2019, Cardiac Arrest and Ischemia - Cardiovascular Update

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

Sudden shock with a Nasty looking ECG. What is it?

Dr. Smith's ECG Blog

MAY 3, 2024

When I was shown this ECG, I said it looks like such widespread ischemia that is might be a left main occlusion, or LM ischemia plus circumflex occlusion (high lateral and posterior OMI). In Figure-1 — I reproduce major points that I've summarized from Dr. Smith's August 9, 2019 post on the subject. There is STE in aVR.

Cardiogenic Shock

Cardiogenic Shock Cardiac Arrest Hospital Ischemia

A man in his 60s with syncope and ST depression. What does the ECG mean?

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A prior ECG was available for comparison: Normal One might be tempted to interpret the ST depression as ischemia, but as Smith says, "when the QT is impossibly long, think of hypokalemia and a U-wave rather than T-wave." Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest.

Ischemia

Ischemia Chest Pain Cardiac Arrest Blog

A man in his 50s with acute chest pain who is lucky to still be alive.

Dr. Smith's ECG Blog

JUNE 21, 2023

You can subscribe for news and early access (via participating in our studies) to the Queen of Hearts here: [link] queen-form This EMS ECG was transmitted to the nearby Emergency Department where it was remotely reviewed by a physician, who interpreted it as normal, or at least without any features of ischemia or STEMI.

Chest Pain

Chest Pain Cardiac Arrest STEMI Defibrillator

What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

JULY 21, 2024

There is no definite evidence of acute ischemia. (ie, Simply stated — t he patient was having recurrent PMVT without Q Tc prolongation, and without evidence of ongoing transmural ischemia. ( Some residual ischemia in the infarct border might still be present. Both episodes are initiated by an "R-on-T" phenomenon.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

JANUARY 2, 2025

See this post: How a pause can cause cardiac arrest 2. It should be kept in mind that on occasions, beta-one agonist can result in increased ventricular ectopy e.g., in severe myocardial ischemia (by increasing myocardial demand), or sometimes with congenital long-QT syndrome. The plan: 1. Place temporary pacemaker 3.

Tachycardia

Tachycardia Cardiomyopathy Blog Bradycardia

ECG Blog #400 — Is this a NSTEMI?

Ken Grauer, MD

OCTOBER 21, 2023

Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiac arrest; shock or profound hypotension; GI bleeding; anemia; "sick patient" , etc. ). To EMPHASIZE: This pattern of diffuse Subendocardial Ischemia does not suggest acute coronary occlusion ( ie, it is not the pattern of an acute MI ).

Blog

Blog Chest Pain Ischemia STEMI

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

His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Am J Med 2019, 132(5):622-630.

Ischemia

Ischemia STEMI Stenosis Chest Pain

ECG Blog #383 — Is this Coronary Disease?

Ken Grauer, MD

JUNE 6, 2023

Part of the ST depression with deep T wave inversion in the lateral chest leads clearly reflects LV "strain" from the marked LVH — but despite the very large QRS amplitudes, this ST-T wave appearance looks disproportionate, suggesting at least a component of ischemia. The plan was to proceed as soon as possible with aortic valve replacement.

Blog

Blog Pulmonary Hypertension Aortic

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

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 2019 Sep 10;140(11):e649-e650] [published correction appears in Circulation. Published 2019 Feb 28. 12 Colchicine, 0.5 34 Colchicine, 0.5 12 Importantly, colchicine, 0.5

Cardiovascular Disease

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease

A Middle-Aged male with Chest Pain and an Unusual ECG

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.

Chest Pain

Chest Pain STEMI Ischemia Myocardial Infarction

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

Dr. Smith's ECG Blog

APRIL 15, 2019

If a patient presents with chest pain and a normal heart rate, or with shockable cardiac arrest, then ischemic appearing ST elevation is STEMI until proven otherwise. It is prudent to treat the other conditions, get the heart rate controlled, and repeat the ECG.

Tachycardia

Tachycardia STEMI Chest Pain Ischemia

What is this ECG finding? Do you understand it before you hear the clinical context?

