Podcasts about lbbb

N Engl J Med 1993;328:673-679Background: Previous trials established that thrombolysis improves mortality in patients with acute myocardial infarction, as seen in the GISSI-1 and ISIS-2 trials. However, thrombolysis has limitations, including an increased risk of bleeding and the inability to achieve arterial patency in approximately 20% of the cases. As a result, there was a growing interest in the use of percutaneous transluminal coronary angioplasty (PTCA).Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Primary Angioplasty in Myocardial Infarction Study Group sought to test the hypothesis that PTCA compared to thrombolysis, improves outcomes and reduces bleeding in patients with acute myocardial infarction.Patients: Eligible patients presented within 12 hours of ischemic chest pain and had ST elevation of at least 1 mm in two or more contiguous electrocardiographic leads. Patients were excluded if they had dementia, LBBB, cardiogenic shock or elevated bleeding risk.Baseline characteristics: The study enrolled 395 patients – 195 assigned to the PTCA arm and 200 assigned to the thrombolysis arm. The average age of patients was 60 years with 73% being men. Approximately 14% had prior myocardial infarction, 43% had hypertension, 12% had diabetes and 2% had congestive heart failure. The average ejection fraction 52%.The infarct was anterior in 34% of the patients, inferior in 59% and lateral in 8%.Procedures: All patients were given 325 mg of aspirin plus 10,000-unit bolus of intravenous heparin. After that, patients were randomly assigned to thrombolytic therapy or PTCA. The thrombolytic agent used was tissue plasminogen activator (t-PA) at a dose of 100 mg (or 1.25 mg/kg of body weight for patients weighing less than 65 kg) over three hours. Patients randomly assigned to PTCA underwent immediate diagnostic catheterization.Angiographic criteria for exclusion from PTCA included left main stenosis of more than 70%, infarct-related vessel was patent, three-vessel disease, morphologic features of the lesion known to indicate high risk, small infarct-related vessels or stenosis 70 years or admission heart rate > 100 bpm. PTCA reduced in-hospital mortality in the “not low risk” group (2.0% vs 10.4%; p= 0.01) but not in the low risk group (3.1% vs 2.2%; p= 0.69).Conclusion: In patients with ST-elevation myocardial infarction, PTCA compared to t-PA reduced death and reinfarction at the hospital and at 6 months with a number needed to treat of approximately 14 and 12, respectively.This was one of the trials that established the foundation for the use of PTCA in patients with acute myocardial infarction. While the treatment effect was large, there are important considerations to keep in mind. First, the sample size was small. In comparison, GISSI-1 had almost 12,000 patients and ISIS-2 had over 17,000. The results of small trials are not always replicated in larger pragmatic trials. Second, the use of aspirin + heparin + t-PA likely increased bleeding in the t-PA arm as heparin plus thrombolysis compared to thrombolysis without heparin increased bleeding without improving outcomes, as seen in the GISSI-2 and ISIS-3 trials. Third, two thirds of the patients had inferior or lateral infarcts and these subgroups did not benefit from thrombolysis in the GISSI-1 trial. Finally, standalone angioplasty is infrequently performed nowadays and patients often receive a stent which has improved vessel patency.In the current era, patients with ST-elevation myocardial infarction receive early revascularization with stent placement, which improved outcomes in these patients. We discussed the limitations above to help readers and learners appraise clinical trials, as these limitations were important at the time of this trial's publication.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

The following question refers to Section 7.4 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by the Director of the CardioNerds Internship Dr. Akiva Rosenzveig, answered first by Vanderbilt AHFT cardiology fellow Dr. Jenna Skowronski, and then by expert faculty Dr. Clyde Yancy.Dr. Yancy is Professor of Medicine and Medical Social Sciences, Chief of Cardiology, and Vice Dean for Diversity and Inclusion at Northwestern University, and a member of the ACC/AHA Joint Committee on Clinical Practice Guidelines.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. American Heart Association's Scientific Sessions 2024As heard in this episode, the American Heart Association's Scientific Sessions 2024 is coming up November 16-18 in Chicago, Illinois at McCormick Place Convention Center. Come a day early for Pre-Sessions Symposia, Early Career content, QCOR programming and the International Symposium on November 15. It's a special year you won't want to miss for the premier event for advancements in cardiovascular science and medicine as AHA celebrates its 100th birthday. Registration is now open, secure your spot here!When registering, use code NERDS and if you're among the first 20 to sign up, you'll receive a free 1-year AHA Professional Membership! Question #37 Mr. S is an 80-year-old man with a history of hypertension, type II diabetes mellitus, and hypothyroidism who had an anterior myocardial infarction (MI) treated with a drug-eluting stent to the left anterior descending artery (LAD) 45 days ago. His course was complicated by a new LVEF reduction to 30%, and left bundle branch block (LBBB) with QRS duration of 152 ms in normal sinus rhythm. He reports he is feeling well and is able to enjoy gardening without symptoms, though he experiences dyspnea while walking to his bedroom on the second floor of his house. Repeat TTE shows persistent LVEF of 30% despite initiation of goal-directed medical therapy (GDMT). What is the best next step in his management?AMonitor for LVEF improvement for a total of 60 days prior to further interventionBImplantation of a dual-chamber ICDCImplantation of a CRT-DDContinue current management as device implantation is contraindicated given his advanced age Answer #37 Explanation Choice C is correct. Implantation of a CRT-D is the best next step. In patients with nonischemic DCM or ischemic heart disease at least 40 days post-MI with LVEF ≤35% and NYHA class II or III symptoms on chronic GDMT, who have reasonable expectation of meaningful survival for >1 year,ICD therapy is recommended for primary prevention of SCD to reduce total mortality (Class 1, LOE A). A transvenous ICD provides high economic value in this setting, particularly when a patient's risk of death from ventricular arrhythmia is deemed high and the risk of nonarrhythmic death is deemed low. In addition, for patients who have LVEF ≤35%, sinus rhythm, left bundle branch block (LBBB) with a QRS duration ≥150 ms, and NYHA class II, III, orambulatory IV symptoms on GDMT, cardiac resynchronization therapy (CRT) is indicated to reduce total mortality, reduce hospitalizations, and improve symptoms and QOL. Cardiac resynchronization provides high economic value in this setting. Mr.

