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https://www.readbyqxmd.com/read/29439890/brugada-type-pattern-on-electrocardiogram-associated-with-high-dose-loperamide-abuse
#1
Christie Sun, Jessica A Brice, Richard F Clark
BACKGROUND: Loperamide has been increasing in popularity recently for its effects separate from treatment of diarrhea. In large doses or in combination with other agents, it can lead to desirable effects in the central nervous system. However, cardiotoxicity has been reported with its abuse. CASE REPORT: A 49-year-old male who had been chronically abusing loperamide was found to have Brugada-like changes on his electrocardiogram (ECG). He had no other clinical symptoms associated with Brugada syndrome and did not have similar findings on previous ECGs...
February 10, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29433586/a-case-report-of-clonidine-induced-syncope-a-review-of-central-actions-of-an-old-cardiovascular-drug
#2
Alexander J Sandweiss, Christopher M Morrison, Anne Spichler, John Rozich
BACKGROUND: Clonidine is an imidazoline sympatholytic, acting on both α 2 -adrenergic and imidazoline receptors in the brainstem to induce antihypertensive and negative chronotropic effects in the vasculature and heart respectively. CASE PRESENTATION: A 69-year-old gentleman with hypertension presented to the emergency department after multiple syncopal episodes over the past 12 months. Electrocardiogram demonstrated sinus bradycardia with a heart rate of 42 beats per minute...
February 13, 2018: BMC Pharmacology & Toxicology
https://www.readbyqxmd.com/read/29432372/ecg-to-decision-time-impact-on-30-day-mortality-and-reperfusion-times-for-stemi-care
#3
Richard Mullvain, Daniel M Saman, Ashlee Rostvedt, Pauline Landgren
OBJECTIVES: Little data are published on the unique care performance metric of electrocardiogram-to-decision time (E2Decide) for primary percutaneous coronary intervention (PCI) treatment of ST-elevation myocardial infarction (STEMI). The objective of this study is to evaluate E2Decide time on mortality and delayed reperfusion. METHODS: This was a retrospective study of STEMI activations treated with primary PCI at 2 PCI-capable hospitals located in Duluth, Minnesota, and Fargo, North Dakota, originating in 3 different settings: (1) primary PCI-capable hospital emergency departments, (2) non-PCI facilities, and (3) in the field by emergency medical services...
March 2018: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29428052/heart-score-and-stress-test-emergency-department-bayesian-decision-scheme-results-from-the-acute-care-diagnostic-collaboration
#4
Naureen Farook, L Cochon, A D Bode, B P Langer, A A Baez
BACKGROUND: Accurate identification of patients at risk of major adverse cardiac events (MACE) places a substantial burden on emergency physicians (EPs). Bayesian nomogram for risk stratification in low- to intermediate-risk cardiovascular patients has not been investigated previously. OBJECTIVE: The objective of this study was to develop a comparative diagnostic model using Bayesian statistics for exercise treadmill test (ETT) and stress echocardiogram (ECHO) to calculate post-test diagnostic risk of MACE using HEART (history, electrocardiogram, age, risk factors, and troponin) risk score as predictor of pretest probability...
February 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29424967/predicting-drug-induced-arrhythmias-by-multiscale-modeling
#5
F Sahli Costabal, J Yao, E Kuhl
Drugs often have undesired side effects. In the heart, they can induce lethal arrhythmias such as torsades de pointes. The risk evaluation of a new compound is costly and can take a long time, which often hinders the development of new drugs. Here we establish a high resolution, multiscale computational model to quickly assess the cardiac toxicity of new and existing drugs. The input of the model is the drug-specific current block from single cell electrophysiology; the output is the spatio-temporal activation profile and the associated electrocardiogram...
