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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
A middle-aged man with acute chest pain.
A 50-something male had onset of chest pain 1 hour prior to ED arrival. It is constant, 9/10, left-sided CP that radiates into left arm and jaw. Endorses some associated SOB, but denies back pain, fever, cough, chills, leg swelling, or other new symptoms. Has never had this before. Takes metoprolol for HTN. Here is the triage ECG:What do you think?This was not identified as OMI by either the conventional algorithm nor the triage faculty physician.Smith: I think leads V3 and V4 are highly concerning, and all but diagnostic, for acute LAD occlusion. I would activate the cath lab, or at least look f...
Source: Dr. Smith's ECG Blog - September 1, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
New ESC 2023 Cardiomyopathy guidelines: Truths trail by 17 years!
It was 2006
Allow me to recount an unassuming piece of a PowerPoint presentation from my institute, Madras Medical College, at the annual Cardiological Society meeting in New Delhi. The paper was categorized under miscellaneous sessions. I vividly remember the day. I have to admit, It was a nearly empty hall E, located in the basement of Hotel Ashoka. After the talk, I looked up to find that neither the chairman nor the handful of kind academic souls had any questions or comments to make. Pausing for a few moments, I quietly walked down the podium with an inexplicable silent pain.
The title of the presentation was &#...
Source: Dr.S.Venkatesan MD - August 27, 2023 Category: Cardiology Authors: dr s venkatesan Tags: cardiomyopathy Dilated cardiomyopathy hypertrophic cardiomyopathy ischemic cardiomyopathy Uncategorized drsvenkatesan ESC 2023 new cardiomyopathy guideline ndlvc non dilated cardiomyopathy Source Type: blogs
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
A man in his 70s with weakness and syncope
DiscussionBrugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% per year. In patients that only have this pattern induced by a sodium channel blocking agent have a lower rate of SCD (0 - 0.35% per year)[1]. Drugs that have been associated with Brugada ECG patterns include tricyclic antidepressants, anesthetics, cocaine, methadone, antihistamines, electrolyte derangements, and even tramadol. [2]. Our patient had a Brugada Type ...
Source: Dr. Smith's ECG Blog - July 22, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Blood Pressure Meds vs Blood Thinners: What ’ s The Difference?
Conclusion
In conclusion, while blood pressure medicines and blood thinners are both crucial to heart health, their roles and mechanisms of action are notably distinct. Blood pressure medication works primarily on the vascular system, aiding in reducing blood pressure by relaxing blood vessels or altering the heart’s function. On the other hand, blood thinners target the blood itself, working to prevent the formation of potentially dangerous blood clots.
Throughout this article, one thing becomes undeniably clear: the importance of regular consultations with your healthcare provider. When it comes to managing m...
Source: The EMT Spot - July 20, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs
Can You Try Cryotherapy With Hypertension?
Conclusion
Returning to our original query: Can you try cryotherapy with hypertension?
The answer is nuanced—it’s a cautious ‘maybe.’
While some research suggests a transient increase in blood pressure, it’s paramount to consult your healthcare provider and closely monitor your response to the treatment.
After all, when it comes to managing health conditions, no stone should be left unturned.
Read also: Can You Practice Tai Chi With Hypertension?
Reference
Cardiovascular and autonomic responses to whole-body cryostimulation in essential hypertension. https://pubmed.ncbi.nlm.nih.gov/25108050/
Source: The EMT Spot - June 19, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs
A man with chest pain off and on for two days, and " No STEMI " at triage.
Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen SmithA 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. Here is his triage ECG which was obtained at 20:34 during active pain.What do you think?This ECG was read as “No STEMI” with no prior available for comparison. It is true this ECG does not meet STEMI criteria (there is 1.0 mm STE in III, and possibly 0.5 mm in aVF), but there is clear evidence of OMI findings on this ECG. Leads II, III, and aVF hav...
Source: Dr. Smith's ECG Blog - June 19, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Two ECGs texted to me in the same hour. What would you recommend?
Written by Pendell MeyersBoth of these cases were sent to me with no information other than adults with acute chest pain. What would be your response?Case 1:Case 2:What if I told you that Case 1 has an abnormal initial troponin, and Case 2 has a normal initial troponin? Case 1An elderly male presented with chest pain. His vitals were within normal limits except some mild hypertension. Here was his triage ECG:What do you think?I texted back: " I just see LVH with no signs of OMI " .I sent this ECG to the Queen of Hearts (PMcardio OMI), and here is the verdict:You can subscribe for news and early access (via partic...
Source: Dr. Smith's ECG Blog - June 15, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Can You Run In Marathons With Hypertension?
Marathons and hypertension: Understand the risks, learn how to stay safe while running, and explore alternative activities to keep your heart healthy and thriving.
Quick Summary
Marathons pose risks for individuals with hypertension: The intense physical exertion can lead to sudden increases in blood pressure, dehydration, irregular heart rhythms, and strain on the kidneys, potentially causing serious complications like heart attacks or strokes.
Safety measures for hypertensive individuals: If participating in a marathon, monitor blood pressure regularly, follow a supervised training regimen, stay hydrated, w...
Source: The EMT Spot - June 10, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs
A young lady with wide complex tachycardia. My first time actually making this diagnosis de novo in real life in the ED!
Written by Pendell MeyersA woman in her 30s with minimal past medical history presented simply stating she was " feeling unwell. " Her symptoms started suddenly about 48 hours ago, but had continued to worsen, including epigastric discomfort, nausea, cough, and dyspnea and lightheadedness on exertion. She denied chest pain and denied feeling any palpitations, even during her triage ECG:What do you think?Despite otherwise normal vital signs, she was appropriately triaged to the critical care area of the ED.She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for ...
Source: Dr. Smith's ECG Blog - June 3, 2023 Category: Cardiology Authors: Pendell 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
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
