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EMERGENCY ECG

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https://www.readbyqxmd.com/read/28515827/transient-left-bundle-branch-block-due-to-severe-hyperkalemia
#1
Kishore Kumar, Madhavi Biyyam, Amandeep Singh, Bharat Bajantri, Hassan Tariq, Suresh Kumar Nayudu, Sridhar Chilimuri
Hyperkalemia is a potentially life-threatening electrolyte imbalance that can lead to sudden death from cardiac arrhythmias and asystole. We present a case of transient left bundle branch block pattern on an electrocardiogram (ECG) secondary to hyperkalemia in a patient with history of end-stage renal disease. A 52-year-old man presented to the emergency room (ER) with chief complaints of weakness and lethargy after missing his regularly scheduled session of hemodialysis. A 12-lead ECG in the ER showed sinus tachycardia at 118 beats/min, wide QRS complexes, peaked T waves and left bundle branch block-like pattern...
April 2017: Cardiology Research
https://www.readbyqxmd.com/read/28506591/early-echocardiography-has-a-low-yield-in-patients-with-transient-ischemic-attack
#2
Elie Harmouche, Ghada A Mahmoud, Michael Ross, Jason Hockenberry, Robin Dharia, Fadi Nahab
STUDY OBJECTIVE: Current guidelines recommend patients presenting with transient ischemic attack (TIA) undergo echocardiography to evaluate for a cardiac source. However, echocardiography is not available daily at many centers. We assessed the yield from early transthoracic echocardiography (TTE) in consecutive patients with TIA evaluated in an emergency department observation unit (EDOU) protocol. METHODS: This observational cohort study took place in an academic medical center from January 1, 2011 to July 31, 2013...
May 11, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28500753/a-0h-1h-protocol-for-safe-early-discharge-of-chest-pain-patients
#3
Arash Mokhtari, Bertil Lindahl, Alexandru Schiopu, Troels Yndigegn, Ardavan Khoshnood, Patrik Gilje, Ulf Ekelund
OBJECTIVES: Guidelines recommend a 0h/1h high-sensitivity cardiac troponin T (hs-cTnT) diagnostic strategy in acute chest pain patients. There is however little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP) using the 0h/1h hs-cTnT strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI) score and ECG for ruling out major adverse cardiac events (MACE) within 30 days...
May 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28500178/electrical-substrate-elimination-in-135-consecutive-patients-with-brugada-syndrome
#4
Carlo Pappone, Josep Brugada, Gabriele Vicedomini, Giuseppe Ciconte, Francesco Manguso, Massimo Saviano, Raffaele Vitale, Amarild Cuko, Luigi Giannelli, Zarko Calovic, Manuel Conti, Paolo Pozzi, Andrea Natalizia, Simonetta Crisà, Valeria Borrelli, Ramon Brugada, Georgia Sarquella-Brugada, Marco Guazzi, Alessandro Frigiola, Lorenzo Menicanti, Vincenzo Santinelli
BACKGROUND: There is emerging evidence that localization and elimination of abnormal electric activity in the epicardial right ventricular outflow tract may be beneficial in patients with Brugada syndrome. METHODS AND RESULTS: A total of 135 symptomatic Brugada syndrome patients having implantable cardiac defibrillator were enrolled: 63 (group 1) having documented ventricular tachycardia (VT)/ventricular fibrillation (VF) and Brugada syndrome-related symptoms, and 72 (group 2) having inducible VT/VF without ECG documentation at the time of symptoms...
May 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/28495906/emergency-corneal-grafting-in-the-uk-a-6-year-analysis-of-the-uk-transplant-registry
#5
Parwez Hossain, Abdo Karim Tourkmani, Dimitri Kazakos, Mark Jones, David Anderson
BACKGROUND: Corneal graft (CG) surgery is the most common and successful tissue transplant worldwide. A small and important group of patients are operated in emergency situations, typically to save a perforated eye. Our knowledge of the indications and outcomes of emergency corneal graft (eCG) is limited. METHODS: Retrospective, multifactorial analysis of all CGs registered by the UK Transplant Service from April 1999 to March 2005. RESULTS: A total of 12 976 CGs were performed...
