Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aVR is often neglected lead. It is an unipolar lead facing the right superior surface. As all the depolarisations are going away from lead aVR, all waves are negative in aVR (P, QRS, T) in normal sinus rhythm. In dextrocardia, (True and technical) the p is upright in aVR. The lead aVR is a very important lead in localisation of Coronary Artery Disease. In the presence of anterior ST elevation, ST elevation in lead aVR and V1 denotes proximal LAD obstruction where ST elevation is more in lead V1, than in aVR. In the presence of anterior ST depression, ST elevation in lead aVR indicates Left Main Coronary Artery (LMCA) Disease where ST elevation is more in aVR than in V1. In wide QRS tachycardia, tall R wave in aVR indicates Ventricular Tachycardia rather than SVT with aberrancy. In the presence of QS complexes in inferior leads, the lead aVR helps to differentiate between inferior wall MI (IWMI) and left anterior fascicular block (LAFB). Initial R in aVR is suggestive of IWMI and terminal R is suggestive of LAFB. In pericarditis, lead aVR is most often the only lead which shows reciprocal ST depression where as in Acute Infarction, usually a group of leads shows reciprocal depression. In the presence of persistent ST elevation in anterior chest leads, the R in aVR is suggestive of left ventricular aneurysm (Goldburger's sign). In acute pulmonary embolism, ST elevation in lead aVR is a bad prognostic sign. In Tricyclic antidepressant toxicity, R in aVR more than 3 mm is an adverse prognostic sign. So in variety of conditions, the aVR is proved to be a valuable lead not only in diagnosis but also in predicting the prognosis.
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PMID:Lead aVR--the neglected lead. 2477 3

A 57-year-old male former smoker presented to the Emergency Department (ED) with blurry vision, headache, and generalized weakness. He was hypoxic on room air and ECG showed sinus tachycardia. A CT pulmonary angiogram was ordered in the ED and revealed no pulmonary embolism but incidentally noted a likely significant stenosis in the proximal LAD. Subsequent cardiac catheterization revealed a 90% stenotic lesion with percutaneous coronary intervention leading to symptom resolution. Unlike coronary CTA, CTPA is performed with non-ECG gated helical scanning and generates motion artifacts associated with myocardial contraction. However, the timing of vascular contrast opacification during CTPA often allows for at least partial evaluation of the coronary arteries, especially ostial and proximal segments. Physicians ordering and evaluating noncardiac-focused CT chest studies, particularly in the ED, should remain cognizant of the radiographic appearance of underlying CAD, particularly life-threatening incidental coronary pathologies to allow for timely management and intervention.
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PMID:Incidental LAD stenosis identified on non-gated chest CTA. 2968 60

The empiric usage of systemic thrombolysis for refractory out of hospital cardiac arrest (OHCA) is considered for pulmonary embolism (PE), but not for undifferentiated cardiac etiology [1, 2]. We report a case of successful resuscitation after protracted OHCA with suspected non-PE cardiac etiology, with favorable neurological outcome after empiric administration of systemic thrombolysis. A 47-year-old male presented to the emergency department (ED) after a witnessed OHCA with no bystander cardiopulmonary resuscitation (CPR). His initial rhythm was ventricular fibrillation (VF) which had degenerated into pulseless electrical activity (PEA) by ED arrival. Fifty-seven minutes into his arrest, we gave systemic thrombolysis which obtained return of spontaneous circulation (ROSC). He was transferred to the coronary care unit (CCU) and underwent therapeutic hypothermia. On hospital day (HD) 4 he began following commands and was extubated on HD 5. Subsequent percutaneous coronary intervention (PCI) revealed non-obstructive stenosis in distal LAD. He was discharged home directly from the hospital, with one-month cerebral performance category (CPC) score of one. He was back to work three months post-arrest. Emergency physicians (EP) should be aware of this topic since we are front-line health care professionals for OHCA. Thrombolytics have the advantage of being widely available in ED and therefore offer an option on a case-by-case basis when intra-arrest PCI and ECPR are not available. This case report adds to the existing literature on systemic thrombolysis as salvage therapy for cardiac arrest from an undifferentiated cardiac etiology. The time is now for this treatment to be reevaluated.
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PMID:Systemic thrombolysis for refractory cardiac arrest due to presumed myocardial infarction. 3274 60