N Engl J Med 2020;382:1395-407 - ISCHEMIAN Engl J Med 2020;382:1608-16 - ISCHEMIA-CKDBackground: The COURAGE trial, published in 2007, represented a major reversal in cardiovascular medicine. In patients with stable CAD an initial strategy of revascularization plus medical therapy did not reduce the chance of dying or having a heart attack compared to an initial strategy of medical therapy alone. Prior to these results, patients with stable CAD were routinely managed with an initial invasive approach and the field of cardiology was intensely focused on finding coronary blockages and “fixing” them in symptomatic and asymptomatic patients alike. Thus, it's not surprising that following results from COURAGE, the practice continued to be vigorously defended and applied routinely in the management of patients with stable CAD.The first major attempt to reverse the results of COURAGE came from the FAME 2 trial, published in 2012, which tested the hypothesis that patients with stable CAD and an abnormal fractional flow reserve (FFR) in the cath lab would do better with an initial invasive strategy compared to medical therapy alone. The trial was stopped early for efficacy but the positive results were driven entirely by revascularization during follow up - not death or heart attack. The trial was criticized for being stopped inappropriately without providing an answer to whether an early invasive strategy improved hard endpoints compared to initial medical therapy alone. The concepts of “faith healing” and “subtraction anxiety” are useful for understanding the results and limitations of the FAME 2 trial.The ISCHEMIA trial which began enrolling patients in 2012 sought to overcome limitations of COURAGE and FAME. The investigative aim of the study was to test the hypothesis that in patients with stable CAD and moderate to severe ischemia on provocative testing, an initial invasive strategy reduced a composite of major cardiac events compared to initial medical therapy alone. The ISCHEMIA-CKD trial was performed in conjunction with the ISCHEMIA Research Group to address an important knowledge gap in managing patients with CAD. Patients with advanced chronic kidney disease (CKD) experience a higher rate of cardiac events than their counterparts without CKD; however, they are also at a higher risk of procedural complications. The standard of care at the time was generally to manage a patient with stable CAD and CKD like any other patient with CAD despite the fact that such patients were historically excluded from participation in clinical trials and thus, there was really no data from clinical trials to guide decision making.The ISCHEMIA-CKD investigators sought to test the hypothesis that in patients with advanced CKD and stable CAD and moderate to severe ischemia on stress testing, an initial invasive strategy reduced death or MI compared to initial medical therapy alone.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients: For the ISCHEMIA trial, eligible patients had to be at least 21 years of age or older with at least moderate ischemia on a qualifying stress test based on the following criteria:* Nuclear perfusion with SPECT or PET with >/= 10% ischemic myocardium* Echocardiography with >/= 3/16 segments with stress-induced severe hypokinesis or akinesis* Cardiac MRI with >/= 10% ischemic myocardium on perfusion imaging and/or >/= 3/16 segments with stress-induced severe hypokinesis or akinesis on wall motion assessment* Exercise treadmill test without imaging that met all 4 following criteria* clinical history of typical angina or typical angina during the stress test* absence of resting ST depression > 1.0 mm or confounders that render exercise EKG non-interpretable (LBBB, LVH with repolarization, pacemaker, etc.)* exercise-induced horizontal or downsloping ST depression >/= 1.5 mm in 2 leads or >/= 2.0 mm in any lead or ST elevation >/= 1.0 mm in a non-infarct territory* either of the following:* workload at which ST segment criteria are met is NOT to exceed completion of stage 2 of a standard Bruce protocol or 7 METS if a non-Bruce protocol is used* ST segment criteria are met at

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by James O'Hara, PhD, PA, Virginia Heart, and Shunmuga Sundaram Ponnusamy, MBBS, MD, CEPS-A, Velammal Medical College Hospital, and Research Institute to discuss a study that evaluated the impact of QRS morphology on the risk of life-threatening ventricular arrhythmias in heart failure patients treated with cardiac resynchronization therapy with a defibrillator (CRT-D). The analysis included 2,862 patients from five major ICD trials, focusing on those with a QRS duration of ≥130 ms. Patients were categorized into those receiving ICD-only or CRT-D. Key findings: Among patients with left bundle branch block (LBBB), those with CRT-D showed a significant 44% reduction in the risk of fast ventricular tachycardia (VT)/ventricular fibrillation (VF) compared to ICD-only patients. They also had a lower fast VT/VF burden and fewer appropriate shocks. In patients with non-left bundle branch block (NLBBB), CRT-D did not reduce the risk of fast VT/VF and was associated with a significant increase in the burden of fast VT/VF events compared to ICD-only patients. The study concludes that CRT-D effectively reduces life-threatening ventricular arrhythmias in LBBB patients but may increase the risk in NLBBB patients.    https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.09.018?s=03 Host Disclosure(s): D. Varghese: Nothing to disclose.    Contributor Disclosure(s): J. O'Hara: Honoraria, Speaking, and Consulting: Medtronic Inc., Boston Scientific  S. Ponnusamy: Honoraria, Speaking, and Consulting: Medtronic Inc.

