Dr. Smith's ECG Blog

JUNE 23, 2023

A 50-something male with unspecified history of cardiomyopathy presented in diabetic ketoacidosis (without significant hyperkalemia) with a wide complex tachycardia and hypotension. The fact that he has a cardiomyopathy argues for a more typical ventricular tachycardia, as does the absence of rSR' in lead V1. It is regular.

Tachycardia 52

Tachycardia Cardiomyopathy Arrhythmia Diabetes 52

Dr. Smith's ECG Blog

DECEMBER 26, 2023

This is a very typical ECG for Hypertrophic Cardiomyopathy. The most recent previous was 4 years prior, and was in the normal range) Elderly patients, and patients with cardiomyopathy (including HOCM), may have troponin values in this range chronically ("chronic myocardial injury").

Chest Pain 93

Chest Pain Cardiomyopathy Blog AFIB 93

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

Dr. Smith's ECG Blog

OCTOBER 15, 2023

Taking a Closer LOOK: We have periodically reviewed cases with low voltage in Dr. Smith’s ECG Blog ( Please see My Comment at the bottom of the page in the November 12, 2020 post, among others ). 12, 2020 post — are 2 causes potentially relevant to my initial considerations in today’s patient, who was found to have acute LAD OMI.

Chest Pain 116

Chest Pain Cardiomyopathy STEMI Blog 116

Dr. S. Venkatesan MD

JULY 1, 2024

In simple terms it mimics a heart of Hypertrophic cardiomyopathy, which we know has brisk ejection. We can also understand the principles of the management of cardiomyopathy from a Giraffe’s heart. This forms the basis behind the ventricular reduction and reconstruction surgery for Ischemic dilated cardiomyopathy.(Batisda

Cardiomyopathy 52

Cardiomyopathy Aortic valve Aortic Blood Pressure 52

Dr. Smith's ECG Blog

APRIL 12, 2023

Example here: DIffuse ST Elevation with Apical Ballooning: is it Takotsubo Stress Cardiomyopathy? In comparison to the previous study, 11/11/2020, there has been a significant interval deterioration of left ventricular systolic function (previous EF 80%), and there is a new large apical wall motion abnormality.

Echocardiogram 52

Echocardiogram Pulmonary Cardiomyopathy Coronary Artery Disease 52

Ken Grauer, MD

AUGUST 22, 2024

PEARL # 4: As alluded to above — the finding of a Tall R Wave in Lead V1 should prompt consideration of the following LIST of the 6 most common Causes: i ) WPW; ii ) RBBB; iii ) RVH; iv ) Posterior MI; v ) HCM ( Hypertrophic CardioMyopathy ); and , vi ) Normal variant — as a diagnosis of exclusion ( See ECG Blog #81 for more on this issue ).

Blog 101

Blog STEMI Tachycardia Cardiomyopathy 101

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

The patient was diagnosed with stress cardiomyopathy. Widespread T wave inversions and prolongation of the QT interval is not uncommon in Takotsubo cardiomyopathy. The QTc then gradually shortened over the course of several days as is usual for stress cardiomyopathy. Potassium was 4,8 mmol/l. ( ref 3,5-4,6 mmol/l ).

Cardiac Arrest 67

Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 67

Dr. S. Venkatesan MD

SEPTEMBER 3, 2024

Recognizing non-sarcomeric Hypertrophic Cardiomyopathy (HCM) by echocardiography is one such task.It With all all these advancements ,how good is echocardiography in ruling out (or in) reversible /treatable HCM mimickers or their molecular subsets. Amyloid -HCM coexistence Medical pathology is never a pure science.It

Bicuspid/Mitral 52

Bicuspid/Mitral Cardiomyopathy Tricuspid Academic 52

Dr. Smith's ECG Blog

OCTOBER 23, 2023

The most important clinical entity associated with motion alternans is large pericardial effusion — though motion alternans has also been observed in some cases of hypertrophic cardiomyopathy. It is important to appreciate that not all pericardial effusions produce electrical alternans.

Tachycardia 130

Tachycardia Cardiac Arrest ICU Blog 130

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

In other words, the severely increased end diastolic pressure from the extremely poor LV function caused by the myocarditis results in extremely poor coronary perfusion pressure. == MY Comment by K EN G RAUER, MD ( 2/16/2020 ): == As per the title by Dr. Smith — this case was not what I thought. 109 (20):361-368, 2012 — CLICK HERE ).

