Ken Grauer, MD

OCTOBER 6, 2023

The ECG in Figure-1 was obtained from a middle-aged woman who presented with "palpitations". Of note — she has a history of untreated hyperthyroidism. QUESTIONS: How would YOU interpret the rhythm in Figure-1 ? Can you explain the atrial activity in this rhythm strip? Figure-1: The initial long lead II rhythm strip in today's case. MY Approach to the Rhythm in Figure-1: As per ECG Blog #185 — I favor the P s, Q s, 3 R Approach for interpretation of the cardiac rhythm — beginning with whichever o

Blog 166

Blog Arrhythmia Cardiac Arrest Tachycardia 166

Dr. Smith's ECG Blog

OCTOBER 21, 2023

A 70 something male presented in severe respiratory distress. The patient had altered mental status and so he was prepared for intubation. Before intubation, he became hypotensive. On the monitor patient had wide-complex tachycardia. The following 12-lead was obtained: What do you think? Differential is ventricular tachycardia versus supraventricular tachycardia with aberrancy versus sinus tachycardia with a aberrancy.

Tachycardia 136

Tachycardia Pulmonary Blood Pressure Cancer 136

ECG Guru

OCTOBER 11, 2023

The patient: This ECG was obtained from a 91-year-old woman who was complaining of weakness. Unfortunately, we have no other information. The ECG: This ECG has something for your basic students, and even more for the more advanced learners. The first thing that anyone should notice is the slow rate. The ventricular rate is around 35 bpm, and regular.

Bradycardia 98

Bradycardia Pacemaker 98

ECG Cases

OCTOBER 17, 2023

In this month's EM Quick Hits podcast: Sarah Reid on an approach to Infant Vomiting, Brit Long on Orbital Cellulitis essentials, Justin Morgenstern on the PATCH trial - Prehospital TXA in Trauma, Christina Shenvi on Prevention and Treatment of Delirium, Jason Hines on Procedural Skills Decay, Aaron Billin on Altitude Sickness. The post EM Quick Hits 52 Infant Vomiting, Orbital Cellulitis, Prehospital TXA in Trauma, Prevention and Treatment of Delirium, Procedural Skills Decay, Altitude Sickness

Pediatrics 94

Pediatrics 94

Science Daily - Heart Disease

OCTOBER 24, 2023

Newly published research proves that it's possible to treat high blood pressure by using specially engineered Lactobacillus paracasei to produce a protein called ACE2 in the gut, reducing gut angiotensin II and, in turn, lowering blood pressure. The study, done in lab rats that are predisposed to hypertension and unable to naturally produce ACE2, opens new doors in the pursuit of harnessing our body's own microbiome to regulate blood pressure.

Hypertension 90

Hypertension Blood Pressure Research 90

Coronary Artery Disease Journal

OCTOBER 31, 2023

Background It is unclear how COVID-19 pandemic affected care and outcomes among patients who are diagnosed with ST-elevation myocardial infarction (STEMI) in the USA. Methods We analyzed the data from National Inpatient Sample from 2016 to 2020 and assessed the impact of COVID-19 infection and the COVID-19 pandemic (year 2020) on in-hospital mortality, length of stay (LOS) and hospitalization costs.P Results There were 1 050 905 hospitalizations with STEMI, and there was an 8.2% reduction in adm

COVID-19 52

COVID-19 STEMI Inpatient Hospital 52

Ken Grauer, MD

OCTOBER 13, 2023

The ECG in Figure-1 was obtained from a woman in her 60s — who was seen in the ED ( E mergency D epartment ) as part of her evaluation for trauma following a motor vehicle accident. She was hemodynamically stable — and did not have chest pain, lightheadedness or syncope. QUESTIONS: HOW would you interpret the rhythm in Figure-1 ? Is this " high -grade" AV block?

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Blog Arrhythmia Bradycardia Download 160

ECG Guru

OCTOBER 24, 2023

Why is this a left bundle branch block? We see a SR with broad QRS complexes (more than 120 ms). These are positive in the leftward leads I and aVL and in V5 and V6. In the more rightward leads III, aVR, and V1-V3, the QRS complexes are predominantly negative with deep S waves. This is a typical LBBB pattern.

