Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. N Engl J Med [Internet] 2019;Available from: [link] Should all patients with shockable arrest be taken to angiography regardless of STEMI or No STEMI?

Defibrillator 113

Defibrillator Cardiac Arrest STEMI Chest Pain 113

Open Heart

NOVEMBER 14, 2023

Background Out-of-hospital cardiac arrest (OHCA) has a dismal prognosis with overall survival around 10%. Previously, 80% of sudden cardiac arrest have been attributed to coronary artery disease. We studied comorbidities and discharge diagnoses in OHCA in all of Sweden.

Cardiac Arrest 52

Cardiac Arrest Coronary Artery Disease Hospital Heart Failure 52

HeartRhythm

APRIL 30, 2024

In part due to advances in guideline-directed medical therapy (GDMT) and availability of implantable cardioverter-defibrillators (ICDs), cardiac arrest (CA) rates among patients with heart Failure (HF) decreased in the early 2000s. Relatively little is known about trends in CA associated with HF over the past decade.

Cardiac Arrest 40

Cardiac Arrest Heart Failure Defibrillator 40

Ken Grauer, MD

JUNE 27, 2024

He developed cardiac arrest shortly after the ECG in Figure-1 was recorded. C ASE C onclusion: As noted above — today's patient developed cardiac arrest shortly after arrival in the ED. See My Comment in the June 1, 2020 post in Dr. Smith's ECG Blog — for review of Pleomorphic VT.

Blog 161

Blog Cardiac Arrest Sudden Cardiac Death Tachycardia 161

Dr. Smith's ECG Blog

APRIL 29, 2020

A 60-something woman presented after a witnessed cardiac arrest. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. Final Diagnosis: Cardiac Arrest due to Torsades from long QT of unknown etiology.

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Journal of Cardiovascular Electrophysiology

NOVEMBER 3, 2023

Graphical abstract depicting cardiac arrest mortality disparities in the young, temporal trends, and its correlation with the social vulnerability index. Abstract Background Cardiac arrest (CA) is a leading cause of death in the United States (US). in 2020 with an average annual percentage change of −1.3% ( p  = .001).

Cardiac Arrest 40

Cardiac Arrest Certification Outcomes Article 40

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Cardiac Troponin Testing in Patients with COVID-19: A Strategy for Testing and Reporting Results. Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. Guo T, Fan Y, Chen M, et al.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

JUNE 5, 2024

IMPRESSION: The finding of sinus bradycardia with 1st-degree AV block + marked sinus arrhythmia + the change in PR interval from beat #5-to-beat #6 — suggests a form of vagotonic block ( See My Comment in the October 9, 2020 post in Dr. Smith's ECG Blog ). As a result — an ICD may need to be considered in selected cases.

Chest Pain 122

Chest Pain Blog Cardiac Arrest Cardiomyopathy 122

Circulation

NOVEMBER 11, 2024

Background:Different from the negative impact of COVID-19 pandemic on outcomes after out-of-hospital cardiac arrest (OHCA) collapsed before emergency medical service (EMS) arrival, there was a report suggested that COVID-19 pandemic did not affect outcomes after OHCA witnessed by EMS personnel.

COVID-19 40

COVID-19 Cardiac Arrest Outcomes Hospital 40

Dr. Smith's ECG Blog

MAY 3, 2024

Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock. Suffice it to say that, "The heart does whatever it will do when a patient is about to arrest". RBBB + LAFB in the setting of ACS is very bad.

Cardiogenic Shock 127

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 127

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 138

Blog Cardiac Arrest Atrial Fibrillation Bradycardia 138

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. So, your next step is to Trace it down, and Copy it over".

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Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 98

Dr. Smith's ECG Blog

OCTOBER 20, 2024

This patient is actively dying from a left main coronary artery OMI and cardiac arrest from VT/VF or PEA is imminent! Complete LMCA occlusion is associated with clinical shock and/or cardiac arrest. The arterial blood gas showed a lactic acidosis with a lactate level of 17mmol/L.

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Ken Grauer, MD

JUNE 14, 2024

The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. C ASE C onclusion: As noted above — the middle-aged man in today's case presented to the ED in cardiac arrest. In view of this history — How would YOU interpret the ECG in Figure-1 ?

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Blog STEMI Cardiac Arrest Tachycardia 155

Ken Grauer, MD

JULY 9, 2023

Blood was drawn , and the patient was promptly placed in a room to be seen — but on entering, the ED physician found her unresponsive in cardiac arrest. Do you see any indication on this ECG of WHY this patient was about to arrest? Is there any indication on this ECG of WHY this patient shortly after had a cardiac arrest?

