Dr. Smith's ECG Blog

NOVEMBER 27, 2023

Written by Jesse McLaren A 45 year old presented with two weeks of recurring non-exertional chest pain, now constant for an hour. Below is old and then new ECG (old on top; new below). What do you think? Both ECGs have normal sinus rhythm, normal conduction and normal voltages. There’s a change in axis that may interfere with direct lead-to-lead comparison, but there appear to be larger T waves in I/aVL and new TWI in III/aVF.

Chest Pain 88

Chest Pain STEMI Ischemia Anatomy 88

Open Heart

NOVEMBER 27, 2023

Introduction This study aimed to evaluate the use and dose of loop diuretics (LDs) across the entire ejection fraction (EF) spectrum in a large, ‘real-world’ cohort of chronic heart failure (HF) patients. Methods A total of 10 366 patients with chronic HF from 34 Dutch outpatient HF clinics were analysed regarding diuretic use and diuretic dose.

Heart Failure 52

Heart Failure Preserved Ejection Fraction Outpatient Diabetes 52

NOVARAD

NOVEMBER 27, 2023

The medical industry has long been burdened by challenges associated with outdated and inefficient medical image sharing systems. These antiquated mechanisms hinder timely access to vital imagery, causing delays in diagnoses and treatment and ultimately compromising patient care.

Patient Care 52

Patient Care 52

Open Heart

NOVEMBER 27, 2023

Objective This study aimed to assess the incidence of early cancer therapy-related cardiac dysfunction (CTRCD) and the characteristics of left and right heart deformations during anthracycline chemotherapy. Methods We prospectively enrolled a cohort of 351 chemotherapy-naïve women with breast cancer and cardiovascular risk factors who were scheduled to receive anthracycline.

Cancer 52

Cancer Risk Factors 52

Heart BMJ

NOVEMBER 27, 2023

Objective Concerns for cardiac involvement after SARS-CoV-2 infection led to widespread cardiac testing in athletes. We examined incidental non-COVID-19 cardiovascular pathology in college athletes undergoing postinfection return-to-play screening. Methods The Outcomes Registry for Cardiac Conditions in Athletes was a nationwide prospective multicentre observational cohort study that captured testing and outcomes data from 45 institutions (September 2020–June 2021).

COVID-19 52

COVID-19 Sudden Cardiac Death Aortic Atrial Fibrillation 52

Open Heart

NOVEMBER 27, 2023

Background Although there are studies examining each one separately, there are no data in the literature comparing the magnitudes of the iatrogenic, percutaneous coronary intervention (PCI)-induced, microvascular dysfunction (Type-4 CMD) and coronary microvascular dysfunction (CMD) in the setting of ischaemia in non-obstructed coronary arteries (INOCA) (Type-1 CMD).

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Heart BMJ

NOVEMBER 27, 2023

Objective A 45% threshold of right ventricular ejection fraction (RVEF) is proposed clinically relevant in patients with pulmonary arterial hypertension (PAH). We aim to determine treatment response, long-term right ventricular (RV) functional stability and prognosis of patients with PAH reaching or maintaining the RVEF 45% threshold. Methods Incident, treatment-naive, adult PAH patients with cardiac magnetic resonance imaging at baseline and first follow-up were included (total N=127) and follo

Pulmonary 52

Pulmonary Hypertension Transplant 52

Heart BMJ

NOVEMBER 27, 2023

Objective Heart failure (HF) is one of the most common and lifestyle-limiting complications of hypertrophic cardiomyopathy (HCM). Prediction of worsening HF using clinical measures alone remains limited. Moreover, the mechanisms by which patients with HCM develop worsening HF have not been elucidated. Therefore, the aim of this study was to develop a plasma proteomics-based model to predict worsening HF among patients with HCM and to identify signalling pathways that are differentially regulated

Heart Failure 52

Heart Failure Cardiomyopathy 52

Open Heart

NOVEMBER 27, 2023

Objectives Postoperative cognitive decline (POCD) or decreased health-related quality of life (HQL) have been reported after cardiac surgery. A previous investigation showed beneficial effects of postoperative cognitive training on POCD and HQL 3 months after heart surgery. Here, we present the 12-month follow-up results. Methods This bicentric, 1:1 randomised and treatment-as-usual controlled trial included elderly patients scheduled for elective heart valve surgery.

