Category: Airway Management
Keywords: Pericarditis (PubMed Search)
Posted: 9/16/2012 by Semhar Tewelde, MD
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Pericarditis is based on clinical diagnosis; typically two of four criteria are found (pleuritic chest pain, pericardial rub, diffuse ST-segment elevation, and pericardial effusion).
Treatment of pericarditis should be targeted at the cause.
Most causes of pericarditis have a good prognosis and are self-limited.
Imazio M. Contemporary management of pericardial diseases. Current Opinion in Cardiology. 27(3):308-17, 2012 May.
Category: Cardiology
Keywords: Lyme disease, Lyme carditis, AV block (PubMed Search)
Posted: 9/2/2012 by Semhar Tewelde, MD
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Lyme disease is the most prevalent arthropod zoonosis in the Northern hemisphere
Rostoff P, Gajos G, Konduracka E, Gackowski A, Nessler J, Piwowarsk W. Lyme carditis: Epidemiology, pathophysiology, and clinical features in endemic areas. International Journal Cardiology
Category: Cardiology
Keywords: ARVD, ARVC, cardiomyopathy, triangle of dysplasia, ICD (PubMed Search)
Posted: 8/26/2012 by Semhar Tewelde, MD
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Arrhythmogenic right ventricular dysplasia (ARVD) is a heritable form of cardiomyopathy, characterized by the replacement of myocytes with adipose and fibrous tissue leading to arrhythmias, right ventricular failure, and sudden cardiac death (SCD)
ECG findings include T-wave inversions in V1–V3 (85% ), epsilon waves (in 33%), as well as a QRS duration >110 ms in V1-V3 (64%)
Azaouagh A, Churzidse S, Konorza T, Erbel R. Arrhythmogenic right ventricular cardiomyopathy/dysplasia: a review and update. Clin Res Cardiol (2011) 100:383–394.
Category: Cardiology
Keywords: T wave inversions, negative T waves, ACS, PE (PubMed Search)
Posted: 8/19/2012 by Semhar Tewelde, MD
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Pulmonary P waves (S1Q3T3 pattern + clockwise rotation) are specific for PE, but not sensitive.
This study examines if an ECG can discriminate between ACS vs. PE
- 40 patients with PE & 87 patients with ACS
- All had negative T waves in the precordial leads (V1-V4) on the admission ECG
The PE group had negative T waves commonly present in leads II, III, aVF, V1, V2, but less frequent in leads I, aVL, and V5 to V6 (p <0.05).
The ACS group had negative T waves in leads III and V1 in 1% compared with 88% of patients with PE (p <0.001).
Sensitivity, specificity, positive predictive value, and negative predictive value for Dx of PE were 88%, 99%, 97%, and 95%, respectively.
Negative T waves in both leads III and V1 may suggest PE can be differentiated from ACS in patients with negative T waves in the precordial leads.
Kosuge M, Kimura K, et al. Electrocardiographic differentiation between acute pulmonary embolism and acute coronary syndromes on the basis of negative T waves. Am J Cardiol. 2007 Mar 15;99(6):817-21.
Category: Cardiology
Keywords: hypertrophic cardiomyopathy (PubMed Search)
Posted: 8/12/2012 by Semhar Tewelde, MD
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Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy (typically asymmetric) that occurs in the absence of pressure overload or storage/infiltrative disease.
HCM demonstrates remarkable diversity in disease course, age of onset, pattern and extent of LVH, degree of obstruction, and risk for sudden cardiac death.
Patients with HCM are at increased risk for sudden death, annual rate of SCD is ~1%. ICDs are recommended for all patients with prior arrest/sustained ventricular tachycardia (class I recommendation).
