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Specialty: Cardiology
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Total 689 results found since Jan 2013.
A woman in her 50s with chest pain and lightheadedness and " anterior subendocardial ischemia "
Written by Pendell MeyersA woman in her 50s presented with acute chest pain and lightheadedness since the past several hours. Here is her triage ECG during active symptoms:What do you think?The ED physician read this as " Normal sinus rhythm. LVH. Marked ST abnormality, possible anterior subendocardial injury. " Smith: I suspect this was a confirmation of the conventional computer interpretation. These are often wrong and lead the physician astray.This is wrong on many levels. The rhythm is some form of heart block (see Ken ' s comments at end of post) with junctional escape. The STD maximal in ...
Source: Dr. Smith's ECG Blog - July 30, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation
A 40-something with persistent Ventricular Fibrillation presented after attempted prehospital resuscitationA 40-something with no previous cardiac history presented to the ED in persistent Ventricular Fibrillation after attempted prehospital resuscitation. He underwent further standard resuscitation EXCEPT that we applied the Inspiratory Threshold Device (ResQPod) AND applied Dual Sequential Defibrillation (this simply means we applied 2 sets of pads, had 2 defib machines, and defibrillated with both with only a fraction of one second separating each defibrillation.Two recent interventions have proven in randomized t...
Source: Dr. Smith's ECG Blog - July 14, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Clinical Examination of Cardiovascular System For Medical Students
Discussion on blood pressure is not included here as a separate topic is dedicated to it.
Though the most commonly examined pulse is the radial, to check some of the characteristics, a more proximal pulse like the brachial or carotid needs to be examined. Following parameters of the pulse are routinely documented: 1. The rate: Normal rate in adult is 60-100 per minute. It is higher in children. Younger the child, higher the pulse rate.
Rhythm: Regular and irregular rhythms are possible. Mild variation with respiration is called respiratory sinus arrhythmia, with higher rate in inspiration. Respiratory sinus arrhythmia may...
Source: Cardiophile MD - May 30, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
50 year old with acute chest pain, with ‘normal’ ECG and falling troponin
Written by Jesse McLaren, with comments from SmithA 50-year old patient on the medical wards developed acute
chest pain, with an ECG labeled (see computer interpretation at the top) and confirmed as normal. What do you
think? There ’s normal sinus rhythm, normal conduction, normal axis,
normal R wave progression, and normal voltages. Lead aVL jumps out as abnormal
because there is a discordant T wave inversion and mild ST depression. This is reciprocal to inferior
mild ST elevation and hyperacute T waves (wide based, bulky, and symmetric, and in III taller than
the QRS complex), and adjacent to ST depression in...
Source: Dr. Smith's ECG Blog - April 21, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A man in his 60s with acute chest pain and high voltage
Sent by Anonymous, written by Pendell MeyersA man in his 60s with history of CAD and 2 prior stents presented to the ED complaining of acute heavy substernal chest pain that began while eating breakfast about an hour ago, and had been persistent since then, despite EMS administering aspirin and nitroglycerin. There was associated diaphoresis, but no dyspnea, nausea, or vomiting. He reported having covid 2 weeks ago, but had seemingly fully recovered.Triage 1104:What do you think?The triage ECG was sent to me with no history (I did not have access to baseline ECGs), and I said that I thought this was just LVH causing the an...
Source: Dr. Smith's ECG Blog - April 14, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Off and on chest pain for 24 hours in a 50s year old man
Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell MeyersA man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath. His pain was initially mild, then became severely worse several hours prior to presentation, but then eased off again and was minimal on arrival. There was no associated diaphoresis, nausea, vomiting, arm pain, jaw pain, syncope, lightheadedness or other acute symptoms.Initial vitals: Temp 36.7 C, BP 161/79, RR...
Source: Dr. Smith's ECG Blog - April 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 50s with chest pain
Sent by anonymous, written by Pendell MeyersA man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. He had episodes of chest pain off and on all night, until about 1 hour prior to arrival when the pain became constant, crushing, 10/10 chest pain that radiated to both arms. He denied any lightheadedness, shortness of breath, vomiting, or abdominal pain. Vitals were within normal limits.Here is his triage ECG at 0343:What do you think?Meyers interpretation: Diagnostic of LAD OMI, with hyperacute T waves in a large LAD distribution including precord...
Source: Dr. Smith's ECG Blog - March 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
QS-wave in V2: 2 cases, different paradigms lead to different treatment times (STEMI - NSTEMI vs. OMI - NOMI)
Submitted by anonymous, written by Pendell Meyers. Additional case by Smith.Case 1A middle aged woman presented with acute chest pain and shortness of breath, unclear time since onset, and likely with episodic symptoms off and on throughout the day. Her vitals were within normal limits.ED1 @1512What do you think?Meyers: Very clear and specific for acute LAD OMI, with hyperacute T waves in the LAD distribution including leads V2-V6, II, III and aVF. Only very slight STE which does not meet STEMI criteria at this time. I am immediately worried that this OMI will not be understood, for many reasons including lack of suf...
