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75 year old dialysis patient with nausea, vomiting and lightheadedness
Written by Jesse McLaren A 75 year-old patient with diabetes and end stage renal disease was sent to the ED after dialysis for three days of nausea, vomiting, loose stool, lightheadedness and fatigue. RR18 sat 99% HR 90 BP 90/60, afebrile. Below is the 15 lead ECG. What do you think? There ’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression and normal voltages. There’s subtle inferior ST elevation with straightening of the ST segment, reciprocal ST depression and T wave inversion in aVL, and ST depression in V2. This is diagnostic of infero-posterior OMI, but it is falsely n...
Source: Dr. Smith's ECG Blog - August 19, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs

Potassium: The Silent Ally In Your Battle With Hypertension
Conclusion: Balancing Potassium Intake As Part Of An Overall Healthy Lifestyle While elevating your potassium intake can be instrumental in your battle against high blood pressure, it’s essential to remember that it’s part of a broader health strategy. There’s no magic bullet in managing blood pressure. A symphony of lifestyle adjustments working in harmony is what lays the groundwork for victory. Eating an overall healthy diet, limiting your sodium intake, getting regular exercise, and quitting smoking if needed – all these factors dance hand in hand with your potassium intake. These habits f...
Source: The EMT Spot - July 26, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs

Can You Drink Licorice With Hypertension?
Conclusion It’s clear that licorice, with its potent compound glycyrrhizin, can potentially raise blood pressure. This makes it a food item to approach with caution for those living with hypertension. But, remember, not all “licorice” you see on shelves contains real licorice root or extract. Checking labels can help identify those sneaky substitutes. Moderation and informed choices are your allies. While occasional licorice consumption might be fine for some, it’s always best to consult your healthcare provider to ensure you’re not jeopardizing your well-being. Delicious alternatives...
Source: The EMT Spot - June 24, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs

8 Risk Factors Of Low Blood Pressure
Conclusion In a nutshell, understanding the risk factors associated with low blood pressure is essential for maintaining good health. Individuals with certain risk factors, such as age, medication usage, underlying medical conditions, dehydration, prolonged bed rest, nutritional deficiencies, pregnancy, and inherited factors, should be particularly aware of the potential for low blood pressure. Regular monitoring of blood pressure, communication with healthcare providers, and appropriate management strategies are important for individuals with these risk factors to ensure their well-being. Furthermore, diet pla...
Source: The EMT Spot - June 23, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs

Can You Drink A Juice Cleanse With Hypertension?
Conclusion Navigating the crossroads of popular health trends and chronic conditions can be challenging. So, can you drink a juice cleanse with hypertension? Yes, but with an asterisk. The nature of the cleanse, your individual health, and the involvement of healthcare professionals all play a pivotal role. The answer lies in striking the right balance – not too much sodium or sugar, an eye on potassium levels, and regular monitoring of blood pressure. As the experiences of Mark, Sarah, and John demonstrated, the journey is unique for everyone. In the words of Dr. Naomi Fisher at Harvard Medical School: ...
Source: The EMT Spot - June 23, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs

10 Methods To Prevent Low Blood Pressure: Steps Toward Optimal Health
Conclusion To sum things up, preventing low blood pressure is crucial for maintaining overall well-being and avoiding potential health complications. By adopting preventive measures, individuals can take control of their health and make informed choices to promote stable blood pressure levels. Incorporating practices such as staying hydrated, maintaining a balanced diet, engaging in regular physical activity, managing stress effectively, and monitoring medications can significantly reduce the likelihood of experiencing low blood pressure episodes and associated symptoms. Prevention not only reduces immediate he...
Source: The EMT Spot - June 18, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs

Can You Consume High-Sodium Foods With Hypertension?
Conclusion The topic of hypertension and high-sodium food consumption presents a nutritional challenge. While research confirms the link between high-sodium foods and increased blood pressure, managing sodium intake is a realistic goal for individuals with hypertension. With the right strategies and active engagement with healthcare providers, it’s possible to navigate the dietary minefield and maintain a balanced, health-supportive diet. Read also: Best Foods, Herbs And Spices To Lower Blood Pressure Reference Association of urinary sodium and potassium excretion with blood pressure. Published by Jo...
Source: The EMT Spot - June 15, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs

I was shown this ECG without any information. What do you think?
I was shown this ECG; " Steve, what do you think of this? " :What is going on?I said: " This is pulse tapping artifact and a long QT "  Why did I say that?Whenever you see a very bizarre EKG, you should think about pulse tapping artifact.  This is when one of the limb lead electrodes is placed over an artery, especially when placed over a dialysis fistula.When you suspect this, your next task is look for the one lead among leads I, II, and III which is NOT bizarre.  Lead I in this ECG is not bizarre [though it does show a very long QT (or QU)].Leads I is formed by the right arm and left arm electro...
Source: Dr. Smith's ECG Blog - November 8, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

What are ventricular ectopic beats (VPC)? Cardiology Basics
Ventricular ectopic beats are premature heart beats originating from the ventricles. Normal heart beats originate from the sinus node, situated in the upper part of right atrium. Sinus node is the natural pacemaker of the heart which gives out regular impulses to induce sequential contractions of atria and ventricles. Ventricular ectopic beats (VEB) are also known by other names like ventricular premature beat (VPB), ventricular premature complex (VPC) and premature ventricular complex (PVC). Ventricular ectopic is the commonest form of cardiac arrhythmia. In a ventricular ectopic beat, the sequence of activation is diffe...
Source: Cardiophile MD - October 25, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

DIAMOND trial: Patiromer for management of hyperkalemia in HFrEF
Patiromer is a nonabsorbed potassium binder used in the treatment of hyperkalemia. Earlier it was tested in patients with chronic kidney disease who were receiving inhibitors of the renin-angiotensin-aldosterone system (RAAS). It was found that patiromer treatment was associated with a decrease in serum potassium levels compared to placebo and a reduction in the recurrence of hyperkalemia  [1]. DIAMOND trial was designed to evaluate patiromer for the management of hyperkalemia in patients receiving RAAS inhibitors for heart failure with reduced ejection fraction (HFrEF) [2]. 1195 patients with RAAS inhibitor related ...
Source: Cardiophile MD - September 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Quiz post - which of these, if any, are OMI? What is the South African Flag Sign? Will you activate the cath lab? Can you tell the difference on ECG?
 Written by Pendell Meyers, additions and edits by Grauer, Smith, McLarenBelow we have 5 cases of adults (ranging from 40-70 years old) who all presented to the ED with acute nontraumatic chest pain that sounded at least somewhat like potential ACS to the provider. You should look at each ECG and decide if it is OMI, not OMI, or something else.Our goal in this post is to compare and contrast OMIs with false positives that mimic them. In this post we will examine the anterolateral distribution that has been described as the " South African Flag Sign. " (SAFS)It is very hard to describe why an ECG expert can easily...
Source: Dr. Smith's ECG Blog - May 11, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

An asymptomatic man in his 50s with heart rate in the 160s - what is the diagnosis? How will you manage this?
 Written by Pendell MeyersA man in his late 50s with history of CAD with CABG, COPD, smoking, cirrhosis, and other comorbidities presented for an outpatient scheduled stress test which had been ordered for some exertional shortness of breath, palpitations, and presyncopal episodes over the past few months. When he presented to the office for the stress test, his screening vitals before any test or intervention were remarkable only for a heart rate of 160 bpm. He denied any symptoms whatsoever.A 12-lead ECG was performed in the office:What do you think?The ECG shows a wide complex regular monomorphic tachycardia. I mea...
Source: Dr. Smith's ECG Blog - April 2, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

A 40-something without past history presents with wide complex tachycardia and crushing chest pain
See Ken Grauer ' s important and detailed ECG analysis at the bottom.CaseA 40-something with no PMH presented with palpitations, tachycardia, and crushing chest pain.This was the prehospital ECG.Sustained wide complex tachycardia.  Is it VT or SVT with Aberrancy?Also: there is no concordant ST segments or clearly excessively discordant ST segments, so superimposed Occlusion MI (OMI) is unlikely.There is a regular wide complex tachycardia, without P-waves, and anLBBB configuration andinferior axis.  [LBBB "configuration" is different from LBBB: it means that there is a predominant S-wave in V1 and V2 and...
Source: Dr. Smith's ECG Blog - February 14, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life.
 Written by Pendell Meyers with edits by SmithA man in his 60s called EMS apparently for shortness of breath. EMS found him in distress and hypoxemic requiring 4 L nasal cannula to maintain oxygen saturation greater than 93%.Here is his triage ECG:What do you think?An old ECG was available on file, from 2 years ago:RBBB, otherwise normal.The triage ECG is diagnostic of life threatening hyperkalemia (sodium channel blockade would also produce this pattern, but the patient was not known to be on any sodium blocking medications). There is the very common brugada pattern STEMI mimic seen in V1 and partially in V3 and aVR....
Source: Dr. Smith's ECG Blog - January 16, 2022 Category: Cardiology Authors: Pendell 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