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ECG Cases

OCTOBER 17, 2023

In this ECG Cases blog Dr. Jesse McLaren guides us through 10 cases, driving home the points that sepsis is a common cause of rapid Afib and diffuse ST depression with reciprocal ST elevation in aVR, myo/pericarditis is a diagnosis of exclusion, endocarditis or lyme carditis can cause AV block, PE can cause low grade fever and ECG signs of acute RV strain and that fever can unmask Brugada syndrome.

Pericarditis 91

Pericarditis AFIB Blog Atrial Fibrillation 91

Science Daily - Heart Disease

OCTOBER 17, 2023

A new study looked at 926 polygenic risk scores for 310 diseases. It found that, on average, only 11% of individuals who develop disease are identified, while at the same time 5% of people who do not develop the disease test positive. Unaffected people usually outnumber those affected which results in far more false than true positive predictions.

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Dr. Paddy Barrett

OCTOBER 31, 2023

An elevated Lp(a) is a common genetic factor that is independently and causally related to premature coronary artery disease. But we must always remember that most genetic risk factors are probabilistic rather than deterministic in terms of risk. Subscribe now The distinction here is crucial, as most of the early work on genetics and risk has led us astray.

Coronary Artery Disease 52

Coronary Artery Disease Heart Disease Atherosclerosis Cardiovascular Disease 52

Ken Grauer, MD

OCTOBER 27, 2023

The ECG in Figure-1 was obtained from an elderly woman — who presented to the ED ( E mergency D epartment ) for dyspnea on exertion over recent weeks. What are YOUR "Quick Thoughts" about this case? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY " Q uick T houghts" on Today's CASE: The ECG in Figure-1 is highly concerning — so it is indeed fortunate that this elderly woman came to the ED when she did!

Blog 103

Blog Pacemaker Bradycardia Arrhythmia 103

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Written by Michael Doyle DO and Timothy Palmieri MD. Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. The described rhythm was an irregular, wide complex rhythm. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin.

Tachycardia 120

Tachycardia Cardiac Arrest ICU Blog 120

Medical Xpress - ECG

OCTOBER 31, 2023

Nearly 200 million people around the globe have coronary heart disease, which accounts for about one in every six deaths, according to the British Heart Foundation. That's why the recent and rapid rise in wearable electronic health-monitoring devices with heart rate-measuring electrocardiograms (ECG) represents a significant step forward. By detecting cardiovascular ailments and helping assess overall cardiac health, wearable ECGs save lives, not to mention exorbitant hospital care costs.

Electrocardiogram 52

Electrocardiogram Heart Disease Hospital 52

MIBHS

OCTOBER 31, 2023

Your heart is the engine that powers your body, which means making heart healthy choices should be a top priority. Heart disease remains one of the leading causes of death worldwide, but the good news is that many of the risk factors are controllable. Heart Healthy Tips Here at Minimally Invasive and Bloodless Heart Surgery with Dr. Ciuffo , we will explore some By making simple lifestyle changes and adopting heart healthy habits, you can significantly reduce your risk of heart disease and enjo

Blood Pressure 52

Blood Pressure Heart Disease Risk Factors Diet 52

Coronary Artery Disease Journal

OCTOBER 30, 2023

Introduction Elevated peak cardiac troponin levels have been linked with increased morbidity and mortality in patients with acute myocardial infarction (AMI). Immature Platelets are young and relatively large platelets that are hyper-reactive and pro-thrombotic compared to regular platelets. Increased immature platelet fraction (IPF) has been associated with an elevated risk of thrombotic events.

Myocardial Infarction 52

Myocardial Infarction STEMI 52

Open Heart

OCTOBER 30, 2023

Objective Animal data suggest that exercise during chemotherapy is cardioprotective, but clinical evidence to support this is limited. This study evaluated the effect of exercise during chemotherapy for breast cancer on long-term cardiovascular toxicity. Methods This is a follow-up study of two previously performed randomised trials in patients with breast cancer allocated to exercise during chemotherapy or non-exercise controls.

Exercise 52

Exercise Cancer Research 52

Ken Grauer, MD

OCTOBER 21, 2023

The ECG in Figure-1 is from an older man with known coronary disease — who presents to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) over the past several days. Troponin is pending. QUESTIONS: In view of this history — How would you interpret the ECG in Figure-1 ? Should the cath lab be activated? Figure-1: The initial ECG in today's case.

