spurts " of the same thing lasting 1-2 hours.E...
Source: Dr. Smith's ECG Blog - January 12, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Hyperacute T-waves -- missed. Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) may be due to transient thrombotic Occlusion MI.
Coronary thrombosis (twice in the same patient!!) without a stenosis or even a culpritDo not miss the last image at the bottom that shows the series of T-waves in V4-V6I recently had a discussion with an incredibly smart and fantastic ECG and Cardiology expert. He was skeptical that you can have OMI with Wellens waves without having a major stenosis on angiogram.I told him I ' ve seen it on occasion and that this happens due to thrombosis of non-obstructive lesions that lead to complete occlusion but that thencompletely lyse and do not show stenosis by the time of the angiogram. I said that even if there is not...
Source: Dr. Smith's ECG Blog - December 29, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Mitral valve area by pressure half time
Measurement of mitral valve area by pressure half time is an often applied method using Doppler echocardiography.
Mitral valve area by pressure half time
Mitral valve area can be calculated from the pressure half time (PHT) of the initial downward slope of the mitral A wave, which fuses with the E wave in mitral stenosis. Lower the slope, lower the mitral valve area and higher the severity of mitral stenosis. Pressure half time is the time taken for the gradient to reduce to half of its peak value. PHT 220 ms corresponds to a mitral valve area of 1 square centimeter. Here the PHT is 163 ms, hence mitral valve area will be...
Source: Cardiophile MD - November 13, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs
PEA cardiac arrest, ROSC, and no STEMI on ECG. Randomized trials say emergent reperfusion is not indicated, right?
This study had a fatal flaw: they did not keep track of all the " Non-STEMI patients " who were NOT enrolled, but instead were sent for immediate angiogram. It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab. So it is highly likely that physicians were very reluctant to enroll patients whom they suspected had Occlusion MI (OMI), even if they did not have STEMI. These physicians did not want a patient with an OMI that was not a STEMI to be randomized to no angiogram. This strong suspicion is supported by their data: only 22 o...
Source: Dr. Smith's ECG Blog - November 4, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Mural endocarditis
Vegetations in infective endocarditis are usually situated on the valves. If they are located on the walls of the cardiac chambers, it is known as mural endocarditis [1]. When mural endocarditis occurs without any cardiac structural abnormalities like ventricular septal defects, it is called primary mural endocarditis [2]. Primary mural endocarditis is extremely rare.
Left atrial mural endocarditis usually occurs due to the jet lesion of mitral regurgitation [1,3]. Left atrial mural endocarditis is usually picked up by trans esophageal echocardiography. Vegetations are mostly located just distal to the mitral orifice betw...
Source: Cardiophile MD - October 31, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
A man in his 60s woken from sleep by epigastric pain. Would you have been able to correctly diagnose him?
Written by Pendell MeyersA man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He called EMS who brought him to the ED. He had active chest pain at the time of triage at 0137 at night, with this triage ECG:I sent this ECG, without any text at all, to Dr. Smith, and he replied: " LAD OMI with low certainty. V3 is the one that is convincing. " After his response I sent him the baseline ECG (below), still with no context at all except that this was his prior ECG:Dr. Smith replied: " Now high certainty. By the way,...
Source: Dr. Smith's ECG Blog - October 5, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Chest pain in a 30-something: Is it Normal variant STE or OMI? Get the prior ECG, and don ' t trust Point of Care troponin assays!
In this study, Smith and others show that the initial high sensitivity troponin is often below the 99th percentile in true STEMI (+) OMI (and sometime even below a very low threshold).[1] Wereski, R., Chapman, A. R., Lee, K. K., Smith, S. W., Lowe, D. J., Gray, A.,& Mills, N. L. (2020). High-Sensitivity Cardiac Troponin Concentrations at Presentation in Patients With ST-Segment Elevation Myocardial Infarction. JAMA Cardiology, 5(11), 1302 –1304.
Source: Dr. Smith's ECG Blog - October 2, 2021 Category: Cardiology Authors: Bracey Source Type: blogs
How did all those calcium entered my father ’ s coronary artery doctor ?
“It was severe double vessel disease & turned out to be a complex angioplasty in LAD ”
Why doctor? what happened?
It was a hard lesion, there was plenty of calcium deposits. It was not clearly visible in the angiogram. I had to do IVUS. Curiously, the calcium was clustered in all the three planes of the vessel ( intima the media and adventitia) and they projected into the lumen blocking the path.
Image collage representation purpose
Thank you, doctor, how did you manage to remove it,?
It was a real struggle. I had to break the calcium shell before deploying the stent. (What we refer to as...
Source: Dr.S.Venkatesan MD - September 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions calcium supplementation coronary calcification intimal medial adventitial calcium ivl wolverine angiosculpt opn balloon orbitel atherectomy osteoporosis plaque calcium rotoablator serum calcium vs coron Source Type: blogs
Some ECG simply require pattern recognition, followed by a bit of investigation
Brooks Walsh @BrooksWalsh helped with this post One of my partners showed me this series of ECGs, without any info:I said: " It ' s a normal variant. Young black male, right? "He said, " Yes, but look at this one recorded 2 hours later. It is different " :There is T-wave inversion in V4 that was not there before.I said: " Yes, small changes can happen even with normal variants. " And there might be a slight difference in lead placement. On the 2nd ECG, V4 is farther to the right -- notice there is more S-wave than on the first and the R/S ratio is smaller. There was also a 3rd ECG at 3.5 h...
Source: Dr. Smith's ECG Blog - August 30, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Photoacoustic Carbon Nanotubes Reveal Dangerous Atherosclerotic Plaques
Researchers at Michigan State University have developed a system that allows the imaging and identification of inflamed atherosclerotic plaques, which are considered to be at risk of rupture. Their system involves administering carbon nanotubes that ...
Source: Medgadget - August 18, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Nanomedicine Radiology Vascular Surgery Source Type: blogs
Classification of TAPVC
Total anomalous pulmonary venous connection (TAPVC) has been classified into four types by Craig JM, Darling RC and Rothney WB in 1957 [1]. It is popularly known as Darling classification. According to this classification, TAPVC is divided into four types based on the anatomic site of the anomalous connection. Type 1 is a supracardiac, type 2 is an intracardiac, type 3 is infracardiac and type 4 a mixed variety. This is the most commonly used classification.
In the supracardiac variety, the four pulmonary veins drain into a common venous chamber which drains to the left brachiocephalic vein through a vertical vein. In typ...
Source: Cardiophile MD - July 31, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Ultrasound Patch Monitors Blood Flow
Researchers at the University of California San Diego created an ultrasound patch that can measure blood flow in vessels as deep as 14 cm within the body. The stretchy patch can be applied to the skin and may help clinicians to monitor and diagnose v...
Source: Medgadget - July 28, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Diagnostics Materials Radiology Thoracic Surgery Vascular Surgery Source Type: blogs
Future for Doctors: 5 Trends in Technology That Shape Medical Specialties
In our latest e-book, The Technological Future of Medical Specialties, we reflect on the major impact digital health and related technologies will have on 20 medical specialties. While technologies will play an important role in practically every medical specialty, they won’t all be as specifically intertwined with digital health technologies as the ones we focused on.
We not only individually analyse how advanced technologies will influence those 20 medical specialties but also explore how patient empowerment will shape the medical profession and the required skills needed for everyone working in this industry. To di...
Source: The Medical Futurist - July 6, 2021 Category: Information Technology Authors: Pranavsingh Dhunnoo Tags: imported Source Type: blogs
