November, 2023

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ECG Video Blog #403 (220) — Ps,Qs,3Rs Approach to this Tachycardia.

Ken Grauer, MD

== — CLICK HERE — for a V ideo presentation of this case! Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #220 — == The long lead II rhythm strip shown in Figure-1 was obtained from an 51-year-old man who presented to the ED ( Emergency Department ) with "palpitations" that began 1 hour earlier. HOW would you interpret this tracing?

Blog 164
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Lost brain function restored in mice after stroke

Science Daily - Stroke

Researchers have succeeded in restoring lost brain function in mouse models of stroke using small molecules that in the future could potentially be developed into a stroke recovery therapy.

Stroke 121
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Quiz post: 2 similar patients with similar ECGs. Which, if any, or both, are OMI? Will you outperform the Queen of Hearts?

Dr. Smith's ECG Blog

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both were awake and alert with normal vital signs. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" What do you think? Here they are: Patient 1, ECG1: Zoll computer algorithm stated: " STEMI , Anterior Infarct" Patient 2, ECG1: Zoll computer algorithm stated: "ST elevation, probably benign early repolarization.

STEMI 109
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EM Quick Hits 53 Postpartum Hemorrhage, Serotonin Syndrome, TBI Herniation Syndromes, Ulcerative Colitis, Pediatric C-Spine Immobilization, Global EM

ECG Cases

On this month's EM Quick Hits podcast: Anand Swaminathan on update to ED management of postpartum hemorrhage, Nour Khatib on serotonin syndrome and its mimics, Katie Lin on an approach to recognition and management of severe TBI and brain herniation syndromes, Hans Rosenberg on the ED management of ulcerative colitis, Heather Cary on pediatric c-spine immobilization controversies and techniques, Navpreet Sahsi on the difference between humanitarian and development work The post EM Quick Hits 53

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Rude Awakening on Trying to Keep Donor Hearts Usable With Common Hormone Infusions

Med Page Today

(MedPage Today) -- Giving unstable brain-dead heart donors intravenous levothyroxine did not lead to more hearts being transplanted, a randomized trial showed. In hemodynamically unstable potential donors, administering the thyroid hormone supplement.

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National Committees Are Back!

Conquering CHD

We have some fantastic news to share with all of you! After a hiatus, we are thrilled to announce the triumphant return of Conquering CHDs National Committees. These dedicated committees are the heart and soul of our organization, and they play a vital role in our mission to support those affected by congenital heart defects (CHDs). If you’re interested in getting involved with any of these committees, want to learn more, or wish to apply, please see our National Committee page for details

Webinar 98
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ECG Blog #405 — Is AV Block Complete (vs AV Dissociation)

Ken Grauer, MD

== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #191 — == The 2-lead rhythm strip shown in Figure-1 was obtained from an elderly woman who presented to the ED following a syncopal episode. On the basis of this rhythm strip — she was diagnosed as being in complete AV Block.

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Acute Dyspnea and Right Bundle Branch Block

Dr. Smith's ECG Blog

I was texted this ECG just as I was getting into bed. It is of an elderly woman who complained of shortness of breath and had a recent stent placed. I was told that the Queen of Hearts had called it OMI with high confidence. What do you think? Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema.

Aneurysm 106
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Journal Club 5 Appendicitis Delay to Appendectomy – Safe?

ECG Cases

You diagnose uncomplicated appendicitis in the ED. The on call General Surgery team wants to wait until the next morning to perform an appendectomy. Is your patient at risk for appendiceal perforation with a delay to surgery? Dr. Rohit Mohindra and Dr. Shelley McLeod analyze the latest RCT that attempts to answer this question, the PERFECT study, on this EM Cases Journal Club.

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Instructors' Collection ECG: Isolated Posterior Wall M.I.

ECG Guru

This interesting case was provided by Dr. Bojana Uzelac, Emergency Medicine physician. We are paraphrasing a translation of her comments here. The patient is a 50-year-old complaining of chest pain. The ECG shows a rare occurrence – an isolated POSTERIOR WALL MI (PWMI). Note that leads V1 through V4 show the usual signs of posterior wall MI. We see ST segment depression, which represents a reciprocal view of the ST elevation present on the posterior wall of the left ventricle.

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Allergic responses to common foods could significantly increase risk of heart disease, cardiovascular death

Science Daily - Heart Disease

Allergic responses to common foods such as dairy and peanuts can increase the risk for heart disease and cardiovascular death as much or more than smoking, new research suggests. And these dangerous allergic responses can strike both people with food allergies and those with no obvious allergy symptoms.

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ECG Blog #402 — Will Adenosine Convert This?