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

We periodically review this intriguing ECG finding that is best known for its association with hypothermia — but which may also be seen in association with a number of other entities, including acute infarction and cardiac arrest. My Comment addresses a few additional aspects of this phenomenon.

Blog

Blog Cardiac Arrest Atrial Fibrillation Bradycardia

Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). Association of Coronavirus Disease 2019 (COVID-19) With Myocardial Injury and Mortality. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Guo T, Fan Y, Chen M, et al.

Cardiac Arrest

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

It is apparently fortunate that she had a cardiac arrest; otherwise, her ECG would have been ignored. Then they did an MRI: Patient underwent cardiac MRI on 10/4 that showed mildly reduced BiV systolic function. She was defibrillated and resuscitated. Smith: this ECG and clinical presentation is diagnostic of LAD Occlusion.

Plaque

Plaque Chest Pain Thrombosis Stenosis

Status epilepticus. What is this ECG pathognomonic of?

Dr. Smith's ECG Blog

NOVEMBER 18, 2019

No more abnormal U-waves == MY Comment, by K EN G RAUER, MD ( 11/18/2019 ): == LOTS of great points regarding use of the ECG in association with electrolyte abnormalities. This is often quite challenging to recognize — but the finding of negative U waves in a patient with chest pain is highly suggestive of ischemia !

Chest Pain

Chest Pain Cardiac Arrest Bradycardia Ischemia

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. 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.

Heart Rhythm

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

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

These include ( among others ) — acute febrile illness — variations in autonomic tone — hypothermia — ischemia-infarction — malignant arrhythmias — cardiac arrest — and especially Hyperkalemia. Patients with such conditions that may transiently mimic the ECG findings of a Brugada-1 pattern are said to have Brugada Phenocopy.

Arrhythmia

Arrhythmia Blog Chest Pain Cardiac Arrest

Young Man with a Heart Rate of 257. What is it and how to manage?

Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

Not all forms of idiopathic VT are predictable based on their ECG appearance ( Anderson et al, 2019 ). Anderson et al, 2019 ) — the chest lead LBBB pattern characteristic of LVOT ( as distinguished from RVOT ) — is that transition tends to occur earlier ( ie, by V1-V2 for LVOT vs after V3 or V4 for RVOT ).

Tachycardia

Tachycardia Heart Disease Ablation Dysrhythmia

Hypothermia at 18 Celsius in V Fib arrest: CPR, then ECMO rewarming, for 3 hours, then Defib with ROSC. Interpret the ECG.

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiac arrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ). Rituparna et al — as well as Chauhan and Brahma ( Int.

Cardiac Arrest

Cardiac Arrest Bradycardia Chest Pain Ischemia

One of those ECGs you need to instantly recognize, which learners may struggle with at first

Dr. Smith's ECG Blog

JANUARY 11, 2025

The ECG shows sinus tachycardia, RBBB+LAFB, and signs of anterolateral acute transmural ischemia (most likely due to acute coronary occlusion), with concordant STE in I and aVL, inappropriate STE in V4-6 (though limited a bit by motion, still definite). Plus recommendations from a 5-member panel on cardiac arrest.

Cardiogenic Shock

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Sudden shock with a Nasty looking ECG. What is it?

A man in his 60s with syncope and ST depression. What does the ECG mean?

A man in his 50s with acute chest pain who is lucky to still be alive.

What are treatment options for this rhythm, when all else fails?

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

ECG Blog #400 — Is this a NSTEMI?

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

ECG Blog #383 — Is this Coronary Disease?

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

A Middle-Aged male with Chest Pain and an Unusual ECG

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

What is this ECG finding? Do you understand it before you hear the clinical context?

Extreme shock and cardiac arrest in COVID patient

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Status epilepticus. What is this ECG pathognomonic of?

Hyperthermia and ST Elevation

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

Young Man with a Heart Rate of 257. What is it and how to manage?

Hypothermia at 18 Celsius in V Fib arrest: CPR, then ECMO rewarming, for 3 hours, then Defib with ROSC. Interpret the ECG.

One of those ECGs you need to instantly recognize, which learners may struggle with at first

Stay Connected