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Total 289 results found since Jan 2013.
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
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
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
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
75 year old with 24 hours of chest pain, STEMI negative
Written by Jesse McLaren A 75 year old
with a history of CABG called EMS after 24 hours of chest pain. HR 40, BP
135/70, RR16, O2 100%. Here ’s the paramedic ECG (digitized by PMcardio). What
do you think? There ’s sinus
bradycardia, normal conduction, normal axis, delayed R wave progression, and
normal voltages. There are inferior Q waves and lead III has mild concave ST
elevation, with subtle reciprocal ST depression in I/aVL. This is diagnostic of
inferior OMI, likely from the RCA. The patient has a hi story of CABG so some of
these changes could be old, but with ongoing chest pain and bradycardia in a
hig...
Source: Dr. Smith's ECG Blog - June 8, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Can Febuxostat Protect From Contrast Induced AKI?
Contrast induced acute kidney injury is an important concern in patients undergoing percutaneous coronary interventions due the larger volume of contrast needed in comparison to diagnostic studies. It is more likely in patients undergoing primary angioplasty for acute myocardial infarction because of greater hemodynamic instability and lack of chance for protective measures like pre-procedure hydration.
A randomized controlled trial evaluated 120 patients with stage 3 chronic kidney disease who underwent PCI for acute coronary syndrome [1]. 60 patients received Febuxostat in addition to intravenous hydration and N-acetylc...
Source: Cardiophile MD - June 2, 2023 Category: Cardiology Authors: Johnson Francis Tags: Coronary Interventions General Cardiology 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
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
Localising WPW : Take it EASY
If some body is struggling with same problem, say for over three decades , there is something seriously wrong with the way we deal with the problem or there is some problem with the problem itself .
How do you localise accessory pathway in WPW syndrome from 12 lead ECG ? is one such entity, This question is asked exclusively in cardiology board exams. Now a 2023 paper from EUROPACE claims, it has come out with a simple algorithm bettering all the previous ones. Please check it for yourself.
One thing we can say with conviction is most of these embryological remnant pathways are posteriorly or laterally dragg...
Source: Dr.S.Venkatesan MD - April 15, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized WPW syndrome 12 LEAD ECG LOCLISATION IN WPW SYNDROME arruda scheme easy wpw algorithm Source Type: blogs
Localising WPW : Take it EASY always
If some body is struggling with same problem, say for over three decades , there is something seriously wrong with the way we deal with the problem or there is some problem with the problem itself .
How do you localise accessory pathway in WPW syndrome from 12 lead ECG ? is one such entity, This question is asked exclusively in cardiology board exams. Now a 2023 paper from EUROPACE claims, it has come out with a simple algorithm bettering all the previous ones. Please check it for yourself.
One thing we can say with conviction is most of these embryological remnant pathways are posteriorly or laterally dragg...
Source: Dr.S.Venkatesan MD - April 15, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized WPW syndrome 12 LEAD ECG LOCLISATION IN WPW SYNDROME arruda scheme easy wpw algorithm 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
What is the ECG Diagnosis?
I came across this ECG while reading ECGs for Cardiologs in order to train the Cardiologs Deep Convolutional Neural Network. I don ' t have any clinical information or any other associated ECGs on this case, but wanted to post it here because it is interesting and it ispathognomonic.What is it?This is a proximal LAD Occlusion. First, there are hyperacute T-waves in V2-V4. These are preceded by ST depression and are de Winter ' s T-waves, though somewhat atypical. There is also a hyperacute T-wave in aVL with subtle STE. There is reciprocal ST depression in II, III, and aVF: it is more vis...
Source: Dr. Smith's ECG Blog - February 10, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A woman in her 50s with acute chest pain
Submitted and written by Anonymous, edits by Meyers and SmithA 50s-year-old patient with no known cardiac history presented at 0045 with three hours of unrelenting central chest pain. The pain was heavy, radiated to her jaw with an associated headache.Triage VS: 135/65 mmHg, 95 bpm, 94% on room air, 16/min, 98.6 FTriage ECG:ECG Interpretation:Sinus rhythm with normal QRS. There is slight STE in V1, V2, and aVR, with STD in V3-V6, I, aVL, and II. There are T waves in lead III which are suspicious for hyperacute T waves, with reciprocal negative large T wave inversions in aVL. I do not think this ECG is by itself diagnostico...
Source: Dr. Smith's ECG Blog - January 6, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
What is Door in – Door Out Time?
What is Door in – Door Out Time?
Door in door out time is applicable when a person presents with ST segment elevation myocardial infarction to a centre which does not have the facility to perform primary angioplasty by percutaneous coronary intervention or PCI.
Recommended door in – door out time in ST elevation myocardial infarction presenting to non-PCI capable center is less than 30 minutes. Primary angioplasty being the best option to open up the infarct related coronary artery, it has to be done at the earliest. So time should not be lost by undue observation at a non PCI capable centre. When the person presen...
Source: Cardiophile MD - November 26, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Pulmonary angiography
Pulmonary angiography can be done by introducing a guidewire initially followed by a modified pigtail catheter like Grollman catheter, under fluoroscopic guidance.
Grollman catheter has a gentle rightward curve and an additional right angled leftward curve proximal to the side holes. The tip of the Grollman catheter has a pigtail shape.
Schematic diagram of modified pigtail Grollman catheter
Non-ionic contrast can be injected into the right and left pulmonary arteries to get corresponding angiograms. The guidewire and catheter are introduced through the femoral vein and directed to the pulmonary artery through the inferio...
Source: Cardiophile MD - November 18, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
