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

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. Figure-1: Reasons for the varied ECG presentation of acute LMain occlusion — excerpted from Dr. Smith’s 8/9/2019 post ( This Table from My Comment in the January 16, 2020 post ). ECG #3 The above ECG shows a polymorphic VT at a rate of about 180 BPM.

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 127

HeartRhythm

APRIL 30, 2024

This patient, a 77-year-old male with a history of ischaemic heart disease and coronary artery bypass grafts, had an implantable cardioverter-defibrillator (ICD) implanted in 2020.

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Coronary Artery Bypass Graft Tachycardia Defibrillator Pacemaker 40

Dr. Smith's ECG Blog

JULY 14, 2023

He underwent further standard resuscitation EXCEPT that we applied the Inspiratory Threshold Device ( ResQPod ) AND applied Dual Sequential Defibrillation (this simply means we applied 2 sets of pads, had 2 defib machines, and defibrillated with both with only a fraction of one second separating each defibrillation.

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Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 85

Dr. Smith's ECG Blog

JULY 21, 2024

He required multiple defibrillations within a period of a few hours. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. Some episodes of PMVT would terminate spontaneously — but on many occasions, the PMVT degenerated to VFib, requiring defibrillation.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 113

DAIC

DECEMBER 19, 2023

Better stratification of risk, the researchers say, would help clinicians to identify people in need of an implantable cardioverter defibrillator (ICD) – a device that monitors heart rhythm and shocks the heart back into a normal rhythm if needed. It adds a missing part of the puzzle.”

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Sudden Cardiac Death Heart Rhythm Biomarkers Cardiomyopathy 105

DAIC

JULY 9, 2024

Recent reports from the American Heart Association outline a chasm of inequity that continues to grow at a critical time as our population becomes more richly diverse,” Churchwell said.

Innovation 111

Innovation Health Disparities Cardiovascular Disease Medicaid 111

Dr. Smith's ECG Blog

JUNE 14, 2024

But artifact is "alive and well" — and learning to recognize it will amaze many of your colleagues ( and may serve to avoid an unnecessary defibrillation or two ). The November 10, 2020 post — for PTA. The October 17, 2020 post — for a 70-year old woman with " Artifactual VT ". I immediately thought this tracing looked bizarre!

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Atrial Fibrillation Tachycardia Chest Pain Blog 76

Ken Grauer, MD

JUNE 14, 2024

A series of VFib episodes followed — each time with successful defibrillation. Recognizing hyperacute T waves — patterns of leads — an OMI ( though not a STEMI ) — See My Comment at the bottom of the page in the November 8, 2020 post on Dr. Smith's ECG Blog. He became unconscious on arrival.

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Blog STEMI Cardiac Arrest Tachycardia 162

Dr. S. Venkatesan MD

FEBRUARY 20, 2024

Tackling SCD was in God’s domain, until the brilliance of Dr. Michel Mirowski shrunk the defibrillator and implanted it under the chest in 1980. (Dr. 2020) The un-disputable fact is ischemic DCM has a target to treat, though it is termed as cardiomyopathy. SCD is the leading cause of mortality in heart failure. N Engl J Med.

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Defibrillator Heart Failure Sudden Cardiac Death Cardiomyopathy 52

Circulation

NOVEMBER 11, 2024

Finally, LV-GLS provided incremental prognostic value over 2020 American College of Cardiology (ACC)/American Heart Association (AHA) risk model (log-likelihood ratios, -262.2 004 for 2020 AHA guideline and 2022 ESC guideline, respectively).Conclusion:Feature 004 for 2020 AHA guideline and 2022 ESC guideline, respectively).Conclusion:Feature

Cardiomyopathy 40

Cardiomyopathy Sudden Cardiac Death Defibrillator Risk Factors 40

Cardiometabolic Health Congress

JULY 17, 2024

Notes: Approved after initial rejection two years prior based on safety data from Japan, where the drug had been used since 2020 It can only be used in kidney disease patients on dialysis for at least 3 months. Join us as we examine the landmark approvals that are revolutionizing patient outcomes.

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Tricuspid Open-Heart Surgery Kidney Disease Pediatrics 59

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

This episode self terminated before defibrillation was possible. That said — in a patient who develops TdP — the overall ECG appearance of this initial ECG is consistent with low K+ and/or low Mg++ ( See My Comment in the May 9, 2020 post — for more on the ECG diagnosis of hypokalemia and hypomagnesemia ).

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Tachycardia Blog Sudden Cardiac Death Arrhythmia 107

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

After resuscitation and defibrillation , there were no more episodes of TdP. Below is the patient’s 12 lead ECG following defibrillation. Of note — the QT interval of beat #5 ( blue line ) is markedly prolonged compared to the QT interval in the beginning of the tracing ( red line ). What does this ECG tell you?

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Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 71

Dr. Smith's ECG Blog

SEPTEMBER 12, 2023

For more on my systematic approach — Check out My Comment in the May 3, 2020 post ). Treatment is by ICD ( implantable cardioverter defibrillator ). Take another LOOK at today's ECG ( which I've reproduced in Figure-1 ): Figure-1: I’ve labeled the initial tracing in today’s case. How Short is the QTc in Today's Tracing?

