Dr. Smith's ECG Blog

AUGUST 3, 2018

There is a narrow complex tachycardia at a rate of 130. ECGs: there is a regular narrow complex tachycardia still at a rate of exactly 130, with no P-waves and also no change since the prehospital ECG. During tachycardia, in this case, the baseline continuously undulates especially in leads II, aVR and V1; very good for atrial flutter.

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Chest Pain Tachycardia Atrial Flutter Ultrasound 40

Dr. Smith's ECG Blog

JANUARY 6, 2024

This is sinus tachycardia (rhythm) with complete heart block (AV node function) with ventricular escape rate just below 30. Never forget that sinus tachycardia is the scariest arrhythmia. For review — GO TO: The June 4, 2018 post ( LA-LL reversal ). The July 29, 2018 post ( LA-RA reversal ).

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Blog Ischemia Tachycardia STEMI 110

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. Sinus tachycardia does not go this fast. A 60-something ow healthy male had syncope while on treadmill. What do you want to do?

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Atrial Flutter Exercise AFIB Tachycardia 63

Dr. Smith's ECG Blog

DECEMBER 11, 2018

Comment by K EN G RAUER, MD ( 12/11/2018 ): = I love this case — because it brings home 3 of my favorite teaching points about electrolyte disorders and ECG interpretation. It is safe even when there is no hypocalcemia, but is particularly safe if there is hypocalcemia, which you can infer from a long ST segment.

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Tachycardia Diabetes Pacemaker Arrhythmia 52

Open Heart

OCTOBER 16, 2024

This study analysed the circadian variation of SCA in the Chinese community.

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Cardiac Arrest Tachycardia Hospital 52

Open Heart

OCTOBER 13, 2022

Methods This retrospective cohort study included all ACS patients aged≥18 years who were admitted to Dr. Hasan Sadikin Central General Hospital from January 2018 to January 2022. The area under the curve (AUC) among PADMA, GRACE, C-ACS and ProACS risk scores was compared using the fisher Z test.

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Dr. Smith's ECG Blog

JULY 16, 2024

Tachycardia and ST Elevation. == MY Comment , by K EN G RAUER, MD ( 7/7 /2024 ): == Among the most rewarding type of case for me during my days working in the ED — would be seeing a patient who presented with acute CP ( C hest P ain ) — who I would be able to “cure” simply by recognizing and treating their arrhythmia. Would you give lytics?

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Atrial Flutter Chest Pain Tachycardia Arrhythmia 59

Dr. Smith's ECG Blog

JUNE 17, 2018

There is sinus tachycardia. Sinus tachycardia, which exaggerates ST segments and implies that there is another pathology. I have always said that tachycardia should argue against acute MI unless there is cardiogenic shock or 2 simultaneous pathologies. Here is that ECG: What do you think?

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Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

Here is his 12-lead: There is a wide complex tachycardia with a rate of 257, with RBBB and LPFB (right axis deviation) morphology. Read about Fascicular VT here: Idiopathic Ventricular Tachycardias for the EM Physician Case Continued He was completely stable, so adenosine was administered. See Learning point 1 below. Arch Intern Med.

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Tachycardia Heart Disease Dysrhythmia Ablation 52

Vector Remote

JULY 18, 2023

Since partnering with Vector Remote Care in 2018 , Wellstar has succeeded in triaging urgent alerts more quickly, reducing time to treatment, and decreasing hospitalizations. Thanks to SmartReports’ prioritization of the alert, Heather and her team contacted the patient and scheduled an immediate appointment within 15 minutes.

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Outcomes Patient Care Defibrillator Tachycardia 52

EMS 12-Lead

AUGUST 22, 2022

From afar, there is gross tachycardia, cadence irregularities, and narrow QRS complexes that may, or may not, be Sinus in origin; and finally – a cacophony of wide complexes that might very well be ventricular in origin. McLaren : We’ve answered the first question – Sinus Tachycardia with episodic runs of wide QRS (RBBB morphology) and PVC’s.