Steve Milliken Steve Milliken is the proud gay author of LATE BLOOMER BABY BOOMER—A Collection of Humorous Essays About Being Gay Back in the Day and Finally Finding My Way. Born and raised in Southern California, his literary escapade takes you on a journey through the decades, chronicling his adventures as a gay baby boomer  and his lifelong pursuit of the perfect coming-out story—spoiler alert: it's a comedy of errors…..While the primary focus of these essays is to bring laughter to the hearts of readers, LATE BLOOMER BABY BOOMER offers more than just entertainment. While drawing comparisons to David Sedaris, it also helps bridge the gay generation gap between the younger and older gay men's communities through its humor and historical perspective on the challenges gay men have faced through the years. His unique blend of laughter and nostalgia with sprinkles of wisdom will captivate readers as a certified remedy for those pesky "I need a good laugh and some enlightenment" moments…. LBBB back cover text:What happens when the class clown becomes the teacher?Whether teaching in the urban ghetto or navigating the gay ghetto, Steve Milliken bridges the gay generation gap as he finds the funny about the lifelong coming out process. This book is for anyone who is gay, knows someone who is gay, or even a “straight” guy who's had a gay experience, like wearing a belt that matches his shoes."Steve Milliken's writing style is reminiscent of David Sedaris's quirky humor, but with own his unique spin. He has the true humorist's ability to find the hilariousness in all of life's awkward and sometimes painful moments. Treat yourself to this book if you love writing that will make you laugh out loud!" ANDI MATHENY, actress, acting coach, and author of Act ALIVE: The Essential Guide to Igniting and Sustaining Your Working Actor CareerAuthor Steve Milliken reveals, “While teaching in the inner-city with an implicit ‘Don't ask, don't tell' policy, I led a double life, somewhere between Dr. Jekyll & Mr. Hyde and Hannah Montana. While intelligent and insightful, I counter this by being incredibly gullible and naïve. Strong, yet timid, caring but sarcastic, I'm all about the balance, as any self-respecting oxymoron should be….” A Southern California native, his wide-ranging essays include concealing your inner sissy in the 60s, a guide for piloting the proper parameters of profanity in the workplace, tapping into your potential for prank calls, and looking behind the scenes at catering to the temperamental stars of the '70s at the famed Brown Derby Restaurant. Steve Milliken's experiential essay titles include “My Rocky Horror Virginity Show,” “Sober Porn,” “My Colonoscopy Eve,” and “Bitch Ass Snitch” to name just a few…. https://linktr.ee//stevemillikenPhoto: Copyright Wilkinson/2024Opening and closing music courtesy the very talented Zakhar Valaha via Pixabay.To contact Wilkinson- email him at BecomingWilkinson@gmail.com

Intermittent fasting, anticoagulation decisions, heterogenous treatment effects, frailty in HF, the importance of the ECG, and industry conflicts are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Intermittent Fasting No, Intermittent Fasting Won't Kill You https://www.medscape.com/viewarticle/1000544 NEJM Paper on Time-Restricted Eating  https://www.nejm.org/doi/full/10.1056/NEJMoa2114833 JAMA TREAT Clinical Trial https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771095 II. Stroke Prevention with OAC Shah Meta analysis of Vitamin K Agonists in AF https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.123.010269 III. Heterogenous Treatment Effects in Trials Pivotal CV Trials May Not Apply to Complex Patients https://www.medscape.com/viewarticle/989129 Analysis of 8 Trials of Multimorbidity and Treatment Response https://doi.org/10.1016/j.amjmed.2024.01.028 IV. Frailty and HF Circulation Outcomes: Multidomain Frailty and Mode of Death in HF  https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010416 V. ECG in LBBB JAMA Cardiology: Revised Definition of LBBB  https://jamanetwork.com/journals/jamacardiology/fullarticle/2816973 VI. Industry Payments to Doctors JAMA: Payments to US Physicians by Specialty https://jamanetwork.com/journals/jama/fullarticle/2816900 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Understanding Sgarbossa's Criteria is important for paramedic students, similar to knowing that a defibrillator is not just a high-tech paperweight. These criteria are a set of electrocardiographic findings designed to sniff out myocardial infarction (MI) in the presence of a tricky accomplice—left bundle branch block (LBBB) or a paced rhythm. Understanding this, you can navigate through the confusion of LBBB, where AMIs might be playing an expert game of hide and seek. Applying the criteria allows for the early identification of ST-elevation MI, potentially saving precious heart muscle and, more importantly, the patient's life—making the difference between a good day and a "why did I get out of bed" day. In the world of emergency medicine, where 'time is muscle,' knowing Sgarbossa's Criteria ensures that paramedics don't just bring patients to the hospital faster but smarter, with a keener eye for those not-so-obvious cardiac events. This knowledge can turn a paramedic from a simple transporter to a life-saving detective, one ECG at a time. Don't forget that we need your help as to what you would like to see in future episodes.  Visit the Ten Minute Medic Facebook page and leave your suggestions.  If selected, we'll give you a shout out and send you a small gift as our appreciation.

Right and left bundle branch blocks can be confusing. Cardiologist explains the difference. https://dralo.net/links

We've got an amazing podcast episode lined up for you that'll surely quench your thirst for knowledge on cardiovascular health. In this episode, we dive deep into four intriguing studies: STUDY #1:  First, we'll explore how the Mediterranean diet can work wonders for your heart, and how a simple low-fat diet may offer similar benefits. Can both diets really reduce mortality in patients at increased risk? Tune in to find out! Karam G et al. Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: Systematic review and network meta-analysis. BMJ 2023 Mar 29; 380:e072003. (https://doi.org/10.1136/bmj-2022-072003) STUDY #2: Next, we'll unravel the mystery behind the low statin use for primary prevention of ASCVD among all race and ethnicity groups, with Black and Hispanic adults being the least likely to receive them. Why is this happening, and what can we do about it?

The following question refers to Section 7.4 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by New York Medical College medical student and CardioNerds Intern Akiva Rosenzveig, answered first by Cornell cardiology fellow and CardioNerds Ambassador Dr. Jaya Kanduri, and then by expert faculty Dr. Randall Starling.Dr. Starling is Professor of Medicine and an advanced heart failure and transplant cardiologist at the Cleveland Clinic where he was formerly the Section Head of Heart Failure, Vice Chairman of Cardiovascular Medicine, and member of the Cleveland Clinic Board of Governors. Dr. Starling is also Past President of the Heart Failure Society of America in 2018-2019. Dr. Staring was among the earliest CardioNerds faculty guests and has since been a valuable source of mentorship and inspiration. Dr. Starling's sponsorship and support was instrumental in the origins of the CardioNerds Clinical Trials Program.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #6 Mr. D is a 50-year-old man who presented two months ago with palpations and new onset bilateral lower extremity swelling. Review of systems was negative for prior syncope. On transthoracic echocardiogram, he had an LVEF of 40% with moderate RV dilation and dysfunction. EKG showed inverted T-waves and low-amplitude signals just after the QRS in leads V1-V3. Ambulatory monitor revealed several episodes non-sustained ventricular tachycardia with a LBBB morphology. He was initiated on GDMT and underwent genetic testing that revealed 2 desmosomal gene variants associated with arrhythmogenic right ventricular cardiomyopathy (ARVC). Is the following statement true or false? “ICD implantation is inappropriate at this time because his LVEF is >35%” True   False   Answer #6 Explanation This statement is False. ICD implantation is reasonable to decrease sudden death in patients with genetic arrhythmogenic cardiomyopathy with high-risk features of sudden death who have an LVEF ≤45% (Class 2a, LOE B-NR). While the HF guidelines do not define high-risk features of sudden death, the 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy identify major and minor risk factors for ventricular arrhythmias as follows: Major criteria: NSVT, inducibility of VT during EPS, LVEF ≤ 49%. Minor criteria: male sex, >1000 premature ventricular contractions (PVCs)/24 hours, RV dysfunction, proband status, 2 or more desmosomal variants. According to the HRS statement, high risk is defined as having either three major, two major and two minor, or one major and four minor risk factors for a class 2a recommendation for primary prevention ICD in this population (LOE B-NR). Based on these criteria, our patient has 2 major risk factors (NSVT & LVEF ≤ 49%), and 3 minor risk factors (male sex, RV dysfunction, and 2 desmosomal variants) for ventricular arrhythmias. Therefore, ICD implantation for primary prevention of sudden cardiac death is reasonable. Decisions around ICD implantation for primary prevention remain challenging and depend on estimated risk for SCD, co-morbidities, and patient preferences, and so should be guided by shared decision making weighing the possible benefits against the risks,

Contributor: Travis Barlock, MD Educational Pearls: The presence of a STEMI has traditionally been used to determine if a patient with acute chest pain requires urgent cath lab management STEMI indicates an occluded coronary artery, and urgent intervention is needed to restore perfusion to ischemic tissue Patients with occluded coronary arteries can present with EKG findings other than STEMI 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department was recently published in the Journal of the American College of Cardiology Recognizes STEMI equivalents that necessitate cath lab management ST depression in precordial leads Indicates a posterior infarct/possible RCA occlusion LBBB c ST elevation meeting modified Sgarbossa criteria Hyperacute and/or De Winter T wave First indication of coronary artery occlusion Most beneficial time to initiate cath lab because more tissue is salvageable These recommendations will likely alter clinical practice for ED management of acute chest pain   References Kontos MC, de Lemos JA, Deitelzweig SB, et al. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Oct 6 2022;doi:10.1016/j.jacc.2022.08.750 Meyers HP, Bracey A, Lee D, et al. Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI. J Emerg Med. Mar 2021;60(3):273-284. doi:10.1016/j.jemermed.2020.10.026  Tziakas D, Chalikias G, Al-Lamee R, Kaski JC. Total coronary occlusion in non ST elevation myocardial infarction: Time to change our practice? Int J Cardiol. Apr 15 2021;329:1-8. doi:10.1016/j.ijcard.2020.12.082   Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/ Donate to EMM today!

امرپ فارسی، طب اورژانس، آبان ۱۴۰۱. بیماران پیوندی، شوک ایندکس، ایسکمی در LBBB، خلاصه‌ی مقالات جدید، طب اورژانس در مناطق دوردست: سوختگی شدید و ...

This week's episode is another round of Fast Facts with the Fellas! Join for an episode where we dive back into BIS, Beta Blockers, and LBBB!!