May 11, 2017: British Journal of Ophthalmology
https://www.readbyqxmd.com/read/28484820/-vertigo-and-dizziness-in-the-emergency-room
#6
REVIEW
A Zwergal, K Möhwald, M Dieterich
Vertigo and dizziness are among the most common chief complaints in the emergency department. Etiologies can be categorized into three subgroups: neurootological (vestibular), medical (especially cardiovascular, metabolic), and psychiatric disorders. The diagnostic approach in the emergency department is based on a systematic analysis of case history (type, time course of symptoms, modulating factors, associated symptoms), clinical examination of the vestibular, ocular motor, and cerebellar systems (head impulse test, nystagmus, skew deviation, positioning maneuver, test of gait and stance), as well as a basal monitoring (vital signs, 12-lead ECG, blood tests)...
May 8, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28483037/effect-of-the-4-h-target-on-time-to-ecg
#7
James A Hughes, C J Cabilan, Caitlin Young, Andrew Staib
Objectives The aim of this study was to assess the relationship between compliance with time-based Emergency Department (ED) targets (known as NEAT) and the time taken to collect an electrocardiogram (TTE) in patients presenting with chest pain.Methods This was a pilot descriptive retrospective cohort study completed in a large inner city tertiary ED. Patients who presented with active or recent chest pain between July 2014 and June 2015 were eligible for inclusion. Pregnant patients, inter-hospital transfers, and traumatic chest pain were excluded...
May 9, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28479090/electrocardiogram-training-for-residents-a-curriculum-based-on-facebook-and-twitter
#8
Stanley S Liu, Sammy Zakaria, Dhananjay Vaidya, Mukta C Srivastava
BACKGROUND: We studied whether social media applications can serve as effective educational tools for teaching electrocardiogram (ECG) interpretation to medical residents. METHODS: 39 emergency, family, and internal medicine residents participated in the 33-week "ECG of the Week" curriculum via Facebook and Twitter. ECG skill was assessed before and after the study with a 10-ECG quiz. Outcomes of interest included predictors of participant response rates and post-study quiz performance...
April 22, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28473422/cardioversion-of-a-supraventricular-tachycardia-svt-in-a-7-year-old-using-a-postural-modification-of-the-valsalva-manoeuvre
#9
Edward John Morley-Smith, James Gagg, Andrew Appelboam
A boy aged 7 years presented with his parents to the emergency department (ED). He had a known diagnosis of paroxysmal supraventricular tachycardia (SVT) and was under the care of paediatricians. He had been suffering episodes of palpitations and chest pain for over a year and had been prescribed atenolol 25 mg ON, though the side effects meant he had not taken it for a month prior to presentation. He had 2 previous confirmed episodes of SVT, one that reverted with Valsalva manoeuvres, and the other with intravenous adenosine...
May 4, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28472282/right-ventricular-outflow-tract-high-density-endocardial-unipolar-voltage-mapping-in-patients-with-brugada-syndrome-evidence-for-electroanatomical-abnormalities
#10
Konstantinos P Letsas, Michael Efremidis, Konstantinos Vlachos, Stamatis Georgopoulos, Nikolaos Karamichalakis, Dimitrios Asvestas, Kosmas Valkanas, Panagiotis Korantzopoulos, Tong Liu, Antonios Sideris
Aims: Epicardial structural abnormalities at the right ventricular outflow tract (RVOT) may provide the arrhythmia substrate in Brugada syndrome (BrS). Electroanatomical endocardial unipolar voltage mapping is an emerging tool that accurately identifies epicardial abnormalities in different clinical settings. This study investigated whether endocardial unipolar voltage mapping of the RVOT detects electroanatomical abnormalities in patients with BrS. Methods and results: Ten asymptomatic patients (8 males, 34...
