Ken Grauer, MD

AUGUST 22, 2024

But for those wanting a "simpler" approach" — Consider the following ( which I review below in my ADDENDUM ): This patient is in a wide, "ugly-looking" and seemingly regular tachycardia without P waves. 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. Smith’s ECG Blog.

Blog 101

Blog STEMI Tachycardia Cardiomyopathy 101

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

Here was the ECG: There is sinus tachycardia. 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.

Cardiogenic Shock 52

Cardiogenic Shock STEMI Pericarditis Blog 52

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 ).

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Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 68

Ken Grauer, MD

FEBRUARY 28, 2023

The ECG and long lead II rhythm strip in Figure-1 — was obtained from a COVID positive patient with persistent tachycardia not responding to Diltiazem. Figure-1: The initial ECG — obtained from a patient with persistent tachycardia. ( Takotsubo (ie, Stress ) Cardiomyopathy. How would YOU interpret this tracing?

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Blog COVID-19 AFIB Pulmonary 78

Ken Grauer, MD

JULY 15, 2023

Given the rapid rate of the tachycardia and the amorphous shape of the QRS — the decision was made to sedate the patient and cardiovert. This phenomenon may sometimes be seen following an episode of a sustained tachycardia — in which marked ST-T wave abnormalities not due to infarction may be seen for a period of hours, or even days!

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Blog Coronary Angiogram Cardiomyopathy Ischemia 78

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 52

Tachycardia Heart Disease Dysrhythmia Ablation 52

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.

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Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

MAY 19, 2022

Hypertrophic Cardiomyopathy or Normal ("Variant")? T-wave inversions and dynamic ST elevation Tachycardia, hyperthyroid, and ST elevation. Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise Exercise Is Medicine? The Cardiorespiratory Implications of Ultra-marathon Bjørkavoll‐Bergseth et al. What is it?

Chest Pain 52

Chest Pain Exercise Pacemaker Coronary Angiogram 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

Shortly after isoprenalin infusion was initiated, there were short runs of ventricular tachycardia. The granulomatous inflammation affects the heart, causing an infiltrative cardiomyopathy The most common manifestations of cardiac sarcoidosis are atrioventricular (AV) block and ventricular tachyarrhythmias (VT).

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Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

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

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Arrhythmogenic cardiomyopathy Long QT syndrome Hypertrophic cardiomyopathy. There is a run of polymorphic ventricular tachycardia — which given the QT prolongation, qualifies as Torsades de Points ( TdP ). There are a number of things to look for in an ECG that can hint at arrhythmia as the cause of an apparent seizure.

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Tachycardia Blog Sudden Cardiac Death Arrhythmia 113

Dr. Smith's ECG Blog

MARCH 6, 2020

Here was his ED ECG: There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities. The absence of any wall motion abnormality makes ischemic cardiomyopathy very unlikely. An ECG was recorded: This shows a regular narrow complex tachycardia at a rate of about 160. BP:143/99, Pulse 109, Temp 37.2 °C

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Open Heart

AUGUST 25, 2023

Background Consensus guidelines support the use of implanted cardioverter-defibrillators (ICD) for primary prevention of sudden cardiac death in patients with either non-ischaemic or ischaemic cardiomyopathy with left ventricular ejection fraction (LVEF) ≤35%. vs 65.4%, p<0.0001), more often white (87.5% vs 38.2%, p<0.0001).

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Defibrillator Sudden Cardiac Death Myocardial Infarction Echocardiogram 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

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. JAMA Cardiol [Internet] 2020;Available from: [link] 4. JAMA Cardiol [Internet] 2020;Available from: [link] 5. 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

OCTOBER 28, 2023

See this even more interesting and more dramatic and fascinating case: History of Hypertrophic Cardiomyopathy (HOCM), with Tachycardia and High Lactate = My Comment by K EN G RAUER, MD ( 10/28 /2023 ): = QUESTION: For clarity in Figure-1 — I've reproduced today's ECG without the long lead rhythm strip. 23/WCC — 2/21/2020 ).

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Preserved Ejection Fraction Sudden Cardiac Death Heart Failure Chest Pain 57

Frontiers in Cardiovascular Medicine

DECEMBER 18, 2024

However, the effects of sacubitril/valsartan on these outcomes, as well as on ventricular tachyarrhythmias, have not been well studied in women with HFrEF.MethodsThis study included consecutive series of patients treated with sacubitril/valsartan at University Hospital Mannheim from 2016 to 2020. were ambulatory and 51.4% were hospitalized.

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Heart Failure Outcomes Hospital Tachycardia 40

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Other than tachycardia, Other than slight tachycardia, vitals were within normal limits (including oxygen saturation). As always, takotsubo cardiomyopathy and focal pericarditis can mimic OMI, but takotsubo almost never mimics posterior MI, and both are diagnoses of exclusion after a negative cath. Is that normal?

Chest Pain 52

Chest Pain STEMI Blog Tachycardia 52

Dr. Smith's ECG Blog

MARCH 6, 2025

Smith comments : Wide complex tachycardia. The differential diagnosis of WCT is: 1) Sinus tachycardia with "aberrancy" (in this case RBBB and LAFB), but there are no P-waves and the QRS morphology is not typical of simple RBBB/LAFB. Also, if the rate is constant, not wavering up and down, it is highly unlikely to be sinus tachycardia.

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Tachycardia Dysrhythmia ICU Pulmonary 95

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. When due to ischemia — Osborn waves may be associated with high risk of developing malignant ventricular arrhythmias ( My Comment in the September 23, 2020 post ).

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STEMI Bradycardia Arrhythmia Cardiac Arrest 52