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EMERGENCY ECG

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https://www.readbyqxmd.com/read/28938508/-angina-pectoris-in-a-young-woman-with-lupus-erythematosus
#1
Simon Braumann, Malte P Bartram, Roman Pfister, Guido Michels
History and clinical findings We present a 31-year old woman with a 6-year history of cutaneous lupus erythematosus (CLE) who presented to the emergency room with typical chest pain. ECG and transthoracic echocardiography were normal. Her working diagnosis of pericarditis was made due to systemic progression of her lupus erythematosus (LE). Treatment with NSAIDs was initiated and her immunosuppressive regimen intensified. The patient was discharged after resolution of her symptoms. A week later, the patient was seen at the rheumatology clinic with recurrence and aggravation of her symptoms...
September 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28930184/use-of-wavelet-transform-to-detect-compensated-and-decompensated-stages-in-the-congestive-heart-failure-patient
#2
Pratibha Sharma, Kimberly Newman, Carlin S Long, A J Gasiewski, Frank Barnes
This research work is aimed at improving health care, reducing cost, and the occurrence of emergency hospitalization in patients with Congestive Heart Failure (CHF) by analyzing heart and lung sounds to distinguish between the compensated and decompensated states. Compensated state defines stable state of the patient but with lack of retention of fluids in lungs, whereas decompensated state leads to unstable state of the patient with lots of fluid retention in the lungs, where the patient needs medication. Acoustic signals from the heart and the lung were analyzed using wavelet transforms to measure changes in the CHF patient's status from the decompensated to compensated and vice versa...
September 20, 2017: Biosensors
https://www.readbyqxmd.com/read/28916174/evaluation-of-beat-to-beat-ventricular-repolarization-lability-from-standard-12-lead-ecg-during-acute-myocardial-ischemia
#3
Salah S Al-Zaiti, Mohammad Alrawashdeh, Christian Martin-Gill, Clifton Callaway, David Mortara, Jan Nemec
BACKGROUND: Acute myocardial ischemia is a common cause of ventricular arrhythmias, yet recent ECG methods predicting susceptibility to ventricular tachyarrhythmia have not been fully evaluated during spontaneous ischemia. We sought to evaluate the clinical utility of alternans and non-alternans components of repolarization variability from the standard 10-second 12-lead ECG signals to risk stratify patients with acute chest pain. METHODS: We enrolled consecutive, non-traumatic, chest pain patients transported through Emergency Medical Services (EMS) to three tertiary care hospitals with cardiac catheterization lab capabilities in Pittsburgh, PA...
August 10, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28900525/a-case-of-legionella-pneumophila-evaluated-with-ct-and-ultrasound
#4
Alessio D'Angelo, Chiara De Simone, Marco Pagnottella, Stefano Rossi, Raffaele Pepe, Giacomo Ruggieri, Giulio Cocco, Cosima Schiavone
A 36-year-old man was admitted to the emergency department of "SS Annunziata" hospital in Chieti complaining of a sharp chest pain arisen some hours before admission. On examination, the patient looked sweaty; his vital signs showed tachycardia and augmented breath rate; sinus tachycardia and normal ventricular repolarization were observed on ECG, and no abnormalities were observed in the echoscan of the hearth. According to the clinical and electrocardiographic findings, and to previous episode of DVT in anamnesis, a thorax CT scan was performed in order to rule out pulmonary embolism...
September 2017: Journal of Ultrasound
https://www.readbyqxmd.com/read/28895038/a-retrospective-external-validation-study-of-the-heart-score-among-patients-presenting-to-the-emergency-department-with-chest-pain
#5
Matthew Jay Streitz, Joshua James Oliver, Jessica Marie Hyams, Richard Michael Wood, Yevgeniy Mikhaylovich Maksimenko, Brit Long, Robert Michael Barnwell, Michael David April
Emergency physicians must be able to effectively prognosticate outcomes for patients presenting to the Emergency Department (ED) with chest pain. The HEART score offers a prognostication tool, but external validation studies are limited. We conducted an external retrospective validation study of the HEART score among ED patients presenting to our ED with chest pain from 1 January 2014 to 9 June 2014. We utilized chart review methodology to abstract data from each patient's electronic medical record. We collected data relevant to each of the five elements of the HEART score: history, electrocardiogram (ECG) interpretation, patient age, patient risk factors, and troponin levels...