Quality of Life 52

Quality of Life Heart Valves Exercise 52

Heart BMJ

NOVEMBER 27, 2023

Objective The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. We designed paired ischaemic and major bleeding risk scores to inform this decision. Methods New Zealand (NZ) patients with ACS investigated with coronary angiography are recorded in the All NZ ACS Quality Improvement registry and linked to national health datasets.

Myocardial Infarction 52

Myocardial Infarction Atrial Fibrillation Stroke Strokes 52

HeartRhythm

NOVEMBER 27, 2023

Cardioneuroablation (CNA) is a promising therapy for reflex asystolic syncope, however, convincing data on the mid-term safety and efficacy of this procedure are still lacking.

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Heart BMJ

NOVEMBER 27, 2023

Proteomic profiling allows measurement of thousands of proteins simultaneously from blood or tissue samples in patients with cardiovascular disease which offers the promise of both improved risk prediction and identification of pathways instrumental in disease progression. In a multi-centre prospective cohort study of 389 patients with hypertrophic cardiomyopathy (HCM), Lumish and colleagues 1 derived and validated an 11-protein proteomics-based model to predict worsening heart failure (HF) over

Heart Failure 52

Heart Failure Cardiomyopathy Cardiovascular Disease 52

Stroke: Vascular and Interventional Neurology

NOVEMBER 27, 2023

Stroke: Vascular and Interventional Neurology, Ahead of Print. BACKGROUNDThe management of nonacute symptomatic internal carotid artery occlusion remains unsatisfactory. Endovascular recanalization has been reported to be feasible but associated with a noteworthy risk of postprocedural complications in patients with symptomatic internal carotid artery occlusion.

Hemorrhage 40

Hemorrhage Stroke Strokes Outcomes 40

Science Daily - Heart Disease

NOVEMBER 27, 2023

Biomedical engineers have developed a method using data from wearable devices such as smartwatches to digitally mimic an entire week's worth of an individual's heartbeats. The new 'digital twins' computational framework captures personalized arterial forces over 700,000 heartbeats to better predict risks of heart disease and heart attack. The advance is an important step toward evaluating the risks of heart disease or heart attack over months to years.

Heart Attack 40

Heart Attack Heart attacks Heart Disease 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 27, 2023

Stroke: Vascular and Interventional Neurology, Ahead of Print. BACKGROUNDThe incidence of subdural hematoma is increasing as the average age in the United States rises, with reported high recurrence and reoperation rates. We therefore aimed to have a better understanding of retreatment following surgical evacuation of subdural hematoma in real‐world practice.METHODSData were extracted from the latest available Nationwide Readmissions Database (2016–2019).

Stroke 40

Stroke Strokes 40

Journal of Cardiovascular Electrophysiology

NOVEMBER 27, 2023

Abstract Introduction The importance of atrio-ventricular synchrony pacing in sinus rhythm patients is known. To identify patients in whom leadless pacemakers are able to guarantee this atrio-ventricular synchrony, we explored correlations among echocardiographic measures of left atrial (LA) size and function (doppler parameter and strain) with A4 amplitude in patients implanted with new generation Micra-AV device.

Pacemaker 40

Pacemaker Article 40

Heart BMJ

NOVEMBER 27, 2023

Clinical introduction A patient in their 70s, a heavy smoker with low body max index (17 kg/m 2 ) already known for previous relapses of pericarditis on echocardiographic follow-up, was admitted for worsening pericardial effusion ( figure 1A,B ; ). Given initial signs of cardiac tamponade, the patient underwent urgent pericardiocentesis (subxiphoid approach) with drainage of 1500 cc of pericardial fluid, without evident complications.

Echocardiogram 40

Echocardiogram Pericarditis 40

Journal of Cardiovascular Electrophysiology

NOVEMBER 27, 2023

Abstract Introduction Fusion pacing requires correct timing of left ventricular pacing to right ventricular activation, although it is unclear whether this is maintained when atrioventricular (AV) conduction changes during exercise. We used cardiopulmonary exercise testing (CPET) to compare cardiac resynchronization therapy (CRT) using fusion pacing or fixed AV delays (AVD).

