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.

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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.

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Cardiac Arrest Heart Failure Defibrillator 40

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.

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Cardiac Arrest Defibrillator Ischemia Tachycardia 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.

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COVID-19 Cardiac Arrest Outcomes Hospital 40

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.

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Blog Cardiac Arrest Atrial Fibrillation Bradycardia 137

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".

Cardiac Arrest 98

Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 98

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 161

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 ).

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Blog Chest Pain Cardiac Arrest Cardiomyopathy 123

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.

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Cardiac Arrest Blog Atrial Fibrillation AFIB 68

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.

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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.

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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.

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Cardiogenic Shock Myocardial Infarction Blood Pressure Cardiac Arrest 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.

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Tachycardia Cardiac Arrest ICU Blog 130

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.

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Cardiogenic Shock Cardiac Arrest Outcomes Research 40

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.

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Hospital Outcomes Cardiac Arrest Heart Failure 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).

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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 ).

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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).

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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.

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AFIB Atrial Fibrillation Tachycardia Blog 103

Dr. Smith's ECG Blog

JANUARY 8, 2024

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG == MY Comment , by K EN G RAUER, MD ( 12/31 /2023 ): == My only hope about today's tragic case — is that the involved providers learn from mistakes made. I include a summarizing Table of ECG Findings in Figure-2 of the ADDENDUM below ).

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Chest Pain Pulmonary Embolism STEMI 71

Dr. Smith's ECG Blog

AUGUST 1, 2020

He has done a lot of great work on cardiac arrest, including as co-author of our study on esmolol in refractory cardiac arrest, and much more with Keith Lurie. This was sent by Guillaume Debaty, from the Grenoble Region of France. See his Google Scholar profile here.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Ischemia 52

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. ). The August 22, 2020 post in Dr. Smith's ECG Blog — which illustrates another case of dynamic ST-T wave changes that resulted from a repolarization variant.

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Blog Chest Pain Ischemia STEMI 98

Dr. Smith's ECG Blog

AUGUST 19, 2023

They had had twice the rate of cardiac arrest and twice the in-hospital mortality[1] In another study of patients diagnosed with STEMI, those on dialysis experienced delayed reperfusion and double the mortality.[2] They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS.

Chest Pain 98

Chest Pain STEMI Myocardial Infarction Blog 98

Dr. Smith's ECG Blog

OCTOBER 17, 2024

There was 100% proximal LAD occlusion with TIMI 0 flow, and cardiac arrest in the cath lab. The emergency physician asked for stat cardiology consult, bedside echo showed anterior akinesis, and the cath lab was activated – with door-to-cath time of 4 hours. When seen — such ST elevation is typically seen in anterior leads.

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Chest Pain STEMI Pulmonary Embolism 73

Dr. Smith's ECG Blog

FEBRUARY 27, 2023

I've reproduced this figure from My Comment in the January 6, 2020 post of Dr. Smith's ECG Blog ). See many examples of Pseudo STEMI due to hyperkalemia at these two posts: Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life.

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Tachycardia Document Blog Bradycardia 52

Dr. Smith's ECG Blog

JULY 27, 2023

While hypertension and sinus tachycardia are the most common manifestations — a variety of other tachyarrhythmias ( including VT leading to cardiac arrest ) and acute MI may be seen. Potential cardiovascular effects of acute amphetamine use are multiple.

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Tachycardia Ischemia Cardiac Arrest Echocardiogram 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

Series of Prehospital ECGs Showing Reperfusion == MY Comment by K EN G RAUER, MD ( 9/21/2020 ): == I wish those cardiologists who continue to strictly adhere to STEMI millimeter criteria would begin reading Dr. Smith’s ECG Blog. A mysterious case.

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STEMI Hospital Blog Defibrillator 52

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.

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Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

Physicians initially attributed symptoms to “panic, anxiety or stress” in half of these patients, with women more likely than men to have their symptoms attributed to psychiatric causes (65% vs. 32%; P < 04). == MY Comment by K EN G RAUER, MD ( 9/7/2020 ): == Interesting case with thorough discussion by Dr. Smith on arrhythmia management.

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Tachycardia Heart Disease Dysrhythmia Ablation 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Figure-2: Causes of Low Voltage on ECG ( Figure reproduced from My Comment at the bottom of the page in the November 12, 2020 post in Dr. Smith's ECG Blog ). Figure reproduced from My Comment at the bottom of the page in the September 7, 2020 post in Dr. Smith's ECG Blog ). What is ELECTRICAL ALTERNANS?

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Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

OCTOBER 26, 2020

Case submitted by Magnus Nossen MD from Norway, written by Pendell Meyers A man in his 50s with no pertinent medical history suffered a witnessed cardiac arrest. 12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC.

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Ischemia Arrhythmia Defibrillator Chest Pain 40

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?

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Defibrillator Cardiac Arrest STEMI Chest Pain 113

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.

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Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52