Commentary by Dr. Emile Daoud

Good morning and welcome to your Friday dose of Your Daily Meds.Bonus Review: How is H+ produced in the stomach and secreted into the gastric lumen?Answer: So CO2 reacts with water under the influence of carbonic anhydrase. This produces the H+, which is then actively transported into the gastric lumen by H+K+-ATPase. The HCO3- in the reaction passes across the basolateral membrane in exchange for Cl- via an antiport.Question:With regard to episodes of delirium, which of the following is not a feature of extrinsic and environmental management?Well-lit room or patient cubicleRemove seeing glasses to reduce risk of injuryRoom or patient cubicle near nursing stationFamily member present Frequent orientation with calendars and clocksHave a think.Scroll for the chat.Quick Investigation:Consider the following ECG:What is the correct rate, rhythm, axis and interpretation, respectively?Ventricular rate 40/min; atrial fibrillation; left axis deviation; rapid ventricular responseVentricular rate 60/min; atrial flutter; normal axis; 3:1 blockVentricular rate 40/min; sinus rhythm; normal axis; complete heart blockVentricular rate 40/min; sinus rhythm; normal axis; left bundle branch blockVentricular rate 60/min; atrial fibrillation; right axis deviation; ischaemic changesHave a think.Do some counting.More scroll for more chat.The Environment:The principles of extrinsic or environmental management of delirium include:Quiet, well-lit rooms or cubicles, near windows to orient to time of dayOptimise hearing and visionRoom or cubicle near nursing station for closer observation and increased cares if agitatedFamily members present for reassurance and re-orientationFrequent orientation with clocks, calendars and remindersSo removing the patients’ seeing glasses is least likely to be an effective method of environmental, non-pharmacological management of delirium.It would probably just make them more crazy…Squiggly Lines:This ECG shows sinus rhythm with complete heart block and ventricular escape rhythm.So sinus rhythm because the sinus node is ticking away regularly giving P waves at a rate of approximately 90/min. But complete heart block because there seems to be no relationship between this sinus rhythm and the ventricular rhythm. So the ventricles will tick along at their own rate (the escape rhythm - which is slower than that of the atrial pacemakers).Note: there are three characteristics of complete heart block. These are A-V dissociation, atrial rate > ventricular rate, and a regular ventricular rate.The ventricular rate is approximately 40/min with sinus rhythm - yep. The QRS complexes are wide with left bundle branch block (LBBB) morphology - wide because the depolarisation is coming from the slow lumbering ventricles, not the snappy quick atria. The axis is normal. And there is a prolonged QT at 600ms.So this person probably looked quite sick…Bonus: What humoral factors stimulate parietal cell gastric acid production?Answer in Monday’s dose.Closing:Thank you for taking your Meds and we will see you Monday for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

The Cleveland Clinic Director of Cardiac MRI, Dr. Deborah Kwon, discusses the principles and clinical applications of cardiac MRI, taking us from the protons to the bedside with a series of illustrative cases. CardioNerds hosts Amit Goyal, Daniel Ambinder, and Carine Hamo are joined by Dr. Nicole Pristera (Cleveland Clinic cardiology fellow). Flutter moment by student doctor Arooma Shahid. On the CardioNerds Myocarditis page you will find podcast episodes, infographic, youtube videos, references, tweetorials and guest experts & contributors, flutter stars and so much more. Take me to the Myocarditis Series PageTake me to the Episode Topics PageCheck out Amit Goyal’s Myocarditis Tweetorial Links in this episode: Mental Filter: Matters of the Heart: Part 1Mental Filter: Matters of the Heart: Part 2Cardiac Imaging Agorà Dr. Debbie Kwon attended medical school at the University of Michigan and internal medicine residency at the University of Pennsylvania. She completed her general cardiology and cardiovascular imaging fellowships at the Cleveland Clinic. She is the Director of Cardiac MRI At the Cleveland Clinic and serves as the Core Lab MRI director for the Pulmonary Vascular Disease Phenomics (PVDOMICS) multicenter National institution of Health (NIH) Study. Dr. Nicole Pristera is a cardiology fellow at the Cleveland Clinic.  She earned her medical degree at Case Western Reserve University and completed her internal medicine residency training at Duke University. Her clinical interests include interventional cardiology and cardiac critical care. Outside of the hospital, she enjoys traveling, hiking, and learning foreign languages. Episode Outline What should we know about the common sequences for cardiac MRI?We all learn about the risks of NSF.  How much of these risks are a reality and when should we truly avoid gadolinium exposure?What are some challenges to MRI: Time of scanningPatient tolerability: breath holding, claustrophobia, lying flatNo patient monitorFerromagnetic devices (especially CIEDs) Artifacts (lead) CostWhat types of information about the heart can we obtain with a CMR?Anatomic: 0.5 x 0.5 x 0.5mm spatial resolutionChamber dimensions, volumes, mass, anomalies (LV aneurysm, hypertrophy)Aortic DissectionCardiac Tumors and Thrombi Congenital defects FunctionalCine images: EF, systolic wall thickening, wall motionMyocardial tagging → strain (infarct/scar)Measurement of blood flow velocity across the cardiac valves and the great vessels: regurg, stenosis, shunts, angioTissue characterization: gadolinium enhancementPerfusion (stress, rest)ViabilityScar (LGE)EdemaIron The role for Cardiac MRI in particular cases discussed with Dr. Kwon CAD: A 45 year old G1P1 woman with prior preeclampsia and anterior STEMI s/p LAD PCI 3 years ago is being seen for chest pain. TTE shows LVEF 45% with mid-apical anterior hypokinesis and apical aneurysm. How does CMR help delineate ischemic heart disease (perfusion, viability, chambers)  Pericarditis: her stress MRI shows an anteroapical perfusion defect and apical aneurysm with mural thrombus, with corresponding LGE. On further review, her chest pain is sharp, pleuritic, and worsens with recumbency. EKG on follow-up shows diffuse ST elevations and PR depressions except for in aVR which shows ST depression and PR elevation. ESR and CRP are moderately elevated.  ARVC: A 35 year old female athlete who is admitted after VF arrest that occurred during a tennis match. Thankfully she received immediate bystander CPR with early defibrillation and prompt ROSC. She has had prior syncope during training and an uncle died suddenly at age 40. Resting EKG shows an incomplete right bundle, right precordial TWIs, and epsilon waves in V1-V3.  On tele she’s had multiple runs of NSVT of LBBB morphology. Echocardiogram shows RV dilation. A heart failure consult is considering EMBx but requests a CMR beforehand.

Hello, this is your captain speaking!We kick off our “Pilot” episode with some introductions of our hosts and then we'll talk all about call centers and doughnuts? Tune in for the wild ride!!!

Dr. Daniel Cantillon discusses their analysis of ECG recordings of over 24,000 patients from the PRECISION study. They found that left bundle branch block (LBBB) and left intraventricular conduction defect (LIVCD) is an important risk factor for increased mortality in patients at risk for cardiovascular disease.

