April, 2023

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ECG Blog #377 — Is the 1st ECG Normal?

Ken Grauer, MD

The patient whose initial ECG is shown in Figure-1 — is a middle-aged man who presented to the ED ( E mergency D epartment ) for new-onset CP ( C hest P ain ). He was hemodynamically stable at the time this tracing was done. The patient was still having CP at the time ECG #1 was obtained — although the severity of his CP was unclear ( ie, It is not known IF this patient’s CP was increasing — the same — or decreasing — at the time the ECG in Figure-1 was recorded ).

Blog 78
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ECG Cases 41 – STEMI, Occlusion MI Complications

ECG Cases

How can we use the awareness of complications to identify false positive STEMI and Occlusion MI that doesn’t meet classic STEMI criteria, and consider specific treatment? Dr. Jesse McLaren reviews the complications of MI through 10 ECG cases and how they alter management. The post ECG Cases 41 – STEMI, Occlusion MI Complications appeared first on Emergency Medicine Cases.

STEMI 82
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How Imaging Equipment Service Powers Patient Care in Broken Bow

Cassling

Large enough to serve, small enough to care. That’s the motto of Melham Medical Center in Broken Bow, Nebraska — and one Cassling supports with reliable imaging equipment service.

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A 50-something with acute chest pain, a computer "Normal" ECG, and a HEART score of 3 (low risk)

Dr. Smith's ECG Blog

A 50-something with no previous cardiac history and no risk factors presented to the ED with acute chest pain (pressure) that radiated to the left arm. An ECG was immediately recorded: Computer read: Normal ECG What do you think? There is ST depression in V1-V3. We showed that this is diagnostic of OMI (of the posterior wall). Moreover, there is ST elevation in V6 (which is getting close to the location of posterior lead V7).

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Variations in current clinical practice of postoperative pericardial effusion: a questionnaire study

Open Heart

Objective Postoperative pericardial effusion (PPE) occurs frequently after cardiac surgery, potentially leading to life-threatening cardiac tamponade. Specific treatment guidelines are currently lacking, possibly leading to variations in clinical practice. Our goal was to assess clinical PPE management and evaluate variation between centres and clinicians.

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Easy Ways to Automate Your Cardio Lab

NOVARAD

To keep pace with the rising number of patients, many cardiology labs are looking to replace manual processes with automation. Reduced staffing, budget constraints, and laboratory consolidation increase the need for automation, and fortunately, the streamlining of everyday activities improves operational efficiencies, reduces errors, and strengthens patient care.

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ECG Blog #376 — A 15yo with Fever.

Ken Grauer, MD

The 12-lead ECG and long lead rhythm strip in Figure-1 — was obtained from a previously healthy 15-year old male , who presented with fever and diarrhea. He was hemodynamically stable. No chest pain. How would YOU interpret the ECG in Figure-1 ? What is the cardiac rhythm? What do you suspect as the clinical diagnosis? Figure-1: The initial ECG in today’s case — obtained from a 15-year old male with fever and diarrhea.

Blog 78

More Trending

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Benefits of Telemedicine

AMS Cardiology

Telemedicine has revolutionized the way we access medical services. By making use of virtual resources and digital communication tools, telemedicine can help patients in numerous ways. The advantages of telehealth already far outweigh the negatives. It can include everything from initial diagnostic appointments to follow-ups to continual training for healthcare professionals.

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A 20-something with intermittent then acute chest pain

Dr. Smith's ECG Blog

This was sent to me by a partner: "Curious what you think of this one we had overnight. Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. He had another episode the day before after exerting himself. No pericardial effusion on ultrasound." What do you think? First, many on Twitter said "Pericarditis".

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History & Future of Cardiac Remote Patient Monitoring

Vector Remote

History & Future of Cardiac Remote Patient Monitoring Healthcare reforms fueled by government legislation and recent technological innovations have propelled cardiac remote patient monitoring to the forefront in the early 2020s, but the history of cardiac remote patient monitoring dates to more than half a century ago. Between the COVID-19 pandemic and increasing amount of chronic diseases found in patients, the need for virtual healthcare has taken flight at an accelerated pace.

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Strengthening Your Cardiology with Single-Click Comprehensive Reporting

NOVARAD

Although almost half of all US adults have at least one form of heart disease, their experiences may vary drastically. While some people have a range of symptoms, others are asymptomatic. Cardiovascular disease , including issues with the heart or blood muscles, come in several forms. Irregular heart rhythms, heart valves functioning incorrectly, heart or blood vessel issues presenting at birth, or the narrowing of blood vessels in the heart or organs are just a few examples of the hazards of ca

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ECG Blog #375 — At Least 3 Major Findings.

Ken Grauer, MD

The ECG in Figure-1 was obtained from a 50-year old man — who presented to the ED ( E mergency D epartment ) with new-onset CP ( C hest P ain ). QUESTIONS: There are at least 3 principal findings on this ECG — some of which deal with a possible “culprit” artery and / or the location of whatever is going on. How many of these findings can YOU identify?