Cardiogenic Shock 52

Cardiogenic Shock STEMI Pericarditis Blog 52

Ken Grauer, MD

DECEMBER 12, 2024

Working through a case of a regular WCT Rhythm in this 80-something woman See My Comment in the May 5, 2020 post on Dr. Smiths ECG Blog. Another case of a regular WCT Rhythm in a 60-something woman See My Comment at the bottom of the page in the April 15, 2020 post on Dr. Smiths ECG Blog. Smiths ECG Blog.

Blog 82

Blog Tachycardia Heart Disease Congenital Heart Disease 82

DAIC

FEBRUARY 29, 2024

24: Joint American College of Cardiology/Journal of the American College of Cardiology Late-Breaking Clinical Trials (Session 402) Saturday, April 6 9:30 – 10:30 a.m. 12:15 p.m.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

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

Ken Grauer, MD

JANUARY 13, 2024

HCM is an "umbrella term" applied to the presence of LVH in the absence of "abnormal cardiac loading conditions" ( Hughes et al — JAHA 9:e015294, 2020 ). . = A bout H CM ( Different Forms of this Entity ): I've excerpted what appears below from My Comment in the December 26, 2023 post in Dr. Smith's ECG Blog.

Blog 159

Blog Ischemia AFIB Hypertension 159

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. hours T-wave are getting larger again The patient went for an angiogram at about 7 hours after arrival. This is not the case.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Ken Grauer, MD

JULY 15, 2023

Subsequent testing supported the presumption of apical cardiomyopathy as the cause of this patient's sustained VT. ie, Severe subendocardial ischemia from sustained VT in a patient severe apical cardiomyopathy resulted in a peak troponin >31,000 ng/L in today's case ). CT coronary angiogram showed no obstructive coronary disease.

Blog 78

Blog Coronary Angiogram Cardiomyopathy Ischemia 78

Dr. Smith's ECG Blog

JUNE 21, 2024

A patient in the ICU with significant underlying cardiac disease [HFrEF 30%, non-ischemic cardiomyopathy, LBBB s/p CRT-D (biventricular pacer), AVNRT s/p ablation a few yrs ago, hx sinus tachycardia while on max tolerated BB therapy] went into a regular wide-complex tachycardia after intubation for severe COPD exacerbation.

Tachycardia 71

Tachycardia Atrial Fibrillation Pacemaker Blog 71

Dr. Smith's ECG Blog

APRIL 25, 2023

Stress induced cardiomyopathy (Takotsubo like LV dysfunction) possible The appearance of wall motion abnormalities in some apical views suggest possibility of stress mediated cardiomyopathy. Regional wall motion abnormality-distal septum anterior and apex. Regional wall motion abnormality-distal inferior wall.

Chest Pain 52

Chest Pain Pericarditis Blog Cardiomyopathy 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

As I have discussed the user-friendly and time-efficient criteria I favor for distinction between VT vs SVT rhythms ( with either preexisting BBB or aberrant conduction ) — I'll refer those interested in more detail to My Comments in the May 5, 2020 — the April 2, 2022 — and the February 14, 2022 posts in Dr. Smith's Blog.

Tachycardia 119

Tachycardia Electrophysiology Atrial Flutter Ischemia 119

Dr. Smith's ECG Blog

JUNE 17, 2016

Look for old ECGs Do serial ECGs Do echocardiography == MY Comment by K EN G RAUER, MD ( 10/1/2020 ): == From time to time — it's helpful to "resurface" prior cases that convey timeless important lessons. The diagnostic problem posed in today's repost from June 17, 2016 is a perfect example of this.

STEMI 52

STEMI Chest Pain Hospital Blog 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

by making it clear to everyone that this is NOT an EKG that one sees with takotsubo cardiomyopathy. Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2023

Or Benign Early Repolarization? = == MY Comment by K EN G RAUER, MD ( 10/1/2020 — edited on 2/4/2023 — ): == From time to time — it's helpful to "resurface" prior cases that convey timeless important lessons. Look for old ECGs Do serial ECGs Do echocardiography June 17, 2016 Anterior STEMI?

Chest Pain 52

Chest Pain STEMI Hospital Blog 52

Dr. Smith's ECG Blog

DECEMBER 10, 2022

Seen together, these 2 ECG findings suggest possible RVH ( For review on "My Take" for the ECG diagnosis of RVH — Please see My Comment at the bottom of the page in the March 6, 2022 post and in the September 1, 2020 post of Dr. Smith's ECG Blog ). As per Dr. Smith — I was happy to learn that this patient was going to cath!