CRT in patients with non-LBBB, ezetimibe, lifestyle diseases in the young, end of life care, and diabetes for the cardiologist are the topics John Mandrola, MD discusses in this week's podcast

On this episode Dave highlights Sgarbossa criteria, which helps us to accurately identify STEMI in the presence of a LBBB. Also in this episode: Example of how a LBBB works Rules to apply when diagnosising LBBB on an ECG Example of a normal LBBB Sgarbossa criteria A & B - inappropriate concordance ECG examples of criteria A & B Pacemakers and diagnosing STEMI   Subscribe to the video version of this podcast to have access to the visuals that accompany the audio as well as additional tools and resources to help improve your understanding.  Subscribe now at CurrentECG.com  And Stay Current!  

In this podcast Ty Harrison, a Physician Assistant with the Minneapolis Heart Institute at Ridgeview Heart Center, addresses which type of stress test for chest pain is correct - why and for whom. Ty will also discuss the issue of assigning the wrong test, and that it is largely multi factorial, secondary to associated risk factors.  Objectives:    Upon completion of this podcast, participants should be able to: Describe how various stress tests are employed. Select which provocative test(s) should be ordered for specific cohorts of patients. Recite the contraindications for stress testing. Identify when a CT coronary angiogram or CMR should be considered, and on which patient subtype(s). CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "Don't Stress the Test" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.”   FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: Before you send a patient over for a stress test, get a baseline EKG. Does the patient have a LBBB?  If so, then is the EKG really not interpretable? If the patient has a history of previous MI, or old Q waves via EKG a stress echo is not the appropriate test; as the patient will likely have wall motion abnormalities. The basics of adenosine testing is there are adenosine receptors on the vascular smooth muscle of cardiac vessels which causes healthy arteries to dilate and those vessels that are unhealthy will not dilate creating a perfusion mismatch. The nuclear portion of the stress test is where the radioisotope is given with the adenosine, which is taken up by healthy myocardium. If area has diminished perfusion, this will create a mismatch.  Dead tissue will not take up isotope - indicative of a previous infarct. The stress portion of the nuclear test will be to assess for a perfusion mismatch to evaluate for signs of ischemia. You want to compare rest vs. stress images. Lexiscan is an A2A agonist. Advantages do not require pharmacy, single injection, short acting. Lexiscan is the stress portion of the nuclear testing. By the way, the radionuclear isotope is about 10 mSv or equivalent to about 200 chest x-rays. Optimal patient for a Lexiscan is someone who cannot exercise, once again LBBB, paced, those who can walk on a treadmill. Specificity and sensitivity: 90% for Lexiscan, if selected correctly. Cons to Lexiscan are: cost, hospital based, radiation exposure, pregnancy. Pearl: things that buy you an angio on treadmill stress testing are EKG changes, redevelopment of chest sxs, image changes. 2 of those 3 criteria moves us to angio. CHAPTER 2 SUMMARY: The 2-main echos we are concerned with are stress echo, and Dobutamine or chemical echo. Unfortunately, the stress echo is not as sensitive as a nuclear test. The pros of a stress echo:  cost, no radiation. The echo process: patient will initially have a baseline-resting echo to look at the EF, and for wall motion abnormalities. Important to point out that this is not a valvular study. Although if Aortic Stenosis is visualized, this generally is a contraindication to stress echo. Sensitivity and specificity:  around 85%, not bad. For the stress portion of the test, you are shooting for about 85% of the patient maximum predicted heart rate. Unfortunately, if obese - a nuclear study is a 2-day test due to large amount of radiation required for the studies. An additional contraindication for stress echo would be morbid obesity, COPD, previous cardiac insult with wall motion abnormalities, LBBB, reduced EF. Dobutamine Echos have limited utility. They take a long time to perform. It makes people feel crummy. Physicians usually have to be present. Once caveat would be for the chronically wheezing asthmatic with bronchospasms or history of status asthmatics. Dobutamine is a B1 and B2 agonist, which will help with asthmatic sxs.  Dobutamine has inotropic properties and less chronotropic activity, which can occasionally require atropine to increase HR. Dobutamine has limited utility. Treadmill stress testing is used to "rule out" disease.  Stress echos are generally considered the appropriate test for women. Caffeine is an adenosine analog and can affect Lexiscan results.  Beta-blockers are typically held for about 36-hours. CHAPTER 3 SUMMARY: A treadmill stress test Bruce protocol is performed in 3-minute increments. Starts at a 10% grade, with a pace 1.8 miles per hour. Goal standard is about 10-minutes. Bruce protocol goes to 21- minutes. Predictive value of a significant coronary event if the patient meets the goals of a Bruce protocol is extremely low. Buzz words that make you stop the treadmill test are pretty self-explanatory, include: reproduced chest pain sxs, drop in BP, arrhythmias, EKG changes. The negative predictive value of a neg CT coronary angiogram - in upper 90% range. Elevated calcium scores can limit the efficacy of the CT coronary angio making it difficult to accurately interpret the test. Stress test is for revealing sxs. Stress tests are not for modifying outcomes.  If the patient can do 4 METS, usually you can clear them for surgery. Stress test should be a rule-out test. CTA FFR is Fractional Flow Reserve - is an assessment of flow across a coronary lesion. In addition, it tends to take the reader out of the equation.

On 13th February 2019, Ami Iskandrian spoke with Wael Jaber about the recently published article entitled ‘Initial experience with regadenoson stress positron emission tomography in patients with left bundle branch block: Low prevalence of septal defects and high accuracy for obstructive coronary artery disease’. The authors of this article have provided a PowerPoint file which summarises the contents of the paper and is free for re-use at meetings and presentations: http://bit.ly/2UYPD4f The article is available at: http://bit.ly/2ZegsAF Be sure to subscribe on your mobile device - search 'JNC/ASNC Podcast'.

