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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.
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!
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.
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.
Speaker: Simran Kaur, Co-founder & CEO at Tattva Health Inc.
AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!
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.
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.
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.
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.
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.
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?
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
Percutaneous coronary intervention (PCI) is widely adopted to treat chronic coronary artery disease. Numerous randomised trials have been conducted to test whether PCI may provide any prognostic advantage over oral medical therapy (OMT) alone, without definitive results. This has maintained the paradigm of OMT as the first-line standard of care for patients, reserving PCI for symptom control.
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.
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.
@RobertHermanMD on Making Waves from Mayo clinic. Artificial Intelligence-Augmented ECG Interpretation Using Smartphone Technology @TheEKGGuy [link] == MY Comment , by K EN G RAUER, MD ( 10/26 /2023 ): == Our THANKS to Drs. Anthony Kashou & Robert Herman for their wonderful ongoing work toward continued evolution and improvement of clinical ECG utilization.
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.
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.
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.
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.
Many adults born with congenital heart disease have never met anyone else with a similar condition - which is where patient support organizations shine!
Why is this a right bundle branch block? We see a SR with broad QRS complexes (more than 120 ms). These are positive in the rightward leads III and especially in V1 and V2. In the more leftward leads I, aVL, V4-V6 there are clear S waves. This is a typical RBBB pattern.
Background Studies have found statin treatment to be associated with improved 1-year survival after transcatheter aortic valve implantation (TAVI), suggesting pleiotropic effects of statins on preventing perioperative complications. Statin treatment is not associated with postoperative cardiovascular complications or mortality; however, other postoperative complications have not been investigated.
Stroke, Volume 54, Issue 12 , Page 3202-3213, December 1, 2023. The Stroke Treatment Academic Industry Roundtable XII included a workshop to discuss the most promising approaches to improve outcome from acute stroke. The workshop brought together representatives from academia, industry, and government representatives. The discussion examined approaches in 4 epochs: pre-reperfusion, reperfusion, post-reperfusion, and access to acute stroke interventions.
Abstract Background Despite the potential benefits of ethanol infusion into the vein of Marshall (EIVOM) for atrial fibrillation (AF) ablation, concerns about its reversible and unpredictable effects persist. Objective To assess the effectiveness of EIVOM in the vein of Marshall (VOM) with collateral veins (CVs) during mitral isthmus and AF ablation.
Catheter ablation of ventricular tachycardia (VT) is an important therapy to reduce morbidity associated with both infarct-related and non-ischemic cardiomyopathies1-4. Although activation and entrainment mapping of VT allow detailed assessment of the VT circuit and optimal locations for ablation, in many cases VTs are non-inducible, not sustained, or not hemodynamically tolerated.
Circulation: Heart Failure, Ahead of Print. Background:Although elevated resting heart rate (HR) is associated with a higher risk of cardiovascular events in patients with heart failure with reduced ejection fraction in sinus rhythm (SR), the relationship between HR and outcomes among patients with heart failure with mildly reduced ejection fraction/heart failure with preserved ejection fraction and in those with atrial fibrillation (AF) is uncertain.
Stroke, Volume 54, Issue 12 , Page 3153-3164, December 1, 2023. BACKGROUND:Moyamoya disease (MMD) is a rare progressive vascular disease that leads to intracranial internal carotid artery stenosis and eventual occlusion. However, its pathogenesis remains unclear. The purpose of this study is to explore the role of abnormally expressed proteins in the pathogenesis of MMD.METHODS:Data-independent acquisition mass spectrometry identifies the differentially expressed proteins in MMD serum by detecti
Abstract Introduction Mechanical force to achieve transseptal puncture (TSP) using a standard needle may lead to overshooting and injury, and can potentially be avoided using a radiofrequency (RF)-powered needle or wire. Applying electrocautery to needles and guidewires as an alternative to purpose-built RF systems has been associated with safety risks, such as tissue coring and thermal damage.
Circulation, Ahead of Print. BACKGROUND:The adult mammalian heart is incapable of regeneration, whereas a transient regenerative capacity is maintained in the neonatal heart, primarily through the proliferation of preexisting cardiomyocytes. Neonatal heart regeneration after myocardial injury is accompanied by an expansion of cardiac fibroblasts and compositional changes in the extracellular matrix.
Circulation: Heart Failure, Volume 16, Issue 11 , Page e010524, November 1, 2023. BACKGROUND:Right ventricular (RV) dysfunction is associated with increased mortality across a spectrum of cardiovascular diseases. The role of obesity in RV dysfunction and adverse outcomes is unclear.METHODS:We examined patients undergoing right heart catheterization between 2005 and 2016 in a hospital-based cohort.
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.
Circulation, Ahead of Print. BACKGROUND:In severely affected patients with catecholaminergic polymorphic ventricular tachycardia, beta-blockers are often insufficiently protective. The purpose of this study was to evaluate whether flecainide is associated with a lower incidence of arrhythmic events (AEs) when added to beta-blockers in a large cohort of patients with catecholaminergic polymorphic ventricular tachycardia.METHODS:From 2 international registries, this multicenter case cross-over stu
Receiving a clot-busting drug in an ambulance-based mobile stroke unit (MSU) increases the likelihood of averting strokes and complete recovery compared with standard hospital emergency care, according to researchers.
Abstract: Venous thromboembolism (VTE), comprising deep-vein thrombosis (DVT) and pulmonary embolism (PE), stands as the third leading cause of vascular-related mortality on a global scale. Anticoagulation prophylaxis undeniably ensures a significant reduction in the risk of DVT, while simultaneously exposing individuals to an elevated likelihood of experiencing both major and minor bleeding events.
Circulation, Ahead of Print. Background:The RADIANCE-HTN SOLO, RADIANCE-HTN TRIO, and RADIANCE II randomized, sham-controlled trials independently met their primary endpoint of a greater reduction in daytime ambulatory systolic blood pressure (SBP) at 2 months after ultrasound renal denervation (uRDN) in patients with hypertension. To characterize the longer-term effectiveness and safety of uRDN vs. sham at 6 months, following the blinded addition of antihypertensive treatments (AHT), we pooled
Atrial fibrillation (AF) diagnosis was associated with a 45% increased risk of mild cognitive impairment (MCI) among a cohort of 4.3 million individuals in the UK, according to a new study.
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