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A man in his 60s with acute chest pain
Sent by anonymous, written by Pendell MeyersA man in his 60s presented with acute chest pain with diaphoresis. He had received aspirin and nitroglycerin by EMS, with some improvement. His vitals were within normal limits. Here is his triage ECG:2045:What do you think?The ECG is subtle, but diagnostic of infero-posterior OMI. The QRS is normal, yet in aVL the normal upright small QRS complex is followed by in appropriately large-volume T wave inversion, which is reciprocal to the T waves in lead III, which are probably hyperacute if compared to available baseline. Corroborating this is the subtle ST depression in V2-V3 whic...
Source: Dr. Smith's ECG Blog - February 6, 2023 Category: Cardiology Authors: Pendell Source Type: blogs

Bonus Features – February 5, 2023 – 78% of data breaches result from hacks or IT incidents, Nova Scotia taps Oracle Cerner for EHR modernization, and more
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job. Research and Studies Nearly 80% of healthcare’s data breaches can be attributed to hacking and IT incidents, according to a recent report from managed security services provider Fortified Health Security. That represents ...
Source: EMR and HIPAA - February 5, 2023 Category: Information Technology Authors: Brian Eastwood Tags: Health IT Company Healthcare IT Security and Privacy Telemedicine and Remote Monitoring Adam Kautzner ADAMS Center Agewell AHIMA AnMed AristaMD Aruba Atlanta Women's Health Group Atlas Dataset Brightside Health CCS Cerner C Source Type: blogs

A cardiac arrest is a tragedy. Multiple cardiac arrests are a moral injury.
On January 2, 2023, Buffalo Bills Safety Damar Hamlin collapsed secondary to cardiac arrest on live television, horrifying millions of Americans. We saw broadcasters, fans, players, and reporters crying on live TV as they watched the psychological trauma of a resuscitation. “No one should ever have to witness this” was a common refrain during the Read more… A cardiac arrest is a tragedy. Multiple cardiac arrests are a moral injury. originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - February 2, 2023 Category: General Medicine Authors: Tags: Physician Cardiology Emergency Medicine Source Type: blogs

Regional wall motion abnormalities in LAD territory on echocardiography.
Echocardiography is one of the simplest investigations to assess the myocardial regional wall motion abnormalities in coronary artery disease. Regional wall motion abnormalities can also be assessed by nuclear imaging and cine CT (computed tomography) scan / MRI (magnetic resonance imaging). The wall motion is scored from 1 to 4 depending on whether it is normal wall motion, hypokinesia, akinesia or dyskinesia. Hypokinesia means reduced contraction, akinesia means absence of contraction and dyskinesia means bulging out in systole. In order to standardize the reporting of wall motion abnormalities, American Society of Echo...
Source: Cardiophile MD - February 2, 2023 Category: Cardiology Authors: Johnson Francis Tags: Echocardiography General Cardiology Source Type: blogs

Primary PCI and its silent encounter with “ myocardial neutrophilia ”
Myocardial infarction,  a gross pathological entity renamed now as STEMI for clinical purposes, is the most famous medical emergency that triggers a series of calls. Right from 911/First medical contact, the ER, that ends up in CCU or a 24/7 cath lab. The heart, can’t wait for all these external responses when it is challenged with a vascular accident. The moment ATO occurs, two things happen. The endogenous fibrinolytic led by native tissue PA (Tpa) tries to get rid of the thrombotic plug by all its means. It succeeds in 15%. We call it spontaneous lysis or aborted MI. Many lives are lost in the remaining before th...
Source: Dr.S.Venkatesan MD - February 1, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized myocardial neutrophilia Source Type: blogs

Dueling OMI: does this 30 year old with chest pain have any signs of occlusion or reperfusion?
Written by Jesse McLaren, with edits from Smith A 30 year old with a history of diabetes presented with two days of intermittent chest pain and diaphoresis, which recurred two hours prior to presentation. Below is ECG #1 at triage. Are there any signs of occlusion or reperfusion?There ’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression and normal voltages. There’s mild inferior ST elevation in III that doesn’t meet STEMI criteria, but it’s associated with ST depression in aVL and V2 that makes itdiagnostic of infero-posterior Occlusion MI (from either RCA or circumflex) – accomp...
Source: Dr. Smith's ECG Blog - January 29, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs

