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Total 167 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

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

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

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

What is thrombolytic therapy for myocardial infarction? Cardiology Basics
Thrombolytic therapy used to be an important mode of early treatment of acute myocardial infarction. Though it has been largely superseded by primary angioplasty, thrombolytic therapy may still be useful in certain situations. It is still an important form of treatment in resource limited locations. Myocardial infarction is usually due to sudden occlusion of a coronary artery by thrombus formation on a pre-existing partial obstruction by an atherosclerotic plaque. Plaque rupture with local thrombus formation is the usual mechanism.  Dissolving the thrombus soon after the occurrence of a myocardial infarction can salv...
Source: Cardiophile MD - October 14, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is myocardial stunning and hibernation? Cardiology Basics
Just as you can get stunned for some time if hit on the head, part of the myocardium can also stop functioning following transient coronary obstruction. This usually occurs following a myocardial infarction after which the occluded coronary artery gets opened up spontaneously or by thrombolytic therapy or primary angioplasty. After a variable period of time, the stunned myocardium usually recovers full function. During the period of stunning, if a large part of myocardium is involved, the person may have features of heart failure due to decreased left ventricular systolic function. Myocardial stunning is the reason for he...
Source: Cardiophile MD - October 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is myocardial viability assessment? Cardiology Basics
Myocardial viability means regions of myocardium which can recover its function if the blood supply is normalized. Viable myocardium will improve after restoring blood supply while non-viable myocardium will not. So myocardial viability assessment is important in deciding whether the person will benefit from revascularization procedures like coronary angioplasty and coronary bypass surgery. There are two types of viable myocardium, stunned myocardium and hibernating myocardium. Stunned myocardium needs only time to recover while hibernating myocardium needs restoration of blood supply. Stunned myocardium is transient dela...
Source: Cardiophile MD - October 12, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is a nuclear stress test? Cardiology Basics
Usual stress test for the evaluation of coronary artery disease is a treadmill exercise ECG. It is commonly part of general health check-up and is widely available. But there are certain situations when the exercise ECG is not interpretable as in a person with left bundle branch block. Then a nuclear stress test will be useful. While exercise ECG tells you that there is a probability of obstructions in coronary arteries, it most often does not identify the region of myocardium supplied by the obstructed vessel. Nuclear stress test will tell you which is the region of myocardium that is affected. If there is already signif...
Source: Cardiophile MD - October 9, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is Wellens ’ syndrome?
What is Wellens’ syndrome? The original description of Wellens’ syndrome dates back to 1982 in which they identified a subgroup of patients admitted with unstable angina who are at high risk of development of an extensive anterior wall myocardial infarction. These patients with critical stenosis high in the left anterior descending coronary artery, had characteristic ST-T segment changes in the precordial leads on or shortly after admission. They noted this finding in 26 of their 145 patients admitted because of unstable angina. In spite of symptom control with nitroglycerine and beta blockade, 12 of the 16 pat...
Source: Cardiophile MD - September 26, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

OCT is not “ Obsessive compulsive tomography ”
This is the story of PCI to LAD from the customary bifurcation workshop for the budding experts, which ended up with a compulsive final OCT run-through, triggering a debate on what to do with the side branch. What shall we do next? Just balloon dilate the distal strut Would consider a second stent. Maybe a TAP  depending upon LCX morphology At this stage, I would like to know the FFR or iFR across LCX Jail. Get rid of this OCT, Let me have look at regular CAG. I bet I can make a better decision. Leave it alone if the clinical status & profile is good Leave it alone? Is it not an incomplete Job? Def...
Source: Dr.S.Venkatesan MD - September 8, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coronary Imaging ILUMEN study oct opitical coherence tomography Source Type: blogs

History of PCI : Listen to Gruentzig ’ s prediction, that were spot on !
It brings a unique sense of greatness and gratitude to hear the voice of the father of Interventional cardiology decades after his demise. Almost 4 decades ago, Andreas Gruentzig described "the ideal catheter" to me. He foresaw the development of FFR, hi-pressure balloons, aspiration catheters, stents, & more. His thoughts on physiologic measurement both during & post-procedure are thought-provoking. #AngioHistory pic.twitter.com/AiBKU6Tjxp— Angioplasty.Org (@angioplastyorg) September 3, 2022 The invention he made has evolved so much. Though, Dr. Gruentzig didn’t live to see any of them, the...
Source: Dr.S.Venkatesan MD - September 5, 2022 Category: Cardiology Authors: dr s venkatesan Tags: history of cardiology Histroy of medicine Dr Gruentzig Source Type: blogs

60 year old with vomiting, diarrhea, and syncope: is this Wellens? Is this type 2 MI?
 Written by Jesse McLaren, with edits/comments by Smith and Grauer A 60 year-old patient with diabetes and ESRD presented with 24 hours of vomiting, diarrhea, weakness and then a syncopal episode. Vitals: RR 18, sat 98%, HR 103, BP 124/71 and temp 38.0. Here ’s their ECG: is this Wellens?  There ’s borderline sinus tach, normal conduction, normal axis, and low voltages in the limb leads. The anterior leads have loss of R waves, mild convex ST segments and primary T wave inversion. In the context of QS waves, T wave inversion indicates old or subacute infarct, or reperfusion after signif icant infarc...
Source: Dr. Smith's ECG Blog - August 19, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs