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Biomedical subjects

Amal Mattu

Publications and source records attributed to Amal Mattu.

At least 19 recordsLinked to original sources
PubMed2006

Body surface mapping in the ED evaluation of the patient with chest pain: use of the 80-lead electrocardiogram system.

Body surface mapping (BSM) is an electrocardiographic (ECG) technique that uses numerous leads on a patient's anterior and posterior chest, enabling more complete visualization of cardiac electrical activity. The rationale behind BSM is an extension of additional lead ECG. Output from BSM is displayed in a 12-lead ECG format, an 80-lead ECG format, and on color contour maps. The color contour maps can be displayed on a torso image or as a flat map.

Algorithms↗
PubMed2006

ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis.

OBJECTIVES: In patients with gastrointestinal (GI) tract bleeding, the bleeding source is uncertain in the absence of hematemesis. We sought to identify clinical variables predictive of an upper GI bleeding source. METHODS: This retrospective cohort study involved patients admitted via the ED for GI tract bleeding without hematemesis, who underwent confirmatory testing. We used logistic regression analysis to identify clinical variables independently associated with an upper GI source. RESULTS: Among 325 patients, odds ratios for the strongest predictors were as follows: black stool, 16.6 (95% confidence interval [CI], 7.7-35.7); age less than 50 years, 8.4 (95% CI, 3.2-22.1); and blood urea nitrogen/creatinine ratio 30 or greater, 10.0 (95% CI, 4.0-25.6). Seven (5%) of 151 with none of these factors had an upper GI tract bleed, versus 63 (93%) of 68 with 2 or 3 factors. CONCLUSION: Black stool, age less than 50 years, and blood urea nitrogen/creatinine ratio of 30 or greater independently predict an upper GI tract bleeding source.

Adult↗
PubMed2006

Intraventricular conduction abnormalities.

There are multiple types of intraventricular conduction abnormalities, each with its own unique clinical significance. It is useful to categorize conduction abnormalities, or blocks, by the number of fascicles involved. This article reviews intraventricular conduction abnormalities.

Bundle-Branch Block↗
PubMed2006

Abdominal pain in the elderly.

Elderly patients who have abdominal pain remain one of the most challenging patient populations. Signs and symptoms of serious disease are often nonspecific. Atypical presentations are common in elderly patients. In addition, the higher incidence of serious pathology in this population requires emergency physicians to be vigilant and thorough in their work-up. Vascular catastrophes are more likely to be seen in this population, and a broad differential diagnosis needs to be considered.

Abdominal Pain↗
PubMed2005

Premature atherosclerosis and acute coronary syndrome in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a vasculitic disorder with potential for multisystem organ dysfunction. Among the organ systems affected is the cardiovascular system. Patients with SLE are prone to premature atherosclerosis; this premature atherosclerosis places the patient at risk for myocardial infarction with onset at a relatively young age. We present 4 patients with SLE who experienced myocardial infarction; these patients also experienced diagnostic and treatment delays because of their relatively young age at presentation. Relevant pathophysiology and diagnostic strategies are discussed.

Adult↗
PubMed2005

The electrocardiogram in right ventricular myocardial infarction.

Right ventricular (RV) myocardial infarction most often occurs in the setting of inferior wall myocardial infarction. Right ventricular infarction complicates approximately 25% (range, 20%-60%) of inferior acute myocardial infarction; it is uncommon to quite rare in anterior and lateral wall acute myocardial infarction. With infarction of the RV, the RV will fail. As such, left ventricular filling pressures are entirely dependent upon the patient's preload; with significant reductions in the preload, hypotension likely results (this hypotension may be worsened by nitroglycerin and morphine). The clinical presentation, in the setting of an ST-elevation myocardial infarction (STEMI) of the inferior wall, involves hypotension, jugular venous distension, and the following electrocardiographic findings: ST-segment elevation of greatest magnitude in lead III (compared with leads II and aVF), ST-segment elevation in lead V1, and/or ST-segment elevation in right chest leads (RV1 through RV6). Therapy, in addition to appropriate management for STEMI, relies largely on enhancing the preload with intravenous fluid and judicious use of vasodilator medications. Patients with inferior wall STEMI with RV infarction have a markedly worse prognosis (both acute cardiovascular complications and death) compared with patients with isolated inferior wall STEMI.

Cardiac Catheterization↗
PubMed2005

Wide-complex tachycardia: beyond the traditional differential diagnosis of ventricular tachycardia vs supraventricular tachycardia with aberrant conduction.

Wide-complex tachycardia (WCT) is defined as a rhythm disturbance with a rate greater than 100 beats/min and a QRS complex duration of 0.12 seconds or more in the adult patient; in the pediatric patient, both rate and QRS complex width are age related. In evaluating this type of tachycardia, there are 2 broad categories usually discussed in the medical literature: ventricular and supraventricular with aberrant intraventricular conduction. There are several other important causes of a WCT encountered in clinical practice, which are less often discussed; these tachycardias often require specific therapies differing from the standard approach to WCT. These tachycardias are diverse; as such, the pathophysiology behind each form of WCT includes toxic, metabolic, and conduction system dysfunction mechanisms.