May 2, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28465689/reversible-inferolateral-st-segment-elevation-associated-with-small-bowel-obstruction
#11
Ankit Upadhyay, Sudheer Chauhan, Umair Jangda, Vipul Bodar, Ahmed Al-Chalabi
ST-segment elevation is an important and alarming electrocardiographic sign that necessitates immediate attention but does not always indicate that the primary pathology is cardiac in origin. It needs to be interpreted in the clinical context as several pathological conditions involving especially gastrointestinal tract may lead to delayed diagnosis and treatment as well as complications from invasive unnecessary interventions. We present two patients, a 64-year-old male and a 71-year-old female, who were admitted to the emergency room of a community-based hospital with similar complaints of worsening epigastric abdominal pain and were diagnosed later with small bowel obstruction...
2017: Case Reports in Medicine
https://www.readbyqxmd.com/read/28465023/the-impact-of-fever-on-corrected-qt-interval
#12
Doran Drew, Adrian Baranchuk, Wilma Hopman, Robert J Brison
AIMS: We were interested in the impact of fever on the QT interval as information on this subject is limited. METHODS: We performed a retrospective, single centre study over a two year period, ending December 31st, 2013. Participants were identified using an electronic chart review of emergency department records linked to an ECG data base. Study subjects were drawn from patients presenting with fever to an academic emergency department in Canada. Our study identified febrile (T>38...
April 18, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28460856/longterm-prognosis-of-low-risk-women-presenting-to-the-emergency-department-with-chest-pain
#13
Moneer Eddin, Sandhya Venugopal, Brittany Chatterton, Angela Thinda, Ezra A Amsterdam
BACKGROUND: Prognosis of low risk women presenting to the emergency department with chest pain has not been clarified. We assessed early and longterm outcomes of such patients and determined the need for predischarge testing METHODS: Retrospective assessment of consecutive low risk women presenting to the ED with chest pain evaluated in a chest pain unit (CPU). Criteria of low risk: age ≤51 yr, no history of cardiovascular disease, diabetes or smoking, negative initial electrocardiogram (ECG), and cardiac troponin...
April 28, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28460689/a-new-4-variable-formula-to-differentiate-normal-variant-st-segment-elevation-in-v2-v4-early-repolarization-from-subtle-left-anterior-descending-coronary-occlusion-adding-qrs-amplitude-of-v2-improves-the-model
#14
Brian E Driver, Ayesha Khalil, Timothy Henry, Faraz Kazmi, Amina Adil, Stephen W Smith
INTRODUCTION: Precordial normal variant ST elevation (NV-STE), previously often called "early repolarization," may be difficult to differentiate from subtle ischemic STE due to left anterior descending (LAD) occlusion. We previously derived and validated a logistic regression formula that was far superior to STE alone for differentiating the two entities on the ECG. The tool uses R-wave amplitude in lead V4 (RAV4), ST elevation at 60 ms after the J-point in lead V3 (STE60V3) and the computerized Bazett-corrected QT interval (QTc-B)...
April 19, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28457177/high-sensitivity-cardiac-troponin-assays-from-improved-analytical-performance-to-enhanced-risk-stratification
#15
Marek Kozinski, Magdalena Krintus, Jacek Kubica, Grazyna Sypniewska
Implementation of cardiac troponin (cTn) assays has revolutionized the diagnosis, risk stratification, triage and management of patients with suspected myocardial infarction (MI). The Universal Definition of MI brought about a shift in the diagnostics of MI, from an approach primarily based on electrocardiography (ECG) to one primarily based on biomarkers. Currently, detection of a rise and/or fall in concentration or activity of myocardial necrosis biomarkers, preferentially cTns, with at least one value above the 99th percentile upper reference limit (URL), is the essential component for the diagnosis of MI...