Random pearls from #IM2019 Day 1. The Curbsiders crew is joined by Kashlak’s POCUS Chief, Renee Dversdal MD at ACP’s Internal Medicine Meeting in Philadelphia to discuss day 1 highlights inlcuding: POCUS, lyme rash, back pain, syphilis, women’s health, patient handoffs, the flip-flop fungal sign a ton of cardiology pearls (ie diuretics, paracentesis for CHF, beta blockers, LBBB, when is it safe to have intercourse after an MI?) and more! "Sorry, no time stamps or full show notes for this one. We're too tired." -The Curbsiders Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. #IM2019 Curbsiders Crew Guest: Renee Dversdal MD, Alan Dow MD, Alia Chisty MD Cohosts: Paul Williams MD, Stuart Brigham MD, Shreya Trivedi MD, Molly Heublein MD, Emi Okamoto MD, Justin Berk MD, Cyrus Askin MD, Matthew Watto MD, Chris Chiu MD Director of operations: Chris Chiu MD Twitter: Cyrus Askin MD, Hannah Abrams MS3 Instagram: Beth Garbitelli MS1 Facebook: Chris Chiu MD Off-air producer: Sarah Phoebe Roberts MPH Marketing: Jen Watto

In part two Bryan takes us through a few case studies with application the Smith-Modified Sgarbossa Criteria. For more information on this and and many excellent ECG case studies, check out Dr. Steve Smiths ECG Blog.  

Commentary by Dr. Valentin Fuster

Commentary by Dr. Valentin Fuster

Bryan Winchell sent me a screen cast he did last year which was FRACKIN AMAZING! He gave me permission to post it on FOAMfrat. I broke it up into two segments. Segment one will look at the conduction abnormalities of a bundle branch block. In part two he gets into case studies of interpreting an MI in the presence of a LBBB using the Smith-Modified Sgarbossa Criteria. www.foamfrat.com

In this episode, we discuss the modified Sgarbossa criteria used to identify STEMI equivalents in patients who have an existing or not known to be old left bundle branch block (LBBB). identifying a STEMI in the setting of a LBBB can be challenging because there are ST segment deviations that can be normal in LBBB. We discuss the modified Sgarbossa criteria that can help the paramedic identify this important STEMI equivalent. paramedicine, paramedic, EMS, STEMI equivalent, Sgarbossa, LBBB The Medical Director Minute podcast is a high yield, rapid fire podcast bringing you high impact discussions on clinical topics right to your smart phone. Each podcast is around 10 minutes in length to make it easy to listen with your busy schedule.

Author: Peter Bakes, MD Educational Pearls:   Pericarditis, LBBB, LVH and left ventricular aneurysms can all present with ST elevation. Ventricular aneurysm will present days after a cardiac event with ST elevation and Q waves in the affected leads. Ventricular aneurysms may cause papillary muscle dysfunction with a resultant holosystolic murmur and even heart failure.   References Victor F. Froelicher; Jonathan Myers (2006). Exercise and the heart. Elsevier Health Sciences. pp. 138–. ISBN 978-1-4160-0311-3. Nagle RE, Williams DO. (1974) Proceedings: Natural history of ventricular aneurysm without surgical treatment. British Heart Journal, 36:1037.

Know what a normal LBBB “looks” like: 1) QRS duration greater than 120 ms 2) Negative QRS Complex in V1 3) Positive QRS Complex in lateral leads (I, aVL, V5-V6) LBBB causes a repolarization abnormality: Consider a “repol” abnormality when there is a “general pattern of ST discordance”, meaning the ST segment opposite the QRS in nearly every lead (can be caused by LVH, LBBB, WPW, etc.). In a LBBB there is normally ST elevation in some leads at baseline. 2013 AHA STEMI Guidelines: “New or presumably new LBBB has been considered a STEMI equivalent. Most cases of LBBB at time of presentation, however, are “not known to be old” because of prior electrocardiogram (ECG) is not available for comparison. New or presumably new LBBB at presentation occurs infrequently, may interfere with ST-elevation analysis, and should not be considered diagnostic of acute myocardial infarction (MI) in isolation”. New or presumed new LBBB does not predict an MI. MI occurs at similar frequencies between patients with a new LBBB, an old LBBB, and patients without a LBBB. Patients with a LBBB frequently have an unequivocal STEMI diagnosis go unrecognized because clinicians aren’t familiar with how to diagnose an MI in this setting. Criteria for diagnosing STEMI in a LBBB Standard Sgarbossa Criteria 1) ST-segment elevation ≥1 mm concordant with the QRS complex in any lead (5 points) 2) ST-segment depression ≥1 mm in lead V1, V2, or V3 (3 points) 3) ST-segment elevation ≥5 mm discordant with the QRS complex in any lead (2 points) Smith Modified Sgarbossa ≥ 1 lead with ≥1 mm of concordant ST elevation ≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression ≥ 1 lead anywhere with ≥ 1 mm STE and proportionally excessive discordant STE, as defined by ≥ 25% of the depth of the preceding S-wave.      