September 11, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28885062/out-of-hospital-cardiac-arrest-always-coronary-angiography
#6
Andrea Rognoni, Chiara Cavallino, Marco Giovanni Mennuni, Lucia Barbieri, Roberta Rosso, Francesco Rametta, Federico Nardi, Alessandro Lupi, Angelo Sante Bongo
Out-of-hospital cardiac arrest (OHCA) remains one of the principle challenges in the setting of critical care medicine and emergency cardiology. Areas covered: Long-term survival rates even after successful resuscitation are variable but increasing in the recent years; due to the improvement of base and advanced cardiac life support techniques an increasing number of resuscitated patients are admitted to the hospital. Recent data suggested that patients surviving to hospital discharge after OHCA presented long-term outcome similar to patients with ST-elevation myocardial infarction...
September 18, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28884028/spontaneous-coronary-artery-dissection-a-rare-manifestation-of-alport-syndrome
#7
Amornpol Anuwatworn, Prince Sethi, Kelly Steffen, Orvar Jonsson, Marian Petrasko
Alport syndrome (AS) is a genetic disorder due to inheritance of genetic mutations which lead to production of abnormal type IV collagen. AS has been associated with renal, auditory, and ocular diseases due to the presence of abnormal alpha chains of type IV collagen in the glomerulus, cochlea, cornea, lens, and retina. The resulting disorder includes hereditary nephritis, corneal opacities, anterior lenticonus, fleck retinopathy, temporal retinal thinning, and sensorineural deafness. Aortic and aortic valve pathologies have been described as extrarenal manifestations of AS in multiple case reports...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28882392/fundus-autofluorescence-in-retinal-artery-occlusion-a-more-precise-diagnosis
#8
J-L Bacquet, M Sarov-Rivière, C Denier, G Querques, B Riou, L Bonin, E Barreau, M Labetoulle, A Rousseau
IMPORTANCE: Retinal artery occlusion (RAO) is a medical emergency associated with a high risk of cerebral vascular accident and other cardiovascular events. Among patients with non-arteritic RAO, a retinal embolus is observed in approximately 40% of cases. Fundus examination and retinography are not reliable to predict the nature of the emboli. OBSERVATIONS: We report three consecutive cases of central and branch RAO that were investigated with fundus autofluorescence, fluorescein angiography and color retinal photographs...
September 4, 2017: Journal Français D'ophtalmologie
https://www.readbyqxmd.com/read/28874951/severe-hyperkalemia-can-the-electrocardiogram-risk-stratify-for-short-term-adverse-events
#9
Nicole Durfey, Brian Lehnhof, Andrew Bergeson, Shayla N M Durfey, Victoria Leytin, Kristina McAteer, Eric Schwam, Justin Valiquet
INTRODUCTION: The electrocardiogram (ECG) is often used to identify which hyperkalemic patients are at risk for adverse events. However, there is a paucity of evidence to support this practice. This study analyzes the association between specific hyperkalemic ECG abnormalities and the development of short-term adverse events in patients with severe hyperkalemia. METHODS: We collected records of all adult patients with potassium (K+) ≥6.5 mEq/L in the hospital laboratory database from August 15, 2010, through January 30, 2015...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28871362/electrocardiographic-markers-of-appropriate-implantable-cardioverter-defibrillator-therapy-in-young-people-with-congenital-heart-diseases
#10
Dunia Bárbara Benítez Ramos, Michel Cabrera Ortega, Jesús Castro Hevia, Margarita Dorantes Sánchez, Ailema Amelia Alemán Fernández, Osmin Castañeda Chirino, Marlenis Cruz Cardentey, Frank Martínez López, Roylan Falcón Rodríguez
Implantable cardioverter-defibrillators (ICDs) are increasingly utilized in patients with congenital heart disease (CHD). Prediction of the occurrence of shocks is important if improved patient selection is desired. The electrocardiogram (ECG) has been the first-line tool predicting the risk of sudden death, but data in CHD patients are lacking. We aim to evaluate the predictive value of electrocardiographic markers of appropriate therapy of ICD in young people with CHD. We conducted a prospective, longitudinal study, in twenty-six CHD patients (mean age 24...