Source: Dr. Smith's ECG Blog - January 28, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A woman in her 20s with syncope
Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and GrauerA woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope.Her initial vital signs revealed a temp of 97.7F, HR 125, RR 20, BP 115/90, and an oxygen saturation of 95% on room air. Upon arrival, she did not appear in acute distress. She was noted to be tachycardic and her heart sounds were distant on physical exam. She had a normal respiratory effort, and her lungs were clear to...
Source: Dr. Smith's ECG Blog - November 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
What do you think of this " Ventricular Bigeminy " ?
Written by Bobby Nicholson MD, with edits by MeyersA woman in her 50s with past medical history of heart failure, prior stroke, atrial fibrillation on Eliquis, lung cancer in remission, and CKD, presented to the emergency department for evaluation of cough and shortness of breath. EKG was obtained in triage and read as ventricular bigeminy. What do you think?On my first read of the EKG, I agreed with the initial interpretation. Pendell Meyers then recommended that I take a second look at the morphology of the QRS complexes. I think it was easiest for me to see in the rhythm strip, but there are clearly P waves in front of ...
Source: Dr. Smith's ECG Blog - November 19, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Which chemotherapeutic agent is well known to cause coronary vasospasm?
5-fluorouracil is well known to cause coronary vasospasm. 5-fluorouracil and its orally active prodrug capecitabine are fluoropyrimidines, belonging to the class of antimetabolites used for treatment of malignancies of breast, head and neck tumours and gastrointestinal tumours.
Mechanisms for coronary vasospasm
Endothelial cell damage with cytolysis and denudation
Increased endothelin-1 bioactivity leading to vasoconstriction
When high dose infusions are given, coronary vasospasm with angina, arrhythmia or even sudden death can occur in up to 5% of patients. Vascular toxicity occurs generally within 72 hours of the...
Source: Cardiophile MD - November 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Balloon aortic valvuloplasty – Cardiology Basics
Balloon aortic valvuloplasty – Cardiology Basics
Balloon aortic valvuloplasty is enlargement of a narrowed aortic valve using balloon catheters. It is also known as balloon aortic valvotomy.
Balloon aortic valvuloplasty has significant risks and lesser benefits compared other procedures for symptomatic severe aortic stenosis like surgical valve replacement and transcatheter aortic valve implantation or TAVI. Hence it is often considered as a bridge treatment or palliative treatment.
Three important scenarios in which balloon aortic valvuloplasty or BAV is considered are: Bridge to decision, bridge to planned treatmen...
Source: Cardiophile MD - October 22, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Two patients with chest pain. Do either of them need emergent reperfusion? Both? Neither?
Written by Pendell MeyersHere is a quick comparison / quiz post. It will be easy for long time blog readers. The two ECGs below are both from middle aged patients with acute chest pain. Do either, neither, or both patients have an ECG diagnostic of OMI, warranting emergent reperfusion therapy?Patient #1:Patient #2:Distinguishing subtle OMI from normal variant ST elevation can be a difficult but important skill that is achieved through supervised pattern memorization and recognition. As in the cases above, the distinction CANNOT BE MADE BY AMOUNT OF MILLIMETERS. Patient #1 has a totally normal, normal variant ECG...
Source: Dr. Smith's ECG Blog - September 9, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
See what happens when the consultant is " Not convinced of STEMI "
Sent by Arjun V, written by Pendell Meyers, edits by SmithA man in his early 40s with history of HTN and obesity suffered sudden out of hospital cardiac arrest. EMS arrived and found him in VF. He was defibrillated successfully, but had several more episodes of VF arrest on the way to the Emergency Department. Here are some examples of his prehospital rhythms:At the ED, sustained ROSC was achieved. He was intubated with minimal available neurologic exam.He had several ECGs recorded in the ED soon after ROSC:The ECGs show likelyAFib with RBBB morphology. There isprofound right axis deviation, which likely r...
Source: Dr. Smith's ECG Blog - July 13, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Is this Myo-pericarditis? Or OMI with subsequent pericarditis? Does the angiogram always explain the ECG findings?
Conclusion: Although at 1st glance, it looked like the ECG picture in Figure-1 might be suggestive of acute pericarditis — on further inspection, there are significant ECG features against the diagnosis of acute uncomplicated pericarditis.As per the superb discussion above by Dr. Smith — evolution of this case (including the ECG picture on serial tracings) — are consistent with what probably occurred in today ' s case, namely the combination of acute OMI from LCx occlusion, followed by development of post-infarction regional pericarditis.
Source: Dr. Smith's ECG Blog - June 11, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
