Dr. Smith's ECG Blog

OCTOBER 21, 2023

On the monitor patient had wide-complex tachycardia. Differential is ventricular tachycardia versus supraventricular tachycardia with aberrancy versus sinus tachycardia with a aberrancy. After the patient was stabilized with supportive care, the heart rate gradually slowed, confirming sinus tachycardia.

Tachycardia 139

Tachycardia Pulmonary Blood Pressure Blog 139

Circulation

NOVEMBER 11, 2024

Introduction:Supraventricular tachycardia (SVT) is known to affect children and teenagers predominantly but can also occur in adults. in adults (above 25 years) from 1999 to 2020. in adults (above 25 years) from 1999 to 2020. Results:From1999 to 2020, 31,036 (AAMR=0.6) in 2020 (APC 13.66). in 2020 (APC 13.66).

Tachycardia 40

Tachycardia Circulation Research Outcomes 40

Dr. Smith's ECG Blog

AUGUST 13, 2020

His previous echo one month prior shows the same thing: “consistent with old infarct in LAD vascular territory, with EF 45%” "I think there is something else causing his tachycardia which is exaggerating his EKG findings and mimicking an acute myocardial infarction." The patient spontaneously converted back to sinus tachycardia.

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

Journal of Cardiovascular Electrophysiology

SEPTEMBER 23, 2024

Abstract Introduction Supraventricular tachycardia (SVT) is a common pediatric arrhythmia. Individuals aged 1–21 years at time of SVT diagnosis initiated on a BB or a CCB between 01/01/2010 and 12/31/2020 were included. Exclusion criteria were pre-excitation, ectopic atrial tachycardia, and hemodynamically significant heart disease.

Pediatrics 40

Pediatrics Tachycardia Academic Arrhythmia 40

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

It's a very "fun" ECG, with initial ectopic atrial tachycardia (negative P waves in inferior leads conducting 1:1 with the QRSs), followed by spontaneous resolution to sinus rhythm. What About the Tachycardia? Today's regular SVT rhythm could be an ectopic atrial tachycardia ( ATach ) — or an automatic junctional tachycardia.

Chest Pain 130

Chest Pain Tachycardia STEMI Blog 130

Dr. Smith's ECG Blog

APRIL 15, 2020

Here is her ED ECG: Here is the ED physician's interpretation: IMPRESSION UNCERTAIN REGULAR RHYTHM, wide complex tachycardia, likely p-waves. LEFT BUNDLE BRANCH BLOCK [120+ ms QRS DURATION, 80+ ms Q/S IN V1/V2, 85+ ms R IN I/aVL/V5/V6] Comparison Summary: LBBB and tachycardia are new. This is clearly ventricular tachycardia.

Tachycardia 52

Tachycardia Nursing Heart Disease Dysrhythmia 52

HeartRhythm

APRIL 30, 2024

Short-long-short (S-L-S) electrocardiographic cycle length patterns are associated with incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF). It is also recognised that pacemakers can facilitate these cycle length sequences, and that the observation of these sequences can predict future VT/VF events.

Coronary Artery Bypass Graft 40

Coronary Artery Bypass Graft Tachycardia Defibrillator Pacemaker 40

Dr. Smith's ECG Blog

JULY 5, 2024

There is a regular wide complex tachycardia. Remember : Adenosine is safe in Regular Wide Complex Tachycardia. Rather, from this one: Very Fast Very Wide Complex Tachycardia Ideally, one would cardiovert. An older patient with no previous medical history arrived at triage complaining of SOB. If it is VT, there will be no effect.

Atrial Flutter 113

Atrial Flutter Tachycardia Atrial Fibrillation AFIB 113

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. Analysis: there is a wide complex tachycardia. This was the interpretation I put into the system: WIDE COMPLEX TACHYCARDIA. It is regular.

Tachycardia 52

Tachycardia Cardiomyopathy Arrhythmia Diabetes 52

Ken Grauer, MD

DECEMBER 23, 2023

RBBB is no longer seen after conversion to sinus rhythm — which supports our suspicion that the intermittent RBBB conduction seen every-other-beat during the tachycardia ( in Figure-1 ) was rate-related. Note that QRS morphology after conversion to sinus rhythm is very similar to QRS morphology of odd-numbered beats during the tachycardia.

Blog 175

Blog Tachycardia Tricuspid Atrial Flutter 175

Dr. Smith's ECG Blog

OCTOBER 23, 2023

An Initial ECG was performed: Initial ECG: Sinus tachycardia with prolonged QT interval (QTc of 534 ms by Bazett). She was admitted to the ICU where subsequent ECGs were performed: ECG at 12 hours QTc prolongation, resolution of T wave alternans ECG at 24 hours Sinus tachycardia with normalized QTc interval. No ischemic ST changes.

Tachycardia 131

Tachycardia Cardiac Arrest ICU Blog 131

Dr. Smith's ECG Blog

JANUARY 5, 2020

Multifocal Atrial Tachycardia 2. of all cases, and 62% of Veritas® misdiagnoses). == MY Comment , by K EN G RAUER, MD ( 1/5/2020 ): == This case illustrates a number of important teaching points. The rhythm is indeed irregularly irregular, so atrial fibrillation must be considered. Sinus with multifocal PACs 3.

Atrial Fibrillation 52

Atrial Fibrillation Tachycardia Arrhythmia Pulmonary 52

Dr. Smith's ECG Blog

JUNE 1, 2020

== MY Comment by K EN G RAUER, MD ( 6/1 /2020 ): == YOU are asked to interpret the ECG shown in Figure-1. When PMVT is associated with a long QT interval — the rhythm is then defined as Torsades de Pointes ( Please SEE My Comment at the bottom of the April 29, 2020 post in Dr. Smith’s ECG Blog ). Figure-1: The initial ECG in the ED.

Tachycardia 52

Tachycardia AFIB Blog Heart Disease 52

Ken Grauer, MD

SEPTEMBER 13, 2024

QUESTIONS: Is the wide tachycardia that is seen best in the chest leads, too irregular to be VT ( V entricular T achycardia )? — For more on the diagnostic significance of identifying AV dissociation in wide tachycardia — See ECG Blog #133 and ECG Blog #151. How certain are YOU of your answer?

Blog 98

Blog Tachycardia Arrhythmia AFIB 98

Dr. Smith's ECG Blog

DECEMBER 13, 2024

NOTE: The ECGs in today's case are recorded in the Cabrera Format ( See Dr. Grauer Comment in the October 26, 2020 post of Dr. Smith's ECG Blog for review on the Cabrera Format ). The 2019 ESC Guidelines for the management of patients with supraventricular tachycardia indicated that IV Amiodarone should not be considered in these populations.

AFIB 103

AFIB Atrial Fibrillation Tachycardia Blog 103

Dr. Smith's ECG Blog

JUNE 14, 2024

The team immediately paged cardiology, concerned for polymorphic ventricular tachycardia. Since sinus conducted QRS complexes cannot co-exist together with ventricular tachycardia, this must all be artifact. The November 10, 2020 post — for PTA. The October 17, 2020 post — for a 70-year old woman with " Artifactual VT ".

Atrial Fibrillation 81

Atrial Fibrillation Tachycardia Blog Chest Pain 81

Ken Grauer, MD

MARCH 27, 2024

Retrospectively — I interpret this 1:1 retrograde conduction as diagnostic of a reentry SVT rhythm as the etiology of the initial tachycardia. 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 186

Blog Congenital Heart Disease Congenital Heart Disease 186

Dr. Smith's ECG Blog

OCTOBER 20, 2024

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 ). The ST-T wave appearance in lead aVR can be anything when there is acute LMain occlusion.

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Dr. Smith's ECG Blog

JANUARY 1, 2024

While the initial impression might not immediately suggest ventricular tachycardia (VT), a closer examination raises suspicion. Additionally, the qR morphology, particularly in a patient with right bundle branch block (RBBB) type wide QRS complex tachycardia (WQCT), lends further support for VT. What is the rhythm?

Tachycardia 112

Tachycardia Blog Ischemia Heart Failure 112

Ken Grauer, MD

AUGUST 29, 2024

PEARL # 2: The way in which I look for flutter waves is to carefully set my calipers at precisely HALF the R-R interval o f the tachycardia ( since IF the rhythm is AFlutter — then the atrial rate should be twice the ventricular rate if there is 2:1 AV conduction ). See text ).

Blog 156

Blog Chest Pain Tachycardia Heart Disease 156

Dr. Smith's ECG Blog

APRIL 9, 2024

With normal EF the tachycardia is not compensatory. And the patient has sinus tachycardia. ( On arrival patient was slightly tachycardic. HR about 90-100/min. Other vital signs normal. Hand held echo showed overall ejection fraction being normal. ACS then becomes less likely. Final diagnosis was myocarditis. at ~100/minute ).

Chest Pain 108

Chest Pain Pericarditis Blog Tachycardia 108

Ken Grauer, MD

JUNE 14, 2024

The rhythm is regular — at a rate just over 100/minute = sinus tachycardia ( ie, the R-R interval is just under 3 large boxes in duration ). Continuing with assessment of ECG #1 in Figure-2: The rhythm is sinus tachycardia at ~110/minute. Figure-2: I've labeled the initial ECG. The QRS complex is obviously wide.

Blog 161

Blog STEMI Cardiac Arrest Tachycardia 161

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

There is a run of polymorphic ventricular tachycardia — which given the QT prolongation, qualifies as Torsades de Points ( TdP ). This patient was having recurrent episodes of polymorphic ventricular tachycardia with an underlying long QT interval ( = Torsades des Pointes ). ECG #2 Interpretation of ECG #2: Underlying sinus rhythm.