September 4, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28870390/how-do-we-balance-the-long-term-health-of-a-patient-with-the-short-term-risk-to-the-physician
#11
Michael B Weinstock, Amal Mattu, Erik P Hess
BACKGROUND: There is a wide variation in practice patterns among emergency medicine physicians; many factors weigh into the medical decision-making process including the health of the patient as well as short-term risk to the physician. OBJECTIVE: The objective of our discussion is to illustrate specific scenarios where medical decisions are focused on the physician's short-term risk, then to propose an approach to shifting the balance to the patient's long-term health...
September 1, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28868102/a-novel-electrocardiographic-sign-of-an-st-segment-elevation-myocardial-infarction-equivalent-de-winter-syndrome
#12
Mustafa Ugur Goktas, Ozgur Sogut, Mehmet Yigit, Onur Kaplan
Patients with de Winter syndrome, also termed anterior ST-segment elevation myocardial infarction (STEMI)-equivalent, represent 2% of all patients with acute anterior myocardial infarctions admitted to emergency departments (EDs). STEMI-equivalents do not present with classical electrocardiogram (ECG) changes but exhibit a critical stenosis of the left anterior descending (LAD) coronary artery. This is under-recognized by clinicians and is therefore associated with high morbidity and mortality. Here, we report a rare case of a novel, typical, STEMI-equivalent ECG pattern without obvious ST-segment elevation in a 34-year-old female who presented to our ED with substantial chest pain and a large, acute, transmural anterior myocardial infarction caused by acute occlusion of the LAD coronary artery...
August 2017: Cardiology Research
https://www.readbyqxmd.com/read/28867265/implantable-cardioverter-defibrillator-implantation-rates-after-out-of-hospital-cardiac-arrest-are-the-rates-guideline-concordant
#13
Edwin C Ho, Sheldon Cheskes, Paul Angaran, Laurie J Morrison, Theresa Aves, Cathy Zhan, Dennis T Ko, Paul Dorian
BACKGROUND: Clinical practice guidelines recommend implantable cardioverter defibrillators (ICDs) for the secondary prevention of sudden death after a cardiac arrest not from a reversible cause, but "real world" implantation rates are not well described. METHODS: Adults with out of hospital cardiac arrest attended by Emergency Medical Services are captured in the Toronto Regional RescuNET database. We analyzed those who survived to hospital discharge and collected data on age, sex, initial rhythm, ST-elevation myocardial infarction (STEMI) on presenting electrocardiogram (ECG), in-hospital revascularization, neurologic status (Modified Rankin Scale [MRS]) at discharge, and admission hospital type...
August 23, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28864718/assessment-of-the-2016-national-institute-for-health-and-care-excellence-high-sensitivity-troponin-rule-out-strategy
#14
Edward Watts Carlton, John William Pickering, Jaimi Greenslade, Louise Cullen, Martin Than, Jason Kendall, Richard Body, William A Parsonage, Ahmed Khattab, Kim Greaves
OBJECTIVE: We aimed to evaluate the limit of detection of high-sensitivity troponin (hs-cTn) and Thrombolysis In Myocardial Infarction (TIMI) score combination rule-out strategy suggested within the 2016 National Institute for Health and Care Excellence (NICE) Chest Pain of Recent Onset guidelines and establish the optimal TIMI score threshold for clinical use. METHODS: A pooled analysis of adult patients presenting to the emergency department with chest pain and a non-ischaemic ECG, recruited into six prospective studies, from Australia, New Zealand and the UK...
September 1, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28862480/national-characteristics-of-emergency-medical-services-responses-for-older-adults-in-the-united-states
#15
Hieu V Duong, Lauren Nicholas Herrera, Justin Xavier Moore, John Donnelly, Karen E Jacobson, Jestin N Carlson, N Clay Mann, Henry E Wang
OBJECTIVE: Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. METHODS: We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports, and standby responses...
