EKG quiz #1

What does this EKG show? 

Answer will be posted soon.

-IkaN

Treatment of myocardial infarction associated pericarditis

Hi everyone! There are two types of myocardial infarction associated with pericarditis. Let

s learn more about the management!

Early infarct-associated pericarditis: Occurs 1 to 3 days after transmural myocardial infarction (because of the interaction of the healing necrotic epicardium with the overlying pericardium). 

Late post-myocardial infarction pericarditis (Dressler’s syndrome): Occurs weeks to months after myocardial infarction. 

Initial therapy includes high-dose aspirin (650 to 1,000 mg every 6 to 8 hours).

Proton pump inhibitor (PPI)  - improves the gastric tolerability of the aspirin. 

Acetominophen can be added for pain management.

Dosing of aspirin:

Initial: 650 mg to 1 g every 8 hours until resolution of symptoms for at least 24 hours and normalization of inflammatory biomarkers (eg, C-reactive protein). A treatment period of one to two weeks before tapering is usually sufficient. 

Taper: Decrease each dose by 250 to 500 mg every 1 to 2 weeks. Ensure patient remains asymptomatic and inflammatory biomarkers are normal. 

There is no published experience on the use of colchicine in peri-infarction pericarditis. Colchicine may reduce the need for pericardiocentesis or other pericardial interventions and is usually given at a dose of 0.6 mg twice daily for a month, or longer if the patient has a recurrence of symptoms.

Why are NSAIDs such as ibuprofen avoided in the peri-infarct period?

Interferes with the antiplatelet aggregation effects of aspirin. 

Interferes with myocardial healing.

PS: Acetominophen does not affect the coagulation system and can be used.

References:

Post-cardiac injury syndrome: aetiology, diagnosis, and treatment https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

Pericardial Disease https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514

-IkaN (Nakeya Dewaswala)

Read EKGs with me #1

Answer below:

Normal P wave ECG notes and mnemonic

Here is the video:

 

Mnemonic:

Notes:
Sinus P waves
Axis: 0 and +75 degrees
Upright: Leads I, II, V5, V6
Inverted: aVR
Duration: <120ms or 3 small squares
Amplitude:
Limb leads: < 2.5 mm (0.25mV)
Precordial leads: < 1.5 mm (0.15mV)

-IkaN

Determining pacemaker type from EKG (RV pacing vs biventricular pacing)

 Hello, cardiowesomites!

Today we are going to learn how to determine pacemaker type from EKG (RV pacing vs biventricular pacing)

Notes:

Normal cardiac pressures mnemonic (Normal Swan-Ganz pressures)

LV aneurysm: Difference between true LV aneurysm and LV pseudoaneurysm

LV aneurysms are most commonly caused by myocardial infarction. What's the difference between true aneurysm and pseudoaneurysm?

Types of pulmonary hypertension mnemonic

Here are my notes and a video on types of pulmonary hypertension - WHO classification! It comes with a mnemonic :)

RV pressure and volume overload notes

Cardiac valves anatomy and mnemonics

Check out the YouTube video here!

-IkaN 

ECG axis mnemonic (short version)

Video here:

 

Notes below:

Brainstem & Cortical Strokes | Mnemonic & Tricks

 https://www.youtube.com/watch?v=5SOe6PzbKgQ

HVPG = Hepatic Venous Pressure Gradient

 HVPG = WHVP - Free Hepatic venous pressures 

• WHVP = Wedged hepatic venous pressure
• gradient between pressures in the portal vein and the intra-abdominal portion of IVC 
• When blood flow in a hepatic vein is stopped by a wedged catheter, the proximal static column of blood transmits the pressure from the preceding communicated vascular territory (hepatic sinusoids) to the catheter. Thus, WHVP reflects hepatic sinusoidal pressure.
• In the normal liver, due to pressure equilibration through interconnected sinusoids, wedged pressure is slightly lower than portal pressure, though this difference is clinically insignificant.

➡️ While in Cirrhosis , Sinusoidal interconnection are lost. Therefore, WHVP gives an accurate estimation of portal pressure in cirrhosis !!!

Normal HVPG = 1-5 mm hg 

HVPG >5 = Portal HTN 

HVPG > 10 = Clinically Significant portal HTN 

HVPG > 12 = Threshold for Variceal Rupture = So use Beta Blocker to ⬇️ it.

Measurement of the Hepatic Venous Pressure Gradient (HVPG)

https://www.youtube.com/watch?v=9cEOpr-MRL4

Thank you ! 🩺