Dr. Smith's ECG Blog

JULY 26, 2023

My Thoughts on the Initial ECG: Systematic interpretation of ECG #1 shows: Sinus bradycardia at ~55-60/minute — normal intervals ( PR-QRS-QTc ) — normal frontal plane axis ( about +20 degrees ) — no chamber enlargement. To facilitate comparison in Figure-1 — I put this 2018 prior tracing ( = ECG #3 ) — together with ECG #1.

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Dr. Smith's ECG Blog

MAY 30, 2023

Here is his ED ECG: There is bradycardia with a junctional escape. Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. For review — GO TO: The June 4, 2018 post ( LA-LL reversal ). The July 29, 2018 post ( LA-RA reversal ). The November 4, 2018 post ( Leads V1,V2 misplacement ).

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All About Cardiovascular System and Disorders

MAY 2, 2024

Athlete’s bradycardia due to increased parasympathetic tone and decreased sympathetic tone is a well-known observation. Though sinus bradycardia is usual, other abnormalities like sinus arrhythmia, sinus arrest, wandering atrial pacemaker and coronary sinus rhythm have been described. 2018 Sep;27(9):1052-1062. N Engl J Med.

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Dr. Smith's ECG Blog

OCTOBER 20, 2024

As per Dr. Nossen — today's initial ECG ( LEFT tracing in Figure-2 ) shows sinus bradycardia with QRS widening due to bifascicular block ( RBBB/LAHB ). There is marked, diffuse ST segment depression in ECG #1.

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European Journal of Heart Failure

NOVEMBER 22, 2023

Hypotension, bradycardia, kidney dysfunction and hyperkalaemia were the main causes of underprescription and/or underdosing, but up to a half of the patients did not receive target doses for unknown causes (51%, 41%, and 55% for BB, ACEi/ARB/ARNI and MRA, respectively). 0.84, and HR 0.74, 95% CI 0.58–0.95, 0.95, respectively).

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Dr. S. Venkatesan MD

NOVEMBER 22, 2024

2018 Jan;111(1):59-69. Reference How many of us know there is a journal exclusive dedicated to AF ? Journal of atrial fibrillation 1.Scridon Scridon A, Şerban RC, Chevalier P. Atrial fibrillation: Neurogenic or myogenic? Arch Cardiovasc Dis. doi: 10.1016/j.acvd.2017.11.001. 2017.11.001. Epub 2017 Dec 8. PMID: 29229215. P, Gehi AK.

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Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Am J Cardiol 2018; 122(8):1303-1309. Patient presentation is important This was a 60-something with acute chest pain: There is sinus bradycardia at a rate of 44. In case you were wondering about the T-waves and bradycardia, the K was normal. Why bradycardia? In summary: At a cutpoint of 17.0, it is 97% sensitive.

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Dr. Smith's ECG Blog

JULY 24, 2018

Hyperkalemia findings include the classic peaked T-waves, as well as the deadly B's of hyperkalemia: Broad (wide QRS), Brady (bradycardia), Blocks (AV blocks), and Bizarre. Learning Points: You must be able to recognize the early stages of hyperkalemia which precede decompensation.

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Dr. Smith's ECG Blog

MAY 6, 2019

Excerpted from Vutthikraivit et al: Acta Cardiol Sin 34:267-277, 2018 ). == Distinction is made between 2 types of Brugada ECG patterns: A B rugada - 1 ECG pattern — shows ≥2 mm coved ST elevation with sharp downslope plus T wave inversion in ≥2 anterior leads. Bradycardia. Acute febrile illness. Variations in autonomic tone.

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Dr. Smith's ECG Blog

NOVEMBER 25, 2022

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. — Sinus Tachycardia ( common in any trauma patient. ).

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Dr. Smith's ECG Blog

FEBRUARY 15, 2018

Here are inferior leads, and aVL, magnified: A closer inspection of the inferior leads and aVL Sinus bradycardia. J Electrocardiology January–February, 2018; Volume 51, Issue 1, Pages e5–e6. I had no history on the case and no prior ECG for comparison. What do you think?

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Dr. Smith's ECG Blog

APRIL 6, 2018

Because hyperkalemia kills by either VT or VF arrest, or by bradycardia with PEA arrest, this should be assumed to be VT until proven otherwise. In 2018 there is generally a delay to onset of dialysis in most EDs. We set the machine to synchronized cardioversion. We could have also considered terbutaline (start at 0.25

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Dr. Smith's ECG Blog

MAY 19, 2020

There is sinus bradycardia with one PVC. Shark Fin morphology has been discussed a number of times on Dr. Smith’s ECG Blog ( For review — See the June 11, 2018 post and the January 24, 2020 post , to name just 2 instances ). She then had a 12-lead: What do you think?

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Dr. Smith's ECG Blog

JANUARY 30, 2019

Heart Rhythm, 4(2), 198-199. [6] Fever-related arrhythmic events in the multicenter survey on arrhythmic events in Brugada syndrome. Heart Rhythm, 15(9): 1394-1401. [7] 7] American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

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Dr. Smith's ECG Blog

MARCH 15, 2023

Baseline bradycardia in endurance athletes limits the use of ß-blockers. For more on SSS — See My Comment at the bottom of the page in the July 5, 2018 post in Dr. Smith’s ECG Blog. Clinically — The importance of factoring in increased vagal tone as a contributing factor to AFib episodes — extends into management.

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Dr. Smith's ECG Blog

APRIL 15, 2019

CLICK HERE — for the ESC/ACC/AHA/WHF 2018 Consensus Document on the 4th Universal Definition of MI, in which these concepts are discussed and illustrated.

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Dr. Smith's ECG Blog

DECEMBER 16, 2018

Additionally, her beta-blocker dose had been decreased because of bradycardia, further predisposing her to atrial flutter. Follow - up: Further discussion with the patient revealed that they had misunderstood the flecainide dosing, and had basically tripled their dose!

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Ken Grauer, MD

OCTOBER 4, 2024

To improve visualization — I've digitized the original ECG using PMcardio ) MY Thoughts on the ECG in Figure-1: This is a challenging tracing to interpret — because there is marked bradycardia with an irregular rhythm and a change in QRS morphology. Figure-1: The initial ECG in today's case. ( The QRS complex is wide ( ie, >0.10

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Circulation: Cardiovascular Quality & Outcomes

FEBRUARY 8, 2024

We aimed to develop standardized, nationally representative CVD events and selected possible CVD treatment–related complication hospitalization costs for use in cost-effectiveness analyses.METHODS:Nationally representative costs were derived using publicly available inpatient hospital discharge data from the 2012-2018 National Inpatient Sample.

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Dr. Smith's ECG Blog

DECEMBER 5, 2019

Regardless of further evaluation, she should avoid bradycardia, AV nodal blockers, Na channel blockers, and fevers. --If Heart Rhythm 2018. --Genetic testing could be helpful to confirm the diagnosis and allow for screening of other at-risk family members. --EP The risk of ventricular fibrillation in asymptomatic patients was 0.9%/y

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