September 1, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28853533/-the-importance-of-lead-avr-in-the-evaluation-of-an-ecg-strip
#16
Asaf Shemer, Pinchas Halpern
Over the years, the aVR lead has been overlooked by clinicians while observing a normal 12-lead ECG (electrocardiogram). A positive P-QRS complex in the aVR lead should raise prompt suspicion for either a congenital heart malrotation or a lead misplacement. In this article we present a case of an asymptomatic patient and a pathological ECG strip displaying ST elevations and a positive QRS in the aVR lead. A follow-up ECG was performed in the emergency department, and revealed a normal sinus rhythm with no abnormalities indicating acute ischemia...
August 2017: Harefuah
https://www.readbyqxmd.com/read/28852969/recovery-from-very-long-aortic-cross-clamping-in-redo-complex-aortic-surgery
#17
Shoichi Suehiro, Koji Shimizu, Megumi Ito, Hayato Nakata, Kazuhiro Akeho, Teiji Oda
A 68-year-old man had undergone ascending aortic replacement for acute type A aortic dissection. Three months later, he had a new aortic dissection with an ulcer-like projection located in the aortic arch with suspected graft infection. An emergent redo total aortic arch and root replacement was performed because of the coexistence of a fragile aortic root wall. The extensive redo procedure necessitated a very long aortic cross-clamping time (516 min). After 25 min of assisted circulation, he was easily weaned from the cardiopulmonary bypass...
August 29, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28851715/oesophageal-mastocytosis-eosinophilic-oesophagitis-without-eosinophils
#18
Donevan Westerveld, Jian Li, Sarah Glover
A 59-year-old male with a history of lifelong asthma, allergic rhinitis and hypercholesterolaemia presented to the emergency department for management of severe substernal chest pain with radiating pain to his left arm, nausea and diaphoresis. Physical examination was unrevealing and a cardiac workup including cardiac enzymes, ECG, chest radiographs were negative for an underlying ischaemic event. A subsequent gastrointestinal workup including oesophageal manometry and oesophagogastroduodenoscopy revealed elevated lower oesophageal pressures and histopathology suggestive of mast cell proliferation, respectively...
August 28, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28843918/the-safety-and-tolerability-of-cariprazine-in-patients-with-manic-or-mixed-episodes-associated-with-bipolar-i-disorder-a-16-week-open-label-study
#19
Terence A Ketter, Gary S Sachs, Suresh Durgam, Kaifeng Lu, Anju Starace, István Laszlovszky, György Németh
BACKGROUND: We evaluated the safety/tolerability of longer-term open-label treatment with cariprazine in patients who had responded to cariprazine for acute bipolar mania. METHODS: In this multinational, multicenter study, open-label, flexible-dose, cariprazine 3-12mg/d was administered for up to 16 weeks to patients (18-65 years) with bipolar mania. Safety evaluations included adverse events (AEs), laboratory values, vital signs, and extrapyramidal symptom (EPS) scales...
August 18, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28839341/long-term-safety-and-tolerability-of-valbenazine-nbi-98854-in-subjects-with-tardive-dyskinesia-and-a-diagnosis-of-schizophrenia-or-mood-disorder
#20
Richard C Josiassen, John M Kane, Grace S Liang, Joshua Burke, Christopher F O'Brien
BACKGROUND: The short-term safety profile of once-daily valbenazine (NBI-98854) has been evaluated in several double-blind, placebo-controlled (DBPC) trials in adults with tardive dyskinesia (TD) who had a diagnosis of schizophrenia/schizoaffective (SCHZ) disorder or mood disorder. Studies with longer treatment duration (up to 48 weeks) were conducted to evaluate the long-term safety of this novel drug in subjects with TD. METHODS: The pooled long-term exposure (LTE) population included valbenazine-treated subjects from 3 studies: KINECT (NCT01688037: 6-week DBPC, 6-week open-label); KINECT 3 (NCT02274558: 6-week DBPC, 42-week blinded extension, 4-week drug-free follow-up); KINECT 4 (NCT02405091: 48-week open-label, 4-week drug-free follow-up)...
August 1, 2017: Psychopharmacology Bulletin
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