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Ekg challenge

Jean E Cibula, Daniel S Demos, Brenda G Fahy
BACKGROUND: A challenge in ICU EEG interpretation is identifying subclinical status epilepticus versus patterns on the ictal-interictal continuum versus other repetitive patterns. In the electrically noisy intensive care unit, identifying and eliminating interference and artifact allow accurate diagnoses from the EEG, avoiding unnecessary treatment or sedation. METHODS: We present a case during Impella (Abiomed Inc, Danvers, MA) continuous flow left ventricular assist device use where the EEG artifact was initially misinterpreted as seizure by the resident and treated as status epilepticus because of the "focal" sharply contoured repetitive pattern...
April 16, 2018: Neurocritical Care
Xianqiang Tang, Qingyun Li, Zhenhua Wang, Yanping Hu, Yuan Hu, Miklas Scholz
Novel soil remediation equipment based on electro-kinetic geosynthetics (EKG) was developed for in situ isolation of metals from paddy soil. Two mutually independent field plot experiments A and B (with and without electric current applied) were conducted. After saturation using ferric chloride (FeCl3 ) and calcium chloride (CaCl2 ), soil water drainage capacity, soil cadmium (Cd) removal performance, energy consumption as well as soil residual of iron (Fe) and chloride (Cl) were assessed. Cadmium dissolved in the soil matrix and resulted in a 100% increase of diethylenetriamine-pentaacetic acid (DTPA) extracted phyto-available Cd...
March 10, 2018: Environmental Science and Pollution Research International
Suparna C Clasen, Bonnie Ky, Rupal O'Quinn, Bruce Giantonio, Ursina Teitelbaum, Joseph R Carver
Background: Fluoropyrimidine chemotherapy [5-fluorouracil (5-FU) and capecitabine] are commonly used agents in the treatment of various solid malignancies. However, their use has been limited by cardiac toxicity, presenting as a wide spectrum of asymptomatic (e.g., EKG changes) and symptomatic (e.g., chest pain) manifestations related to coronary vasospasm leading to myocardial ischemia. Historically, patients with suspected coronary vasospasm have been treated with traditional acute ischemic workup and various combinations of anti-anginal therapies...
December 2017: Journal of Gastrointestinal Oncology
Katie L Konesky, Weidun Alan Guo
OBJECTIVES: Traumatic cardiac arrest (TCA) represents a unique problem, and poses difficult challenges in the care of trauma patients. Although the literature has suggested that attempted resuscitation from TCA in trauma is futile and consumptive of medical and human resources, studies have recently demonstrated that the outcome of TCA is comparable cardiac arrest secondary to non-traumatic events. The objective of this study was to determine the incidence, predictors, and outcomes following TCA...
November 25, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Ashraf Abugroun, Fatima Ahmed, Daniel Vilchez, Lalita Turaga
Apical hypertrophic cardiomyopathy (ApHCM) is a rare variant of hypertrophic cardiomyopathy, characterized by a spade-like left ventricular cavity. A 58-year-old African-American female with past medical history of hypertension presented for evaluation of recurrent exertional chest tightness, palpitations and headache. Prior workup including multiple stress tests and angiogram was non-conclusive. Electrocardiogram (EKG) showed characteristic marked T-waves inversions in inferior leads and left ventriculography revealed left ventricle apical hypertrophy with spade like left ventricular cavity that was typical of Yamaguchi syndrome...
October 2017: Cardiology Research
Kelsey Noss, Sandra M Aguero, Travis Reinaker
Patients may intermittently require antimicrobial therapy with a QTc-prolonging antibiotic, which presents a challenge for prescribers of patients already taking a QTc-prolonging antiarrhythmic. Manufacturers recommend close monitoring for evidence of QTc-prolongation with the concomitant use of QTc-prolonging medications, but the monitoring parameters are not well-defined. Previous studies recommend a surveillance electrocardiogram (EKG) be completed both before and after the initiation of QTc-prolonging medications, but it is unknown to what degree EKGs displaying the QTc-interval are used to alter physician order entry and pharmacist order verification during concomitant therapy...
November 1, 2017: Pharmacy (Basel, Switzerland)
Benton R Hunter, Jennifer Martindale, Osama Abdel-Hafez, Peter S Pang
Acute heart failure (AHF) patients rarely present complaining of 'acute heart failure.' Rather, they initially present to the emergency department (ED) with a myriad of chief complaints, symptoms, and physical exam findings. Such heterogeneity prompts an initially broad differential diagnosis; securing the correct diagnosis can be challenging. Although AHF may be the ultimate diagnosis, the precipitant of decompensation must also be sought and addressed. For those AHF patients who present in respiratory or circulatory failure requiring immediate stabilization, treatment begins even while the diagnosis is uncertain...