The November 2017 episode of the JAAPA Podcast with hosts Kristopher Maday and Adrian Banning features CME articles on chest pain with concomitant left bundle branch block and the non-pharmacologic management of insomnia. Our hosts also discuss substance abuse screening in adolescents, synthetic cannabinoid use, and quick review of DKA. Also, Adrian gives her take on the use of scientific evidence in clinical practice. Plus, Kris keeps it classy with his favorite movie from his college days.     CME Article – Managing Chest Pain in Patient with Concomitant LBBB (4:44) CME Article - A nonpharmacologic approach to managing insomnia in primary care (9:25) Review Article – Substance abuse screening in adolescents (17:43) Review Article – Synthetic cannabinoids (21:57) Review Article – Efficiently finding and using evidence to guide clinical practice and improve care (25:26) QRS - DKA (35:50)

If you've had an MI with a STEMI or a new LBBB the decision to go to the cath lab is pretty straight forward. If you've collapsed with a cardiac arrest of presumed cardiac aetiology (the majority of them) and gained a ROSC (return in spontaneous circulation) then the decision to go the the lab immediately is pretty variable and can depend of the clinicians involved, the ECG or the system within which you work. The Resus Council and the European Society of Cardiology have some guidance on the topic and that is a must read. Today we have a look at a commonly quoted paper in the literature, The PROCAT database, to see if we can shed some light on the topic. We'd love to hear feedback and comments on the podcast in the comments section. Enjoy! References 2014 ESC/EACTS Guidelines on myocardial revascularization; page 2585 Resus Council; Post Resus Care section 6 Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry. Dumas F. Circ Cardiovasc Interv. 2010 Jun 1;3(3):200-7. doi: 10.1161/CIRCINTERVENTIONS.109.913665. Epub 2010 May 18.

Podcast summary of articles from July 2016 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include Pulmonary Embolism, Myocardial Infarction in LBBB, Urinary Tract Infection Myths, Pediatric Airway Emergencies, and board review on Neuroleptic Malignant Syndrome.

Commentary by Dr. Valentin Fuster

This is part 2 of a 2 part series covering 12-Lead ECG interpretation, focusing on LBBB and Sgarbossa criteria.See omnystudio.com/listener for privacy information.

This is part 2 of a 2 part series covering 12-Lead ECG interpretation, focusing on LBBB and Sgarbossa criteria.

In Part 1 of this Episode on Acute Coronary Syndromes Risk Stratification Dr. Eric Letovksy, Dr. Mark Mensour and Dr. Neil Fam discuss common pearls and pitfalls in assessing the patient who presents to the ED with chest pain. They review atypical presentations to look out for, what the literature says about the value of traditional and non-traditional cardiac risk factors, the diagnostic utility of recent cardiac testing, and which patients in the ED should have a cardiac work-up. Finally, in the ED work up of Acute Coronary Syndromes Risk Stratification, they highlight some valuable key points in ECG interpretation and how best to use and interpret cardiac biomarkers like troponin. Drs. Letovksy, Mensour & Fam address questions like: How useful are the traditional cardiac risk factors in predicting ACS in the ED? How does a negative recent treadmill stress test, nuclear stress test or angiogram effect the pre-test probability of ACS in the ED? What does recent evidence tell us about the assumption that patients presenting with chest pain and a presumed new LBBB will rule in for MI and require re-perfusion therapy? How can we diagnose MI in the patient with a ventricular pacemaker? What is the difference between Troponin I and Troponin T from a practical clinical perspective? Is one Troponin ever good enough to rule out MI in the patient with a normal ECG? Should we be using a 2hr delta troponin protocol? How will the new ultra-sensitive Troponins change our practice? and many more.....

In Part 1 of this Episode on Acute Coronary Syndromes Risk Stratification Dr. Eric Letovksy, Dr. Mark Mensour and Dr. Neil Fam discuss common pearls and pitfalls in assessing the patient who presents to the ED with chest pain. They review atypical presentations to look out for, what the literature says about the value of traditional and non-traditional cardiac risk factors, the diagnostic utility of recent cardiac testing, and which patients in the ED should have a cardiac work-up. Finally, in the ED work up of Acute Coronary Syndromes Risk Stratification, they highlight some valuable key points in ECG interpretation and how best to use and interpret cardiac biomarkers like troponin. Drs. Letovksy, Mensour & Fam address questions like: How useful are the traditional cardiac risk factors in predicting ACS in the ED? How does a negative recent treadmill stress test, nuclear stress test or angiogram effect the pre-test probability of ACS in the ED? What does recent evidence tell us about the assumption that patients presenting with chest pain and a presumed new LBBB will rule in for MI and require re-perfusion therapy? How can we diagnose MI in the patient with a ventricular pacemaker? What is the difference between Troponin I and Troponin T from a practical clinical perspective? Is one Troponin ever good enough to rule out MI in the patient with a normal ECG? Should we be using a 2hr delta troponin protocol? How will the new ultra-sensitive Troponins change our practice? and many more..... The post Episode 15 Part 1: Acute Coronary Syndromes Risk Stratification appeared first on Emergency Medicine Cases.

In anticipation of Episode 15, 'Acute Coronary Syndromes' with Dr. Eric Letovsky, Dr. Mark Mensour and Dr. Neil Fam, we present here, Dr. Helman's 'Best Case Ever' of an ACS patient. In Episode 15: 'Acute Coronary Syndromes', Drs. Fam, Mensour , Letovsky and Helman discuss questions like: How does a recent negative stress test or angiogram effect the pre-test probability of ACS in the ED? What does recent evidence tell us about the assumption that patients presenting with chest pain and a presumed new LBBB will rule in for MI and require reperfusion therapy? [wpfilebase tag=file id=376 tpl=emc-play /] [wpfilebase tag=file id=377 tpl=emc-mp3 /]

In anticipation of Episode 15, 'Acute Coronary Syndromes' with Dr. Eric Letovsky, Dr. Mark Mensour and Dr. Neil Fam, we present here, Dr. Helman's 'Best Case Ever' of an ACS patient. In Episode 15: 'Acute Coronary Syndromes', Drs. Fam, Mensour , Letovsky and Helman discuss questions like: How does a recent negative stress test or angiogram effect the pre-test probability of ACS in the ED? What does recent evidence tell us about the assumption that patients presenting with chest pain and a presumed new LBBB will rule in for MI and require reperfusion therapy? [wpfilebase tag=file id=376 tpl=emc-play /] [wpfilebase tag=file id=377 tpl=emc-mp3 /] The post Best Case Ever 4 Acute Coronary Syndrome From Venous Source appeared first on Emergency Medicine Cases.