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Tachycardia Cardiomyopathy Electrophysiology ICU 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

Tachycardia (or nearly) 2. Tachycardia, = 1.8. Finally , they found these independent predictors of PE: Note that tachycardia only has an Odds ratio of 1.8. Tachycardia is unusual in ACS unless there is cardiogenic shock or a second simultaneous pathology. Some providers were worried about ACS because of this ECG.

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Chest Pain Pulmonary Tachycardia Embolism 52

Dr. Smith's ECG Blog

MAY 1, 2023

First, we have a narrow-complex, regular tachycardia, with a rate of about 135-140. This narrows our differential for the rhythm down to sinus tachycardia, paroxysmal supraventricular tachycardia (PSVT, or SVT), and atrial flutter. Tachycardia and ST Elevation. Christmas Eve Special Gift!! Is this inferor STEMI?

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Atrial Flutter Tachycardia Arrhythmia Blog 52

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

Here was the ECG: There is sinus tachycardia. This was sent by a reader. A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. and K was normal. This is "Shark Fin" morphology. Smith — this case was not what I thought. I did recognize the S hark F in m orphology of dramatic ST elevation.

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Cardiogenic Shock STEMI Pericarditis Blog 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2019

The principal d ifferential d iagnosis i s similar to what we derived in the October 16, 2019 Case : i ) Sinus Tachycardia ; ii ) Reentry SVT ( either A VNRT if the reentry circuit is contained within the normal AV nodal pathway — or A VRT if an accessory pathway is involved ) ; iii ) Atrial Tachycardia ; or iv ) Atrial Flutter.

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Tachycardia Atrial Flutter Blog Arrhythmia 52

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.

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AFIB Tachycardia Atrial Fibrillation Blog 52

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. For review — GO TO: The June 4, 2018 post ( LA-LL reversal ).

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Atrial Fibrillation Ischemia AFIB Tachycardia 52

Ken Grauer, MD

JULY 15, 2023

Given the rapid rate of the tachycardia and the amorphous shape of the QRS — the decision was made to sedate the patient and cardiovert. This phenomenon may sometimes be seen following an episode of a sustained tachycardia — in which marked ST-T wave abnormalities not due to infarction may be seen for a period of hours, or even days!

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Dr. Smith's ECG Blog

NOVEMBER 4, 2022

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! Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. Miranda DF, Lobo AS, Walsh B, et al. A normal PR interval.

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Ischemia STEMI Stenosis Chest Pain 52

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. Because the SA node is sick the SA node recovery time is often prolonged, which is why long pauses most commonly follow episodes of tachycardia ( which produced SA node suppression ).

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Atrial Fibrillation AFIB Bradycardia Pacemaker 52

Ken Grauer, MD

JUNE 2, 2023

2 short runs of SVT ( presumably atrial tachycardia ). 2 short runs of SVT ( presumably atrial tachycardia ). The July 5, 2018 post in Dr. Smith's ECG Blog — ( Please see My Comment at the bottom of the page for Review on the ECG diagnosis of S ick S inus Syndrome). Bradycardia was not limited to nighttime hours.

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Dr. Smith's ECG Blog

OCTOBER 28, 2020

This is sinus tachycardia at a Rate of ~115/minute. For more on the ECG findings when leads V1 and V2 are placed too high on the chest — Please SEE My Comment at the bottom of the page in the November 4, 2018 post of Dr. Smith’s ECG Blog ). The Rhythm is regular and rapid. Simply repeat the ECG after verifying correct lead placement.

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STEMI Chest Pain Blog Tachycardia 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

Sinus Tachycardia ( common in any trauma patient. ). 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. — Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ).

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Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

A b rief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality. I find AV dissociation in VT to be very difficult to differentiate from artifact, as there are always random blips on tachycardia tracings. Past medical history includes coronary stenting 17 years prior.

