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Blood Pressure Meds vs Blood Thinners: What ’ s The Difference?
Conclusion In conclusion, while blood pressure medicines and blood thinners are both crucial to heart health, their roles and mechanisms of action are notably distinct. Blood pressure medication works primarily on the vascular system, aiding in reducing blood pressure by relaxing blood vessels or altering the heart’s function. On the other hand, blood thinners target the blood itself, working to prevent the formation of potentially dangerous blood clots. Throughout this article, one thing becomes undeniably clear: the importance of regular consultations with your healthcare provider. When it comes to managing m...
Source: The EMT Spot - July 20, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs

I was reading ECGs on the system when I came across this one, called " normal " by the conventional computer algorithm
I come in early for every shift to read the ECGs on the system that have not yet been " confirmed " .  I came across this one:The computer calls is: " SINUS RHYTHM. NORMAL ECG "What do you think? Be VERY careful when the computer calls the ECG " Normal " .  I saw the inferior ST depression (which is reciprocal to subtle STE in aVL) and the subtle ST depression in precordial leads and thought:" If this patient came in with chest pain, then it is an acute OMI. "So I looked on the computer.  Turns out that it was a 50-something patient with no previous cardiac history who had called 911 for chest pain...
Source: Dr. Smith's ECG Blog - July 12, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

63 year old with " good story for ACS " but negative troponins.....
 This was texted to me from a former resident, while working at a small rural hospital, with the statement:" I can ’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS. "  (Chest pain or discomfort)What do you think?Here was my response:" Suspicious for inferior posterior OMI.  Get serial ECGs "He then sent a previous from 4 years prior:" This is totally normal, which confirms that the first EKG does indeed represent OMI "Then the patient ' s chest pain resolved and he recorded another:The ST depression in aVL is gone and the T-waves are less hyperacu...
Source: Dr. Smith's ECG Blog - July 2, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

A man in his 50s with acute chest pain who is lucky to still be alive.
 Sent by Magnus Nossen MD, written by Pendell MeyersA man in his 50s, previously healthy, developed acute chest pain. EMS was called, and they recorded the following ECG on scene at 13:16:What do you think?Below is the version standardized by PM Cardio appMeyers interpretation:Findings are specific for posterior (and also likely inferior) wall transmural acute infarction, most likely due to acute coronary occlusion (OMI). There is a relatively normal QRS yet there is STD maximal in V2-V4, which resolves from V4 to V6. The inferior leads may have a slightly full T wave (possibly hyperacute if compared to baseline which...
Source: Dr. Smith's ECG Blog - June 21, 2023 Category: Cardiology Authors: Pendell Source Type: blogs

A man with chest pain off and on for two days, and " No STEMI " at triage.
 Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen SmithA 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. Here is his triage ECG which was obtained at 20:34 during active pain.What do you think?This ECG was read as “No STEMI” with no prior available for comparison. It is true this ECG does not meet STEMI criteria (there is 1.0 mm STE in III, and possibly 0.5 mm in aVF), but there is clear evidence of OMI findings on this ECG. Leads II, III, and aVF hav...
Source: Dr. Smith's ECG Blog - June 19, 2023 Category: Cardiology Authors: Pendell Source Type: blogs

A 40-something male with resolving chest pain and a " Normal ECG " by computer and cardiology overread
A 40-something male presented by ambulance with one hour of chest pain that was improving after sublingual nitroglycerine and 325 mg of aspirin, chewed.  Here is his initial ED ECG:What do you think?I read this ECG without any history as reperfusing inferior and posterior OMI due to the Q-wave in lead III with minimal STE and reciprocal ST depression in V2-V4 (which should never be there).  The large upright T-wave in V2 is consistent with reperfusion.Any ST Depression Maximal in V1-V4 is OMI until proven otherwiseI sent this ECG with no information to Pendell.  We send each other EKG by the dozens...
Source: Dr. Smith's ECG Blog - June 5, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief).
I received the following text message with these 3 EKGs (providers text me ECGs all day every day; most are false positives; many are subtle true positives):" Hi Steve, here are 3 EKGs for you (my colleague ' s case).  A 67 yo f developed chest pain this morning. "EKG #1Followed 15 minutes by this #2 EKG:Then the patient received aspirin andDilaudid (hydromorphone, same effect as morphine) and the pain went away and there was this 3rd ECG:Smith comment: hydromorphone will make any pain go away (or improve) without any improvement in the underlying pathology.  Do NOT give it unless you are committed to t...
Source: Dr. Smith's ECG Blog - May 31, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