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Cardiac Arrest Blog Atrial Fibrillation AFIB 72

Dr. Smith's ECG Blog

OCTOBER 23, 2023

She was successfully revived after several rounds of ACLS including defibrillation and amiodarone. In practice — It appears that electrical alternans is most often seen in association with regular SVT rhythms ( See the example in My Comment at the bottom of the page, in the September 7, 2020 post in Dr. Smith's ECG Blog ).

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Tachycardia Cardiac Arrest ICU Blog 120

Cardiomatics

FEBRUARY 9, 2022

Both the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION) and the Cardiac Resynchronisation—Heart Failure (CARE-HF) trials [3,4], which were the cornerstone of electrotherapy in HF patients, showed up to a 36% reduction in mortality, an effect size rarely seen in trials today [5]. Cureus 2020, 12, 9349. [2]

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Heart Failure Myocardial Infarction Medicare Cardiac Function 52

All About Cardiovascular System and Disorders

OCTOBER 25, 2023

CASTLE-AF randomized 363 patients with atrial fibrillation and left ventricular ejection fraction of 35% or less, NYHA class II-IV heart failure and having an implanted defibrillator to either catheter ablation or medical therapy with rate or rhythm control [5]. 2020 Oct 1;383(14):1305-1316. Epub 2020 Aug 29. N Engl J Med.

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Atrial Fibrillation Heart Failure Ablation Cardiac Arrest 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). While today's case is the first we have published on cardiac sarcoidosis — we have featured infiltrative cardiomyopathy ( ie, with amyloidosis — in the November 15, 2020 post in Dr. Smith's ECG Blog ). The biopsy was consistent with cardiac sarcoidosis.

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Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 86

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab. I’ve previously discussed clinical application of the Mirror Test on several occasions ( SEE My Comment at the bottom of the page in both the September 13, 2020 post and the February 16, 2019 post in Dr. Smith’s ECG Blog ).

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STEMI Hospital Blog Defibrillator 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Rhythm C: This telemetry strip from an older adult was initially thought to need defibrillation. The November 10, 2020 post — for PTA. The October 17, 2020 post — for a 70-year old woman with " Artifactual VT ". Rhythm B: This patient was seen in the ED — and thought to be in AFlutter with 4:1 AV conduction.

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Chest Pain Blog Critical Care Arrhythmia 67

Dr. Smith's ECG Blog

APRIL 29, 2020

She was never defibrillated. 3 of the 4 have similarly bizarre PVCs. == MY Comment by K EN G RAUER, MD ( 4/29/2020 ): == Cardiac Arrest with Bizarre PVCs/Torsades de Pointes: Intriguing case with many interesting features. As was seen in this case — defibrillation and/or overdrive pacing may be needed. What do you think?

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

MAY 6, 2019

Cardioversion/defibrillation. A partial list includes the following: Certain drugs ( antiarrhythmics; calcium channel blockers; ß-blockers; antianginals; psychotropic medications; alcohol; cocaine; other drugs ). Acute febrile illness. Variations in autonomic tone. Hypothermia. Electrolyte imbalance ( hypokalemia; hyperkalemia ). Bradycardia.

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

Int J Cardiol Heart Vasc 2020 3. There was 100% proximal LAD occlusion, EF was 55% with severe hypokinesis to mid-distal septum and apex. First troponin I was 150 ng/L (normal <26 in males and <16 in females) and peak was 7,500. Int J Cardiol Heart Vasc 2021 2. Aslanger et al. Lemkes et al. Eur Heart J 2018 4. Bergmark et al.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC. In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. EMS found the patient in VFib and performed ACLS for 26 minutes then obtained ROSC.

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Ischemia Arrhythmia Defibrillator Chest Pain 40

Dr. Sanjay Gupta

MARCH 6, 2022

Around Xmas time in 2020, she developed a flu-like illness and after that she started noticing that she was getting breathless on very modest levels of exertion. Interventions that may prolong life include implantation of a defibrillator. So she contacted her GP but unfortunately couldn’t even get an appointment for 3 weeks.

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Chronic Disease Quality of Life Heart Failure Nursing 40

Dr. Smith's ECG Blog

JANUARY 30, 2019

ADDENDUM ( 10/24/2020 ): In the past, the diagnosis of Brugada Syndrome required not only the presence of a Brugada-1 ECG pattern — but also a history of sudden death, sustained VT, non-vasovagal syncope or a positive family history of sudden death at an early age. Smith on this blog ( Simply search for Brugada Syndrome! ).

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. For review of ECG findings expected with Takotsubo Cardiomyopathy — Please see My Comment at the bottom of the page in the March 25, 2020 post in Dr. Smith's ECG Blog ). Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

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Plaque Chest Pain Thrombosis Stenosis 52

HeartRhythm

APRIL 30, 2024

Inpatient implantation of secondary prevention implantable cardioverter defibrillator (ICD) is variable and subject to healthcare disparities. The incidence of sudden cardiac death is over 300,000 in the United States.

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Inpatient Sudden Cardiac Death Defibrillator 40

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

Treatment is by ICD ( implantable cardioverter defibrillator ). The disorder is rare — but it takes on importance as a potential cause of atrial and ventricular arrhythmias, including cardiac arrest. Males with a QTc ≤330 ms — and females with a QTc ≤340 ms are defined as having SQTS , even if they are asymptomatic.

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Chest Pain Cardiac Arrest STEMI Arrhythmia 52