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Tachycardia Cardiogenic Shock Angina Blog 138

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

We have often referred to this almost magical m irror- i mage r elationship for ST-T waves in leads I II and aV L — which when present, means a cute i nferior O MI until you prove otherwise ( See My Comment on the 8/9/2018 SSmith Blog Post ). CLICK HERE — for my detailed discussion of this subject ).

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Dr. Smith's ECG Blog

JUNE 2, 2023

She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for a regular tachycardia, possible rales at both bases, some mild RUQ abdominal tenderness. Thus, I believe it is a regular, monomorphic, wide complex tachycardia. Or it could simply still be classic VT. What is the Diagnosis?

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Tachycardia Cardiomyopathy Electrocardiogram Article 96

DAIC

APRIL 16, 2025

Ventrax is intended to facilitate placement of devices used in ablation procedures commonly performed to treat an abnormally fast heartbeat known as ventricular tachycardia (VT). Retrograde Aortic Access During Ventricular Tachycardia Ablation: Indications, Techniques, and Challenges. commercial release of its Ventrax Delivery System.

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Aortic Sudden Cardiac Death Electrophysiology Ablation 52

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.

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Atrial Fibrillation Tachycardia Blog Chest Pain 81

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?

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Ischemia Atrial Flutter Arrhythmia Tachycardia 52

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. Chapter 10: Recurrent Ventricular Tachycardia (pg. 2] Viskin, S., 3] Murphy, M.

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Tachycardia AFIB Arrhythmia Coronary Artery Bypass Graft 52

Circulation

NOVEMBER 11, 2024

Introduction:Supraventricular tachycardia (SVT) is common and poorly tolerated in patients who have undergone Fontan procedure. Rate of recurrence did not differ between those who had the procedure before or after 2018. Atrial Tachycardia (70%) and Typical Atrial Flutter (65%) were the most common SVTs ablated.

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Ablation Atrial Flutter Outcomes Arrhythmia 40

Dr. Smith's ECG Blog

APRIL 6, 2018

There is a regular, wide complex, (mostly) monomorphic tachycardia. The differential of wide, regular, monomorphic tachycardia is: VT or SVT with aberrancy, all +/- hyperkalemia (see diagrams below). Really wide tachycardia = VT or SVT with conduction abnormality + hyperkalemia, until proven otherwise.

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Cardiac Arrest Tachycardia Defibrillator ICU 52

Journal of Cardiovascular Electrophysiology

FEBRUARY 7, 2024

Chagas disease (ChD) was associated with increased rates of ventricular tachycardia and ventricular fibrillation in ICD patients only in the initial two periods, but there was no statistical difference in the last period. Methods This retrospective observational study included patients who received ICDs between October 2007 and December 2018.

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Defibrillator Sudden Cardiac Death Tachycardia Public Health 40

Dr. Smith's ECG Blog

OCTOBER 20, 2024

NOTE: For those wanting more practice recognizing Shark Fin ST-T wave changes — we've shown cases of this entity in the following ECG Blog posts ( among others ): In the June 11, 2018 post — In the October 4, 2019 post — In the November 22, 2019 post — in the January, 24, 2020 post — in the February 16, 2020 post — in the April 25, 2020 post — in the (..)

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Circulation: Arrhythmia and Electrophysiology

DECEMBER 20, 2024

This study aimed to create a preprocedural screening tool to identify patients at risk of non-PV triggers during first-time AF ablation.METHODS:All patients who underwent first-time AF ablation at the Hospital of the University of Pennsylvania between 2018 and 2022 were identified.

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Atrial Fibrillation Ablation Electrophysiology Tachycardia 40

Circulation

NOVEMBER 10, 2023

We performed propensity score matched (PS) analysis of LBBAP and BVP in a 1:1 ratio.

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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.

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Chest Pain Blog Arrhythmia Critical Care 63