2020, Cardiac Arrest and Tachycardia

ECG Blog #436 — Bigeminy or Alternans?

Ken Grauer, MD

JUNE 27, 2024

He developed cardiac arrest shortly after the ECG in Figure-1 was recorded. IMPRESSION: Given the presence of a wide tachycardia — with 2 distinct QRS morphologies, and no sign of P waves — a presumed diagnosis of B i D irectional Ventricular Tachycardia has to be made. What is the most likely cause of this arrhythmia?

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Blog Cardiac Arrest Sudden Cardiac Death Tachycardia

How a pause can cause cardiac arrest

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

While on telemetry monitoring he suffered cardiac arrest and was resuscitated. What ECG finding may have contributed to (or precipitated) the cardiac arrest? Learning points : Takotsubo can lead to cardiac arrest from ventricular arrhythmia. There are no clear signs of OMI. There is a prolonged QTc.

Cardiac Arrest

Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

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

Cardiac Arrest Defibrillator Ischemia Tachycardia

Extreme shock and cardiac arrest in COVID patient

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

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock

ECG Blog #434 — WHY Did this Patient Arrest?

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. The rhythm is regular — at a rate just over 100/minute = sinus tachycardia ( ie, the R-R interval is just under 3 large boxes in duration ). Should you activate the cath lab?

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Blog STEMI Cardiac Arrest Tachycardia

Does this T wave pattern mean anything?

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. T wave alternans is a harbinger of cardiac instability and TdP. (3) No ischemic ST changes.

Tachycardia

Tachycardia Cardiac Arrest ICU Blog

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

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

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

Sudden Palpitations in a Young Adult

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 ). The 2019 ESC Guidelines for the management of patients with supraventricular tachycardia indicated that IV Amiodarone should not be considered in these populations.

AFIB

AFIB Atrial Fibrillation Tachycardia Blog

ECG Blog #385 — This Patient Arrested Soon After

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

What do you suspect from this ECG in this 40-something with SOB and Chest pain?

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. KEY Findings in ECG #1 include the following: Sinus tachycardia at ~110/minute. Junctional tachycardia? ).

Chest Pain

Chest Pain Pulmonary Embolism STEMI

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

Dr. Smith's ECG Blog

JULY 21, 2024

This progressed to electrical storm , with incessant PolyMorphic Ventricular Tachycardia ( PMVT ) and recurrent episodes of Ventricular Fibrillation ( VFib ). 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.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!) Plus recommendations from a 5-member panel on cardiac arrest. This feature is invaluable for assessing QRS morphology with wide tachycardias in the differentiation between SVT vs VT rhythms. Eur Heart J.

Chest Pain

Chest Pain Cardiogenic Shock Tachycardia Ischemia

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Dr. Smith's ECG Blog

MAY 5, 2022

After initiating treatment for hyperkalemia, repeat ECG showed resolution of Brugada pattern: The ECG shows sinus tachycardia. 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).

Chest Pain

Chest Pain Bradycardia Cardiac Arrest STEMI

Two patients with chest pain and RBBB: do either have occlusion MI?

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. There is sinus tachycardia at ~100/minute. As often emphasized by Dr. Smith — sinus tachycardia is not a common finding with acute OMI unless something else is going on (ie, cardiogenic shock ). As per Dr.

Chest Pain

Chest Pain STEMI Pulmonary Embolism

What are these hyperacute T waves, with STE and T-wave inversion in aVL, and STD in inferior leads?

Dr. Smith's ECG Blog

FEBRUARY 27, 2023

Descriptive analysis of the ECG in today's case reveals a regular, narrow tachycardia at ~130/minute , without clear sign of sinus P waves. But the rate is ~130/minute — which is a bit fast for sinus tachycardia. So IF this is sinus tachycardia with a sinoventricular rhythm — then we have to explain WHY the rate is this fast.

