October, 2023

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Expert human ECG interpretation and/or the Queen of Hearts could have saved this patient's anterior wall

Dr. Smith's ECG Blog

This is a re-post of an excellent case from 2021. See it again now, along with our new Queen of Hearts functionality. We've come a long way in 2 years! And the pace only quickens. A man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He called EMS who brought him to the ED.

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ECG Blog #400 — Is this a NSTEMI?

Ken Grauer, MD

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.

Blog 94
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Instructors' Collection ECG: Complete Heart Block or High Grade AVB?

ECG Guru

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.

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EM Quick Hits 52 Infant Vomiting, Orbital Cellulitis, Prehospital TXA in Trauma, Prevention and Treatment of Delirium, Procedural Skills Decay, Altitude Sickness

ECG Cases

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

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Study shows engineered gut bacteria can treat hypertension

Science Daily - Heart Disease

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.

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The impact of COVID-19 and the COVID-19 pandemic on hospitalized patients with STEMI in the United States: insights from the National Inpatient Sample

Coronary Artery Disease Journal

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

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Four patients with chest pain and ‘normal’ ECG: can you trust the computer interpretation?

Dr. Smith's ECG Blog

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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Left Bundle Branch Block

ECG Guru

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 46 ECG in Fever and Infectious Disease

ECG Cases

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.

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Genetic risk scores not useful in predicting disease

Science Daily - Heart Disease

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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The Value Of Lifestyle In Those With An Elevated Lp(a)

Dr. Paddy Barrett

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.

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Does this T wave pattern mean anything?

Dr. Smith's ECG Blog

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.

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New electrode design promises major improvements in wearable electrocardiograms

Medical Xpress - ECG

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.

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10 Simple Tips To Keep Your Heart Healthy

MIBHS

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

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Correlation between baseline immature platelets fraction levels and peak troponin in patients with acute myocardial infarction

Coronary Artery Disease Journal

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.

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Effects of exercise during chemotherapy for breast cancer on long-term cardiovascular toxicity

Open Heart

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.

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Technology and the Future of Cloud-Based Medical Image Sharing

NOVARAD

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.

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Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

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 102
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Heat-related cardiovascular deaths in the U.S. may more than double within decades

American Heart News - Stroke News

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.

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How to Help Your Child Stay Still During Medical Imaging

Conquering CHD

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.

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Effects of cardiac rehabilitation on inflammatory biomarkers in unstable ischemic heart disease patients following percutaneous coronary intervention: a randomized controlled study

Coronary Artery Disease Journal

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).

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Facilitators and barriers to hypertension management in urban Nepal: findings from a qualitative study

Open Heart

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.

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Physiology Friday #189: Could Nasal Breathing Improve Your Heart Health?

Physiologically Speaking

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.

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A 20-something woman with cardiac arrest.

Dr. Smith's ECG Blog

The patient is a 20 something female. She is healthy with no known cardiac disease. She was admitted to the neurology department due to headache and vomiting. She was found to have a viral CNS infection. A few days into her hospital stay she developed chest discomfort and the following ECG was recorded. What do you think? Why such large T-waves? Are these hyperacute T-waves?

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Brugada Syndrome: Diagnosis and Risk Stratification

All About Cardiovascular System and Disorders

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.

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From NASH to MASH: New Terms for Liver Diseases Unveiled at the 2023 Cardiometabolic Health Congress

Cardiometabolic Health Congress

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

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The Next Paradigm: Advancing Medical Education in Colon & Rectum Surgery

ADN Center of Excellence

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.

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Associations of health-related quality of life with major adverse cardiovascular and cerebrovascular events for individuals with ischaemic heart disease: systematic review, meta-analysis and evidence mapping

Open Heart

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.

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Prevalence and effects of acute myocardial infarction on hospital outcomes among COVID-19 patients

Coronary Artery Disease Journal

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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What clinical scenario fits best?

Dr. Smith's ECG Blog

B elow are 4 ECGs from the same patient. Accompanying the ECGs is some clinical information. Look at the ECGs and consider the timeline and other information. At the bottom will be five alternative clinical scenarios to explain the findings. Which one do you think fits better with the ECGs and their timeline? The patient is a 60 something female. She was admitted to the hospital with clinical signs of infection.

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Rate vs Rhythm Control in Atrial Fibrillation

All About Cardiovascular System and Disorders

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.

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Ventricular Tachycardia

ECG Guru

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.

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Early Career Journey: The Business of Medicine—How to Successfully Transition from Training to Practice

Society of Thoracic Surgeons - Early Career

Webinar Early Career Journey: The Business of Medicine—How to Successfully Transition from Training to Practice kchalko Fri, 10/20/2023 - 14:04 December 7, 2023 Leaders in cardiothoracic surgery will share valuable information about the transition from training to practice from academic, private practice, and hospital perspectives. Topics will include networking with colleagues, conducting a job search, negotiating a contract, and managing personal finances.

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Why percutaneous revascularisation might not reduce the risk of myocardial infarction and mortality in patients with stable CAD?

Open Heart

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.

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Revolutionizing Patient Care Through Minimally Invasive Techniques

ADN Center of Excellence

In the fast-paced world of modern medicine, staying at the forefront of innovation is crucial for providing the best patient care. One area that has made significant strides in revolutionizing patient care is the field of minimally invasive techniques. As doctors committed to enhancing patient outcomes, let's delve into how these techniques are changing the landscape of healthcare and improving the overall patient experience.

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This ECG was handed over at triage. See how the Queen of Hearts AI does with these explainability images.

Dr. Smith's ECG Blog

Submitted by anonymous, written by Pendell Meyers I was at triage when this ECG was presented to me. What do you think? Here's what the Queen of Hearts thinks: Note that the Queen has "HIGH" confidence that this is OMI. As noticed by the AI, if the patient presented with chest pain , then even this subtle ECG is diagnostic of OMI. Specifically , this ECG is diagnostic of acute LAD OMI, with hyperacute T waves likely in V3 and V4, very small but abnormal STE in V2-V4 (because of its there is a lo

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Hemostasis after transradial coronary intervention by rotary compression device with sterile gauze is associated with more adverse events: a retrospective study

Coronary Artery Disease Journal

Objective We investigated the relationship between using a rotary compression device (RCD) with or without sterile gauze and adverse events in transradial access (TRA) for coronary intervention. Methods In this study involving 933 patients at Yueyang Hospital, we recorded TRA-related adverse events, such as bleeding, forearm hematoma, swollen palms, radial artery occlusion (RAO) and others.