You hear the red phone ring as you are about to take a bite out of your sandwich in CCT. The notification is for a patient being brought in for “VT.” You ask the dispatcher if EMS is performing CPR, and they tell you that the patient is awake and Read more…
In a previous post, I presented a case of Takotsubo non-ischemic cardiomyopathy that met “STEMI” criteria and was diagnosed by angiography. Let’s take a moment to discuss some other non-ischemic cause of ST elevation, otherwise known as “STEMI mimics.” 1) Benign Early Repolarization and Left Ventricular Hypertrophy ST-elevation does Read more…
In last week’s post, we reviewed Pluymaekers et al (1), a randomized control trial from the Netherlands on early or delayed cardioversion for recent-onset atrial fibrillation (AF). In this post, we will analyze our practice in the U.S. and discuss some of the arguments for and against cardioversion in the Read more…
A recent NEJM article, “Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation” by Pluymaekers et al has reinvigorated debate in the blogosphere, academia conference halls, and podcast-dom over management of recent-onset atrial fibrillation (AF) (1,2,3). Prior studies have demonstrated that cardioversion for recent-onset atrial fibrillation (typically defined by a duration Read more…
It’s intern year and you’re on nights in the MICU. You’re always a little bit out of your element when not in the ED. Tonight you get sign out on an older lady with afib and CHF presenting for AMS, being followed by neuro and on BiPAP and critically ill Read more…
A 37-year-old male with no past medical history comes into the ED complaining of palpitations and weakness. He has felt intermittent palpitations in the past, but they usually self resolve within a few minutes. The symptoms started when he first woke up, and this has been ongoing for the past Read more…
Digitalis, a cardiac glycoside, is an age-old drug used since the time of the Romans. It wasn’t until the 18th century when the study of digitalis propelled humankind into the age of modern medicinal therapeutics. The cardiac glycosides are isolated from the foxglove and were espoused by William Withering, a famous Read more…
They were fine yesterday, now they’re drowning! “Flash” (acute) pulmonary edema is a common critical condition in the emergency department, and it can have multiple precipitating factors and etiologies. After evaluating for acute myocardial infarction, tachydysrhythmias, and valvular pathologies based on physical exam and ECG, the treatment for these Read more…
While we may be trapped in our concrete jungle here in Brooklyn, many of us and some of our patients do occasionally get outside. In the Northeast in particular, this means a high risk of getting a tick bite and contracting everyone’s favorite zoonotic disease: Lyme Disease. This past month’s Read more…
By Dr. C. Sterling M.D. Pathophysiology of Right Ventricular Failure The most common cause of pulmonary hypertension in the U.S. is left-sided heart failure, but many cases of pulmonary hypertension remain undocumented. Pulmonary arterial hypertension is a specific category of pulmonary hypertension and is a relatively rare disease. In the ED, we Read more…