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Blog Chest Pain Ischemia STEMI 99

Dr. Smith's ECG Blog

OCTOBER 18, 2023

Written by Jesse McLaren Four patients presented with chest pain. All initial ECGs were labeled ‘normal’ or ‘otherwise normal’ by the computer interpretation, and below are the ECGs with the final cardiology interpretation. If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation?

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Chest Pain STEMI Electrocardiogram Ischemia 117

NOVARAD

OCTOBER 30, 2023

In our fast-paced digital age, instant access to information is not a luxury but a necessity. For years, the medical imaging sector clung to outdated practices, such as distributing crucial images via CDs —a time-consuming method often fraught with challenges.

Technology 52

Technology 52

American Heart News - Stroke News

OCTOBER 30, 2023

Research Highlights: Cardiovascular deaths from extreme heat in the United States are projected to increase by 162% by the middle of the century, based on a hypothetical scenario where currently proposed U.S. policies to reduce greenhouse gas.

Research 52

Research 52

Coronary Artery Disease Journal

OCTOBER 30, 2023

Introduction Several blood inflammatory markers, such as high-sensitivity C-reactive protein (hs-CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), are linked to increased risk for cardiovascular diseases. This study aimed to evaluate these inflammatory markers after cardiac rehabilitation (CR) in patients with unstable ischemic heart disease (UIHD) who underwent successful percutaneous coronary intervention (PCI).

Cardiac Rehabilitation 52

Cardiac Rehabilitation Heart Disease Biomarkers Cardiovascular Disease 52

Conquering CHD

OCTOBER 30, 2023

Medical imaging plays an essential role in CHD care. However, for parents, the thought of their child undergoing medical imaging can be a source of stress and anxiety. It’s not uncommon for children to feel scared or uneasy about the process, making it difficult for them to sit still and cooperate with the medical team. Tips and Tricks for Kids and Medical Imaging Here are some strategies you can use to help your child cope and sit still during medical imaging from other CHD parents. 1.

Outcomes 52

Outcomes Education Blog 52

Ken Grauer, MD

OCTOBER 29, 2023

= NOTE: These are my "slides" for November 2, 2023 — for my M edALL p resentation. The talk will be recorded and posted on-line. Based on ECG Blog #351 ( www.tinyurl.com/KG-Blog-351 ) LINK to this Page — www. tinyurl.com/KG-MedAll-351 — = = ECG Blog #205 = The Systematic Approach I favor. The "formula" = [link] LINK for Blog #205 = [link] - = Figure: The Systematic Approach that I favor.

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Blog Chest Pain STEMI 78

Dr. Smith's ECG Blog

OCTOBER 30, 2023

A 60 yo with 2 previous inferior (RCA) STEMIs, stented, called 911 for one hour of chest pain. He had no h/o heart failure. Here is the first prehospital ECG (time 0, after one hour of pain): I do not see evidence of OMI, and neither did the Queen of Hearts Here is the 2nd prehospital ECG (time 10 minutes, after 70 minutes of pain): No change On arrival, the first ED ECG was recorded 20 minutes after the last one (90 minutes after pain onset): What do you think?

STEMI 112

STEMI Heart Failure Stent Stents 112

Open Heart

OCTOBER 29, 2023

Introduction In Nepal, one-fourth of the adult population has hypertension. Despite provision of comprehensive hypertension services through the primary healthcare system, huge gaps in treatment and control of hypertension exist. Our study explored the individual, interpersonal, health system and community-level barriers and facilitators affecting hypertension management in urban Nepal.

Hypertension 52

Hypertension Blood Pressure 52

Physiologically Speaking

OCTOBER 27, 2023

Greetings! Welcome to the Physiology Friday newsletter. I’m excited to say that this week, Physiologically Speaking cracked the 7,000 subscriber mark. I can’t even express how grateful I am for my audience, whether you’re a long-time subscriber or a first-time reader.

Physiology 52

Physiology 52

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

Brugada Syndrome: Diagnosis and Risk Stratification Hello friends, this is the modified version of my talk at Indian Heart Rhythm Society Conference, New Delhi, 2023, on Brugada Syndrome. Hope you will enjoy this session. Initial description of Brugada syndrome in 1992 was that of syncopal episodes and/or sudden death in persons with structurally normal heart and a characteristic ECG pattern of right bundle branch block with ST segment elevation in leads V1 to V3.

Sudden Cardiac Death 52

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

Cardiovascular Ultrasound

OCTOBER 25, 2023

Intra-cardiac echocardiography (ICE) has become an important tool for catheter ablation. Adoption of ICE imaging is still limited because of its prohibitively high cost. Our aim was to study the safety and fea.

Electrophysiology 52

Electrophysiology Ablation Research 52

Cardiometabolic Health Congress

OCTOBER 26, 2023

A session at the 18 th Annual Cardiometabolic Health Congress (CMHC), explored the intersection of cardiometabolic conditions such as obesity and insulin resistance with liver disease, beginning with some important new updates on the preferred terms for these diseases. Robert H. Eckel, MD On Thursday, Oct. 19, 2023, attendees of the 18 th Annual CMHC in Boston heard from experts in hepatology and endocrinology in a session titled The Intersection of MASH and Cardiometabolic Risk: Applying Advanc

Diabetes 52

Diabetes Kidney Disease Obesity Anatomy 52

Dr. Smith's ECG Blog

OCTOBER 25, 2023

Written by Sean Trostel MD, peer reviewed by Meyers, Smith, Grauer, etc. A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergency department after an episode of syncope while standing in line at a grocery store. He did not have chest pain. Here is his triage ECG: What do you think?

Ischemia 112

Ischemia Chest Pain Cardiac Arrest Blog 112

Open Heart

OCTOBER 27, 2023

Objective To investigate the association between health-related quality of life (HRQoL) and major adverse cardiovascular and cerebrovascular events (MACCE) in individuals with ischaemic heart disease (IHD). Methods Medline(R), Embase, APA PsycINFO and CINAHL (EBSCO) from inception to 3 April 2023 were searched. Studies reporting association of HRQoL, using a generic or cardiac-specific tool, with MACCE or components of MACCE for individuals with IHD were eligible for inclusion.

Quality of Life 52

Quality of Life Heart Disease Article 52

ADN Center of Excellence

OCTOBER 26, 2023

Dear doctors, welcome to a new chapter in our medical training journey! As a company that has long been recognized for its commitment to providing top-notch education in interventional cardiology, we're excited to announce our foray into the field of Colon and Rectum Surgery. Our dedication to excellence and continuous learning remains unwavering, and we are eager to extend our expertise to this vital area of medicine.

Education 52

Education Best Practices Webinar Interventional Cardiology 52

All About Cardiovascular System and Disorders

OCTOBER 25, 2023

Rate vs Rhythm Control in Atrial Fibrillation Rate vs rhythm control as a management strategy in atrial fibrillation has been a long standing topic for debate. Though at one look rhythm control would appear to be the ideal strategy, long term adverse effects of the currently available medications for rhythm control is the often cited down side. AFFIRM [1] and RACE [2] trials were the main reason for the debate as they failed to show any benefit for the rhythm control strategy.

Atrial Fibrillation 52

Atrial Fibrillation Heart Failure Ablation Cardiac Arrest 52

Coronary Artery Disease Journal

OCTOBER 23, 2023

Background Acute myocardial infarction (AMI) is one of the most lethal complications of COVID-19 hospitalization. In this study, we looked for the occurrence of AMI and its effects on hospital outcomes among COVID-19 patients. Methods Data from the 2020 California State Inpatient Database was used retrospectively. All COVID-19 hospitalizations with age ≥ 18 years were included in the analyses.

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COVID-19 Myocardial Infarction Hospital ICU 52

ECG Guru

OCTOBER 24, 2023

There are several differential diagnoses in the presence of broad-complex tachycardia. The most common cause of wide-complex tachycardia is ventricular tachycardia. In 2nd place is sinus tachycardia/supraventricular tachycardia with aberrant conduction or preexisting bundle branch block.

Tachycardia 52

Tachycardia 52

Dr. Smith's ECG Blog

OCTOBER 8, 2023

Imagine you just started your ED shift. It's a busy Friday afternoon. Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECG s that has not been overread by a physician. All of the patients presented with chest pain , and they are all in triage. Which, if any, of these patients has OMI, with myocardium at risk and need for emergent PCI?

Ischemia 109

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 109