A 40-something with 100 minutes of chest pain
I was reading ECGs on the system, and saw this one:What do you think?I knew that, if the patient had presented with chest discomfort, that this ECG is diagnostic of inferior posterior OMI, even though it is not a STEMI.However, it is difficult to recognize for an interpreter who is does not have special expertise in OMI ECG diagnosis. We taught an AI system fromPM Cardio to recognize patterns of subtle OMI (beware: this version of the app is not available to the public yet).  We named the AI app the " Queen of Hearts " This is what the Queen said about this ECG:" OMI with High Confid...
Source: Dr. Smith's ECG Blog - March 27, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

A man in his 60s with acute chest pain
Sent by anonymous, written by Pendell MeyersA man in his 60s presented with acute chest pain with diaphoresis. He had received aspirin and nitroglycerin by EMS, with some improvement. His vitals were within normal limits. Here is his triage ECG:2045:What do you think?The ECG is subtle, but diagnostic of infero-posterior OMI. The QRS is normal, yet in aVL the normal upright small QRS complex is followed by in appropriately large-volume T wave inversion, which is reciprocal to the T waves in lead III, which are probably hyperacute if compared to available baseline. Corroborating this is the subtle ST depression in V2-V3 whic...
Source: Dr. Smith's ECG Blog - February 6, 2023 Category: Cardiology Authors: Pendell Source Type: blogs

Chest pain, and Cardiology didn ' t take the hint from the ICD
Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and GrauerA 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The screening physician ordered an EKG and noted his ashen appearance and moderate distress. Triage EKG:What do you think?Triage physician interpretation: -sinus bradycardia-lateral ST depressionsWhile there are lateral ST depressions (V5, V6) the deepest ST depressions are in V4. Additionally, lead V3 has ST depressions, which are always abnormal (recall that lead V3 will haveST elevation under nor...
Source: Dr. Smith's ECG Blog - January 23, 2023 Category: Cardiology Authors: Bracey Source Type: blogs

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said " Nothing too exciting. "
This article fails to specify whether it was troponin I or T, but I contacted the institution and they used exclusively troponin I during that time period.Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. The impact of ST-segment elevation on the prognosis of patients with Takotsubo cardiomyopathy. J Electrocardiol [Internet] 2022;Available from: http://dx.doi.org/10.1016/j.jelectrocard.2022.09.009Cardiology opinion: Takotsubo Cardiomyopathy (EF 30-35%)V Fib Cardiac arrestProlonged QTCNSTEMI (Smith comment: is it NSTEMI or is it Takotsubo?  -- these are entirely different)Moderate sin...
Source: Dr. Smith's ECG Blog - November 30, 2022 Category: Cardiology Authors: Steve Smith 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

What is PT-INR monitoring? Cardiology Basics
INR is short for International Normalized Ratio of Prothrombin Time. It is also called PT-INR. The INR monitoring is used to monitor the dosage of vitamin K antagonists like warfarin. Vitamin K antagonists are used for stroke prevention in atrial fibrillation as well as for deep vein thrombosis and pulmonary embolism. Non vitamin K oral anticoagulants (NOACs), also known as direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban and apixaban do not need INR monitoring. Warfarin is routinely used when there is a mechanical prosthetic valve, to prevent valve thrombosis and thromboembolism. As of now, DOACs are not i...
Source: Cardiophile MD - October 25, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Chest pain and anterior ST depression. What ’s the cause(s)?
Written by Jesse McLaren, with edits from Smith and GrauerA 60 year old with no past medical history presented with two hours of chest pain radiating to the left arm, with normal vitals. What do you think?  I sent this to Dr. Meyers without any other information, and he responded, “do you have a prior to make sure that it is all just because of the delta wave? Would be careful to make sure it’s not inferoposterior OMI superimposed on baseline WPW.” In other words, when there are ST/T wave changes thefirst question is whether there ’s abnormal depolarization, because this will be followed by abnormal ...
Source: Dr. Smith's ECG Blog - October 13, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs

A man in his 50s with acute chest pain without STEMI criteria. Trop negative. Cath lab cancelled. But how about the ECG and echo?
Case submitted by Matt Tanzi MD, written by Pendell MeyersA man in his early 50s presented with substernal chest pain and that started 1 hour prior to arrival. There was some radiation to the left jaw and diaphoresis. He had ongoing pain on arrival.Initial triage ECG:What do you think?I sent this to Dr. Smith who immediately replied that it is diagnostic of OMI, but difficult to tell whether it is1) anterolateral with de Winter morphology, or instead2) A combination of Aslanger ' s pattern (inferior OMI with single lead STE in III and reciprocal STD in I, aVL, plus widespread STD of subendocardial ischemia) with ...
Source: Dr. Smith's ECG Blog - September 22, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

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