May 2017: Critical Reviews in Clinical Laboratory Sciences
https://www.readbyqxmd.com/read/28451686/data-requirements-for-the-correct-identification-of-medication-errors-and-adverse-drug-events-in-patients-presenting-at-an-emergency-department
#16
Bettina Plank-Kiegele, Thomas Bürkle, Fabian Müller, Andrius Patapovas, Anja Sonst, Barbara Pfistermeister, Harald Dormann, Renke Maas
BACKGROUND: Adverse drug events (ADE) involving or not involving medication errors (ME) are common, but frequently remain undetected as such. Presently, the majority of available clinical decision support systems (CDSS) relies mostly on coded medication data for the generation of drug alerts. It was the aim of our study to identify the key types of data required for the adequate detection and classification of adverse drug events (ADE) and medication errors (ME) in patients presenting at an emergency department (ED)...
April 28, 2017: Methods of Information in Medicine
https://www.readbyqxmd.com/read/28451088/the-association-of-right-coronary-artery-conus-branch-size-and-course-with-st-segment-elevation-of-right-precordial-leads-and-clinical-outcome-of-acute-anterior-myocardial-infarction
#17
Samad Ghaffari, Mohammadreza Taban Sadeghi, Mohammad Hossein Sayyadi
Introduction: Coronary artery disease is the leading cause of death worldwide and electrocardiogram (ECG) is a reliable diagnostic tool to determine a myocardial infarction. The present study tried to compare the relationship between the ECG findings and angiographic findings in patients with acute anterior myocardial infarction. Methods: Seventy-four patients with acute anterior ST elevation myocardial infarction (Ant- STEMI) presenting to the emergency room in the first 12 hours after the onset of symptoms were studied...
2017: Journal of Cardiovascular and Thoracic Research
https://www.readbyqxmd.com/read/28451014/role-of-h-fabp-values-in-determining-the-etiologic-factors-of-the-cardiac-injuries
#18
Guleser Akpinar, Ali Duman, Bedia Gulen, Mucahit Kapci, Ertugrul Altinbilek, Ibrahim Ikizceli
INTRODUCTION: Cardiac injury resulting from blunt thoracic trauma is a frequent clinical occurrence which is difficult to diagnose. Our purpose in this study was to research whether H-FABP, which is a new marker for the diagnosis of cardiac injury, can be used in this patient group. METHODS: 50 patients with blunt thoracic injury who were admitted to our emergency service within a period of 8 months and 50 cases as controls were included in our study. RESULTS: Of the 50 patients with blunt thoracic injury in our study, 88% were male while 12% were female...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28444167/electrical-cardiac-injuries-current-concepts-and-management
#19
Victor Waldmann, Kumar Narayanan, Nicolas Combes, Daniel Jost, Xavier Jouven, Eloi Marijon
Electrical injuries are a commonly encountered hazard in both the home and workplace. However, clinicians are often uncomfortable when faced with the patient who presents with an electric shock due to sparse literature and lack of systematic recommendations on this topic. Electrical injuries can range from minor skin burns to life threatening internal organ damage. A thorough clinical assessment to ascertain the path of current through the body and possible internal injury is essential. The main concern in an apparently stable individual after an electric shock is the potential for delayed occurrence of cardiac arrhythmias which will require monitoring in the intensive care setting...
April 20, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28441614/learning-from-an-analysis-of-closed-malpractice-litigation-involving-myocardial-infarction
#20
Kuan-Han Wu, Yung-Lin Yen, Chien-Hung Wu, Chi-Yuan Hwang, Shih-Yu Cheng
OBJECTIVE: To examine the epidemiologic data, identify the pattern of dispute, and determine clinical litigious errors by analyzing closed malpractice claims involving myocardial infarction (MI) in Taiwanese courts. METHODS: A retrospective descriptive study was performed to analyze the verdicts pertaining to MI from the population-based database of the Taiwan judicial system between 2002 and 2013. The results of adjudication, involved specialists, primary dispute leading to lawsuits, and litigious errors were recorded...
April 13, 2017: Journal of Forensic and Legal Medicine
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