Adult↗
PubMed2005

Modern management of cardiogenic pulmonary edema.

Cardiogenic pulmonary edema (CPE) is a life-threatening condition that is frequently encountered in standard emergency medicine practice. Traditionally, diagnosis was based on physical assessment and chest radiography and treatment focused on the use of morphine sulfate and diuretics. Numerous advances in diagnosis and treatment have been made, however. Serum testing for B-type natriuretic peptide (BNP) has improved the accuracy of diagnoses in these patients. Treatment should focus on fluid redistribution with aggressive preload and afterload reduction rather than simply on diuresis. Some specific medications and noninvasive positive pressure ventilation have been shown to be safe and rapidly effective in improving patients' symptoms and improve outcomes.

Emergency Medicine↗
PubMed2004

Usefulness and validity of diagnostic nasogastric aspiration in patients without hematemesis.

STUDY OBJECTIVE: We estimate the test characteristics of nasogastric aspiration to diagnose upper gastrointestinal tract hemorrhage in patients without hematemesis. METHODS: In this retrospective cohort study, medical records from patients admitted to 2 urban hospitals between 1997 and 2002 for gastrointestinal tract bleeding without hematemesis were reviewed. Positive nasogastric aspiration results were classified by the severity of hemorrhage, and negative results were classified by the presence or absence of bile. The reference standard for nasogastric aspiration was the source of bleeding-upper versus non--upper gastrointestinal tract--from the hospital discharge summary. Confidence intervals (CIs) for proportions and likelihood ratios (LRs) were calculated. RESULTS: Of 333 eligible patients, 235 were offered nasogastric aspiration, and 220 accepted the test. Results of 220 attempts were distributed as follows: negative, 158 (72%), including 9 (4%) with bile; nasogastric aspiration aborted, 13 (6%); and positive, 49 (23%), including 4 (2%) that were strongly positive (> or =450 mL red blood). Test characteristics of nasogastric aspiration to detect upper gastrointestinal tract bleeding in 213 patients with a reference standard diagnosis were as follows: sensitivity 42% (95% CI 32% to 51%), specificity 91% (95% CI 83% to 95%), negative predictive value 64% (95% CI 56% to 71%), and positive predictive value 92% (95% CI 79% to 97%). The nasogastric aspiration accurately predicted the source of bleeding in 66% of patients (95% CI 59% to 72%). The likelihood ratio of a positive nasogastric aspiration was 11 (95% CI 4 to 30), and the likelihood ratio of a negative nasogastric aspiration was 0.6 (95% CI 0.5 to 0.7). CONCLUSION: In patients without hematemesis, a positive nasogastric aspiration, seen in 23%, indicates probable upper gastrointestinal tract bleeding (LR+ 11), but a negative nasogastric aspiration, seen in 72%, provides little information (LR- 0.6).

Aged↗
PubMed2003

Additional electrocardiographic leads in the ED chest pain patient: right ventricular and posterior leads.

In the evaluation of the patient with chest pain, the 12-lead electro cardiogram is a less-than-(ECG) perfect indicator of acute myocardial infarction (AMI), particularly when used early in the course of the acute ischemic event; this relative insensitivity for AMI results from many different issues, including a less-than-optimal imaging of certain areas of the heart. It has been suggested that the sensitivity of the 12-lead ECG can be improved if 3 additional body surface leads are used in selected individuals. Acute posterior (PMI) and right ventricular myocardial infarctions are likely to be underdiagnosed, because the standard lead placement of the 12-lead ECG does not allow these areas to be assessed directly. Additional leads frequently used include leads V(8) and V(9), which image the posterior wall of the left ventricle, and lead V(4R), which reflects the status of the right ventricle. The standard ECG coupled with these additional leads constitutes the 15-lead ECG, the most frequently used additional lead ECG in clinical practice. The use of the additional leads might not only confirm the presence of AMI, but also provide a more accurate reflection of the true extent of myocardial damage.

Aged↗
PubMed2003

The Brugada syndrome.

Brugada syndrome describes the syndrome of sudden cardiac death in the setting of the following electrocardiographic findings: right bundle branch block pattern with ST-segment elevation in the right precordial leads. The right bundle branch block may be incomplete while the ST segment elevation is minimal. The electrocardiographic findings are not constant. Patients suspected of having Brugada syndrome should be promptly referred for electrophysiological testing and treatment. Rapid referral and placement of an implantable cardioverter defibrillator (ICD) is associated with an excellent prognosis, whereas failure to diagnose this condition is associated with a high risk for sudden death. Therefore, it is imperative that all emergency physicians be familiar with the typical ECG manifestations of Brugada syndrome. Three illustrative cases are presented with a review of the syndrome.

Adult↗
PubMed2002

Malaria: a rising incidence in the United States.

