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Total 187 results found since Jan 2013.
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
50 year-old in remote rural community with chest pain and ‘normal’ ECG
Submitted by anonymous, edited by Jesse McLarenThe first person " I " and " me " is this anonymous sender. A 50 year old presented to the emergency department of a
remote rural community (where the nearest cath lab is a plane ride away) with
one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation. What do you think, and how would you
manage the patient?There ’s normal sinus rhythm, normal conduction, normal axis,
normal R wave progression and normal voltages. There’s clear T wave inversion
in III/aVF, which is reciprocal to subtle ST elevation and h...
Source: Dr. Smith's ECG Blog - September 8, 2023 Category: Cardiology Authors: Jesse McLaren 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
Cardiology Image quiz : A diagnosis no one wants to make !
What is the lesion?
It looks like an Intracardiac tumor, a myxoma ? a variant of HCM ? Is it a hydatid cyst, ?
No it’s not. I can give one clue. This is a man-made condition.
Oh ok, did this happen inside the cath lab ?
Yes, you got it, right. But need a diagnosis.
Can you give me one more clue?
This patient was undergoing PCI for chronic total occlusion.
So, it must be a complication. Then I need to know the list of complications during CTO PCI.
Yes, but you may not find this one in the conventional list. Let me come out with the answer.
...
Source: Dr.S.Venkatesan MD - July 10, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 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
A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day
This was sent by a colleague.A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go. She had one BP that was measured at 160/120, uncertain when and what the BP was at other moments. Home meds were labetalol and nifedipine. There are T-wave inversions in precordial leads. The patient is pain free, so it is qu...
Source: Dr. Smith's ECG Blog - May 10, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Learning new lessons from a stressful “ ST segment ”
This is the Incidental ECG of an apparently healthy 50-year-old businessman, recorded while applying for health insurance
How will you describe this ECG?
Let me magnify it for you
Why this big fuss about this ECG?
Such ECGs are so common. Looking at the ST segment, we are supposed to think of significant CAD,, LVH, Aortic stenosis or variants of cardiomyopathy, and sometimes electrolytic shifts. The fact that it is recorded at rest, and the patient is absolutely asymptomatic, it is very unlikely there is ongoing ischemia.It could be a myocardial origin or an unk...
Source: Dr.S.Venkatesan MD - April 22, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized non specific st segment Source Type: blogs
Compare these two ECGs. Do either, neither, or both show anything important?
One case sent by Dr. Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve SmithTake a look at these two ECGs below from two patients in the ED, first without any clinical context. Full case details and outcomes are below.Case 1:Case 2: Case 1:What do you think?This was sent to Dr. Smith by SamGhali (@EM_RESUS) with zero other info. Smith ' s response was: " OMI Mimic. "Later, this info was supplied by Sam:This
ECG was recorded in a 23-year-old African American man with a history
of psychiatric illness, acute alcohol/drug intoxication, brought in by
police officers status post being ...
Source: Dr. Smith's ECG Blog - April 17, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Watch what happens when you teach others how to find OMI
Submitted by Dr. Caio Aguiar from Brazil, written by Pendell MeyersIt is immensely rewarding to receive these emails, like I received from Dr. Aguiar last week:" Last year I had a couple of lessons with you while on my internship.I finished my residency of Emergency Medicine and I ’m working at a great Emergency Department here in Brazil.Since then, I started looking for OMI EKG findings and not just STEMI.So, I ' m a follower of your blog, and I think I have a interesting case that I attended yesterday. "Case" Male, 43yo, come to ED with Epigastric Pain started 3 hours ago. Risk Factors: High Cholesterol. Vitals S...
Source: Dr. Smith's ECG Blog - March 21, 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
Using Telehealth to Serve Disparate Populations
The following is a guest article by Josh Wilda, CIO at University of Michigan Health-West.
Armando Ruiz is like many who walk through the doors of Exalta Health: an elderly man greeted in his native Spanish by a bilingual marquee outside the small purple clinic on Grand Rapids’ main thoroughfare. He’s also one of many Exalta patients who took advantage of a partnership with a local hospital to receive needed specialty care through a unique hybrid remote/in-person model.
The partnership between Exalta and University of Michigan Health-West serves a variety of business objectives for both providers. As ...
Source: EMR and HIPAA - March 6, 2023 Category: Information Technology Authors: Guest Author Tags: Ambulatory Clinical Communication and Patient Experience Health IT Company Healthcare IT Hospital - Health System Telemedicine and Remote Monitoring Armando Ruiz Exalta Exalta Health Grand Rapids Hybrid Care Josh Wilda Laura Kass Source Type: blogs
Life, death, and the balance in between: a cardiac anesthesiologist ’ s story PODCAST
Subscribe to The Podcast by KevinMD. Catch up on old episodes! David Alfery is a cardiac anesthesiologist who shares his experiences in the operating room and intensive care unit. In this discussion, he reflects on the lessons he learned about life, death, and the balance in between through his encounters with patients. He offers a
Read more…
Life, death, and the balance in between: a cardiac anesthesiologist’s story [PODCAST] originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - January 27, 2023 Category: General Medicine Authors: The Podcast by KevinMD Tags: Podcast Cardiology Source Type: blogs
Furore over FOURIER is (un)warranted : Evolocumab is an Innocent molecule !
Welcome back to the big molecular science of PCSK and its antagonist Evolocumab, a monoclonal antibody designed to target and prevent the LDL receptor catabolism inside the lysosomes. Evolocumab was approved by FDA for aggressive lowering of LDL, following a customary study published in NEJM 2017, that released this double-edged anti-lipid molecule into the human domain with all fanfare.
It aimed to reduce the LDL as low as possible in selected patients with familial LDLemia & and those who don’t tolerate statins. Now, a study was silently released in BMJ open, at the fag end of 2002, which is causing ripp...
Source: Dr.S.Venkatesan MD - January 16, 2023 Category: Cardiology Authors: dr s venkatesan Tags: lipid metabolism evolocumab fourier study how low ldl can go inclisiron lipid guidelines acc aha esc csi Source Type: blogs
Take a break from cardiology : How to debate a complex topic in a forum ?
Pardon ,this video is nothing to do with cardiology. It is from the archives of the United nations library .This can teach some important lessons in art of communication , sharing to all folks, especially medical students. It was recorded in 1959 in Newyork, UN head quarters.Four 17 year old school girls & boys were invited for a debate on a complex topic. Does God exist ? How do you pray ? and what is the purpose of different religions ?
I keep wondering , how these youngsters accumulated so much wisdom and express it in such a polite manner too. Mind you, this was recorded , when learning happened with ...
Source: Dr.S.Venkatesan MD - January 16, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized evidence based cardiology medical education religion and god medical profession Source Type: blogs
