ECG changes in acute MI

The ECG changes are often  critical in the diagnosis of acute MI and guiding therapy.
There is a series of ECG changes reflect the evolution of the infarction (The Figure below).
1.The earliest changes are : tall, positive, hyper acute T waves in the ischemic vascular territory.
2.This is followed by elevation of the ST segments (myocardial “injury pattern”).
3.Over hours to days, T-wave inversion frequently develops.
4.And finally, diminished R-wave amplitude or Q waves occur, representing significant myocardial necrosis and replacement by scar tissue, and they are what one seeks to prevent in treating the acute MI .

 Temporal evolution of ECG changes in acute myocardial infarction.

Note the tall hyperacute T waves and loss of R-wave amplitude,followed by ST-segment elevation,T-wave inversion,and development of Q waves.Persistent ST-segment elevation suggests left ventricular aneurysm.

Von Hippel-Lindau

Von Hippel-Lindau disease is an autosomal dominant disorder that consists of some combination of retinal angioma, cerebellar or spinal cord hemangioblastoma, renal cell carcinoma, pheochromocytoma, and visceral cysts. About 25% of patients with retinal angiomas will have at least one non-ocular manifestation. About 60% of patients with non-ocular manifestations will have retinal angiomas.

Thus any patient who has Von Hippel-Lindau disease must undergo periodic ophthalmologic examination. Conversely, any patient found to have a retinal angioma should be evaluated for non-ocular manifestations.

The yellow mound fed by a large arteriole and drained by an even larger vein is a capillary hemangioma. It is located in the retinal periphery, beyond the view of the direct ophthalmoscope.

Patients often have many such lesions. If untreated, they will gradually grow, bleed, and leak serous fluid that will finally detach the retina.

Fortunately, laser photocoagulation destroys small lesions. Larger lesions are harder to extinguish; they are treated with a freezing probe placed on the outside of the globe.

Hordeolum Vs Chalazion ...Clinical Summary

A hordeolum is an acute inflammation and/or abscess involving the glandular structures of the eyelid and presents as an acute, tender swelling of the eyelid or eyelid margin. An internal hordeolum involves the meibomian glands, while an external hordeolum (stye) involves the glands of Zeis or Moll at the base of the eye lashes. When bacterial etiology is present, S aureus is the most frequently implicated pathogen.
A chalazion is a firm, nontender lump that arises from obstruction of a meibomian gland. Tenderness, when present, occurs during lid swelling and cyst formation. Both hordeola and chalazia are associated with blepharitis, inflammation of the lid margins associated with plugging of the glandular ducts, and crusting around the lashes. Conditions such as seborrheic dermatitis of the eyelids, rosacea, or rarely eyelash infestation with lice can cause blepharitis and resultant blockage of the meibomian glands.

 Hordeolum. Focal swelling and erythema at the lid margin are seen in this hordeolum.

Chalazion. This chalazion shows nodular focal swelling and erythema from meibomian cyst formation. Pain is present during swelling and cyst formation.

The 5 W's of post-operative fever

Wind---pneumonia, atelectasis at 1st 24- 48 hours
Water---urinary tract infection at Anytime after post op day 3
Wound---wound infections at Anytime after post op day 5
Wonderdrugs---especially anesthesia
Walking---walking can help reduce deep vein thromboses and pulmonary embolus usually occures at Day 7-10

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