February 9, 2018: International Journal for Numerical Methods in Biomedical Engineering
https://www.readbyqxmd.com/read/29420956/performance-of-coronary-risk-scores-among-patients-with-chest-pain-in-the-emergency-department
#6
Dustin G Mark, Jie Huang, Uli Chettipally, Mamata V Kene, Megan L Anderson, Erik P Hess, Dustin W Ballard, David R Vinson, Mary E Reed
BACKGROUND: Both the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the Emergency Department Assessment of Chest pain Score (EDACS) can identify patients with possible acute coronary syndrome (ACS) at low risk (<1%) for major adverse cardiac events (MACE). OBJECTIVES: The authors sought to assess the comparative accuracy of the EDACS (original and simplified) and modified HEART risk scores when using cardiac troponin I (cTnI) cutoffs below the 99th percentile, and obtain precise MACE risk estimates...
February 13, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29415807/improvement-of-door-to-electrocardiogram-time-using-the-first-nurse-role-in-the-ed-setting
#7
Laura Stanfield
INTRODUCTION: This quality improvement project compared door-to-electrocardiogram (ECG) times for patients presenting with symptoms suggestive of acute coronary syndrome within a community hospital emergency department before and after first-nurse (emergency nurse stationed in the ED waiting room) training. METHOD: Door-to-ECG time was compared before and after the educational intervention using Acute Coronary Treatment and Intervention Outcomes Network (ACTION) registry data reported by the facility...
February 4, 2018: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29412147/evaluation-of-chest-compression-artefact-removal-based-on-rhythm-assessments-made-by-clinicians
#8
Erik Alonso, Elisabete Aramendi, Unai Irusta, Mohamud Daya, Carlos Corcuera, Yuanzheng Lu, Ahamed H Idris
AIM: To evaluate the performance of a state-of-the-art cardiopulmonary resuscitation (CPR) artefact suppression method by assessing to what extent the filtered electrocardiogram (ECG) can be correctly diagnosed by emergency medicine doctors. METHODS: A total of 819 ECG segments were used. Each segment contained two consecutive 10s intervals, an artefact free interval and an interval corrupted by CPR artefacts. Each ECG segment was digitally processed to remove CPR artefacts using an adaptive filter...
February 2, 2018: Resuscitation
https://www.readbyqxmd.com/read/29410284/coronary-angiographic-findings-and-outcomes-in-patients-with-sudden-cardiac-arrest-without-st-elevation-myocardial-infarction-a-swedeheart-study
#9
Axel Wester, Moman A Mohammad, Pontus Andell, Rebecca Rylance, Josef Dankiewicz, Hans Friberg, Stefan James, Elmir Omerovic, David Erlinge, Sasha Koul
BACKGROUND/AIM: Sudden cardiac arrest (SCA) has a substantial mortality rate and the acute coronary syndrome constitutes the major cause. Post-resuscitation electrocardiogram ST-elevation SCA (STE-SCA) is a strong indication for emergency coronary angiography, but the role of early angiography and PCI in patients without ST-elevation (NSTE-SCA) remains to be established. This paper aimed to describe this patient group and evaluate the prognostic effect of early PCI in a large nationwide cohort of NSTE-SCA patients undergoing coronary angiography...
February 1, 2018: Resuscitation
https://www.readbyqxmd.com/read/29407011/the-de-winter-ecg-pattern-in-the-absence-of-acute-coronary-artery-occlusion
#10
Eusebio García-Izquierdo, Carolina Parra-Esteban, Jesús G Mirelis, Ignacio Fernández-Lozano
A 26-year-old man presented to the emergency department with chest pain and electrocardiogram (ECG) changes compatible with the de Winter pattern. Emergent coronary angiography was used to rule out the presence of significant stenosis. Cardiac magnetic resonance imaging confirmed the diagnosis of myocarditis. This case underlines the lack of data regarding the positive predictive value of this ECG pattern for the diagnosis of acute myocardial infarction. Until further prospective studies are available, we believe that the de Winter ECG pattern should be considered as an "ST-elevation equivalent" when myocardial ischemia is suspected...
