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A 50-something with Regular Wide Complex Tachycardia: What to do if electrical cardioversion does not work?
Case submitted by anonymous. Written by Smith. Ken ' s piece at the bottom is excellent.A 50-something presented with sudden onset palpitations 8 hrs prior while sitting at desk at work. He had concurrent sharp substernal chest pain that resolved, but palpitations continued.Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Past medical history includes coronary stenting 17 years prior. A brief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality.Initial ED ECG:What do you think?This wa...
Source: Dr. Smith's ECG Blog - September 20, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 50-something with Regular Wide Complex Tachycardiaa: What to do if electrical cardioversion does not work?
Case submitted by anonymous. Written by Smith. Ken ' s piece at the bottom is excellent.A 50-something presented with sudden onset palpitations 8 hrs prior while sitting at desk at work. He had concurrent sharp substernal chest pain that resolved, but palpitations continued.Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Past medical history includes coronary stenting 17 years prior. A brief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality.Initial ED ECG:What do you think?This wa...
Source: Dr. Smith's ECG Blog - September 20, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
New ESC 2023 Cardiomyopathy guidelines: Truths trail by 17 years!
It was 2006
Allow me to recount an unassuming piece of a PowerPoint presentation from my institute, Madras Medical College, at the annual Cardiological Society meeting in New Delhi. The paper was categorized under miscellaneous sessions. I vividly remember the day. I have to admit, It was a nearly empty hall E, located in the basement of Hotel Ashoka. After the talk, I looked up to find that neither the chairman nor the handful of kind academic souls had any questions or comments to make. Pausing for a few moments, I quietly walked down the podium with an inexplicable silent pain.
The title of the presentation was &#...
Source: Dr.S.Venkatesan MD - August 27, 2023 Category: Cardiology Authors: dr s venkatesan Tags: cardiomyopathy Dilated cardiomyopathy hypertrophic cardiomyopathy ischemic cardiomyopathy Uncategorized drsvenkatesan ESC 2023 new cardiomyopathy guideline ndlvc non dilated cardiomyopathy Source Type: blogs
Outpatient Vascular Care: Good, bad or ugly?
BY ANISH KOKA
Filling in the holes of recent stories in the New York Times, and Propublica on the outpatient care of patients with peripheral arterial disease
Most have gotten used to egregiously bad coverage of current events that fills the pages of today’s New York Times, but even by their now very low standards a recent telling of a story about peripheral artery disease was very bad.
The scintillating allegation by Katie Thomas, Jessica Silver-Greenberg and Robert Gebeloff is that “medical device makers are bankrolling doctors to perform artery clearing procedures that can lead to amputations...
Source: The Health Care Blog - July 24, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Anish Koka Medical Devices Outpatient vascular care Source Type: blogs
Fight Aging! Newsletter, July 17th 2023
In conclusion, the longevity-associated genotype of FLT1 may confer increased lifespan by protecting against mortality risk posed by hypertension. We suggest that FLT1 expression in individuals with longevity genotype boosts vascular endothelial resilience mechanisms to counteract hypertension-related stress in vital organs and tissues.
Resistance Exercise Slows the Onset of Pathology in a Mouse Model of Alzheimer's Disease
https://www.fightaging.org/archives/2023/07/resistance-exercise-slows-the-onset-of-pathology-in-a-mouse-model-of-alzheimers-disease/
With the caveat that mouse models of Alzheimer's...
Source: Fight Aging! - July 16, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
What happens to FFR after stenting ?
A simple question with mammoth repercussions in the revascularization world.
How was the question ? Was it difficult ?
Don’t worry, it wouldn’t be the same even for elite cardiology experts worldwide. It is not a Himalayan task, though, to find an answer. All it requires is a simple FFR run through pre and post PCI (Now RFR, iFR, QFR). Surprisingly, very few inquisitive minds wanted to do this. I can find 5 related papers. The fifth one is very specific: REPEAT-FFR study. Go through at least that one paper and find the answer yourself.
Cardiology fellows it is worth reading about this important stud...
Source: Dr.S.Venkatesan MD - July 8, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha bari 2 d courage study eapci epicardial myocardial dissociiation es guideinnedmt ffr ffr rfr qfr ffr vs oct ISCHEMIA trial medical management for cad myocardial revascularisation ORBITA study Source Type: blogs
Distal vs proximal strut crossing in BFL : Who is trying to sustain the confusion ?
Anyone who is flushed with millions can become a member of The Hurlingham Club in London or the Yacht Club in Monaco, or other glamorous clubs in the world. But, EBC* is different. Only cardiologists are privileged to enter. EBC is obviously different and unique. It is probably the only club addressing exclusively bifurcation coronary lesions. Apart from immense pride and academic entertainment, it teaches us some deep technical points. (By the way, BFL* is the minuscule spoke in the gigantic wheels of global atherosclerosis)
Approach to BFL
Although 90% of BFL still require a only drugs or simple single stent or a p...
Source: Dr.S.Venkatesan MD - July 4, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Wide complex tachycardia and hypotension in a 50-something with h/o cardiomyopathy -- what is it?
