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‘ Women ’ s pain ’ – not just ‘ women ’ s pain ’
Women really do get a rough deal when it comes to pain. We live with the myth that because women experience pain in childbirth and (often) with periods of course women can ‘deal with it.’ Until recently women and female animals haven’t been included in pain research, and guess what? Women and female animals don’t have the same biological system for processing nociception. Men are told ‘don’t be a girl’ about their pain. Women are told they ‘look too good’ to be experiencing pain. Women don’t get taken seriously when they ask for help with their pain &#...
Source: HealthSkills Weblog - April 20, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Pain Pain conditions Chronic pain gender gender disparity Health healthcare Research sex women Source Type: blogs

Myocardial Ischemia-Reperfusion Injury
Myocardial Ischemia-Reperfusion Injury is a paradoxical exacerbation of cellular dysfunction and cell death occurring after restoration of blood supply in previously ischemic tissues. Reperfusion of the myocardium after coronary occlusion in acute myocardial infarction can cause reperfusion arrhythmias like accelerated idioventricular rhythm. Myocardial ischemia-reperfusion injury can also occur after cardiac surgery and circulatory arrest [1].  Though reperfusion is essential for salvage of the myocardium it can sometimes cause paradoxical damage. Reperfusion injury can also affect distant organs occasionally leadin...
Source: Cardiophile MD - April 20, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology 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

An anesthesiologist ’ s story: Going beyond the protocol to save a life
I was waiting for my son at the ice rink in one of Chicago’s northern suburbs. Hundreds of people had gathered to watch the Illinois State Championship games. A parent, who knew I was an anesthesiologist, grabbed me by the elbow and said, “Hey, Doc, someone in the lobby is not feeling well.” I went Read more… An anesthesiologist’s story: Going beyond the protocol to save a life originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - April 15, 2023 Category: General Medicine Authors: Tags: Physician Cardiology Surgery 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

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

How do we reduce hypertension in Black Americans?
Nearly half of all Americans have high blood pressure, but hypertension disproportionately affects Black Americans, with 56 percent of this population affected. The disparity is especially stark for stage II hypertension, which affects 42.1 percent of Black Americans compared with 28.7 percent of white Americans. “In the United States, at any decade of life, blacks Read more… How do we reduce hypertension in Black Americans? originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - April 8, 2023 Category: General Medicine Authors: Tags: Conditions Cardiology Source Type: blogs

RBBB and LAFB. Is it trifascicular block? The complexities of Wenckebach, with Ken Grauer analysis.
This patient presented with complications of his dialysis fistula.Medical history:History of Ischemic Heart DiseaseHistory of Congestive Heart FailureDiabetes Mellitus requiring treatment with insulinPre-operative serum creatinine>2 mg/dLHe had this ECG recorded:What do you think?There is AV 2nd degree AV Block (Mobitz I, Wenckebach) with RBBB and LAFBThe physicians recognized the RBBB and LAFB, but not the Wenckebach. They compared to a previous ECG and thought they were identical.  Here is the previous ECG from 2 months prior for pre-op for cataract surgeryThis appears to be atrial fibrillation with RBB...
Source: Dr. Smith's ECG Blog - April 6, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

70-year-old with acute chest pain, STEMI negative: just an old infarct?
Submitted by Dr. Dennis Cho (@DennisCho), written by Jesse McLaren A 70-year-old with no cardiac history presented with 2 hours of chest pain radiating to the neck, associated with shortness of breath. What do you think?There ’s normal sinus rhythm, first-degree AV block, normal axis and voltages. R wave progression is abnormal: there are Q waves in aVL/V2-3 and loss of R wave in V2. This is accompanied by minimal ST elevation in aVL/V1-V2 and more pronounced inferior reciprocal ST depression, and minimal ST depression V5-6. This is diagnostic of OMI, either proximal LAD or first diagonal. Q wave, old infarct?B...
Source: Dr. Smith's ECG Blog - April 4, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs

Pre-operative cardiac fitness : No, it is not acceptable , you are not authorised to do this !
A 62-year-old man who is being scheduled for prostate surgery with no cardiac risk factors or comorbid status came for surgical clearance. I examined him and took an ECG, everything was fine and gave him clearance for surgery.  I was surprised to spot him the very next day, waiting in the lounge of my office. He said, his anesthetist was not happy with my pre-op-cardiac assessment report, suggested it was incomplete, and sent me back for echocardiography to know the LV ejection fraction. I wanted to clarify with the patient, what exactly happened when he met his anesthesiologist. “I am not sure doctor, the momen...
Source: Dr.S.Venkatesan MD - April 3, 2023 Category: Cardiology Authors: dr s venkatesan Tags: cardiac surgery Cardiac fitness for non cardiac surgery preoperative cardiac risk assesment surgical clearance and cardiac fitness Source Type: blogs

A 50-something with chest pain. what to do? And get the PM Cardio app for your own use here!
This was sent to me by a friend.It is from a 50-something with chest pain:What do you think?This was marked as " Not a STEMI " by the physicians.  It is not a STEMI, but it isdiagnostic of an LAD OMI (Occlusion MI).  There is subtle ST Elevation in V1-V4 and hyperacute T-waves in V2-V6.There is also subtle but diagnostic INFERIOR ST Elevation, with reciprocal ST Depression in aVL.I uploaded this to our new PM Cardio AI Bot app.  We call the app the " Queen of Hearts "First, it transforms it to a digital file and standardizes the image.  Here is the result:Next, it interprets the digital data:A...
Source: Dr. Smith's ECG Blog - March 31, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

A 40-something with 100 minutes of chest pain
I was reading ECGs on the system, and saw this one:What do you think?I knew that, if the patient had presented with chest discomfort, that this ECG is diagnostic of inferior posterior OMI, even though it is not a STEMI.However, it is difficult to recognize for an interpreter who is does not have special expertise in OMI ECG diagnosis. We taught an AI system fromPM Cardio to recognize patterns of subtle OMI (beware: this version of the app is not available to the public yet).  We named the AI app the " Queen of Hearts " This is what the Queen said about this ECG:" OMI with High Confid...
Source: Dr. Smith's ECG Blog - March 27, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

The dark side of immortality: What if we could live forever?
I sat in a lecture hall at Baylor College of Medicine many years ago. It was noon, and though October had bought some respite from Houston’s heat and humidity, the air-conditioned room was still very inviting. To top it, there was lunch. The lunch came with a rider — sitting through Grand Rounds — and Read more… The dark side of immortality: What if we could live forever? originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - March 24, 2023 Category: General Medicine Authors: Tags: Physician Cardiology Source Type: blogs

85 year old with chest pain, STEMI negative, then normal troponin but with relatively large delta: discharge?
Conclusion:This patient should NEVER have been ruled out by troponin.And the ECG findings, which are diagnostic of OMI, were also missed.Thus, this is the protocol Fred Apple and I developed for Hennepin for the Abbott Architect:==================================My Comment by KEN GRAUER, MD (3/24/2023):==================================I like this case by Dr. McLaren — because it allows us to highlight a very important fault of the outdated STEMI paradigm that is all-too-often forgotten — namely, Being sure to obtain and clinically correlate at least 2 serial ECGs&...
Source: Dr. Smith's ECG Blog - March 24, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs