Πνευμονολογικό Ιατρείο Κ. Ν. Μανάρα

27/11/2025

26/11/2025

🫀 Myocardial Infarction – ECG Changes (Easy & High-Yield)

MI produces sequential ECG changes depending on the stage. These changes help identify acute vs old MI and location of the infarct.

🔥 1️⃣ Hyperacute Phase (Minutes)

Tall, broad, hyperacute T waves

Localized to area of infarction

Often the earliest sign

🔥 2️⃣ Acute ST-Elevation Phase

ST elevation in leads facing the infarct

ST depression in opposite (reciprocal) leads

ST morphology: convex/“tombstone”

🔥 3️⃣ Evolving Phase (Hours–Days)

T wave inversion

Appearance of pathological Q waves

Width ≥ 0.04 sec (1 small box)

Depth ≥ 25% of R wave

🔥 4️⃣ Chronic / Old MI

Persistent Q waves

ST segment returns to baseline

T waves may remain inverted or normalize

⭐ Localizing MI on ECG – Lead-Wise
MI Location Leads Showing ST Elevation Artery Involved
Anterior MI V1–V4 LAD
Septal MI V1–V2 LAD (septal branch)
Lateral MI I, aVL, V5–V6 LCX
Inferior MI II, III, aVF RCA (or LCX)
Posterior MI ST ↓ in V1–V3 (mirror) RCA/LCX
Right Ventricular MI V3R, V4R Proximal RCA
🧠 Simple Mnemonic

Q1 T2 S3

Q waves → older infarction

T wave inversion → evolving

ST elevation → acute

(Think reverse: ST → T → Q as time progresses)

🔍 Reciprocal Changes

Inferior MI → ST ↓ in I, aVL

Lateral MI → ST ↓ in II, III, aVF

Anterior MI → posterior mirror changes (tall R, ST ↓ in V1–V3)

26/11/2025

✅ Acid–Base Disorders

Step 1: Look at pH
• pH ↓ (7.45) → Alkalosis

✅ Step 2: Look at PaCO₂ and HCO₃⁻

Use them to identify if the problem is respiratory (PaCO₂) or metabolic (HCO₃⁻).

✅ If pH and PaCO₂ move in OPPOSITE directions → Respiratory disorder
• pH ↓ & CO₂ ↑ → Respiratory acidosis
• pH ↑ & CO₂ ↓ → Respiratory alkalosis

✅ If pH and HCO₃⁻ move in SAME direction → Metabolic disorder
• pH ↓ & HCO₃⁻ ↓ → Metabolic acidosis
• pH ↑ & HCO₃⁻ ↑ → Metabolic alkalosis

✅ Compensation

Metabolic disorders → lungs compensate (change CO₂)

Metabolic acidosis
• CO₂ should ↓ to match ↓ HCO₃⁻
• Quick rule:
Expected CO₂ ≈ 1.5 × HCO₃ + 8 (±2)
(Winter’s formula)

Metabolic alkalosis
• CO₂ should ↑
• For every ↑1 mmol/L in HCO₃⁻ → CO₂ ↑ by 0.7 mmHg

Respiratory disorders → kidneys compensate (change HCO₃⁻)

✅ Respiratory acidosis (CO₂ ↑)

Acute: HCO₃ ↑ by 1 mmol/L per 10 mmHg CO₂
Chronic: HCO₃ ↑ by 4 mmol/L per 10 mmHg CO₂

✅ Respiratory alkalosis (CO₂ ↓)

Acute: HCO₃ ↓ by 2 mmol/L per 10 mmHg CO₂
Chronic: HCO₃ ↓ by 4 mmol/L per 10 mmHg CO₂

23/10/2025

What is the pneumococcal vaccine, and who needs it?

This JAMA Internal Medicine Patient Page describes how the pneumococcal pneumonia vaccine works, who should get it, and its benefits and side effects.

https://ja.ma/474XNw0

14/10/2025

Stepwise Management of Spontaneous Pneumothorax

1. Do a PA Chest X-ray (CXR)
• If you suspect pneumothorax, take a posteroanterior (PA) chest X-ray to confirm.
2. Assess the degree of breathlessness
• Ask about symptoms and examine the patient.
• How breathless the patient is will guide how you manage them.
3. Differentiate between types of pneumothorax
• Primary (PSP): occurs in healthy lungs.
• Secondary (SSP): occurs in people with existing lung disease and is usually more severe.

Emergency Note: Tension Pneumothorax
• This is a medical emergency — diagnosis is clinical (don’t wait for a CXR).
• Immediate treatment:
Insert a large-bore needle (cannula) into the 2nd intercostal space at the midclavicular line to release trapped air.
• After emergency decompression, insert a chest drain to prevent recurrence.

06/10/2025

Long COVID brain fog is real - and now,
we know what's causing it.
A breakthrough brain scan reveals the science behind the symptoms.
Scientists in Japan have identified a biological cause behind the cognitive "brain fog" experienced by many Long COVID patients—a breakthrough that could lead to reliable diagnosis and treatment.
A team at Yokohama City University used a cutting-edge brain imaging method to detect abnormal increases in AMPA receptors (AMPARs), molecules essential for learning and memory, in people suffering from Long COVID. These elevated receptor levels, observed using [11CJK-2 PET imaging, were closely linked to the severity of cognitive symptoms and inflammation markers, offering the first clear molecular explanation for the condition.
The findings, published in Brain Communications, show that AMPAR density not only tracks with brain fog severity but also enables near-perfect distinction between affected and healthy individuals-100% sensitivity and 91% specificity. This offers promise for both diagnostic tools and treatments, such as drugs that suppress AMPAR activity. With brain fog affecting over 80% of Long COVID sufferers globally, this research marks a significant step toward validating the condition and accelerating efforts to address it with targeted therapies.

04/10/2025

Learn about genetic COPD and order a free AlphaID At Home Saliva Collection Kit to find out your risk for genetic COPD, or alpha-1 antitrypsin deficiency (AATD).

04/10/2025

Common antibiotics (like doxycycline and minocycline), antidepressants, and diuretics may increase the risk of skin hyperpigmentation, according to a large real-world data analysis. The risk was notably higher for tetracyclines (≈2-fold) and modest for hydrochlorothiazide. http://ms.spr.ly/6184saCty

03/10/2025