2020, Defibrillator and Ischemia - Cardiovascular Update

ECG Blog #436 — Bigeminy or Alternans?

Ken Grauer, MD

JUNE 27, 2024

Acute myocardial ischemia. 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. CPVT ( Catecholaminergic PolyMorphic VT ). Familial hypokalemic periodic paralysis.

Blog

Blog Cardiac Arrest Sudden Cardiac Death Tachycardia

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

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

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

Dr. Smith's ECG Blog

JULY 21, 2024

He required multiple defibrillations within a period of a few hours. There is no definite evidence of acute ischemia. (ie, This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. Some residual ischemia in the infarct border might still be present.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

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A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

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.

Cardiac Arrest

Cardiac Arrest Chest Pain Defibrillator Atrial Flutter

Does this T wave pattern mean anything?

Dr. Smith's ECG Blog

OCTOBER 23, 2023

She was successfully revived after several rounds of ACLS including defibrillation and amiodarone. Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. On arrival to the ED the patient was intubated with normal vital signs.

Tachycardia

Tachycardia Cardiac Arrest ICU Blog

Seizure in a 30 something

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 ).

Tachycardia

Tachycardia Blog Sudden Cardiac Death Arrhythmia

Why ICDs are less effective in Non Ischemic DCM ?

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.

Defibrillator

Defibrillator Heart Failure Sudden Cardiac Death Cardiomyopathy

A Middle-Aged male with Chest Pain and an Unusual ECG

Dr. Smith's ECG Blog

MAY 6, 2019

Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Ischemia/infarction. Cardioversion/defibrillation.

Chest Pain

Chest Pain STEMI Ischemia Myocardial Infarction

What kind of AV block is this? And why does she develop Ventricular Tachycardia?

Dr. Smith's ECG Blog

JANUARY 23, 2024

Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). Discussion : The initial ECG in today's case is pathological for any patient, especially for a 50-year old previously heathy female.

Tachycardia

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death

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

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. Acute ischemia?

Cardiac Arrest

Cardiac Arrest Defibrillator Ischemia Tachycardia

Fascinating case of dynamic shark fin morphology - what is going on?

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.

Ischemia

Ischemia Arrhythmia Defibrillator Chest Pain

Hyperthermia and ST Elevation

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

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

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."

Plaque

Plaque Chest Pain Thrombosis Stenosis

Sometimes a patient is fortunate to have a cardiac arrest

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Defibrillation was performed, and ROSC was achieved. The other challenge posed by the ECG of a patient with marked LVH with "strain" is distinguishing between the ST-T wave inversion in one or more lateral leads due solely to LVH vs that due to acute ischemia or infarction.

Cardiac Arrest

Cardiac Arrest STEMI Blog Ischemia

ECG Blog #436 — Bigeminy or Alternans?

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

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

Webinars

A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

Does this T wave pattern mean anything?

Seizure in a 30 something

Why ICDs are less effective in Non Ischemic DCM ?

A Middle-Aged male with Chest Pain and an Unusual ECG

What kind of AV block is this? And why does she develop Ventricular Tachycardia?

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

Fascinating case of dynamic shark fin morphology - what is going on?

Hyperthermia and ST Elevation

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Sometimes a patient is fortunate to have a cardiac arrest

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