Ken Grauer, MD

You are told that the patient next door is in the regular SVT ( S upra V entricular T achycardia ) rhythm shown in Figure-1. QUESTIONS: Is the rhythm AVNRT or AVRT? Is Adenosine likely to convert this rhythm? Figure-1: How would YOU interpret this ECG? MY Thoughts on the ECG in Figure-1: When faced with a challenging cardiac arrhythmia — It is a "luxury" to have access to a long lead rhythm strip containing 3 simultaneously -recorded leads.

Blog 136
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Rad Tech Week Demonstrates Need for Year-Round Appreciation

Cassling

It’s one of the best weeks of the year – National Radiologic Technologist Week! Cassling’s annual commemoration of Rad Tech Week has taken place for 14 years, and for good reason, this week is an opportunity to stop and appreciate the hard work technologists, physicians, support teams and other healthcare workers put forth to ensure a compassionate, high-quality patient experience.

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How important are old ECGs in Non-obvious cases of potential OMI?

Dr. Smith's ECG Blog

In the last post, we saw how important old ECGs are in assessing the current ECG in a patient without atypical presentation (in this previous case, the patient had no chest pain, and the apparent inferior OMI did not have reciprocal ST depression in lead aVL). Here is that last post: A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?

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Ep 188 Hemoptysis – ED Approach and Management

ECG Cases

Key principles and approach to management of both non-massive and massive hemoptysis with Dr. Scott Weingart and Dr. Bourke Tillmann, who answer questions such as: What are the factors to consider in the decision to intubate patients with massive hemoptysis? How can one reliably distinguish hemoptysis from pseudohemoptysis? What is the evidence for tranexamic acid in patients with hemoptysis?

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Early Rhythm Control, Lifestyle Modification and More Tailored Stroke Risk Assessment Are Top Goals in Managing Atrial Fibrillation

American Heart News - Heart News

DALLAS and WASHINGTON (Nov. 30, 2023) — The American Heart Association (AHA) and the American College of Cardiology (ACC), along with several other leading medical associations, have issued a new guideline for preventing and optimally managing atrial.

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Any activity is better for your heart than sitting -- even sleeping

Science Daily - Heart Disease

Replacing sitting with as little as a few minutes of moderate exercise a day tangibly improves heart health, according to new research.

Exercise 106
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ECG Video Blog #404 (344) — Mobitz I, Mobitz II. or neither?

Ken Grauer, MD

== — CLICK HERE — for a V ideo presentation of this case! ( 15 minutes ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #344 — == How would YOU interpret the lead II rhythm strip shown in Figure-1 ? Is the rhythm Mobitz I or Mobitz II 2nd-degree AV Block? Or — Is it “ something else ”? Figure-1: How would YOU interpret this lead II rhythm strip?

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Mammography in 2023: Updated Laws Providers Need to Know

Cassling

Breast cancer is the second most common cancer among women in the United States. Currently, it accounts for nearly 30% of all new female cancers each year. For 2023, the American Cancer Society estimated that 297,790 new cases of invasive breast cancer would be diagnosed and about 43,700 women would die from breast cancer. Despite the high number of diagnoses, the death rate from breast cancer has been decreasing steadily in the US since 1989.

Cancer 96
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What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest. She said this was midsternal and felt like a tightness.

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2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Circulation

Circulation, Ahead of Print. AimThe “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation” provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation.MethodsA comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Re

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Coronary heart disease before age 45 may increase risk of dementia later in life

American Heart News - Heart News

Research Highlights: People diagnosed with coronary heart disease had a significantly increased risk of developing dementia later in life, according to an analysis of data for more than 430,000 people from the UK Biobank. Participants who had.

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Ground-breaking discovery could pave the way for new therapies to prevent cardiovascular disease and stroke

Science Daily - Heart Disease

Researchers have discovered the mechanism by which cholesterol in our diet is absorbed into our cells. This discovery opens up new opportunities for therapeutic intervention to control cholesterol uptake that could complement other therapies and potentially save lives.

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Intermittent Theta-Burst Stimulation for Stroke: Primary Motor Cortex Versus Cerebellar Stimulation: A Randomized Sham-Controlled Trial

Stroke Journal

Stroke, Ahead of Print. BACKGROUND:Stroke survivors with impaired balance and motor function tend to have relatively poor functional outcomes. The cerebellum and primary motor cortex (M1) have been suggested as targets for neuromodulation of balance and motor recovery after stroke. This study aimed to compare the efficacy and safety of intermittent theta-burst stimulation (iTBS) to the cerebellum or M1 on balance and motor recovery in patients with stroke.METHODS:In this randomized, double-blind

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Cardiac stereotactic radiation therapy for refractory ventricular arrhythmias in patients with left ventricular assist devices

Journal of Cardiovascular Electrophysiology

Abstract Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure refractory to medical therapy. However, the incidence of ventricular arrhythmias (VAs) is high in this population, both in the acute and delayed phases after implantation. About one-third of patients implanted with an LVAD will experience sustained VAs, predisposing these patients to worse outcomes and complicating patient management.