Tachycardia

Tachycardia Document Blog Bradycardia

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

Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

Here is his 12-lead: There is a wide complex tachycardia with a rate of 257, with RBBB and LPFB (right axis deviation) morphology. Read about Fascicular VT here: Idiopathic Ventricular Tachycardias for the EM Physician Case Continued He was completely stable, so adenosine was administered. See Learning point 1 below. Arch Intern Med.

Tachycardia

Tachycardia Heart Disease Dysrhythmia Ablation

Cardiologist declines taking patient to the cath lab. Patient dies.

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Other than tachycardia, Other than slight tachycardia, vitals were within normal limits (including oxygen saturation). About two hours after admission, he suffered a cardiac arrest (whether it was VF/VT or PEA is not available) and expired. The rhythm in ECG #1 is sinus tachycardia at 115-120/minute.

Chest Pain

Chest Pain STEMI Blog Tachycardia

Profound ST depression in II, III, aVF

Dr. Smith's ECG Blog

JULY 27, 2023

His prehospital ECG showed "inferior" ST depression and high voltage, with tachycardia. I suspected no OMI, that this could be due to LVH plus tachycardia. Conclusion: Type II MI probable due to hypoxia and tachycardia from resp arrest and amphetamine use. On arrival to the ED, the patient was diaphoretic, tachycardic.

Tachycardia

Tachycardia Ischemia Cardiac Arrest Echocardiogram

Unconscious + STEMI criteria: activate the cath lab?

Dr. Smith's ECG Blog

JANUARY 21, 2023

The relationship between J wave and ventricular tachycardia during Takotsubo cardiomyopathy. Internat J Arrhyth 2020 Uesako H, Fukikawa H, Hashimoto S, et al. The final letter in the SLOWED mnemonic is " D " for "Dead" ( resulting from VT/VF or asystolic cardiac arrest ).

STEMI

STEMI Bradycardia Arrhythmia Cardiac Arrest

Brugada Syndrome: Diagnosis and Risk Stratification

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

2020 Sep;31(9):2474-2483. Type 2/3 ECG which gets converted to type 1 pattern with sodium channel blockers have 2 points. Rattanawong P, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Putthapiban P, Prasitlumkum N, Mekraksakit P, Mekritthikrai R, Chung EH. J Cardiovasc Electrophysiol. Gourraud JB, Barc J, Thollet A, Le Marec H, Probst V.

Sudden Cardiac Death

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia

A woman in her 20s with syncope

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

The ECG shows sinus tachycardia, a narrow, low voltage QRS with alternating amplitudes, no peaked T waves, no QT prolongation, and some minimal ST elevation in II, III, and aVF (without significant reciprocal STD or T wave inversion in aVL). It is difficult to tell if there is collapse during diastole due to the patient’s tachycardia.

Pericarditis

Pericarditis Tachycardia Ultrasound Blood Pressure

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

Otherwise vitals after intubation were only notable for tachycardia. An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. She was ventilated by bag-valve-mask by EMS on arrival and was quickly intubated with etomidate and succinylcholine. A rectal temperature was obtained which read 107.9

Heart Rhythm

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

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. MY Thoughts on ECG #1: The rhythm is sinus tachycardia at 105-110/minute. A mysterious case.

STEMI

STEMI Hospital Blog Defibrillator

Cardiovascular Update

ECG Blog #436 — Bigeminy or Alternans?

How a pause can cause cardiac arrest

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

Extreme shock and cardiac arrest in COVID patient

ECG Blog #434 — WHY Did this Patient Arrest?

Does this T wave pattern mean anything?

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

Sudden Palpitations in a Young Adult

ECG Blog #385 — This Patient Arrested Soon After

What do you suspect from this ECG in this 40-something with SOB and Chest pain?

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

An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Two patients with chest pain and RBBB: do either have occlusion MI?

What are these hyperacute T waves, with STE and T-wave inversion in aVL, and STD in inferior leads?

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

Cardiologist declines taking patient to the cath lab. Patient dies.

Profound ST depression in II, III, aVF

Unconscious + STEMI criteria: activate the cath lab?

Brugada Syndrome: Diagnosis and Risk Stratification

A woman in her 20s with syncope

Hyperthermia and ST Elevation

Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

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