2018, AFIB and Tachycardia - Cardiovascular Update

A young man with palpitations.

Dr. Smith's ECG Blog

MAY 7, 2024

The two ECGs above were texted to me with the text: "Young Guy came in in SVT but now in and out of irregular wide complex tachycardia. -- not sure if polymorphic VT vs. a fib with WPW." FINAL Points in Today's CASE: Even though the SPERRI value during AFib in today's case was not below 250 msec. Definitely atrial fibrillation.

Atrial Fibrillation

Atrial Fibrillation AFIB Ablation Chest Pain

Wide-complex tachycardia: VT, aberrant, or "other?"

Dr. Smith's ECG Blog

DECEMBER 16, 2018

Wide-complex tachycardia: VT or aberrant, or "other?" A wide-complex tachycardia in an older patient must immediately suggest ventricular tachycardia. Sinus tachycardia with aberrancy was unlikely as the rate was consistently 150 bpm, without spontaneous variation. And indeed the QRS morphology strongly supported VT (e.g.

Tachycardia

Tachycardia Atrial Flutter AFIB Atrial Fibrillation

Regular Wide Complex Tachycarida with poor LV function and hypotension. Duration unknown. How to manage?

Dr. Smith's ECG Blog

JULY 5, 2024

There is a regular wide complex tachycardia. Remember : Adenosine is safe in Regular Wide Complex Tachycardia. Rather, from this one: Very Fast Very Wide Complex Tachycardia Ideally, one would cardiovert. At the time, it seemed that virtually all cardiac patients with chronic AFib or heart failure were on this medication.

Atrial Flutter

Atrial Flutter Tachycardia Atrial Fibrillation AFIB

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Syncope while on a treadmill

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

This strip was obtained: Apparent Wide Complex Tachycardia at a rate of 280 What do you think? Troponins 34>33>43, likely secondary to myocardial injury from tachycardia. Is longterm endurance-training a risk factor for AFib and AFlutter? == Why is Today's Initial Rhythm AFlutter? Sinus tachycardia does not go this fast.

Atrial Flutter

Atrial Flutter Exercise AFIB Tachycardia

A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. The Initial ECG in Today's Case: As per Dr. Meyers — the initial ECG in today's case shows sinus tachycardia with bifascicular block ( = RBBB/LAHB ). Sinus Tachycardia ( common in any trauma patient. ).

Tachycardia

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia

Syncope and Atrial fibrillation in a Healthy 70-something Male

Dr. Smith's ECG Blog

JULY 5, 2018

My Comment , by K EN G RAUER, MD ( 7/5/2018 ): This blog post provides an excellent example of how a patient with SSS ( = S ick S inus S yndrome ) may present. Many patients have a T achy- B rady syndrome in which tachyarrhythmias ( most commonly rapid AFib ) alternate with periods of bradycardia. second in duration.

Atrial Fibrillation

Atrial Fibrillation AFIB Bradycardia Pacemaker

A woman in her 60s with palpitations

Dr. Smith's ECG Blog

APRIL 24, 2022

The ECG there reportedly showed an irregular tachycardia, and the patient was immediately referred to the emergency room. Here is her ECG on arrival: There is a wide complex tachycardia that is irregularly irregular (this is difficult to determine at these very high rates). Vitals were within normal limits other than heart rate.

AFIB

AFIB Tachycardia Atrial Fibrillation Blog

Does this ST Depression Maximal in V3 Represent Posterior OMI?

Dr. Smith's ECG Blog

AUGUST 17, 2022

ACUTE MI (I allowed Acute MI to be in the report because I knew there would be an elevated troponin from ischemia, which is the definition of acute MI -- but in this case it would most likely be a Type 2 MI from tachycardia) There is also LA-RA lead reversal. The rhythm is rapid AFib. The QRS complex in lead I looks "funny".

Atrial Fibrillation

Atrial Fibrillation Ischemia AFIB Tachycardia

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Can J of Cardiol 2018, 34: 132-145 Here are some other cases: LVH, LBBB, RBBB, and RVH may manifest ST depression without any ischemia! See this case: what do you think the echocardiogram shows in this case?

Ischemia

Ischemia STEMI Stenosis Chest Pain

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

Sinus Tachycardia ( common in any trauma patient. ). Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ). 72; Issue 9; 2018 ) — A ) Brugada-1 ECG pattern, showing coved ST-segment elevation ≥2 mm in ≥1 right precordial lead, followed by a negative T-wave. —

Arrhythmia

Arrhythmia Blog Chest Pain Cardiac Arrest

Palpitations while awaiting CABG

Dr. Smith's ECG Blog

JUNE 14, 2024

The team immediately paged cardiology, concerned for polymorphic ventricular tachycardia. Since sinus conducted QRS complexes cannot co-exist together with ventricular tachycardia, this must all be artifact. The January 30, 2018 post — for PTA. The rhythm terminated before it could be captured on 12-lead.

Atrial Fibrillation

Atrial Fibrillation Tachycardia Blog Chest Pain

Of Twists and Turns

EMS 12-Lead

APRIL 28, 2022

Initial vital signs include: NIBP 99/58 HR 150-160 (trend) RR 10 (spontaneous, but shallow) SpO2 86 (RA) BBS CTA The initial rhythm strip is attached: Figure 1 There is a wide complex tachycardia of varying morphology, amplitude, and R-R cycle length. The rS configuration in Lead I displays a persistent rightward axis.

Tachycardia

Tachycardia AFIB Arrhythmia Coronary Artery Bypass Graft

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

2) Tachycardia to this degree can cause ST segment changes in several ways. First , there can simply be diffuse ST depressions (which obligates reciprocal STE in aVR) associated with tachycardia which are not indicative of ischemia. Is this inferor STEMI? Atrial Flutter with Inferior STEMI? What is the Diagnosis?

Ischemia

Ischemia Atrial Flutter Arrhythmia Tachycardia

Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

JANUARY 15, 2024

We can see enough to make out that the rhythm is sinus tachycardia. Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW.

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

A young man with palpitations.

Wide-complex tachycardia: VT, aberrant, or "other?"

Regular Wide Complex Tachycarida with poor LV function and hypotension. Duration unknown. How to manage?

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Syncope while on a treadmill

A teenager involved in a motor vehicle collision with abnormal ECG

Syncope and Atrial fibrillation in a Healthy 70-something Male

A woman in her 60s with palpitations

Does this ST Depression Maximal in V3 Represent Posterior OMI?

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

Palpitations while awaiting CABG

Of Twists and Turns

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Noisy, low amplitude ECG in a patient with chest pain

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