Category: Cardiology
Keywords: takotsubo cardiomyopathy, stress cardiomyopathy, broken-heart syndrome (PubMed Search)
Posted: 8/5/2012 by Semhar Tewelde, MD
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Takotsubo cardiomyopathy a.k.a. stress cardiomyopathy is an acute reversible disorder characterized by left ventricular (LV) dysfunction most commonly affecting postmenopausal women
The LV adopts the shape of an octopus trap (“takotsubo”) describing the narrow neck and broad base globular form during systole
Symptoms include precordial chest pain, dyspnea, or heart failure presenting with pulmonary edema mimicking ACS
Mayo Clinic Diagnostic Criteria
- Suspicion of AMI based on symptoms and STEMI on ECG
- Transient hypokinesia or akinesia of the middle and apical regions of LV
- Functional hyperkinesia of the basal region of LV
- Normal coronary arteries (luminal narrowing <50%)
- Absence of recent head injury, ICH, HCOM, myocarditis, or pheochromocytoma
Treatment is symptomatic and determined based on complications during the acute phase; occasionally requiring IABP or ECMO
Prognosis is better than those with ACS, however initial LVEF is similar to those seen with ischemic heart disease
Castillo Rivera AM, Ruiz-Bailen M, Rucabado Aguilar L. Takotsubo Cardiomyopathy – a clinical review. Medical Science Monitor. 17 (6): RA 135-47, 2011 Jun.
Category: Cardiology
Keywords: yamaguchi cardiomyopathy, apical hypertrophic cardiomyopathy, hypertrophic cardiomyopathy (PubMed Search)
Posted: 7/29/2012 by Semhar Tewelde, MD
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Yamaguchi Cardiomyopathy
Yamaguchi cardiomyopathy a.k.a. apical hypertrophic cardiomyopathy (AHCM) was first described 1976 in Japanese patients.
AHCM is a variant of hypertrophic cardiomyopathy that is nonobstructive with predominant involvement of the apex of the heart.
AHCM is frequently misdiagnosed as ACS or STEMI since the typical ECG abnormalities include giant inverted T waves or ST elevation in the mid precordial leads, however coronaries are characteristically clean on cardiac catheterization.
Echocardiography classically used to diagnosis HCM may frequently miss AHCM because hypertrophy is only localized to the apex.
Nuclear magnetic resonance imaging or angiography reveals the pathognomonic "ace of spades" configuration of the left ventricle with systolic obliteration of the apical region.
Unlike HCM sudden cardiac death is very uncommon.
Olearczyk B, Gollol-Raju N, Menzies D. Apical Hypertrophic Cardiomyopathy Mimicking Acute Coronary Syndrome: A Case Report and Review of the Literature. Angiology Vol 59; No. 5. Oct/Nov 2008 629-631.
Category: Cardiology
Keywords: Atrial fibrillation, a fib (PubMed Search)
Posted: 7/15/2012 by Semhar Tewelde, MD
(Updated: 8/14/2024)
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Atrial fibrillation is most commonly associated with cardiovascular disease
Non cardiac causes: pulmonary disease/PE, hyperthyroidism, sympathomimetics, drugs/ETOH
AFFIRM & RACE trials compared outcomes of a fib patients treated w/ rate vs. rhythm control
- No significant difference in survival between groups
Risk of thromboembolic CVA
- Rhythm control = Rate control + anticoagulation
New data challenges the need for strict heart rate control
- Resting heart rate should be <110 bpm
Use CHADS2 score to identify who requires anticoagulation based on %risk of emboli
- Chronic heart failure, HTN, Age>75, DM, Stroke/TIA
Atrial Fibrillation. Bontempo L, Goralnick E. Emerg Med Clin N Am 29 (2011)747-758.
Category: Cardiology
Keywords: Sgarbossa Criteria, MI, LBBB (PubMed Search)
Posted: 6/24/2012 by Semhar Tewelde, MD
(Updated: 7/15/2012)
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LBBB is defined by 3 criteria QRS >125msec, V1- QS or rS, and R wave peak time 60ms with no q wave in leads I, V5, V6
Sgarbossa E, et al. ELECTROCARDIOGRAPHIC DIAGNOSIS OF EVOLVING ACUTE MYOCARDIAL INFARCTION IN THE PRESENCE OF LEFT BUNDLE-BRANCH BLOCK. NEJM Feb 22, 1996: Vol 334; No. 8