Setting Priorities

I’m going to define 2 broader resolutions immediately, and then put off development of more resolutions and goals for another 2 weeks while I focus on my immediate situation:

1) Better health care.

2) A more focused effort on curing diseases.

In terms of the immediate, I need to work on the EKG interpretations.  I have attempted several times to obtain the results of the stress test that was performed with its corresponding EKG tracing (it beeped once – an abnormality?).  Unfortunately, I was too unfocused at the end to get my heart rate values, and diastolic blood pressure.  I know that the physician’s report was performed immediately after the stress test, like the x-ray and EKG’s.  It does not make sense to do it any other time.  They have not released the data to me despite several requests by now. It makes me angry – they have collected data on my body, and not given me the data.  They have said that I should call back on Friday.  This is too late.  The gas and heat will be turned off where I am staying on the 8th.  This means I need to move out.

I don’t have enough gas money to go there and come back to try to get a Lantus prescription.  But really, there are only 2 more working days to solve this.

This was what the EKG’s looked like coming in to the ER.

IMG_0801

Below is what it looked like walking out of the ER 4 hours later after some 4 baby aspirins and 45 min. of saline (?) IV:

IMG_0802

The stress test EKG’s which were done 5 days later are not yet available to me.

A little bit of analytical work on the incoming EKG,leadII-leadVI

 

 

Maybe P-mitrale morphology suggesting possible left atrial enlargement.  NB: I started to use the mm dimensions that many other people use when analyzing these charts, but they don’t make sense to me, so I reverted back to ms and mV.  These seem to correspond to what everyone else is using.  The mm dimensions used by others do not correspond to mm on my chart paper.

So, trying to pull together some tentative observations and hypotheses here.  The P wave which is said to represent atrial contraction appears notched (the 2 atrial signals are slightly separated), but not significantly broadened.  According to a book by the cardiology board, this might indicate a slowing of conduction to the left atrium, left atrial hypertrophy, or left atrial dilation.  The normal conduction path for both atria starts at the SA node on the right of the heart when the right atrium is full.  It moves through the right atrium to the AV node via 3 intermodal pathways, and across to the left atrium through Bachmann’s bundle, and down all sides of the atrium to the diametrically opposed wall where the wavefronts meet, and according to this site, normally do not continue to conduct down the left ventricle because there are no conducting cells or the cells are refractory (depolarization of the left ventricle normally occurs via the AV node, where it separates into a right and left bundle branch of Purkinje fibers at the bundle of His, the signal moving from bottom to top of both ventricles toward the atria).

There may be some biatrial enlargement because of the height of the P-wave, although it is of interest to note that the height is not the same on both sides of the wave.  This remains to be explained.  The pattern that I see in lead VI seems more similar to the LAE pattern reported in the above work.  According to this paper, hypertension in the range that I presented with (180/100) statistically might cause a broadening of the P-wave, but not the notched appearance.  One could theorize that if one had peripheral vascular problems, there might be a relative filling problem in the right atrium relative to the left one, thus the signal for contraction would initiate late relative to the filling of the left atrium which would therefore overfill and dilate.  Not all causes of hypertension are related to peripheral vascular resistance so this might not be seen in the above study.

In terms of what is going on with the baseline.  I’m trying to put together the chart recording with what is going on with the channels.   At rest, there should be a certain ionic equilibrium that forms the baseline current.  As the cell depolarizes, and the EKG P-wave starts to go up, my understanding is that Na+ channels open, and Na+ moves rapidly into the cell, and Ca++ also in, but somewhat more slowly.  This is phase 0 or depolarization.  This is followed by phase 1 (repolarization), where the Na+ channels close, but Ca++ continues to flow into the cell.  During phase 2,  K+ starts to flow out of the cell, as Ca++ continues to flow into the cell. A plateau is reached.  This is the slow repolarization phase.  It is followed by a faster repolarization phase (phase 3), where the Ca++ channels close, but K+ still flows out of the cell.   In phase 4, the resting phase, Na+/K+ pumps restore the ionic membrane balance.

So why is the baseline shifted down after the P wave? (and also after the QRS wave?).  Is it ischemia, the absence of enough oxygen in the tissue cell to synthesize ATP to provide the needed energy for the channels to reestablish an equilibrium quickly?  Why would only these channels be affected, and not the Ca++ or Na+ or K+ channels that depolarize/repolarize?

Still, not coming up with a very good explanation of exactly what the T-wave is.  Repolarization of the ventricle, I’m pretty sure it is not.  It is some kind of action potential generated after the main ventricular repolarization.

I guess that most of the auscultations are not showing a very strong 1st heart sound – that corresponding to the opening of the aortic valve, and closing of the mitral valve.  The S1 sound seems there in the left carotid artery, but almost not anywhere else.

Trying to put together this figure with the chest x-ray and phonogram.  I went ahead and recorded some more phonograms of various other arteries.

Below: The left and right common carotids measured near the clavicle.

common_carotids

Below: Left carotid and right external carotids measured under the jaw (the noise in the middle is me marking the file half way as I transfer the scope).

carotids

below: the left and right temporal arteries:

temporals

below: the occipital artery:

occipital

 

below: Left renal (measured on left side of back near spine and bottom of ribcage, I’m not sure this is correct, but ).

left_renal

below: Right renal (measured as above but reaching behind my back from the left to the right side of the spine – not too sure about this).

right_renal

Left and right subclavians

subclavians

Left brachial

left_brachial

Right brachial

right_brachial

 

Below: Left iliac and right iliac measured at the groin

l_and_r_iliac

Below: Left pedal (pretty much absent) and right pedal at the ankle.

left_and_right_pedal

I managed to pick up a little left pedal after the bike ride yesterday.

left_pedal

I wish there was some way of filtering out papers that involve killing animals for medical research.  It is very upsetting to me.  I had a nightmare that a very old pit bull was being experimented on in a lab, and the people had left the lab, and I was having to choose between being set up to go to jail over trying to rescue him, and walking away.

I kind of had a thought last night that one of the jobs that I might consider part time in big science, is taking other people’s grants that involve animal research, and redesigning the experiments in ways that involve the use of natural human or animal lives.  I would consider this as a 20% investment of time, like public service on a referred “animal research redesign” grant committee.

Advertisements
This entry was posted in Uncategorized. Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s