A 50-something male with unspecified history of cardiomyopathy presented in diabetic ketoacidosis (without significant hyperkalemia) with a wide complex tachycardia and hypotension.Bedside echo showed " mildly reduced " LV EF.Here is the ED ECG:What do you think?Analysis: there is a wide complex tachycardia. It is regular. There are no P-waves. The morphology is of RBBB and LAFB. The initial part of the QRS is very fast, suggesting that it starts in conducting fibers and not in myocardium. Thus, it is probably SVT with aberrancy (RBBB + LAFB) or it is posterior fascicular VT (which starts in the pos...
Source: Dr. Smith's ECG Blog - June 23, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
When ” Cath lab viability ” competes with myocardial viablity … Just carry on !
Pure science
Whenever possible ,before doing a coronary revascularisation procedure , check twice the segments you try to perfuse is really short of blood supply and truly needs the procedure. Don’t ever waste your resources and try to blood-feed the dead myocardium. It’ can never be awakened !
Pragmatic science
I was conversing with my colleague recently , who has grown into suave , Interventional cardiologist with a huge academic & societal repute .He owns a personal cathlab and planning to get one more.
I learnt a non-academic reality lesson from him .
When planning myocardial revasascularisation, ...
Source: Dr.S.Venkatesan MD - June 8, 2023 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics cardiology wisdom cardiology-ethics Cardiology-Statistics cath lab tips and tricks Medical education Medical ethics medical quotes medical satistics Two line sermons in cardiology wisdom in cardiology cath lab viablity vs Source Type: blogs
ChatGPT Misses the Mark in Healthcare – What It Needs to Succeed
The following is a guest article by Michael Blum, MD, Cardiologist, Co-founder and CEO at BeeKeeperAI and Former Chief Medical Information Officer at UCSF Medical Center
The advent of OpenAI’s ChatGPT3 (GPT3) Artificial Intelligence (AI)-powered chatbot sparked an unprecedented societal appreciation for the power of AI. While AI has been broadly deployed across industries for a decade, it remained mostly hidden from the typical user. The release of GPT3 in late 2022 changed all of that.
Suddenly, a user with minimal computer literacy and no programming or data science training whatsoever could ask an AI-based applicati...
Source: EMR and HIPAA - May 31, 2023 Category: Information Technology Authors: Guest Author Tags: AI/Machine Learning Analytics/Big Data C-Suite Leadership Clinical Health IT Company Healthcare IT Hospital - Health System Security and Privacy AI Hallucination BeeKeeperAI Chatbots ChatGPT ChatGPT4 Cyber Risks Generative AI 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
Feeling guilty now, for a past professional crime !
Having retired, find little more time in browsing the academic images lying idle in old computers.It is intresting, still a tiring job to pick any useful learning stuff, from heaps of data hiding in different hard drives.
This set of ECGs I could retrive from the year 2011, A 31-year-old male presented to our CCU at 4.50 PM.
The treatment was Initiated in 10 minutes and completed in an hour, (Those days cath lab wasn’t functioning 24/7, more importantly, there was no external interference with our professional decision-making process)
The ECG was repeated at 7.15 PM
I think this case is much rele...
Source: Dr.S.Venkatesan MD - May 26, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Cell Culture Chamber Mimics Mechanical States of Disease
Researchers at the University of Göttingen in Germany have developed a cell culture chamber that lets them culture tissue samples, mimic the mechanical conditions that tissues experience in various disease states, and closely monitor tissue reaction...
Source: Medgadget - May 23, 2023 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Medicine Pathology uniGoettingen Source Type: blogs
How RPM Can Reduce AI ’s Bias Problem & Improve Health Equity
The following is a guest article by Arnaud Rosier, PhD, Founder and CEO at Implicity
Artificial intelligence (AI) is one of the most promising breakthrough technologies of the modern healthcare era, yet it also has the potential to be one of the most dangerous. AI algorithms that are trained on limited or poorly representative data sets can exhibit signs of bias in their results, skewing decision-making and possibly leading to ethnic, gender, and social discrimination and other unintentional consequences for the patients they serve.
Unfortunately, research shows that bias is already creeping into the nascent field of AI an...
Source: EMR and HIPAA - May 19, 2023 Category: Information Technology Authors: Guest Author Tags: AI/Machine Learning Analytics/Big Data Clinical Health IT Company Healthcare IT Telemedicine and Remote Monitoring Academic Medical Center Ai Algorithm AI bias AMC Arnaud Rosier PhD Artificial Intelligence Dr. Arnaud Rosier HCP Source Type: blogs
A “ hard talk ” with chat GPT : Evidence vs Experience in medicine
Dr .S.Venkatesan MD
Good morning GPT. Let me introduce myself . I am a medical doctor, practicing cardiology, in Chennai India. I have had a long-standing query in very fundamental principles of the practice of medicine. Just wanted to chat and clarify with you.
Welcome, I am here to help you
Medicine is both art and a science. In recent times the movement of evidence-based medicine (EBM ) is trying to overturn the clinical experience. I have a feeling it is not fair. We can’t create evidence for every decision we make in clinical science right?
My first question is
Can experience-based medical care be...
Source: Dr.S.Venkatesan MD - May 5, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized ai in medicine artificial intelligence chat gpt in medicine evidence vs experience based medicine Source Type: blogs
