Ken Grauer, MD

OCTOBER 13, 2023

As a result — IF no "fixable" cause is found ( ie, ischemia/infarction — electrolyte disturbance — rate-slowing medication ) — then because of the AV block and very slow heart rate, this patient will probably need a pacemaker. There are also twice as many P waves as QRS complexes — so at the least, there is 2nd-degree AV block.

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Blog Arrhythmia Bradycardia Download 160

Dr. Smith's ECG Blog

MARCH 22, 2022

There is no ischemia, certainly no concern at all for OMI. These ER patients did not have ischemia — and the variation in ST elevation was not related to either heart rate or QRS amplitudes ( Variation in ST-Segment Elevation in Early Repolarization: Electrocardiography 40:10,2007 ).

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Blog Ischemia Chest Pain Arrhythmia 52

Dr. Smith's ECG Blog

JUNE 30, 2023

And ECGs can change and evolve even when there is no ischemia. Although this is not a common phenomenon — You will see it on occasion ( See the July 24, 2013 post , among others — in Dr. Smith's ECG Blog ). LEARNING POINT : 1. Morphology matters. Pattern recognition is essential. AI does a great job at this but most humans do not.

Chest Pain 52

Chest Pain Blog Ischemia Document 52

Ken Grauer, MD

JULY 22, 2023

Although this " Imbalance " of precordial T waves is not see n very often — in the “right” clinical setting, it has been associated with recent OMI ( O cclusion-based MI ) , most often from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM — and ECG Blog #350 ).

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Blog Chest Pain STEMI AFIB 78

Dr. Smith's ECG Blog

MAY 6, 2019

Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Ischemia/infarction. Acute febrile illness. Hypothermia.

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Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

Computer read: "Non-specific ST abnormality, consider anterior subendocardial ischemia" There are very poor R-waves in V1-V4 suggesting old anterior MI. Firstly, subendocardial ischemia does not localize on 12-Lead ECG. But the real question at hand is: Are these precordial ST-depressions a result of subendocardial ischemia?

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Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

This suggests further severe ischemia. There is 1 mm of ST segment elevation in lead aVR — which in the context of ST segment flattening in most other leads, suggests that there may be a component of subendocardial ischemia from underlying coronary disease. Detailed coronary artery evaluation not performed. Downstream vasospasm?

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Coronary Angiogram Plaque Thrombosis STEMI 105

DAIC

JANUARY 23, 2024

mg reduced the risk of cardiovascular death, MI or heart attack, ischemic stroke, or ischemia-driven coronary revascularization by 31% compared with placebo.34 2013;368(21):2004-2013. Published 2013 Apr 4. This in turn leads to an overall reduction in IL-6 production and CRP concentration.12 12 Colchicine, 0.5 N Engl J Med.

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Cardiovascular Disease Heart attacks Heart Attack Coronary Artery Disease 111

Ken Grauer, MD

APRIL 29, 2023

The overall ST-T wave appearance in this lead looks more like LV “strain” than ischemia. ECG Blog #184 — illustrates the "magical" mirror-image opposite relationship with acute ischemia between lead III and lead aVL ( featured in Audio Pearl #2 in this blog post ). T waves are upright and peaked in anterior leads V1,V2,V3.

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Blog Chest Pain STEMI Ischemia 78

Dr. Smith's ECG Blog

JUNE 1, 2020

COMPARE ECG #1 with ECG #2: I think the easiest way to make the case for Pleomorphic VT is to compare the 2 tracings in Figure-3: I took ECG #2 in Figure-2, from the October 12, 2013 post in Dr. Smith’s ECG Blog. Instead, antiarrhythmic drugs such as amiodarone or ß-blockers may be needed — and/or treatment targeted to correcting ischemia.

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Tachycardia AFIB Blog Heart Disease 52

Dr. Smith's ECG Blog

MAY 8, 2023

EKG shown here: LAFB with no clear signs of OMI or ischemia. 8 , 9 The most recent American College of Cardiology and American Heart Association ST-elevation myocardial infarction (STEMI) guidelines (2013) give no direction on diagnosing occlusion myocardial infarction in patients with ventricular paced rhythm. No labs were performed.

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Dr. Smith's ECG Blog

NOVEMBER 28, 2022

2013 Sep;26(9):965-1012.e15. Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. J Am Soc Echocardiogr. doi: 10.1016/j.echo.2013.06.023. 2013.06.023. PMID: 23998693. Appleton C, Gillam L, Koulogiannis K. Cardiac Tamponade. Cardiol Clin. 2017 Nov;35(4):525-537.

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Pericarditis Tachycardia Ultrasound Blood Pressure 52

Dr. Smith's ECG Blog

JUNE 1, 2022

Here is his ECG: There is no clear evidence of OMI or ischemia. This " imbalance of precordial T waves" is not seen very often — and in the “right” clinical setting, has been associated with recent OMI from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM ).

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Chest Pain STEMI Myocardial Infarction Bradycardia 52

Ken Grauer, MD

OCTOBER 27, 2023

This suggests ischemia of uncertain duration. Section 20 ( 54 pages = the " long " Answer ) from my ACLS-2013-Arrhythmias Expanded Version provides detailed discussion of WHAT th e AV Blocks are — and what they are not ! There is deep, symmetric T wave inversion with a prolonged QTc interval in anterior leads V1,V2,V3.

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Blog Pacemaker Bradycardia Arrhythmia 103

Dr. Smith's ECG Blog

JULY 22, 2023

This definition was changed following an expert consensus panel in 2013 — so that all that is currently needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria. Panel B in Figure-1 illustrates the Brugada Type-2 or “Saddle-back” ECG pattern.

Chest Pain 75

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 75

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

Ischemic ST-segment depression maximal in V1-V4 (versus V5-V6) of any amplitude is specific for Occlusion Myocardial Infarction (versus nonocclusive ischemia). Arch Cardiovasc Dis 2013 Khan AR et al. JAHA 2022 Grosmaitre P et al.

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

Stroke Journal

FEBRUARY 1, 2024

Objective:To investigate the treatment outcomes of MT in tVBO.Method:This international, multicenter, retrospective cohort included patients with MT for tVBO and isolated BAO from 2013 to 2023. Secondary outcomes included complete recanalization (modified Thrombolysis in Cerebral Ischemia [mTICI] ≥ 2C) and 90-day mortality rate.

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Outcomes Thrombolysis Ischemia Stroke 40

EMS 12-Lead

APRIL 2, 2022

Below is a refresher on appropriate precordial lead placement. [6] 6] A more robust examination of lead malposition can be found at the Emergency Medicine Cases website by the great Dr. Jesse McLaren. link] Also, do not miss Dr. Grauer's great explanations on -- LAFB [link] RBBB-LBBB-IVCD [link] LBBB-Sgarbossa-LVH-MI [link] [1] Ravi, S.,

Myocardial Infarction 52

Myocardial Infarction Stents Stent STEMI 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

This definition was changed following an expert consensus panel in 2013 — so that at the present time, all that is needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria.

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Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

MAY 5, 2022

This definition was changed following an expert consensus panel in 2013 — so that at the present time, all that is needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria. Panel B in Figure-5 illustrates the Brugada Type-2 or “Saddle-back” ECG pattern.

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Chest Pain Bradycardia Cardiac Arrest STEMI 52