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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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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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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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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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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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?

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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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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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Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. IF the initial ECG following successful defibrillation shows evidence of acute OMI — such patients have much to gain from immediate cath with PCI. As per Dr. Smith — the intuitive answer should be obvious.

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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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DAIC

FEBRUARY 12, 2024

The guidelines for atrial fibrillation ( AF ) from the American Heart Association ( AHA ) in 2019 and the European Society of Cardiologists ( ESC ) in 2020 recommend continued monitoring and evaluation for patients with atrial high-rate episodes (AHRE), with the ESC noting a preference for remote monitoring.5,6 2023;12:e029126.

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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%.

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Defibrillator Sudden Cardiac Death Myocardial Infarction Echocardiogram 52

Ken Grauer, MD

JUNE 27, 2024

Despite prolonged resuscitation with multiple defibrillation attempts — the patient could not be saved. = See My Comment in the June 1, 2020 post in Dr. Smith's ECG Blog — for review of Pleomorphic VT. That said, it does occur — and awareness of the entities associated with this diagnosis may be important in evaluation and treatment.

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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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Circulation: Arrhythmia and Electrophysiology

FEBRUARY 3, 2025

However, limited data exist on the global trends of implantable cardioverter defibrillator (ICD) utilization and its impact on mortality/morbidity burden reduction.METHODS:Electronic databases were systematically searched up to March 2024 for studies reporting on ICD utilization rates in hypertrophic cardiomyopathy.

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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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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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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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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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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

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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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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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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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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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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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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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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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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.

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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! ).

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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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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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Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Defibrillation was performed, and ROSC was achieved. To facilitate recall of these concepts We've conveniently added a link in the menu at the top of every page in Dr. Smith's ECG Blog that takes you to My Comment in the June 20, 2020 post , in which I review a user-friendly approach to ECG recognition of LVH and "Strain" ( See Figure-2 ).

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Dr. Smith's ECG Blog

MARCH 6, 2025

Second , when you have a rhythm problem, you are likely to be able to fix the problem with electricity (cardioversion, defibrillation, pacing). And if you wait for troponin, much myocardium is lost by the time you make the diagnosis. Third , while you are making a decision about a rhythm, myocardium is not rapidly dying.

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