Diabetes 52

Diabetes Hypertension Blog Cardiomyopathy 52

Dr. Smith's ECG Blog

JUNE 20, 2020

He was admitted for monitoring, as his risk of a ventricular dysrhythmia as cause of the syncope is high ( very high due to HFrEF and ischemic cardiomyopathy ). IF you missed the KEY Findings on the pre-hospital ECG of todays case Please take another look at My Comment at the bottom of the page of that February 6, 2020 post.

STEMI 52

STEMI Hospital Coronary Angiogram Dysrhythmia 52

Ken Grauer, MD

FEBRUARY 28, 2023

Takotsubo (ie, Stress ) Cardiomyopathy. These cases provide insight to assessment for MAT: The January 5, 2020 post in Dr. Smith’s ECG Blog — for an example of MAT. Myocardial injury with Covid may arise from a number of potential causes — which include: Acute myocarditis. Acute Right Heart Strain. Acute pulmonary embolus.

Blog 78

Blog COVID-19 AFIB Pulmonary 78

Dr. Smith's ECG Blog

DECEMBER 19, 2023

To paraphrase Dr. Smith's comments in the May 19, 2020 post : — Non-obstructive coronary disease does not ne cessarily imply no plaque rupture with thrombus. This is not the case. There is a trend toward these patients being younger — with a greater relative percentage of women — and fewer traditional cardiac risk factors.

Plaque 127

Plaque Angina Blog Stents 127

Dr. Smith's ECG Blog

NOVEMBER 15, 2020

Diagnosis : Extremely slow Atrial flutter == MY Comment , by K EN G RAUER, MD ( 11/15/2020 ): == Some of the most interesting ECG cases I have seen have been picked up “reading through a stack of ECGs” — in the same manner that Dr. Smith picked up today’s case. It turned out that he had a history of slow atrial flutter.

Atrial Flutter 52

Atrial Flutter Cardiomyopathy Chest Pain Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 31, 2020

Very good summary of the data on Fractional Flow Reserve and Instantaneous Wave Free Ratio: [link] == MY Comment by K EN G RAUER, MD ( 1/31/2020 ): == Interesting case to review! We are told that this middle-aged male patient has a history of prior MI with stents.

Angina 52

Angina Stents Stent Aneurysm 52

Dr. Anish Koka

JANUARY 1, 2023

Events of cardiomyopathy or cardiac failure were reported by eight participants after the Novavax COVID-19 Vaccine, Adjuvanted (0.03%) and one participant after placebo (<0.01%). Myocarditis and/or pericarditis were reported by two participants after the Novavax COVID-19 Vaccine, Adjuvanted (0.01%) and no participants after placebo.

COVID-19 52

COVID-19 Pericarditis Chest Pain Biomarkers 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

He had a h/o ischemic cardiomyopathy and right MCA stroke. For another example of intermittent RBBB conduction, in which a similar initial deflection with terminal delay facilitated recognition of RBBB Conduction — Please SEE the June 25, 2020 post in Dr. Smith's Blog. Later, I obtained more clinical history.

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 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

MAY 19, 2022

Hypertrophic Cardiomyopathy or Normal ("Variant")? Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise Exercise Is Medicine? The Cardiorespiratory Implications of Ultra-marathon Bjørkavoll‐Bergseth et al. Both cTnI and cTnT increased in all individuals, reaching the highest level at 3 hours after the race.

Chest Pain 52

Chest Pain Exercise Pacemaker Coronary Angiogram 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

AUGUST 8, 2020

As always, Takotsubo stress cardiomyopathy and focal myocarditis are rare possibilities which can only be proven after a negative cath. More to come. == MY Comment by K EN G RAUER, MD ( 8/8/2020 ): == I LIKE this case by Dr. Meyers — because of the subtle changes seen on serial tracings. What do you think?

Pericarditis 52

Pericarditis STEMI Chest Pain Arrhythmia 52

Open Heart

APRIL 20, 2022

Objectives To describe a cohort of patients with arrhythmogenic left ventricular cardiomyopathy (ALVC), focusing on the spectrum of the clinical presentations. Methods Patients were retrospectively evaluated between January 2012 and June 2020. Results Fifty-two patients (63% males, age 45 years (31–53)) composed the study cohort.

Cardiomyopathy 52

Cardiomyopathy Chest Pain Sudden Cardiac Death Heart Failure 52

Circulation

NOVEMBER 11, 2024

The mortality rate of alcohol-related cardiomyopathy using ICD code I42.6 Alcoholic cardiomyopathy) was studied from 2001-2020. 100,000 deaths.Conclusions:The mortality trends associated with alcohol-related cardiomyopathy have not changed significantly over the past two decades. 100,000 deaths in four U.S

Cardiomyopathy 40

Cardiomyopathy Certification Circulation Research 40