Exercise 40

Exercise Stroke Strokes Article 40

Heart BMJ

NOVEMBER 27, 2023

The number of patients at the intersection of cancer and cardiovascular disease (CVD) is increasing, reflecting ageing global populations, rising burden of shared cardiometabolic risk factors, and improved cancer survival. Many cancer treatments carry a risk of cardiotoxicity. Baseline cardiovascular risk assessment is recommended in all patients with cancer and requires consideration of individual patient risk and the cardiotoxicity profile of proposed anticancer therapies.

Cardio Oncology 40

Cardio Oncology Cancer Cardiovascular Disease Risk Factors 40

Journal of Cardiovascular Electrophysiology

NOVEMBER 27, 2023

Abstract Continuous flow left ventricular assist devices (CF-LVADs) have been shown to reduce mortality and morbidity in patients with advanced heart failure with reduced ejection fraction. However, ventricular arrhythmias (VA) are common, are mostly secondary to underlying myocardial scar, and have a higher incidence in patients with pre-LVAD VA. Sustained VA is well tolerated in the LVAD patient but can result in implantable defibrillator (ICD) shocks, right ventricular failure, hospitalizatio

Defibrillator 40

Defibrillator Arrhythmia Best Practices Quality of Life 40

Heart BMJ

NOVEMBER 27, 2023

Damage to the atrioventricular conduction axis continues to be a problem subsequent to transcatheter implantation of aortic valvar prostheses. Accurate knowledge of the precise relationships of the conduction axis relative to the aortic root could greatly reduce the risk of such problems. Current diagrams highlighting these relationships rightly focus on the membranous septum.

Aortic 40

Aortic Aortic valve 40

HeartRhythm

NOVEMBER 27, 2023

Pulsed field ablation (PFA) is a nonthermal energy source for ablation of cardiac arrhythmias. This study investigated the prospective outcomes of a novel PFA generator in conjunction with a commercially available, contact force-sensing, focal ablation catheter.

Ablation 40

Ablation Pulmonary Arrhythmia Outcomes 40

Heart BMJ

NOVEMBER 27, 2023

There were great advances in the treatment of heart failure (HF) over the past decades, characterised by the inclusion of ARNI and SGLT2 inhibitors in the latest guidelines. The use of cardiac myosin inhibitors specifically for patients with hypertrophic cardiomyopathy (HCM) is also making large steps forward, which reflects the next step towards more personalised treatment. 1 The increasing repertoire of treatments makes it even more important to select those patients who will benefit the most

Cardiomyopathy 40

Cardiomyopathy Heart Transplant Transplant Heart Failure 40

HeartRhythm

NOVEMBER 27, 2023

Pulse field ablation (PFA) using a pentaspline catheter is an effective and safe treatment method for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF).1,2 However, the efficacy and safety of PFA for non PV targets is largely unknown. We present a case of a macro-reentrant atrial tachycardia in the lateral right atrium (RA) treated by PFA using a pentaspline catheter.

Tachycardia 40

Tachycardia Ablation Atrial Fibrillation Pulmonary 40

Heart BMJ

NOVEMBER 27, 2023

It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change. (Charles Darwin) Despite being proposed more than three decades ago, dual antiplatelet therapy has become a cornerstone of medical treatment for patients suffering from acute coronary syndrome after the introduction of bare metal stents to overcome the risk of restenosis and stent thrombosis associated with such devices.

