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Total 1840 results found since Jan 2013.
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
A 40 year old with nonspecific symptoms including dizziness
.What do you notice about the ECG?There is a very short QT interval. This is often found in hypercalcemia. See Ken Grauer ' s comments below for detail.Thus, the patient ' s chemistry was done and revealed ionized hypercalcemia of 6.3 mg/dL (normal 4.4 - 5.2)Followup: he was found to have hyperparathyroidism===================================MY Comment, by KEN GRAUER, MD (9/12/2023):===================================Today ' s ECG is remarkable for an uncommon but important finding that we periodically review, because it otherwise is all-too-easy to overlook. For example — Did YO...
Source: Dr. Smith's ECG Blog - September 12, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Judge for yourself the management of this patient with " NSTEMI, multivessel disease "
DISCUSSION:The administration of
opioid analgesia prior to cath in patients with concern for ACS is associated
with longer door-to-balloon times, and greater peak troponin levels. The rate
of Occlusion MI in those who received pre-cath opioids was double the rate of
those without pre-cath opioids, and STEMI(-) OMI patients who received pre-cath
opioids waited 10 hours on average longer to get cath than those who did not
received opioids. These results add support to our hypothesis that a major
mechanism of harm caused by opioid medications in ACS patients involves delays
to the cath lab for patients with STEMI(-) OMI.=====...
Source: Dr. Smith's ECG Blog - September 10, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A 50-something with chest pain.
This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. He reports feeling nauseated with emesis. He reports that this chest pain feels different than prior chest...
Source: Dr. Smith's ECG Blog - September 3, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A simple tip for peace of mind … for the modern patient
Preamble
A patient who had a PCI some time back , asked me in one of his recent visit.
Doctor what is microvascular endothelial dysfunction and erosison ? Am I at risk of developing it ?
What am I supposed to answer ? Yes, I some how managed .” Don’t worry , it is a complex biological phenomenon. you need not go deeper into that. Take medicines regularly” He wasn’t happy with my answer is a different story.
A simple tip for peace of mind … for the modern patient
If the current generations of patients , equipped with hyper-knowledge engines, insist to understand 100% about the...
Source: Dr.S.Venkatesan MD - August 20, 2023 Category: Cardiology Authors: dr s venkatesan Tags: patient education ai in medicine faith trust in doctors patient behaviour patient empowerment technology in mediine 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
Chest pain and T wave inversion, NSTEMI?
Case submitted and written by Dr. Mazen El-Baba and Dr. Emily Austin, with edits from Jesse McLarenA 50 year-old patient presented to the Emergency Department with sudden onset chest pain that began 14-hours ago. The nurse alerted the MD because the patient was still symptomatic, diaphoretic and “looking unwell”. What do you think? ECG interpretation: sinus rhythm, normal conduction (PR, QRS, and QTc), normal axis, delayed R-wave progression, and normal voltages. There ’s primary TWI inferiorly (aVF and III) and V6, with reciprocal tall T-wave in lead I/aVL, and a Q wave in III. The...
Source: Dr. Smith's ECG Blog - August 10, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Lecture by Smith: Selected Cases of Occlusion MI (OMI), or not, on the ECG
This may be my best lecture yet. I gave it virtually to the Kaiser group.You can access it also on the " Lectures and Podcasts " link on the Banner above.https://drive.google.com/file/d/1SSe2AmEyfkrQhRJt1FGmVxvnt3g3c4BN/view?usp=drive_link===================================MY Comment, by KEN GRAUER, MD (8/6/2023):===================================Brilliant talk by Dr. Smith on the state of the art addressing the “need for OMI — and the fallacy of STEMI ”. For skeptics (including cardiologists) — Any questions about “Who is Dr. Smith?” are compellingly answered by the several...
Source: Dr. Smith's ECG Blog - August 6, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
OMI Pocket Guide
📕OMI Pocket Guide TheOMI Pocket Guide (https://omiguide.org) is a user-friendly online resource designed to help healthcare professionals learn how to recognize subtle signs of acute coronary occlusion on the ECG which represent occlusion myocardial infarctions (OMI). Learning to recognize OMIs is an important clinical skill because it helps identify the subpopulation of " NSTEMIs " who are likely to be found with total thrombotic occlusion at the time of cardiac catherization.Although there are more criteria to consider when looking for OMIs compared to STEMIs, anyone can learn them, and this guid...
Source: Dr. Smith's ECG Blog - August 3, 2023 Category: Cardiology Authors: Mark Hellerman Source Type: blogs
A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation
A 40-something with persistent Ventricular Fibrillation presented after attempted prehospital resuscitationA 40-something with no previous cardiac history presented to the ED in persistent Ventricular Fibrillation after attempted prehospital resuscitation. He underwent further standard resuscitation EXCEPT that we applied the Inspiratory Threshold Device (ResQPod) AND applied Dual Sequential Defibrillation (this simply means we applied 2 sets of pads, had 2 defib machines, and defibrillated with both with only a fraction of one second separating each defibrillation.Two recent interventions have proven in randomized t...
Source: Dr. Smith's ECG Blog - July 14, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
I was reading ECGs on the system when I came across this one, called " normal " by the conventional computer algorithm
I come in early for every shift to read the ECGs on the system that have not yet been " confirmed " . I came across this one:The computer calls is: " SINUS RHYTHM. NORMAL ECG "What do you think? Be VERY careful when the computer calls the ECG " Normal " . I saw the inferior ST depression (which is reciprocal to subtle STE in aVL) and the subtle ST depression in precordial leads and thought:" If this patient came in with chest pain, then it is an acute OMI. "So I looked on the computer. Turns out that it was a 50-something patient with no previous cardiac history who had called 911 for chest pain...
Source: Dr. Smith's ECG Blog - July 12, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
63 year old with " good story for ACS " but negative troponins.....
This was texted to me from a former resident, while working at a small rural hospital, with the statement:" I can ’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS. " (Chest pain or discomfort)What do you think?Here was my response:" Suspicious for inferior posterior OMI. Get serial ECGs "He then sent a previous from 4 years prior:" This is totally normal, which confirms that the first EKG does indeed represent OMI "Then the patient ' s chest pain resolved and he recorded another:The ST depression in aVL is gone and the T-waves are less hyperacu...
Source: Dr. Smith's ECG Blog - July 2, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Heritable Component for Bicuspid Aortic Valve and Thoracic Aortic Disease?
Is there a heritable component for bicuspid aortic valve disease and thoracic aortic disease including aneurysm and dissection? So it seems, from a study published in Circulation from the University of Utah School of Medicine [1]. The study included a huge database of 3, 812, 588 unique individuals! From the database they identified probands with a diagnosis of bicuspid aortic valve, thoracic aortic aneurysm or thoracic aortic dissection. Age and sex matched controls in the ratio 10:1 were identified for each proband. They also identified first degree relatives, second degree relatives and first cousins of the p...
Source: Cardiophile MD - June 18, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology 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