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Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?

Dr. Smith's ECG Blog

By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. She's had multiple PCI procedures. She also has sick sinus syndrome (SSS) and intermittent high grade AV block for which she had a dual chamber pacemaker implanted. On the day of presentation she complained of typical chest pain, and stated it feels like prior MI.

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Flipped C-Terminal Ends of apoA1 Promote ABCA1-Dependent Cholesterol Efflux by Small HDLs

Circulation

Circulation, Ahead of Print. BACKGROUND:Cholesterol efflux capacity (CEC) predicts cardiovascular disease independently of high-density lipoprotein (HDL) cholesterol levels. Isolated small HDL particles are potent promoters of macrophage CEC by the ABCA1 (ATP-binding cassette transporter A1) pathway, but the underlying mechanisms are unclear.METHODS:We used model system studies of reconstituted HDL and plasma from control and lecithin-cholesterol acyltransferase (LCAT)–deficient subjects to inve

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Rationale and design of the ESC Heart Failure III Registry – Implementation and discovery

European Journal of Heart Failure

ABSTRACT Aims Heart failure outcomes remain poor despite advances in therapy. The European Society of Cardiology Heart Failure III Registry (ESC HF III Registry) aims to characterize HF clinical features and outcomes and to assess implementation of guideline-recommended therapy in Europe and other ESC affiliated countries. Methods Between 1 November 2018 and 31 December 2020, 10 162 patients with chronic or acute/worsening HF with reduced, mildly reduced, or preserved ejection fraction were enro

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Cut salt, cut blood pressure

Science Daily - Heart Disease

Nearly everyone can lower their blood pressure, even people currently on blood pressure-reducing drugs, by lowering their sodium intake, reports a new study. It found 70-75% of all people, regardless of whether they are already on blood pressure medications or not, are likely to see a reduction in their blood pressure if they lower the sodium in their diet.

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Association Between Onset Age of Coronary Heart Disease and Incident Dementia: A Prospective Cohort Study

Journal of the American Heart Association

Journal of the American Heart Association, Volume 12, Issue 23 , December 5, 2023. BackgroundThe association of age at coronary heart disease (CHD) onset with incident dementia remains unexplored. This study aimed to examine whether younger onset age of CHD is associated with a higher risk of incident dementia.Methods and ResultsData were obtained from the UK Biobank.

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Viability and Outcomes With Revascularization or Medical Therapy in Ischemic Ventricular Dysfunction

JAMA Cardiology

This secondary analysis of a randomized clinical trial assesses whether myocardial viability testing identifies patients with ischemic left ventricular dysfunction who benefit from percutaneous coronary intervention.

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Chest pain and new regional/reciprocal ECG changes compared to previous ECGs: code STEMI?

Dr. Smith's ECG Blog

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.

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Dental Caries, Race and Incident Ischemic Stroke, Coronary Heart Disease, and Death

Stroke Journal

Stroke, Ahead of Print. BACKGROUND:Dental caries is a highly prevalent disease worldwide. In the United States, untreated dental caries is present in >1 in 5 adults. The objective of this study was to determine the relationship between dental caries and incident ischemic stroke, coronary heart disease (CHD) events, and death.METHODS:The dental cohort (n=6351) of the ARIC study (Atherosclerosis Risk in Communities) was followed for incident ischemic stroke, CHD event, and all-cause mortali

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Headset identifies 78% of strokes prior to hospital arrival: Study

Becker's Hospital Review - Cardiology

Sacramento, Calif.-based Sutter Health has taken part in testing and researching a headset designed to help emergency technicians better identify large vessel occlusion ischemic strokes prior to patients arriving at the hospital.

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First multi-chamber heart organoids unravel human heart development and disease

Science Daily - Heart Disease

Heart disease kills 18 million people each year, but the development of new therapies faces a bottleneck: no physiological model of the entire human heart exists -- so far. A new multi-chamber organoid that mirrors the heart's intricate structure enables scientists to advance screening platforms for drug development, toxicology studies, and understanding heart development.

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Wearable Digital Health Technology

The New England Journal of Medicine

Wearable DHT has reached an inflection point between fanciful descriptions and practical applications. The editors announce a series of articles focusing on the clinical applications of wearable DHT.

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Cerebral Small Vessel Disease, Hypertension, and Vascular Contributions to Cognitive Impairment and Dementia: Dementia Series

Hypertension Journal

Hypertension, Ahead of Print. Hypertension-associated cerebral small vessel disease is a common finding in older people. Strongly associated with age and hypertension, small vessel disease is found at autopsy in over 50% of people aged ≥65 years, with a spectrum of clinical manifestations. It is the main cause of lacunar stroke and a major source of vascular contributions to cognitive impairment and dementia.