Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Written by Willy Frick with edits by Ken Grauer A woman in her 70s with a history of hypertension presented with acute onset shortness of breath. In patients with narrow QRS ( not this patient), this pattern is highly suggestive of acute pulmonary embolism. In PE, there is almost always some hypoxia without any pulmonary edema.

Cardiogenic Shock 128

Cardiogenic Shock Ultrasound Tachycardia Pulmonary 128

American College of Cardiology

AUGUST 5, 2024

What is the impact and prognostic value of the new 2022 European guideline definition of post-capillary pulmonary hypertension (pcPH) in heart failure (HF), which lowered the level of mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR)?

Pulmonary 44

Pulmonary Heart Failure Hypertension Article 44

Frontiers in Cardiovascular Medicine

FEBRUARY 1, 2024

Phase II and III randomized clinical trials were identified by searching the MEDLINE/PubMed, Cochrane Library and ASCO Meeting abstracts, from inception to June 2022. 1.53), but no significant difference was found for any-grade hypertension, and for vascular events. 2.97) and PFS (HR 0.49, 95% CI: 0.39–0.63)

Myocardial Infarction 64

Myocardial Infarction Hypertension Embolism Pulmonary 64

Circulation

NOVEMBER 11, 2024

Pulmonary vein thrombi (PVTs) are common and are underestimated. In 2022, we reported that 98.6% of senior patients with age-related diseases such as hypertension, dyslipidemia and atrial fibrillation had PVTs, as estimated by cardiac computed tomography (CT) and transesophageal echocardiography (TEE). from 50 y.o. from 50 y.o.

Pulmonary 45

Pulmonary Diabetes Atrial Fibrillation Hypertension 45

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Retrieved July 2, 2022, from [link] Moyé, D. Retrieved July 2, 2022, from [link] Sybrandy, K. Retrieved July 2, 2022, from [link] == MY Comment , by K EN G RAUER, MD ( 2/4 /2024 ): == Today's case by Dr. Small-but-present initial Q waves are seen in 4/6 chest leads ( ie, in leads V2,V3,V4,V5 — as per the RED arrows in Figure-1 ).

Tachycardia 115

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

DAIC

JUNE 19, 2024

The pipeline of algorithms likely to clear regulatory hurdles and enter the cardiac market over the next 12-18 months include those for Pulmonary Hypertension, Cardiac Amyloidosis, Diastolic dysfunction, and Hyperkalaemia. In April 2022 BMS had received FDA approval for Camzyos, the first drug developed specifically for targeting HCM.

AFIB 105

AFIB Reimbursement Research Atrial Fibrillation 105

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Smith comment: before reading anything else, this case screamed pulmonary embolism to me. I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. Vitals were normal.

Chest Pain 73

Chest Pain STEMI Pulmonary Embolism 73

BoardVitals - Cardiovascular

MAY 15, 2022

In early 2022, the ABIM updated its fee structure to help physicians pay less over time to maintain their certifications. Heart Failure and Cardiomyopathy 19% Valvular Disease 15% Pericardial Disease 3% Congenital Heart Disease 3% Vascular Diseases 5% Systemic Hypertension and Hypotension 8.5% How much does the exam cost?

Certification 52

Certification Congenital Heart Disease Coronary Artery Disease Cardiovascular Disease 52

Ken Grauer, MD

APRIL 13, 2024

NOTE: For more on ECG recognition of RVH and/or pulmonary hypertension ( re the qR pattern in lead V1 ) — See ECG Blog #234 and Blog #248.

Blog 118

Blog Tachycardia Pulmonary Arrhythmia 118

Dr. Smith's ECG Blog

OCTOBER 10, 2022

The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). CT angiogram showed extensive saddle pulmonary embolism. He had multiple cardiac arrests with ROSC regained each time. This is a quiz.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Circulation

NOVEMBER 11, 2024

Untreated, it may result in heart failure due to volume loading of the left heart, pulmonary hypertension, and infective endarteritis. Background:The persistently patent arterial duct accounts for ~12% of congenital heart lesions. years (IQR1.30–5.84), 5.84), median weight 13.2kg (IQR 9.0–19.5),

Anatomy 40

Anatomy Congenital Heart Failure Pulmonary 40

Dr. Smith's ECG Blog

FEBRUARY 12, 2023

This suggests that there is pulmonary hypertension and thus possibly RVH. The estimated pulmonary artery systolic pressure is 31 mmHg + RA pressure. In a patient with RVH — the finding of a qR pattern has been closely correlated with pulmonary hypertension. Right atrial enlargement, severe.