February 2018: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29407007/new-insights-into-the-use-of-the-12-lead-electrocardiogram-for-diagnosing-acute-myocardial-infarction-in-the-emergency-department
#11
REVIEW
David F Miranda, Angie S Lobo, Brooks Walsh, Yader Sandoval, Stephen W Smith
The 12-lead electrocardiogram (ECG) remains the most immediately accessible and widely used initial diagnostic tool for guiding management in patients with suspected myocardial infarction (MI). Although the development of high-sensitivity cardiac troponin assays has improved the rule-in and rule-out and risk stratification of acute MI without ST elevation, the immediate management of the subset of acute MI with acute coronary occlusion depends on integrating clinical presentation and ECG findings. Careful interpretation of the ECG might yield subtle features suggestive of ischemia that might facilitate more rapid triage of patients with subtle acute coronary occlusion or, conversely, in identification of ST-elevation MI mimics (pseudo ST-elevation MI patterns)...
February 2018: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29404363/electrocardiographic-artifact-potentially-misleading-to-the-wrong-management
#12
Srishti Sareen, Mannu Nayyar, Brian Wheeler, Michelle Skelton, Rami N Khouzam
Atrial flutter (AF) is the second most common supraventricular tachyarrhythmia following atrial fibrillation. We present an interesting case of a diagnostic challenge manifested as an electrocardiogram (ECG) recording mimicking AF in a patient with Parkinson's disease (PD). A 72-year-old African-American female with history of PD presented to our Emergency Department with a one day history of chest pain. Her vital signs were within normal limits. Physical exam was remarkable for bilateral resting hand tremors at a frequency of 6-8 hertz and mild cogwheel rigidity in both upper extremities...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29390373/ozone-therapy-induced-sinus-arrest-in-a-hypertensive-patient-with-chronic-kidney-disease-a-case-report
#13
Wen-Juan Tang, Long Jiang, Ying Wang, Ze-Min Kuang
RATIONALE: Ozone autohemotherapy as an alternative treatment method has been applied to the treatment of several diseases. Here, we report a patient used ozone autohemotherapy to treat her hypertension and diabetes. Nevertheless, the patient occurred sudden dizziness and black haze due to hyperkalemia. PATIENT CONCERNS: A 54-year-old woman who was admitted to our emergency department complaining of sudden dizziness and black haze for 5 hours. DIAGNOSES: The blood potassium test showed hyperkalemia...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29382258/school-burnout-and-heart-rate-variability-risk-of-cardiovascular-disease-and-hypertension-in-young-adult-females
#14
Ross W May, Gregory S Seibert, Marcos A Sanchez-Gonzalez, Frank D Fincham
Emerging research documents the relationship between school burnout and some indicators of increased cardiovascular risk. Indicators of cardiovascular functioning assessed via ambulatory blood pressure and heart rate variability (HRV) have not been thoroughly explored in this research domain. Therefore, the current study examined relationships between school burnout and indicators of cardiac functioning via 24 h ambulatory blood pressure (BP) and electrocardiogram monitoring in a sample of young adult female undergraduates (N = 88)...
January 30, 2018: Stress: the International Journal on the Biology of Stress
https://www.readbyqxmd.com/read/29380478/a-comparison-of-care-delivered-in-hospital-based-and-freestanding-emergency-departments
#15
Jesse M Pines, Mark S Zocchi, Bernard S Black
OBJECTIVE: We compare case-mix, hospitalization rates, length of stay (LOS), and resource use in independent freestanding emergency departments (FSEDs) and hospital-based emergency departments (H-EDs). METHODS: Data from 74 FSEDs (2013-5) in Texas and Colorado, were compared to H-ED data from the 2013-14 National Hospital Ambulatory Medical Care Survey. In the unrestricted sample, large differences in visit characteristics (e.g. payer and case mix) were found between patients that use FSEDs compared to H-EDs...