Malaria is frequently a deadly disease, particularly in tropical countries of the world where this protozoan infection is endemic. While physicians in tropical countries are familiar with the presentation, those who do not practice in endemic regions of the world may neglect to add tropical diseases to their differential diagnosis of fever. Epidemiologic data from the CDC show the number of cases of malaria being diagnosed in the United States in the last decade has risen sharply. With international travel continuing to rise, there is strong reason to consider malaria as a source of fever.

Antimalarials↗
PubMed2002

Serum phosphate abnormalities in the emergency department.

Abnormalities in serum phosphate levels are more prevalent in certain subsets of Emergency Department patients than in the general population. Patients with diabetic ketoacidosis, chronic obstructive pulmonary disease, alcoholism, malignancy, and renal failure are at increased risk. Multiple factors, including nutritional intake, medications, renal or intestinal excretion, and cellular redistribution, are potential etiologies. The clinical manifestations of mild hypophosphatemia or hyperphosphatemia are typically minor and nonspecific (myalgias, weakness, anorexia). When the imbalance is severe, critical complications may occur (tetany, seizures, coma, rhabdomyolysis, respiratory failure, ventricular tachycardia). Mild asymptomatic hypophosphatemia can be treated with oral phosphate supplementation (15 mg/kg daily) on an outpatient basis. Patients with severe or symptomatic hypophosphatemia should be treated with IV phosphate therapy (0.08-0.16 mg/kg over 6 h) and admitted for monitoring and subsequent serum electrolyte testing. Mild asymptomatic hyperphosphatemia is commonly managed in renal failure by limiting dietary intake and reducing absorption with phosphate-binding salts. Hemodialysis may be required for severe hyperphosphatemia with symptomatic hypocalcemia.

Blood Chemical Analysis↗
PubMed2002

Electrocardiographic T-wave inversion: differential diagnosis in the chest pain patient.

Inverted T waves produced by myocardial ischemia are classically narrow and symmetric. T-wave inversion (TWI) associated with an acute coronary syndrome (ACS) is morphologically characterized by an isoelectric ST segment that is usually bowed upward (ie, concave) and followed by a sharp symmetric downstroke. The terms coronary T wave and coved T wave have been used to describe these ischemic TWIs. Prominent, deeply inverted, and widely splayed T waves are more characteristic of non-ACS conditions such as juvenile T-wave patterns, left ventricular hypertrophy, acute myocarditis, Wolff-Parkinson-White syndrome, acute pulmonary embolism, cerebrovascular accident, bundle branch block, and later stages of pericarditis.

Adult↗
PubMed2002

The prominent T wave: electrocardiographic differential diagnosis.

The prominent T wave is an abnormal T-wave morphology encountered in the earliest phase of ST-segment elevation acute myocardial infarction (AMI). Prominent T waves, however, are associated with other diagnoses, including hyperkalemia, early repolarization, and left ventricular hypertrophy (LVH). This article focuses on the electrocardiographic differential diagnosis of the prominent T wave with the presentation of 4 illustrative cases. We also recommend that the designation hyperacute should refer exclusively to the prominent T waves of ST-segment elevation AMI.

Adult↗
PubMed2002

Electrocardiographic manifestations of hypothermia.

Hypothermia is generally defined as a core body temperature less than 35 degrees C (95 degrees F). Hypothermia is one of the most common environmental emergencies encountered by emergency physicians. Although the diagnosis will usually be evident after an initial check of vital signs, the diagnosis can sometimes be missed because of overreliance on normal or near-normal oral or tympanic thermometer readings. The classic and well-known electrocardiographic (ECG) manifestations of hypothermia include the presence of J (Osborn) waves, interval (PR, QRS, QT) prolongation, and atrial and ventricular dysrhythmias. There are also some less known (ECG) findings associated with hypothermia. For example, hypothermia can produce ECG signs that simulate those of acute myocardial ischemia or myocardial infarction. Hypothermia can also blunt the expected ECG findings associated with hyperkalemia. A thorough knowledge of these findings is important for prompt diagnosis and treatment of hypothermia. Six cases are presented that show these important ECG manifestations of hypothermia.

Adult↗
PubMed2002

Electrocardiographic ST segment elevation: left ventricular aneurysm.

Left ventricular aneurysm (LVA), also described as dyskinetic left ventricular segment, is defined as a localized area of infarcted myocardium that bulges outward during both systole and diastole. LVAs most often are noted after large anterior wall events but may also be encountered status after inferior and posterior wall injuries. In most cases, LVA is manifested electrocardiographically by varying degrees of ST segment elevation (STE), which may be difficult to distinguish from ST segment changes caused by acute myocardial infarction. The STE is generally associated with well-developed, completed Q waves in the anterior precordial leads, and there will not be reciprocal ST depression in the contralateral leads. This article focuses on the electrocardiographic findings useful in making the diagnosis of left ventricular aneurysm as well as distinguishing LVA from other STE syndromes.

Aged↗