Return to McAllen: A Father-Son Interview
By IAN ROBERTSON KIBBE You are going to hear a little more about McAllen, TX on THCB Shortly. And before we dive into what’s happened there lately, I thought those of you who weren’t here back in the day might want to read an article on THCB from July 2009. Where then THCB editor Ian Kibbe interviewed his dad David Kibbe about what he was doing as a primary care doc in McAllen–Matthew Holt By now, Dr. Atul Gawande’s article on McAllen’s high cost of health care has been widely read.  The article spawned a number of responses and catalyzed a national discussion on cost controls and t...
Source: The Health Care Blog - January 27, 2023 Category: Consumer Health News Authors: matthew holt Tags: Uncategorized David Kibbe Ian Robertson Kibbe McAllen Physicians TX Source Type: blogs

Life, death, and the balance in between: a cardiac anesthesiologist ’ s story PODCAST
Subscribe to The Podcast by KevinMD. Catch up on old episodes! David Alfery is a cardiac anesthesiologist who shares his experiences in the operating room and intensive care unit. In this discussion, he reflects on the lessons he learned about life, death, and the balance in between through his encounters with patients. He offers a Read more… Life, death, and the balance in between: a cardiac anesthesiologist’s story [PODCAST] originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - January 27, 2023 Category: General Medicine Authors: Tags: Podcast Cardiology Source Type: blogs

Cardiology update: Should mRNA vaccine myocarditis be a contraindication to future COVID-19 vaccinations ?
BY ANISH KOKA Myopericarditis is a now a well reported complication associated with Sars-Cov-2 (COVID-19) vaccinations. This has been particularly common with the messenger RNA (mRNA) vaccines (BNT162b2 and mrna-1273), with a particular predilection for young males. Current guidance by the Australian government “technical advisory groups” as well as the Australian Cardiology Society suggest patients who have experienced myocarditis after an mRNA vaccine may consider a non-mRNA vaccine once “symptom free for at least 6 weeks”. A just published report of 2 cases from Australia that document myopericarditi...
Source: The Health Care Blog - January 26, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Anish Koka mRNA vaccine myocarditis Source Type: blogs

Why sharing your complete medical history with your clinicians is important
It’s your first visit to a cardiologist because you’ve had occasional episodes of an irregular heartbeat. As you fill out your pre-appointment paperwork, you carefully list the symptoms you’re experiencing and the treatments your primary care physician has recommended before referring you to a specialist. You don’t mention that you recently started taking Lexapro (escitalopram) Read more… Why sharing your complete medical history with your clinicians is important originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - January 24, 2023 Category: General Medicine Authors: Tags: Physician Cardiology Primary Care Source Type: blogs

How minimizing treatment burden can help patients with chronic conditions
An older patient recently told me that she spent 80 days over the past year in a doctor’s office. This represented over 20 percent of her life. She was relatively well but had several chronic medical conditions that required frequent office visits. In addition to these visits, she navigated scheduling, prescriptions, laboratory testing, and copayments. Read more… How minimizing treatment burden can help patients with chronic conditions originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - January 23, 2023 Category: General Medicine Authors: Tags: Physician Cardiology 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

Epsilon Wave
Epsilon wave, the classical ECG finding in arrhythmogenic right ventricular dysplasia is seen at the end of the QRS complex. Epsilon wave is typically seen in right precordial leads though it has been noted in left precordial leads in those with left ventricular involvement. ARVD is better termed arrhythmogenic cardiomyopathy because of the possibility of left ventricular involvement. Epsilon wave represents the delayed activation of surviving islands of myocardium within the fibrofatty tissue in ARVD [1]. Some have called it as a ‘post excitation’ wave, as a corollary to the delta wave in pre excitation. It ...
Source: Cardiophile MD - January 20, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

The “open data” movement runs aground on FOURIER
BY ANISH KOKA Reanalysis of a trial used to approve a commonly used injectable cholesterol-lowering drug confirms the original analysis by accident. The open-data movement seeks to liberate the massive amount of data generated in running clinical trials from the grasp of the academic medical-pharmaceutical industrial complex that mostly runs the most important trials responsible for bringing novel therapeutics to market. There are only a few elite academic trialist groups capable of running large trials and there’s ample reason to be suspicious about the nexus that has developed between academia and the pharmace...
Source: The Health Care Blog - January 19, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Uncategorized Source Type: blogs

The Open Data Movement Runs Aground on FOURIER
BY ANISH KOKA Reanalysis of a trial used to approve a commonly used injectable cholesterol-lowering drug confirms the original analysis by accident. The open-data movement seeks to liberate the massive amount of data generated in running clinical trials from the grasp of the academic medical-pharmaceutical industrial complex that mostly runs the most important trials responsible for bringing novel therapeutics to market. There are only a few elite academic trialist groups capable of running large trials and there’s ample reason to be suspicious about the nexus that has developed between academia and the pharmace...
Source: The Health Care Blog - January 19, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Anish Koka FDA regulations Fourier open data Source Type: blogs