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Showing posts from March, 2020

Fainting & Syncope

Now let's talk about situations when a patient passes out. More specifically it's known as a "syncopal episode" Now when a person passes out, it could be from a number of reasons and many of those reasons do not have to be life threatening. What we're really concerned about when a person goes unconscious is that they're unable to protect themselves from the fall. And if they can't protect themselves from the fall there's any number of things that can go wrong. They can hit their head, they can hit their face, and they can even break bones. So when we come up to a person that has had a syn-cable episode or has passed out, we still want to asses them for life threatening conditions. We want to check them for the potential of having a concussion or neck injury. Once we've ruled out those different possible side effects, we can begin to just see if the patient maybe just has a self-limited issue going on. They need to re-hydrate, maybe they need to...

The various mechanisms of supraventricular tachycardia (SVT)

Most SVTs are due to re-entrant circuits as you see here. Thinking about where that circuit exists can help you better understand the EKG, how to diagnose and ultimately treat. . 1️⃣AVNRT is the most common one we think of SVT. This is a re-entrant circuit within the AV node itself when it has “dual node” physiology with both a slow and fast pathway. A PAC or PVC at the right millisecond of the cycle can sneak in an impulse to activate that circuit. . 2️⃣ AVRT also involves the AV node for one limb of the circuit but uses an accessory pathway (WPW) as the second part. This can be an “orthodromic” AVRT with the circuit going down the AV node and back up the pathway — or “antidromic” when it goes down the pathway first and then up the node. The QRS is wide in antidromic AVRT as it conducts down the acessory pathway like a delta wave. . 3️⃣ Atrial tachycardia can be re-entry or due to “automaticity” due to an irritable focus that will recurrently fire PACs that can produce runs of tachyca...

The Atrial Fibrillation Connection to Stroke & Heart Failure

What is The Atrial Fibrillation Connection to Stroke & Heart Failure Atrial fibrillation or A-fib is basically a disorganized rhythm of the upper chambers of the heart, which are called the atria. So in intrinsically, A-fib is always thought of as a benign rhythm. However, it’s been shown to people in A-fib live shorter than people that are not an A-fib what we call a normal sinuous rhythm. And with A-fib, you have various physiologic changes that can happen to cause problems, meaning you can have low flow through the heart, which can cause congestive heart failure, which then prompts you to be hospitalized more frequently. You can also have stasis or, again, low flow, which can cause blood clots to form in the heart, which can then fire off to other parts of the core, meaning the brain or the body or the legs can cause clotting problems. There’s a significant percentage of stroke patients in the country, has strokes due to embolic phenomenon from these clots that are formed i...