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Blog Cardiac Arrest Pulmonary AFIB 78

Dr. Smith's ECG Blog

DECEMBER 13, 2023

For technical reasons — P waves are not well visible in this tracing — BUT — the P wave in lead I appears to be larger than the P wave in lead II , which is often a tip-off to LA-LL Reversal ( See My Comment in the November 19, 2020 and the May 24, 2022 posts in Dr. Smith's ECG Blog ).

Blog 123

Blog Chest Pain Cardiac Arrest Cardiomyopathy 123

DAIC

JANUARY 11, 2024

Researchers analyze primary and secondary cardiovascular outcomes in 132,784 inpatients with COVID-19 (October 8, 2020 to September 30, 2021) and 31,173 inpatients with non-COVID-19 pneumonia (January 1, 2019 to December 31, 2019) in Korea. The results indicate a lower risk of cardiovascular disease in COVID-19 patients.

COVID-19 103

COVID-19 Hospital Thrombosis Inpatient 103

Circulation

NOVEMBER 11, 2024

1] Physical and emotional triggers have been linked with occurrence of Stress induced Cardiomyopathy.Methods:We have obtained the National Readmission database for the year of 2020. Total 494 patients had cardiac arrest and 191 patients out of this 494 had died. Incidence of Cardiac Arrest was 4.7%

Cardiomyopathy 40

Cardiomyopathy Cardiac Arrest Risk Factors Hemorrhage 40

Dr. Smith's ECG Blog

SEPTEMBER 12, 2023

For more on my systematic approach — Check out My Comment in the May 3, 2020 post ). Smith’s ECG Blog: SQTS is an inherited cardiac channelopathy determined by the presence of symptoms ( syncope, cardiac arrest ) — positive family history — and the ECG finding of an abnormally short QTc interval.

Cardiac Arrest 69

Cardiac Arrest Blog Atrial Fibrillation AFIB 69

Open Heart

JUNE 5, 2024

Results From 1 January 2005 to 31 December 2020, 2727/18 988 (14.4%) patients were SMuRF less, with the proportion increasing over time. SMuRF-less patients were more likely to present with cardiac arrest (6.6% Mean age was similar for patients with and without SMuRFs (63 years), and fewer females were SMuRF-less (19.8%

Cardiogenic Shock 52

Cardiogenic Shock Myocardial Infarction Outcomes Coronary Artery Disease 52

Circulation: Cardiovascular Interventions

JANUARY 20, 2025

METHODS:This retrospective cohort study analyzed data from 2 academic centers involving patients with intermediate-risk PE from January 2020 to January 2024. The primary outcome was a composite of 30-day mortality, resuscitated cardiac arrest, hemodynamic instability, and 90-day readmission.

Embolism 40

Embolism Pulmonary Outcomes Cardiac Arrest 40

Circulation

NOVEMBER 11, 2024

This study aims to evaluate the outcomes of chronic opioid therapy on HFpEF patients.Methods:Studying the National Inpatient Sample (2016-2020), we identified adult HFpEF patients using the appropriate ICD-10 codes -after excluding patients with end-stage renal disease (ESRD)- and compared outcomes between chronic opioid users and non-users.

Preserved Ejection Fraction 40

Preserved Ejection Fraction Inpatient Cardiogenic Shock Heart Failure 40

Open Heart

AUGUST 27, 2023

Methods and results 2407 consecutive patients presenting to Harefield Hospital with measured arterial blood gases, from January 2011 to December 2020, were studied to build the training set. 30-day mortality in this group was 17.2%. 1 point, 5–9.9: The validation metrics were excellent with a c-statistic of 0.9,

Cardiac Arrest 52

Cardiac Arrest Hospital 52

Journal of the American Heart Association

NOVEMBER 28, 2023

A total of 406 patients were enrolled at 80 sites between 2016 and 2020. Average age was 64±12 years, 24% were female, 17% had a witnessed out‐of‐hospital cardiac arrest, 27% had in‐hospital cardiac arrest, and 9% were under active cardiopulmonary resuscitation during MCS implantation.

Cardiogenic Shock 40

Cardiogenic Shock Myocardial Infarction Blood Pressure Cardiac Arrest 40

Journal of the American Heart Association

MARCH 21, 2025

However, the association of socioeconomic vulnerability and outcomes after hospitalization is uncertain.Methods and ResultsAmerican Heart Association COVID19 Cardiovascular Disease Registry hospitalizations between March 1, 2020, and June 30, 2022, linked with Medicare feeforservice claims, were analyzed.

COVID-19 40

COVID-19 Medicare Cardiogenic Shock Hospital 40

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. The described rhythm was an irregular, wide complex rhythm.