Blog 78
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Journal Club 3 – Dexamethasone and Ketorolac in Acute Renal Colic

ECG Cases

Does the addition of dexamethasone to ketorolac improve pain scores in patients suffering from renal colic? Find out through this critical appraisal of a recent RCT on this EMC Journal Club. The post Journal Club 3 – Dexamethasone and Ketorolac in Acute Renal Colic appeared first on Emergency Medicine Cases.

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Forensic Radiology: A Path Forward in Strengthening Forensic Science

Cassling

Forensic science plays an increasingly significant role in the investigation and resolution of criminal activities. As modern technology advances, it presents new opportunities for solving complex cases and enhancing the efficiency of forensic investigations. One of the most revolutionary developments in contemporary forensic science is the utilization of imaging techniques, particularly forensic radiology.

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50 year old with acute chest pain, with ‘normal’ ECG and falling troponin

Dr. Smith's ECG Blog

Written by Jesse McLaren, with comments from Smith A 50-year old patient on the medical wards developed acute chest pain, with an ECG labeled (see computer interpretation at the top) and confirmed as normal. What do you think? There’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression, and normal voltages. Lead aVL jumps out as abnormal because there is a discordant T wave inversion and mild ST depression.

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External validation and updating of prediction models of bleeding risk in patients with cancer receiving anticoagulants

Open Heart

Objective Patients with cancer are at increased bleeding risk, and anticoagulants increase this risk even more. Yet, validated bleeding risk models for prediction of bleeding risk in patients with cancer are lacking. The aim of this study is to predict bleeding risk in anticoagulated patients with cancer. Methods We performed a study using the routine healthcare database of the Julius General Practitioners’ Network.

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How to Create Automatic Coronary Tree Diagrams

NOVARAD

Coronary artery disease (CAD) is the most common type of heart disease and the leading cause of death globally: one in four people lose their lives to CAD annually. Coronary arteries provide the heart with the oxygen-rich blood that it needs to function, carrying away oxygen-depleted blood. In a patient with CAD, atheromatous plaques build inside the coronary arteries, reducing the flow of oxygen-rich blood to the heart muscle by narrowing or blocking the arteries.

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ECG Blog #374 — Do You Know the "Culprit"?

Ken Grauer, MD

The ECG in Figure-1 was obtained from a 90-year old woman — who presented with a 2-to-3 day history of chest pain, that became worse on the day of admission. How would YOU interpret the ECG in Figure-1 ? Is there acute coronary occlusion? If so — What is the " culprit " artery? Figure-1: The ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

Blog 78
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The Science Has Spoken on Revascularization

Society of Thoracic Surgeons - Congenital

New research supports surgeons' assertions that the optimal treatment for multivessel coronary artery disease—to improve not only long-term survival but also lower risk of complications—is coronary artery bypass surgery.

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Ep181 Cerebral Venous Thrombosis, Idiopathic Intracranial Hypertension, Giant Cell Arteritis and Peripartum Headaches

ECG Cases

In this episode, Dr. Roy Baskind and Dr. Ahmit Shah answer such questions as: when is an opening pressure on LP required? When should we pull the trigger on ordering a CT venogram in the patient with unexplained headache? Which older patients who present with headache require an ESR/CRP? How do the presentations of cerebral venous thrombosis (CVT) and idiopathic intracranial hypertension (IIH) compare and contrast?

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Compare these two ECGs. Do either, neither, or both show anything important?

Dr. Smith's ECG Blog

One case sent by Dr. Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve Smith Take 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.

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Affirmative action in Medicine : A forbidden debate?

Dr. Anish Koka

As a young boy, I grew up reading of the triumph of good over evil in my favorite Indian comic book: Amar Chitra Katha. The tales of the virtuous vassals imbued by a godly spirit vanquishing the forces of darkness is powerful and appealing in large measure because we believe we inhabit a world where the good guys won. But unlike the comic books, the bad guys in the real world don’t have horns, and don’t look like J.R.R Tolkien’s trolls - they wear suits and have fancy degrees a

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Instructors' Collection ECG: Acute Anterior M.I. and Ventricular Fibrillation

ECG Guru

The Patient: This series of ECGs is from a 65-year-old woman who was complaining of a sudden onset of chest pain, nausea, and weakness. She stated that the pain increased on inspiration. She reported a history of non-insulin-dependent diabetes mellitus (NIDDM). ECG No. 1, 14:46: This ECG includes V4Right, V8 and V9 in place of V4, V5, and V6.

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ECG Blog #373 — 86yo and this Rhythm.