September 2017: Progress in Cardiovascular Diseases
Htun Latt, Thein Tun Aung, Chanwit Roongsritong, David Smith
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a relatively under-recognized hereditary cardiomyopathy. It is characterized pathologically by fibro-fatty infiltration of right ventricular (RV) myocardium and clinically by consequences of RV electrical instability. Timely intervention with device therapy and pharmacotherapy may help reduce the risk of arrhythmic events or sudden cardiac death. Here, we describe a classic case of a young adult with ARVC and a brief literature review. The patient presented with exertional palpitations and ARVC was suspected after his routine electrocardiogram (EKG) revealed symmetric T wave inversions and possible epsilon waves in right precordial leads...
March 2017: Journal of Community Hospital Internal Medicine Perspectives
U Ezema, D Daberkow, T Delord, L Guidry, N R Sells
INTRODUCTION: Left main coronary artery (LMCA); thrombus with an acute myocardial infarction identified with coronary angiography is a clinically rare condition with an extremely high mortality rate. We present a case of LMCA thrombus that presented as a non-ST elevation myocardial infarction (NSTEMI);. CASE: A 45-year-old woman with a history of tobacco use and hyperlipidemia presented with a complaint of 10/10 "hard pain" across her chest radiating to her left shoulder and breast which woke her from sleep...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
Ira M Bernstein, Sarah A Hale, Gary J Badger, Carole A McBride
OBJECTIVE: The objective of the current study was to evaluate cardiovascular function; including blood pressure, cardiac output, pulse wave velocity and vascular compliance in nonpregnant nulliparous women compared to women with a history of preterm preeclampsia. STUDY DESIGN: This was a case control study. Blood pressure was measured using the Finapres Pro. Baseline cardiac output was determined by echocardiography. Pulse wave velocity was estimated using simultaneous electrocardiographic tracings and ultrasound determined arterial flow waveforms and calculated as estimated distance divided by the time interval between EKG r-wave peak and ultrasound derived peak popliteal artery flow...
October 2016: Pregnancy Hypertension
Kai O Hensel, Lucia Wilke, Andreas Heusch
The value of conventional echocardiography is limited by differences in inter-individual image interpretation and therefore largely dependent on the examiners' expertise. Speckle tracking Echocardiography (STE) is a promising but technically challenging method that can be used to quantitatively assess regional and global systolic and diastolic myocardial performance. Myocardial strain and strain rate can be measured in all three dimensions - radial, circumferential, longitudinal - of myocardial deformation...
October 20, 2016: Journal of Visualized Experiments: JoVE
Hazem E Hassan, Deanna Kelly, Moshe Honick, Sagar Shukla, Ahmed Ibrahim, David A Gorelick, Matthew Glassman, Robert P McMahon, Heidi J Wehring, Ann Marie Kearns, Stephanie Feldman, Mingming Yu, Ken Bauer, Jia Bei Wang
Cocaine use disorder (CUD) remains a significant public health challenge. l-Tetrahydropalmatine (l-THP), a well-tolerated and nonaddictive compound, shows promise for the management of CUD. Its pharmacologic profile includes blockade at dopamine and other monoamine receptors and attenuation of cocaine self-administration, reinstatement, and rewarding properties in rats. This study evaluated the safety of l-THP in human cocaine users and its influence on the safety and pharmacokinetics (PK) of cocaine. Twenty-four cocaine-using adult men were randomized to receive l-THP (30 mg twice a day orally) or placebo double-blind for 4 days, with an intranasal cocaine (40 mg) challenge on the fourth day...
February 2017: Journal of Clinical Pharmacology
Thein Tun Aung, Edward Samuel Roberto, Abdul Wase
BACKGROUND: Holt-Oram syndrome (HOS) is a rare but significant syndrome consisting of structural heart defects, conduction abnormalities, and upper extremity anomalies. It was first described in the British Heart Journal in 1960 by Mary Holt and Samuel Oram as a report of atrial septal defect, conduction disturbances, and hand malformations occurring in family members. Patients can present with heart blocks or symptoms of underlying congenital heart defects. CASE REPORT: A 41-year-old man with Holt-Oram syndrome presented with seizure-like activity and was found to have an underlying conduction disturbance...