Tachycardia 131

Tachycardia Cardiac Arrest ICU Blog 131

European Journal of Heart Failure

DECEMBER 19, 2024

Methods and results Among 657 patients enrolled from March 2020 to November 2023, 198 (30.1%) received oxygen therapy (OT), 96 (14.6%) underwent non-invasive ventilation (NIV), and 363 (55.3%) underwent invasive mechanical ventilation (iMV). for the NIV group ( p =0.005), even after excluding patients with cardiac arrest at presentation.

Cardiogenic Shock 40

Cardiogenic Shock Cardiac Arrest Outcomes Research 40

Circulation

NOVEMBER 11, 2024

This study aimed to evaluate the effect of MP on postoperative inflammation and outcomes in neonatal cardiac surgery with cardiopulmonary bypass (CPB).Methods:From Methods:From September 2020 to August 2023, 86 neonates who underwent cardiac surgery with CPB were enrolled in this double-blind randomized controlled trial.

Outcomes 40

Outcomes Cardiac Arrest Circulation Research 40

Dr. Smith's ECG Blog

JULY 21, 2024

As I review in My Comment in the January 16, 2020 post of Dr. Smith's ECG Blog ( and have reproduced in Figure-2 below ) — the ECG of patients with acute LMCA occlusion may be varied. Smith's ECG Blog — it is rare in practice to see LMCA occlusion, because most such patients die before reaching the hospital.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Circulation

NOVEMBER 11, 2024

Understanding the association with acute myocarditis (AMC) is crucial for preemptive management strategies and improving patient outcomes.Methods:We identified and compared adults (>18 years) with SID vs. non-SID patients hospitalized with AMC using the National In-patient sample database from 2016-2020.

Hospital 40

Hospital Outcomes Cardiac Arrest Heart Failure 40

Circulation

NOVEMBER 11, 2024

AAMRs were stable in recent years for Non-Hispanic (NH) Asian or Pacific Islanders (2018-2020; APC (11.7 [-0.9, Ischemic heart disease (AAMR 2.0), hypertensive disease (AAMR 1.7), and cardiac arrest (AAMR 1.4) The AAMR declined from 1999 to 2016 (APC -3.0 [-3.3, -2.8]) and rose till 2022 (APC 4.6 [3.4, 100000 people).

Cancer 40

Cancer Cardiovascular Disease Cardiac Arrest Heart Disease 40

Circulation

NOVEMBER 11, 2024

Data was obtained from the Hospital Corporation of America (HCA) enterprise-wide database from January 2020 to September 2023 using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).

Heart Failure 40

Heart Failure Cardiac Arrest Kidney Disease Atrial Fibrillation 40

Dr. Smith's ECG Blog

MAY 19, 2020

I suspect this is Type 2 MI due to prolonged severe hypotension from cardiac arrest. 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 ). 24, 2020 post ( link to that post given above ).

Defibrillator 52

Defibrillator Circulation Plaque Cardiac Arrest 52

European Journal of Heart Failure

DECEMBER 13, 2023

Methods and results This nationwide observational cohort study describes all AMICS patients treated with Impella (ABIOMED, Danvers, MA, USA) and/or VA-ECMO in 2020–2021. Impella patients were older (34% vs. 13% >75 years, p  < 0.001) and less frequently presented after an out-of-hospital cardiac arrest (18% vs. 40%, p  < 0.001).

Cardiogenic Shock 40

Cardiogenic Shock Myocardial Infarction Cardiac Arrest Hospital 40

Dr. Smith's ECG Blog

DECEMBER 13, 2024

NOTE: The ECGs in today's case are recorded in the Cabrera Format ( See Dr. Grauer Comment in the October 26, 2020 post of Dr. Smith's ECG Blog for review on the Cabrera Format ). Regarding AFib with WPW: The very rapid heart rate and at times extremely short R-R intervals put the patient with AFib and WPW at risk of cardiac arrest from VFib.

AFIB 103

AFIB Atrial Fibrillation Tachycardia Blog 103

All About Cardiovascular System and Disorders

OCTOBER 25, 2023

But the full cohort of the CABANA trial did not show a significant reduction in the primary composite end point of death, disabling stroke, serious bleeding or cardiac arrest [7]. 2020 Oct 1;383(14):1305-1316. Epub 2020 Aug 29. 2019 Apr 2;321(13):1261-1274. doi: 10.1001/jama.2019.0693. PMID: 30874766; PMCID: PMC6450284.

Atrial Fibrillation 52

Atrial Fibrillation Heart Failure Ablation Cardiac Arrest 52

Dr. Smith's ECG Blog

MAY 5, 2022

Steve, what do you think of this ECG in this Cardiac Arrest Patient?" A woman in her 50s with dyspnea and bradycardia A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB). HyperKalemia with Cardiac Arrest. The February 11, 2020 post ( LA-RA reversal ).

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52