January 30, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29375232/acute-myocardial-infarction-and-concomitant-stroke-as-the-manifestations-in-a-patient-with-type-a-aortic-dissection-a-case-report-with-three-years-of-follow-up
#16
Po-Jung Yuan, Wai-Kin Wong
A 55-year-old male patient presented with repeated acute retrosternal chest pain. Twelve-lead electrocardiogram and cardiac enzymes revealed non-ST elevation myocardial infarction. He was treated as non-ST elevation myocardial infarction at first. The symptoms of left-sided hemiparesis and aphasia occurred later on after admission. The results of emergent brain computed tomography and magnetic resonance imagining demonstrated acute stroke. The unusual presentation warned us of the possibility of aortic dissection...
January 2018: Acta Cardiologica Sinica
https://www.readbyqxmd.com/read/29360264/diminished-respiratory-sinus-arrhythmia-response-in-infants-later-diagnosed-with-autism-spectrum-disorder
#17
Carolyn E B McCormick, Stephen J Sheinkopf, Todd P Levine, Linda L LaGasse, Ed Tronick, Barry L Lester
Indicators of risk for developing Autism Spectrum Disorder (ASD) are difficult to detect within the first year of life. In this study, infants who were originally followed prospectively to examine general developmental risks due to substance exposure interacted with their mother and an unfamiliar experimenter for 2-min episodes at 4 months of age. Electrocardiogram was collected to measure respiratory sinus arrhythmia (RSA) and the session was video recorded for behavioral coding. Two groups of infants were compared: infants with a diagnosed ASD outcome (N = 8) and matched controls (N = 186)...
January 23, 2018: Autism Research: Official Journal of the International Society for Autism Research
https://www.readbyqxmd.com/read/29355072/topiramate-induced-chest-pain-a-case-report
#18
Jared L Ostroff, Jessica N LeClair Barnet, Marissa L Ostroff, Corey S Laskey
BACKGROUND: Topiramate, an anticonvulsant used for prophylaxis of migraines and epilepsy, is commonly associated with adverse effects of cognitive dulling and fatigue. Chest pain is a potential adverse effect that to our knowledge has not been reported with the use of topiramate. CASE PRESENTATION: We present the case of a 38-year-old female with a seizure disorder who experienced chest pain after the first dose of topiramate. On day 1, she presented to the emergency department, was admitted, and over the course of 3 days had a chest X-ray, electrocardiogram (ECG), and echocardiogram, and her vitals, basic metabolic panel, complete blood counts, troponin, and d-dimer levels were monitored...
January 1, 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29352673/chest-pain-in-a-young-female
#19
Paul S Basel, Daniel Reschke, Michael D April
Acute Coronary Syndrome (ACS) is a common diagnosis in the emergency department (ED), the most severe manifestation of which is ST elevation on electrocardiogram (ECG). ST elevation reflects obstruction of flow through the coronary arteries, most commonly due to coronary atherosclerotic plaque rupture. However, alternative causes of coronary obstruction causing ST elevation are possible. Spontaneous coronary artery dissection (SCAD) is an unusual cause of ST elevation in ED patients which providers may encounter in patients without traditional atherosclerosis risk factors...
January 11, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29350674/takotsubo-cardiomyopathy-in-an-ultra-centenarian-woman
#20
Laura Bonfanti, Silvia Buratti, Luigi Vignali, Giuseppe Lippi, Franco Masini, Michele Bianconcini, Gianfranco Cervellin
A 101 years-old woman was admitted to our Emergency Department (ED) for acute dyspnea which onset nearly two hours before presentation. She had been on hydrochlorothyazyde-amiloride therapy due to mild hypertension. No other relevant features were present in the clinical history. The old lady had never been admitted to the hospital, and she was still living alone. A few days before hospital admission, one of the daughters became ill, so that a caregiver was paid for assisting her 12/24. This new circumstance was reluctantly accepted by the old lady...
January 16, 2018: Acta Bio-medica: Atenei Parmensis
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