Traumatic ischaemic cardiomyopathy in a 27-year-old: a case report.

Background: Coronary injury after blunt chest trauma is rare. This case illustrates the importance of evaluating for coronary injury after any episode of blunt chest wall trauma. Case summary: We review the case of a 27-year-old male who presented with acutely decompensated heart failure several months after a motor vehicle accident with chest wall impact from the steering wheel. Coronary angiography demonstrated an occluded left anterior descending artery, and he was found to have a severe ischaemic cardiomyopathy. After multiple hospital and intensive care unit admissions due to multi-organ dysfunction and debility, he was unable to tolerate any guideline-directed medical therapy. He was unable to be listed for heart transplantation due to his co-morbidities, multi-system sequelae of his heart failure, deconditioning, and recent substance use. He was ultimately discharged home with hospice. Conclusion: Coronary or other cardiac injuries should be considered in the evaluation of all patients after blunt chest wall trauma, regardless of prior risk factors for ischaemia.

Complications of catheter ablation for ventricular tachycardia.

With the increasing literature demonstrating benefits of catheter ablation for ventricular tachycardia (VT), the number of patients undergoing VT ablation has increased dramatically. As VT ablation is being performed more routinely, operators must be aware of potential complications of VT ablation. This review delves deeper into the practice of VT ablation with a focus on periprocedural complications.

Evaluation of atrial fibrillation using wearable device signals and home blood pressure data in the Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) Study: A Subgroup Analysis (MIPACT-AFib).

Background: The rising adoption of wearable technology increases the potential to identify arrhythmias. However, specificity of these notifications is poorly defined and may cause anxiety and unnecessary resource utilization. Herein, we report results of a follow-up screening protocol for incident atrial fibrillation/flutter (AF) within a large observational digital health study. Methods: The MIPACT Study enrolled 6,765 adult patients who were provided an Apple Watch and blood pressure (BP) monitors. From March to July 2019, participants were asked to contact the study team for any irregular heart rate (HR) notification. They were assessed using structured questionnaires and asked to provide 6 Apple Watch EKGs. Those with arrhythmias or non-diagnostic EKGs were sent 7-day monitors. The EHR was reviewed after 3 years to determine if participants developed arrhythmias. Results: 86 participants received notifications and met inclusion criteria. Mean age was 50.5 (SD 16.9) years, and 46 (53.3%) were female. Of 76 participants assessed by the study team, 32 (42.1%) reported anxiety surrounding notifications. Of 59 participants who sent at least 1 EKG, 52 (88.1%) were in sinus rhythm, 3 (5.1%) AF, 2 (3.4%) indeterminate, and 2 (3.4%) sinus bradycardia. Cardiac monitor demonstrated AF in 2 of 3 participants with AF on Apple Watch EKGs. 2 contacted their PCPs and were diagnosed with AF. In total, 5 cases of AF were diagnosed with 1 additional case identified during EHR review. Conclusion: Wearable devices produce alarms that can frequently be anxiety provoking. Research is needed to determine the implications of these alarms and appropriate follow-up.

Etiology-based strabismus classification scheme for pediatricians.

BACKGROUND: Pediatricians are regularly involved in the initial examination of children presenting with strabismus, a common ocular condition occurring in 3% of children. The objective of this review was to gain insight into pediatric residents, fellows and attendings` understanding of strabismus, and to propose an etiology-based strabismus classification scheme to aid this understanding. METHODS: A survey was conducted in a single Department of Pediatrics in a university academic institution in order to assess the degree of understanding of the classification, etiology and nomenclature of strabismus. A targeted literature review, pertinent to our classification scheme for strabismus in the pediatric age group, is provided to clarify the various underlying etiological conditions for pediatricians. RESULTS: The surveyed cohort (n=26) consisted of 10 (38.5%) attendings and 16 (61.5%) pediatricians-in-training. Although 69% of survey participants felt comfortable performing an ocular motility evaluation, only 19% had a clear understanding of the underlying etiology of strabismus, 8% had a clear understanding of strabismus nomenclature and none of the participants had clear knowledge of a classification scheme of strabismus. We propose an etiologic-based strabismus classification scheme with streamlined nomenclature geared towards Pediatricians to facilitate the management of pediatric patients with various ocular misalignments. Eight major categories of this classification scheme include (1) physiologic, (2) comitant, (3) paralytic, (4) sensory, (5) syndromic, (6) orbital, (7) supranuclear and (8) pseudostrabismus. CONCLUSIONS: Pediatricians at all levels of professional experience have a limited command of strabismus. An etiology-based classification scheme of strabismus may assist in understanding the underlying causes and facilitate the management of strabismus in the pediatrician`s office.