Ken Grauer, MD

The 12-lead ECG and long lead II rhythm strip in Figure-1 was obtained from an 86-year old man — who presented to the ED ( E mergency D epartment ) with presyncope. No chest pain. Th e patient was hemodynamically stable in association with this rhythm. How would YOU interpret the ECG in Figure-1 ? What is the rhythm ? Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chest pain. ( T o improve visualization — I've digitized the original ECG using

Blog 78
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Research priorities relating to the delivery of cardiovascular prevention and rehabilitation programmes: results of a modified Delphi process

Open Heart

Objective The purpose of this British Association for Cardiovascular Prevention and Rehabilitation (BACPR) research priority setting project (PSP) was to identify a top 10 list of priority research questions for cardiovascular prevention and rehabilitation (CVPR). Methods The PSP was facilitated by the BACPR clinical study group (CSG), which integrates as part of the British Heart Foundation Clinical Research Collaborative.

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Cassling Employees Assemble Kits for a Cause

Cassling

Each year, employees of Cassling raise donations for charities around the country. Non-profit organizations that have benefitted from employees’ generosity over the years include the Food Bank for the Heartland, Ronald McDonald House Charities, Lifescape South Dakota, Unfaulted and more.

Blog 52
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A man in his 60s with acute chest pain and high voltage

Dr. Smith's ECG Blog

Sent by Anonymous, written by Pendell Meyers A man in his 60s with history of CAD and 2 prior stents presented to the ED complaining of acute heavy substernal chest pain that began while eating breakfast about an hour ago, and had been persistent since then, despite EMS administering aspirin and nitroglycerin. There was associated diaphoresis, but no dyspnea, nausea, or vomiting.

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MOC and the Demise of CME

Dr. Wes

With the ongoing forcing of participation in Maintenance of Certification (MOC) of US physicians by the American Board of Medical Specialties (ABMS)and its 24 member boards, we are seeing the slow demise of physician-selected Continuing Medical Education (CME) in America. Attendance at specialty society meetings is at an all-time low.

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Extended monitoring detects more arrhythmias in hypertrophic cardiomyopathy, researchers find

Medical Xpress - ECG

Thirty day electrocardiogram (ECG) monitoring in patients with hypertrophic cardiomyopathy (HCM) detects more arrhythmias than the standard 24 to 48 hours, according to late breaking science presented at EHRA 2023, a scientific congress of the European Society of Cardiology (ESC).

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ECG Blog #372 — PVCs or Aberrant?

Ken Grauer, MD

I was asked for my interpretation of this tracing. No history was provided. How would YOU interpret this long lead II rhythm strip? Are the different-looking beats PVCs or supraventricular impulses conducted with aberration? — or — Something else? Figure-1: The long lead II rhythm strip for today’s case. No history was available. ( To improve visualization — I've digitized the original ECG using PMcardio ).

Blog 78
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High burden of rheumatic heart disease confirmed by echocardiography among Pacific adults living in New Zealand

Open Heart

Background Despite numerous echocardiographic screening studies of children in high incidence acute rheumatic fever (ARF)/rheumatic heart disease (RHD) communities, little is known about the prevalence of RHD in adults in these populations. We sought to determine the prevalence of RHD in an urban area of South Auckland, New Zealand, where previous studies had shown the prevalence of RHD in children to be around 2%.

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Lipid molecules help to get stroke therapies into the brain

Science Daily - Stroke

Researchers have found that a promising stroke therapy, known as antisense oligonucleotides, is preferentially taken up from the blood into areas of stroke damage in the brain when the molecules are linked to a specific kind of lipid. This therapy can be given relatively late after a stroke occurs, and is hoped to lead to reduced stroke-related disabilities.

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A 40-something woman with acute pulmonary edema -- see the Speckle Tracking echocardiogram.

Dr. Smith's ECG Blog

A 49 year old woman with h/o COPD only presented with sudden dyspnea. She had acute pulmonary edema on exam. Prehospital Conventional algorithm interpretation: ANTERIOR INFARCT, STEMI Transformed ECG by PM Cardio: PM Cardio AI Bot interpretation: OMI with High Confidence What do you think? There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD.

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ABMS Maintenance of Certification – Its Origins, Realities, and Implications for Medicine – Part I

Dr. Wes

This piece first appeared on Sensible Med on 4/26/2023. If you’re a board-certified internist, you’re probably quite familiar with the controversy surrounding the American Board of Internal Medicine (ABIM) that began when lifelong board certification mysteriously became time-limited in 1990.

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Smart watches could predict future heart problems

Medical Xpress - ECG

Wearable devices such as smart watches could be used to detect a higher risk of developing heart failure and irregular heart rhythms in later life, suggests a new study led by UCL researchers.

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Published Research

Society of Thoracic Surgeons - Research

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. Adult Cardiac Surgery Database Lead Author Title Publication Date Jacob Raphael Red Blood Cell Transfusion and Pulmonary Complications: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis The Annals of Thoracic Surgery January 2024 Joseph Sabik Multi-Arterial

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Integrated approach to cardiovascular disease in people experiencing homelessness: a qualitative study

Open Heart

Background Homelessness is associated with an increased risk of cardiovascular disease (CVD), beyond impact of socioeconomic status. CVD is preventable and treatable, though barriers to interventions exist for people experiencing homelessness. Those with lived experience of homelessness and health professionals with relevant expertise can help to understand and address these barriers.