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Total 168 results found since Jan 2013.

Chest pain and T wave inversion, NSTEMI?
Case submitted and written by Dr. Mazen El-Baba and Dr. Emily Austin, with edits from Jesse McLarenA 50 year-old patient presented to the Emergency Department with sudden onset chest pain that began 14-hours ago. The nurse alerted the MD because the patient was still symptomatic, diaphoretic and “looking unwell”. What do you think?      ECG interpretation: sinus rhythm, normal conduction (PR, QRS, and QTc), normal axis, delayed R-wave progression, and normal voltages. There ’s primary TWI inferiorly (aVF and III) and V6, with reciprocal tall T-wave in lead I/aVL, and a Q wave in III. The...
Source: Dr. Smith's ECG Blog - August 10, 2023 Category: Cardiology Authors: Jesse McLaren 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

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

A man in his early 40s with chest pain a " normal ECG " by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?
This study looked at less than 1000 cases, which is not nearly enough (see below for analysis) and they used cardiologists as the gold standard (a very poor gold standard), NOT presence or absence of Occlusion MI (which we have done in all of our ECG studies, and must be ascertained by 1) TIMI 0/2 flow on angiogram or 2) culprit + TIMI 3 flow and very high troponin. So this study is worthless and must be ignored. I have here 38 cases of " Computer Normal " ECGs which were critically abnormal and the vast majority are missed acute coronary occlusions (Missed Acute OMI) and most were recognized ...
Source: Dr. Smith's ECG Blog - May 23, 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

What do you think of this ECG?? Is this during pain, or after pain resolution? Also, see the CT image of the heart.
If you saw this ECG only knowing that it is an acute chest pain patient, what would be your interpretation?This is a trick question, as you will see below.  But you can make a diagnosis here, and Pendell and I do this all the time when reading ECGs from databases. I sent this to Pendell without any information at all, and he replied " Postero-lateral Reperfusion. "The T-waves in V2-V4appear hyperacute, suggesting LAD occlusion,BUT there is also T-wave inversion that is typical morphology forreperfusion in V5 and V6.Thus, one must think of reperfusion.  When there is reperfusion and there are large T-waves in...
Source: Dr. Smith's ECG Blog - March 6, 2023 Category: Cardiology Authors: Steve Smith 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

An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex
 Written by Pendell MeyersFamily of an elderly woman with many comorbidities called EMS when she suddenly experienced shortness of breath, nausea, vomiting, and near syncope. She was alert and oriented and hypotensive with initial BP 70/50. A 12 lead ECG was obtained by EMS and is shown below:What do you think?There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!) The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in mo...
Source: Dr. Smith's ECG Blog - November 11, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

What is myocardial contrast echocardiography?
Myocardial contrast echocardiography (MCE) is used for the assessment of myocardial microcirculation and endocardial demarcation. MCE uses gas-filled microbubbles that are inert and remain wholly within the vascular space. These microbubbles have an intravascular rheology similar to that of red blood cells [1]. A continuous intravenous infusion of microbubbles is given to achieve a steady state. These microbubbles are destroyed by high energy ultrasound. The rate of microbubble replenishment within the ultrasound beam is measured and represents the mean red blood cell velocity [2]. Normally, the ultrasound beam fills with...
Source: Cardiophile MD - November 1, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Triggers for IABP
Intra-Aortic Balloon Pump inflates the balloon in diastole and deflates at the onset of systole. This image of the IABP screen shows diastolic augmentation in the pressure tracing. Period during which the balloon remains inflated is shown as a horizontal bar below the ECG tracing at the top. Live visual indication of balloon inflation will also be there in the balloon inflation indicator at the bottom of the screen when the IABP is operational. Any of the several types of triggers can be used for timing for inflation in diastole. ECG trigger: Balloon will be inflated in the middle of the T wave and deflated at the peak o...
Source: Cardiophile MD - October 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Understanding “ Damping and Ventricularization ” in cath lab.
“Never take your eyes off the monitor and the pressure curve”  It is one of the basic instructions given to the fellows & technicians as they start engaging the coronary artery and Intubating the coronary ostium in their early cath lab postings. There are two commonly heard noise bites in the cath lab for the beginner. 1. Damping 2.Ventricularization. Damping It is the deformation of the normal arterial pressure curve, with a  blunting of both systolic and diastolic pressure that drops compared to aortic pressure. Extreme damping can mimic a straight line with few wavy undulations. It means the forward f...
Source: Dr.S.Venkatesan MD - October 26, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coronary artery damping and ventricularization Source Type: blogs

What is cardiogenic shock? Cardiology Basics
When the heart is not able to pump enough blood for perfusing the vital organs and the blood pressure falls, it is known as cardiogenic shock. Most important cause of cardiogenic shock is an acute myocardial infarction. Cardiogenic shock can also occur in other conditions like a fulminant myocarditis. In case of myocardial infarction, it is more likely to occur in those who are older, having multivessel coronary artery disease, and in those with a previous myocardial infarction. Cardiogenic shock is a potentially life threatening condition and needs urgent treatment. Even with treatment about half of those with cardiogeni...
Source: Cardiophile MD - October 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG
Conclusions: outpatients with witnessed cardiac arrest and primary PEA carry a high probability of Massive Pulmonary Embolism________________Case Continued:" Initial ROSC EKG showed what appeared to be in atrial fibrillation with inferior ST elevations, depressions in aVL, concerning for STEMI. "He had multiple cardiac arrests with ROSC regained each time. " Endotracheal tube re-intubation was confirmed multiple times, bilateral breath sounds, yet O2 saturation remained in the 50s and 60s. I was able to visualize the ETT on initial intubation pass through the cords however given his continued hypoxemia, I felt it...
Source: Dr. Smith's ECG Blog - October 10, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

Bezold-Jarisch reflex – Cardiology Basics
Bezold-Jarisch reflex – Cardiology Basics Bezold-Jarisch reflex was described as a cardiovascular response to injection of veratrum alkaloids in experimental animals. It consisted of apnea, bradycardia and hypotension. It was first described by von Bezold in 1867 [1] and later confirmed by Jarisch [2]. The reflex depends on intact vagal nerves and is mediated through medullary centres controlling respiration, heart rate and vasomotor tone [3]. The afferent limb of the Bezold-Jarisch reflex is from the cardiac sensory receptors through the non-myelinated vagal afferent pathways. The left ventricle, particularly the in...
Source: Cardiophile MD - October 8, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology 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