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Procedure: Electrocardiogram
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Total 559 results found since Jan 2013.
A woman in her 60s with syncope and vomiting. Does she need a pacemaker?
Written by Pendell Meyers with some edits by Steve SmithA woman in her 60s on chemotherapy presented to the Emergency Department for a syncopal episode just prior to arrival. She was walking to the bathroom when she suddenly felt nauseous and passed out. EMS was called by the patient ' s daughter, and en route to the ED she vomited twice. On arrival to the ED, she adamantly denies chest pain but says she ' s " just still not feeling well. " She had no prior known cardiac disease.Triage at 0755:The rhythm is most either atrial fibrillation with complete heart block and resulting junctional escape, or atrial flutter wi...
Source: Dr. Smith's ECG Blog - November 19, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Philips to Expand Its Cardiac Diagnostics and Monitoring Portfolio With the Acquisition of Cardiologs
Royal Philips (NYSE: PHG; AEX: PHIA), a global leader in health technology, today announced that it has signed an agreement to acquire Cardiologs, a France-based medical technology company focused on transforming cardiac diagnostics using artificial intelligence (AI) and cloud technology. Cardiologs will further strengthen Philips’ cardiac monitoring and diagnostics offering with innovative software technology, electrocardiogram (ECG) […]
Source: EMR and HIPAA - November 10, 2021 Category: Information Technology Authors: Healthcare IT News Tags: Health IT Company Healthcare IT Telemedicine and Remote Monitoring AEX: PHIA BioTelemetry Cardiac Monitoring Cardiologs ECG Health IT Acquisitions Healthcare AI Healthcare Wearables Medical Devices NYSE: PHG Philips Roy Jakobs 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
Acute Pulmonary Edema, PEA Arrest, LBBB, First degree AV Block, and STD maximal in V3, V4
An elderly woman had sudden SOB and 911 was called. Medics found her with labored breathing and 75% saturations. She was put on high flow oxygen. After placing her in the ambulance, she had a PEA arrest. She was intubated and ventilated, and given compression decompression CPR with theResQPod andResQPump.Aside:these 2 devices were invented by researcher Keith Lurie, who is in the Department of EM here at Hennepin; this isthe only method of CPR ever proven in a randomized trial to improve outcome in cardiac arrest see this ResQTrial, published in Lancet in 2011:Treatment of out-of-hospital cardi...
Source: Dr. Smith's ECG Blog - October 25, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
An elderly man who dies 12 hours later - could he have been saved?
Sent by Anonymous, written by Pendell Meyers and Steve SmithAn elderly man with good neurologic baseline but history of CABG presented to the ED with acute lightheadedness, shortness of breath, and chest pressure radiating to both arms. He had just recently been admitted for similar symptoms which had been diagnosed as an NSTEMI, and he received a stent to the ostial LCX one week ago. At that time his EF was 30%. He returned to the same hospital where he had just received his LCX stent.Here is his first ECG at triage, with chest pain temporarily resolved:He then had spontaneous return of chest pain while in the ED, wi...
Source: Dr. Smith's ECG Blog - October 22, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
I thought the ECG diagnosis was obvious. But many missed it. So I ' m showing it.
I was reading ECGs in the system and came across this one:What do you think?Computer diagnosis: --ST DEVIATION AND MARKED T-WAVE ABNORMALITY, ANTEROLATERAL ISCHEMIA --ST DEVIATION AND MODERATE T-WAVE ABNORMALITY, CONSIDER INFERIOR ISCHEMIA I thought the ECG diagnosis was obvious, but no comment was made by the providers who ordered it. That could be because they never saw it, as the patient eloped before full evaluation. But then I showed it to multiple smart providers and not a single one saw it. So I thought it would be good to show it to blog readers.Everyone went straight to the ST...
Source: Dr. Smith's ECG Blog - October 18, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Potassium channel suppressed in hypokalemia – Cardiology MCQ – Answer
Potassium channel suppressed in hypokalemia – Cardiology MCQ – Answer
Potassium channel suppressed in hypokalemia – Correct answer: 1. Ikr
Prolongation of action potential duration in hypokalemia is due to inhibition of the outward potassium current. IKr, the rapid component of the delayed rectifier potassium current, is markedly suppressed in hypokalemia. There is rapid inactivation of IKr during repolarization. Downregulation of IKr occurs in chronic hypokalemia. In addition chronic hypokalemia causes internalization of IKr channels, reducing their surface density on the plasma membrane. Prolongation...
Source: Cardiophile MD - October 9, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance 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
A man in his 70s with chest pain, shortness of breath, and acute huge anterior ST elevation
Written by Pendell MeyersA man in his 70s presented to the ED complaining of various symptoms including chest pain and shortness of breath. He had a very hard time explaining his symptoms, and it was very hard to obtain an accurate history. It was unclear to us how long the patient had been experiencing symptoms, but I feel confident that he was actively having symptoms at the time of my evaluation. He did seem to admit to using cocaine, possibly yesterday evening, but unclear. His vitals were within normal limits except mild tachycardia.Here was his triage ECG:What do you think?I texted it to Dr. Smith with no information...
Source: Dr. Smith's ECG Blog - September 9, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
A 76 Year Old Female With Recurrent Syncope, Lightheadedness, Palpitations and Negative Stress Test
Written by Lucas Goss MD, peer reviewed by Meyers, Smith, BraceyA 76 year old female with a history of arial fibrillation not on anticoagulation, non-obstructive CAD found on coronary CTA 2 years prior, HTN, HLD, recurrent lightheadedness, and syncope status post loop recorder placement, presented for another episode of feeling lightheaded, diaphoretic, and feeling like she “was going to die.” She was discharged just the day prior for her second hospitalization for similar episodes. She was actually at the pharmacy to pick up her medicines the day after discharge when this episode occurred, and pharmacy staff sat her d...
Source: Dr. Smith's ECG Blog - September 4, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Carbon Nanotube Thread Lets Clothes Monitor Health
Researchers at Rice University managed to create flexible carbon nanotube fibers that can be incorporated into clothing to function as wearable health monitors. The new thread is highly conductive, but it is washable and strong, allowing it to functi...
Source: Medgadget - August 31, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Materials Nanomedicine nanotubes riceuniversity 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
Wide and weird
Written by Clare Gunn MD, peer reviewed by Smith, Meyers, BraceyA 74-year-old female presented to the ER after a trip and fall (unclear if purely mechanical or due to possible unsteadiness) causing her to cut her leg. Due to chronic anticoagulation for atrial fibrillation, she could not stop the bleeding, so she came the ED. On arrival she is found to be hypoxemic requiring four liters of oxygen via nasal cannula. While getting her leg wound repaired, the patient was also evaluated for hypoxemia and tachycardia and was found to have this ECG:What do you think?Here was her most recent prior ECG on file for comparison:...
Source: Dr. Smith's ECG Blog - August 27, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
A 52 year old female with chest pain
Written by Pendell Meyers, edits by Steve SmithA 52 year old female with history of hypothyroidism and smoking presented to the ED with an episode of chest pain that began suddenly around 1500 while sitting down at work. She states it felt like a central chest pressure that radiated to her jaw. The pain had been persistently present since since 1500 (seen at 1615 in the ED), but had waxed and waned in severity, with the initial onset of pain being the worst. She had dyspnea and diaphoresis when the pain began. Coworkers called EMS who administered aspirin and NTG, which the patient says did not relieve her pain. During ini...
Source: Dr. Smith's ECG Blog - August 16, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
