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

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

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 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

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 ).

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Blog Chest Pain Ischemia STEMI 99

Ken Grauer, MD

MAY 26, 2023

This ST depression appears to be maximal in leads V3-to-V5 — which could reflect acute posterior OMI ( O cclusion-based M yocardial I nfarction ) — most probably with multi -vessel disease ( ie, diffuse subendocardial ischemia suggested by the ST depression with ST elevation in aVR>V1 ). This patient has new CP — and — he is hypotensive.

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Blog Ischemia STEMI Cardiac Arrest 78

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. The Queen was not able to see this one: Of course we do not know for certain that the inferior findings represent ischemia. It was not.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Ischemia 52

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 78

Blog Pulmonary Hypertension Aortic 78

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

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in most other leads (and/or a component of subendocardial ischemia pattern). Plus recommendations from a 5-member panel on cardiac arrest.

Chest Pain 52

Chest Pain Cardiogenic Shock Tachycardia Ischemia 52

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 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

This is a case written by Dan Lee (One of our fantastic Hennepin Residents, class of 2020 ) edits by Smith A 60 something-year-old man with a history of ESRD, LVH and prior CABG presented after an episode of hypotension during his hemodialysis, run followed by a syncopal episode which caused his run to be terminated early.

Chest Pain 52

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia 52

Dr. Smith's ECG Blog

JULY 27, 2023

hours ECG: Not much change hs troponin I peaks at 500 ng/L 8 hours Next morning Urine drug screen: Amphetamine, Methamphetamine, Fentanyl, Fentanyl metabolite Formal Bubble Contrast Echocardiogram: Indications for Study: Silent Ischemia. Conclusion: Type II MI probable due to hypoxia and tachycardia from resp arrest and amphetamine use.

Tachycardia 52

Tachycardia Ischemia Cardiac Arrest Echocardiogram 52

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.

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Chest Pain STEMI Myocardial Infarction Blog 98

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 2020 Jan 28;141(4):e60] [published correction appears in Circulation. 2020 Apr 21;141(16):e774]. 12 Colchicine, 0.5 34 Colchicine, 0.5 12 Importantly, colchicine, 0.5

Cardiovascular Disease 111

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease 111

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. 2020 Sep;31(9):2474-2483. Spontaneous type 1 ECG has the highest number of points at 3.5, Arch Cardiovasc Dis.

Sudden Cardiac Death 52

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 26, 2020

See these other related cases: A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB). Appreciation of this PEARL #8 is important for assessing ischemia because hyperkalemia may either mimic or mask ischemic ECG changes! Is this just right bundle branch block?

Bradycardia 52

Bradycardia Ischemia Cardiac Arrest AFIB 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?

Tachycardia 40

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.

Ischemia 40

Ischemia Arrhythmia Defibrillator Chest Pain 40

Dr. Smith's ECG Blog

JANUARY 30, 2019

In addition to a spontaneous or induced Brugada-1 ECG pattern, criteria for B rugada S yndrome require one or more of the following: History of cardiac arrest, of polymorphoic VT, or of non-vagal syncope — positive family history of sudden death at an early age — a similar ECG in close relatives.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 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.

Tachycardia 52

Tachycardia Heart Disease Dysrhythmia Ablation 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.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

Occurrence of “J Waves” in 12-Lead ECG as a Marker of Acute Ischemia and Their Cellular Basis. Internat J Arrhyth 2020 Uesako H, Fukikawa H, Hashimoto S, et al. Occurrence of "J waves" in 12-lead ECG as a marker of acute ischemia and their cellular basis. Acad Emerg Med 1999 Rituparna S, Suresh S, Chandrashekhar M, et al.

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Smith comment: The patient was lucky to have a cardiac arrest. By undergoing an arrest, providers became aware of his OMI which had not been noticed on his diagnostic ECG, and he thus has a chance at some myocardial salvage. Had he not had one, he would have sat in the waiting room until his entire myocardium at risk infarcted.

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Cardiac Arrest STEMI Blog Ischemia 86

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. To quote Drs.

Cardiogenic Shock 137

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest 137

Ken Grauer, MD

MARCH 29, 2025

This may be a sign of cardiac "stunning" following an MI or cardiac arrest ( See ECG Blog #272 for more on Causes of Low Voltage ). Thus ongoing ischemia could have served as the substrate that precipitated the sustained episode of VT discussed in today's case.

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Blog Tachycardia Cardiac Arrest Download 108