Thrombosis 40

Thrombosis Stents Stent 40

HeartRhythm

NOVEMBER 27, 2023

Atrial fibrillation (AF) is the most common heart arrhythmia and considered to be a progressive chronic disease associated with an increased morbidity and mortality. Recent data suggests a link between inflammation, oxidative stress and AF, although the underlying mechanisms are not fully understood. As oxidized lipoproteins cause structural damage and electrophysiologic changes in cardiomyocytes, it is feasible that the transformation of atheroprotective high-density lipoprotein (HDL) into dysf

Atrial Fibrillation 40

Atrial Fibrillation Chronic Disease Electrophysiology Arrhythmia 40

Heart BMJ

NOVEMBER 27, 2023

Medical journal editors face many challenges in the ongoing transformation of scientific publishing including the replacement of print by digital publication, the proliferation of journals, increasing emphasis on open access and the introduction of preprint websites. Historically, the evolution of journal editorship reflects the changing environment and standards for scientific publishing. 1 Over the past 50 years, it has become established that an essential function of a medical journal is to p

Research 40

Research Education 40

HeartRhythm

NOVEMBER 27, 2023

Arrhythmogenic cardiomyopathy (ACM) is a heart muscle disease characterized by replacement of ventricular myocardial by fibrofatty scar tissue which underlies morpho-functional ventricular abnormalities and life-threatening ventricular arrhythmias potentially responsible of sudden cardiac death (SCD), mostly in young people and athletes 1,2. Although the original disease phenotype was characterized by a predominant right ventricular (RV) involvement (arrhythmogenic right ventricular cardiomyopat

Cardiomyopathy 40

Cardiomyopathy Sudden Cardiac Death Arrhythmia 40

Becker's Hospital Review - Cardiology

NOVEMBER 27, 2023

Continuing regular check-ups for some mothers into the "fourth-trimester" — the three month after giving birth —may help reduce cardiovascular-related deaths, a top indirect cause of maternal deaths, according to the American Heart Association.

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Circulation: Cardiovascular Quality & Outcomes

NOVEMBER 27, 2023

Circulation: Cardiovascular Quality and Outcomes, Ahead of Print.

Outcomes 40

Outcomes Circulation 40

Dr. Malcolm Kendrick

NOVEMBER 27, 2023

27th November 2023 Relentlessly falling productivity (Part a). Regulatory constraints. I was in the midst of writing another blog on what is wrong with the NHS, happily highlighting a few of the many pointless tasks that get in the way of clinical work. But my attention kept being drawn to the more general issue of the widespread fall in productivity.

Hospital 52

Hospital Nursing Outpatient Article 52

Open Heart

NOVEMBER 27, 2023

Objective Prehospital rule-out of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in low-risk patient with a point-of-care troponin measurement reduces healthcare costs with similar safety to standard transfer to the hospital. Risk stratification is performed identical for men and women, despite important differences in clinical presentation, risk factors and age between men and women with NSTE-ACS.

Chest Pain 52

Chest Pain Risk Factors Hospital 52

Heart BMJ

NOVEMBER 27, 2023

Objective To characterise the mechanics responsible for the reduced ejection fraction (rEF) in high-gradient severe aortic stenosis (AS). Methods 21 patients with high-gradient severe AS (aortic valve area (AVA) <1.0 cm 2 and mean gradient (MG) >40 mm Hg) were included. They included 9 patients with rEF (EF <50%) and 12 with preserved ejection fraction (pEF) (EF >50%).

Stenosis 40

Stenosis Aortic Preserved Ejection Fraction Aortic valve 40

Journal of Cardiovascular Electrophysiology

NOVEMBER 27, 2023

Abstract Introduction Pulsed field ablation (PFA) represents a novel, nonthermal energy modality that can be applied for single-shot pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative data with regard to deep sedation to established single-shot modalities such as cryoballoon (CB) ablation are scarce. The aim of this study was to compare a deep sedation protocol in patients receiving PVI with either PFA or CB.

Atrial Fibrillation 40

Atrial Fibrillation Ablation Pulmonary Article 40

Heart BMJ

NOVEMBER 27, 2023

Sleep-disordered breathing (SDB) is common in individuals with established cardiovascular disease (CVD), particularly those with heart failure (HF). There are two main types of SDB, central sleep apnoea (CSA) and obstructive sleep apnoea (OSA) which frequently overlap as mixed SDB. Investigating for SDB could be considered in patients with excessive daytime sleepiness, male sex, high body mass index, low ejection fraction, atrial fibrillation (AF), in patients with no dipping blood pressure patt

Cardiovascular Disease 40

Cardiovascular Disease Blood Pressure Atrial Fibrillation Heart Failure 40