February 17, 2016: American Journal of Case Reports
Bellal Joseph, Tahereh O Jokar, Mazhar Khalil, Ansab A Haider, Narong Kulvatunyou, Bardiya Zangbar, Andrew Tang, Muhammad Zeeshan, Terence O'Keeffe, Daniyal Abbas, Rifat Latifi, Peter Rhee
BACKGROUND: Blunt cardiac injury (BCI) is an infrequent but potentially fatal finding in thoracic trauma. Its clinical presentation is highly variable and patient characteristics and injury pattern have never been described in trauma patients. The aim of this study was to identify predictors of mortality in BCI patients. METHODS: We performed an 8-year retrospective analysis of all trauma patients diagnosed with BCI at our Level 1 trauma center. Patients older than 18 years, blunt chest trauma, and a suspected diagnosis of BCI were included...
June 2016: American Journal of Surgery
Bogdan G Muntean, Mattias Roser, Saba Suhail, Patrick Nagel, Barbara Bellmann
CASE REPORT: This article reports the case of a 76-year-old patient with multiple implantable cardioverter defibrillator (ICD) interventions of the single chamber ICD. On admission the 12-lead electrocardiogram (ECG) documented a wide QRS complex tachycardia without clearly identifiable P waves. The patient had previously had two ventricular tachycardia (VT) ablations due to VT storms. The resting ECG revealed a sinus rhythm with a wide QRS complex. During the electrophysiological investigation typical atrial flutter could be detected and an ablation of the cavotricuspid isthmus was performed...
December 2015: Herzschrittmachertherapie & Elektrophysiologie
Arnon Adler, Raphael Rosso, Ehud Chorin, Ofer Havakuk, Charles Antzelevitch, Sami Viskin
Risk stratification in Brugada syndrome remains a clinical challenge because the event rate is low but the presenting symptom is often cardiac arrest (CA). We review the data on risk stratification. A history of CA or malignant syncope is a strong predictor of spontaneous ventricular fibrillation (VF), whereas the prognostic value of a history of familial sudden death and the presence of a SCN5A mutation are less well defined. On the electrocardiogram, the presence of spontaneous type I electrocardiogram increases the risk for VF in all studies, whereas the presence of fragmented QRS complexes and early repolarization correlates with increased risk in several studies...
January 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Yaniel Castro-Torres, Raimundo Carmona-Puerta, Richard E Katholi
Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a challenge for the medical community due to the tragic outcomes in most cases. In the last two decades some ventricular repolarization (VR) markers have been found to be useful to predict malignant cardiac arrhythmias in several clinical conditions. The corrected QT, QT dispersion, Tpeak-Tend, Tpeak-Tend dispersion and Tp-e/QT have been studied and implemented in clinical practice for this purpose...
August 16, 2015: World Journal of Clinical Cases
Laure Léger, Boris Gojanovic, Nicole Sekarski, Erik J Meijboom, Yvan Mivelaz
Sudden cardiac death (SCD) affects 2/100,000 young, active athletes per year of which 40% are less than 18 years old. In 2004, the International Olympic Committee accepted the Lausanne Recommendations, including a 12-lead electrocardiogram (ECG), as a pre-participation screening tool for adult Olympic athletes. The debate on extending those recommendations to the pediatric population has recently begun. The aims of our study were to highlight the characteristics of the young athlete ECG, phenotypical manifestations of SCD-related disease in children, and challenges of implanting ECG screening in athletic children...
January 2016: Pediatric Cardiology
Xue-Yang Deng, Jun-Jun Chen, Hong-Yan Li, Zhan-Qiang Ma, Shi-Ping Ma, Qiang Fu
The aim of the present study was to investigate the cardioprotective effects of Timosaponin B II (TB), a main bioactive constituent from Anemarrhenae asphodeloides Bge, on an isoproterenol (ISO)-induced myocardial infarction model in rats and explore its underlying mechanisms. Rats were treated with TB (50 mg/kg, 100 mg/kg) or diltiazem hydrochloride (DH, 5 mg/kg) by gastric gavage for five days. At the 4th and 5th days, myocardial injury was induced by ISO injection (85 mg/kg) at an interval of 24 h for 2 consecutive days...
October 5, 2015: Chemico-biological Interactions
L Zou, J Liu, H Zhang, S Wu, C Long, B Ji, Z Yu, Y Tang, L Meng, A Wu
OBJECTIVE: Due to the weak ascending aorta, it is extremely challenging to establish an anterograde selective cerebral perfusion (ASCP) model in rabbits, especially when cardioplegic arrest is required. Herein, the aim of this study was to establish a rabbit ASCP model with cardiac arrest being easily performed and being similar to the clinical scenario. MATERIALS AND METHODS: Twenty-two adult New Zealand white rabbits were selected for ASCP model establishment and another 22 rabbits were utilized for blood donation...
May 2016: Perfusion
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