Pulmonary 40

Pulmonary Chest Pain Hypertension Tricuspid 40

All About Cardiovascular System and Disorders

OCTOBER 25, 2023

CABANA Trial randomized 2204 patients with AF aged 65 years or more and those below 65 years with one or more risk factors for stroke for catheter ablation with pulmonary vein ablation or drug therapy with rate or rhythm control. 2022 Nov 22;146(21):1561-1563. Epub 2022 Nov 21. N Engl J Med. 2008 Jun 19;358(25):2667-77.

Atrial Fibrillation 52

Atrial Fibrillation Heart Failure Ablation Cardiac Arrest 52

Dr. Smith's ECG Blog

JULY 7, 2023

An old formal echo was found from 6 mo ago: Dilated right ventricle with septal flattening and estimated right ventricular systolic pressure of 70 mmHg (significant pulmonary hypertension). She ruled out for acute MI by troponins. See further discussion of R/S ratio greater than 1 in lead V1 by Ken below.

Chest Pain 52

Chest Pain AFIB Blog Atrial Fibrillation 52

European Journal of Heart Failure

FEBRUARY 26, 2024

CI, cardiac index; FC, functional class; IQR, interquartile range; NT-proBNP, N-terminal pro-brain natriuretic peptide; PVR, pulmonary vascular resistance; sPAP, systolic pulmonary artery pressure; TAPSE, tricuspid annular plane systolic excursion; WHO, World Health Organization.

Pulmonary 40

Pulmonary Heart Failure Hypertension Ultrasound 40

Circulation

NOVEMBER 11, 2024

Background:Research into pulmonary hypertension (PH) reveals significant sex-based disparities in long-term survival rates. Circulation, Volume 150, Issue Suppl_1 , Page A4138397-A4138397, November 12, 2024. Through diagnostic codes, medical records, and imaging studies, 3,296 PH cases and 497,580 cases without PH were identified.

Pulmonary 40

Pulmonary Hypertension BMI Outcomes 40

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Published Research kschukar Thu, 04/20/2023 - 11:12 Recently published (2016 – present) manuscripts utilizing STS data: Adult Cardiac Surgery, General Thoracic Surgery, Congenital Heart Surgery, and Intermacs/Pedimacs.

Research 52

Research Coronary Artery Bypass Graft Aortic valve Congenital 52

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Institutional Coronary Artery Bypass Case Volumes and Outcomes European Journal of Heart Failure October 2023 Makoto Mori 1 Robotic Mitral Valve Repair for Degenerative Mitral Regurgitation The Annals of Thoracic Surgery August 2023 Carlos Diaz-Castrillion 2 Volume-Failure to Rescue Relationship in Acute Type A Aortic Dissections: An Analysis of The (..)

Research 52

Research Coronary Artery Bypass Graft Aortic valve Congenital 52

Heart BMJ

JANUARY 13, 2025

Background Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH), while balloon pulmonary angioplasty (BPA) is an alternative for inoperable patients. The TAPSE/systolic pulmonary artery pressure ratio improved similarly in both groups. 95% CI 0.82

Pulmonary 52

Pulmonary Angioplasty Hypertension Tricuspid 52

Dr. Smith's ECG Blog

MARCH 3, 2025

A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chest pain and shortness of breath. I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Acute coronary occlusion and acute pulmonary edema can coexist.

Tachycardia 74

Tachycardia Pulmonary Chest Pain Stenosis 74

Dr. Smith's ECG Blog

JANUARY 21, 2025

Bedside POCUS showed very poor LV function and a few pulmonary B lines. A Chest X-ray did not show pulmonary edema. However, he was never hypoxic, his heart rate never went above 120, he was not hypertensive or hypotensive. He was put on BiPAP. The echo showed inferior apical akinesis, which was NOT noted on the previous echo.

Chest Pain 62

Chest Pain STEMI Tachycardia Myocardial Infarction 62

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Rupture can be either free wall rupture (causing tamponade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock. The term "rupture" makes it sound like some sort of explosion or massive blowout, but it is usually a small, slow leak that, over time, can cause tamponade and death.

Chest Pain 89

Chest Pain Pericarditis Myocardial Infarction Dementia 89

Dr. Smith's ECG Blog

OCTOBER 27, 2024

He carries the diagnoses hyperlipidemia, hypertension, and diabetes. No pulmonary embolism is identified. 2022;Available from: [link] Click here to sign up for Queen of Hearts Access. == MY Comment, by K EN G RAUER, MD ( 10/27/2024 ): == I view today's case as unfortunate. He presented to the ED for evaluation chest pain.

STEMI 121

STEMI Chest Pain Myocardial Infarction Aneurysm 121