2020 AFIB Ischemia 
Ken Grauer, MD
JANUARY 13, 2024
My written interpretation on a tracing such as this one would read, "Marked LVH and 'strain' and/or ischemia — with need for clinical correlation." BOTTOM LINE: ECG changes of LV "strain" and/or ischemia that we see on today's initial ECG — were not present 9 years earlier. WPW Cardiac arrhythmias ( including AFib ).
Dr. Smith's ECG Blog
FEBRUARY 2, 2024
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.
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). There is STE in aVR. Thus, there is high lateral OMI with diffuse ST depression. Moreover, left main occlusion often presents near death.
Ken Grauer, MD
MARCH 29, 2023
M y I MPRESSION : The rhythm in Figure -1 is almost certain to be very rapid AFib in a patient with WPW. NOTE #2: Surprisingly, it is not uncommon for patients in AFib with WPW to be hemodynamically stable — despite having exceedingly rapid ventricular rates. ECG Blog #284 — Reviews a case similar to today's Very Fast AFib.
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. Atrial fib may cause Occlusion mimic."
Dr. Smith's ECG Blog
JANUARY 22, 2020
There was no evidence of ischemia. See this terrible case: Computer often fails to diagnose atrial fibrillation in ventricular paced rhythm, and that can be catastrophic == MY Comment , by K EN G RAUER, MD ( 1/22/2020 ): == Our THANKS to Dr. Smith for presenting this extremely interesting case. Hyperkalemia. Her K was normal 3.
Dr. Smith's ECG Blog
JANUARY 9, 2024
Are you confident there is no ischemia? Primary VT , and the VT with tachycardia is causing ischemia with chest discomfort (supply-demand mismatch/type 2 MI)? Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? Do you agree with this strategy? How can you better assess the ST segments?
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