Tachycardia 113

Tachycardia Blog Sudden Cardiac Death Arrhythmia 113

Journal of Cardiovascular Electrophysiology

NOVEMBER 7, 2024

All pediatrics presenting to AUBMC between 2000 and 2020 who underwent cardiac ablation were included. The remaining 15% of patients presented with less common types of arrhythmias, including other supraventricular tachycardias (SVTs), retrograde dual atrioventricular nodal reentry, and premature ventricular contractions (PVC).

Pediatrics 40

Pediatrics Ablation Tachycardia Arrhythmia 40

Ken Grauer, MD

SEPTEMBER 21, 2024

MY Interpretation of Today's Initial ECG: I've labeled key findings in Figure-2 for today's initial ECG: The rhythm is sinus tachycardia at ~105/minute. The sinus tachycardia is a definite concern that something acute may be ongoing. Figure-2: I've labeled t he initial ECG. All intervals ( PR, QRS, QTc ) are normal.

Chest Pain 120

Chest Pain Blog Thrombosis Tachycardia 120

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

This strip was obtained: Apparent Wide Complex Tachycardia at a rate of 280 What do you think? Troponins 34>33>43, likely secondary to myocardial injury from tachycardia. Sinus tachycardia does not go this fast. A 60-something ow healthy male had syncope while on treadmill. What do you want to do?

Atrial Flutter 64

Atrial Flutter Exercise AFIB Tachycardia 64

Dr. Smith's ECG Blog

AUGUST 6, 2024

I focus my thoughts on a qualitative approach to these 3 pre-hospital ECGs — all obtained from patients presenting with acute CP ( C hest P ain ). == ECG #1 — from a 70-ish year old Woman with acute CP and Dyspnea The rhythm is sinus tachycardia at a surprisingly rapid rate of ~115/minute. Sometimes — You have to be there.

Chest Pain 104

Chest Pain Ischemia Pericarditis Tachycardia 104

Ken Grauer, MD

SEPTEMBER 6, 2024

You are shown the ECG in Figure-1 — told only that the patient had a “continuous" tachycardia. PEARL # 4: This less common form of "fast-slow" AVNRT that is illustrated in Figure-3 — has also been known as an "incessant" tachycardia. ECG Blog #138 — AFlutter vs Atrial Tachycardia. What is the differential diagnosis?

Blog 98

Blog Tachycardia Ablation 98

Dr. Smith's ECG Blog

JANUARY 6, 2024

This is sinus tachycardia (rhythm) with complete heart block (AV node function) with ventricular escape rate just below 30. Never forget that sinus tachycardia is the scariest arrhythmia. The February 11, 2020 post ( LA-RA reversal ). The March 18, 2020 post ( LA-RA reversal ). The August 28, 2020 post ( LA-LL reversal ).

Blog 111

Blog Ischemia Tachycardia STEMI 111

Dr. Smith's ECG Blog

JUNE 26, 2023

As I discuss in detail in My Comment at the bottom of the page in the May 24, 2020 post in Dr. Smith's ECG Blog — AV dissociation is not the same as AV block. ANSWER to the Challenge Question: Note that the rhythm in ECG #2 is sinus tachycardia at ~100-105/minute. PEARL # 5: Accelerated junctional rhythms are not common in adults.

Tachycardia 97

Tachycardia Blog Arrhythmia 97

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

JULY 21, 2024

This progressed to electrical storm , with incessant PolyMorphic Ventricular Tachycardia ( PMVT ) and recurrent episodes of Ventricular Fibrillation ( VFib ). As I review in My Comment in the January 16, 2020 post of Dr. Smith's ECG Blog ( and have reproduced in Figure-2 below ) — the ECG of patients with acute LMCA occlusion may be varied.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Open Heart

APRIL 20, 2022

Methods Patients were retrospectively evaluated between January 2012 and June 2020. Objectives To describe a cohort of patients with arrhythmogenic left ventricular cardiomyopathy (ALVC), focusing on the spectrum of the clinical presentations. Significant right ventricular involvement was an exclusion criterion.

Cardiomyopathy 52

Cardiomyopathy Chest Pain Sudden Cardiac Death Heart Failure 52

Dr. Smith's ECG Blog

OCTOBER 25, 2022

We see a regular tachycardia with a narrow QRS complex and no evidence of OMI or subendocardial ischemia. The differential of a regular narrow QRS tachycardia is sinus tachycardia, SVT, and atrial flutter with regular conduction. Now the patient is in sinus tachycardia. Her initial EKG is below. Same as initial ECG.

Tachycardia 52

Tachycardia Atrial Flutter Dysrhythmia Ablation 52

Open Heart

AUGUST 25, 2023

Methods Patients with lowest LVEF between 30% and 35% without an ICD prior to the lowest-LVEF echo (defined as ‘time zero’) were identified by querying echocardiography data from 28 November 2001 to 9 July 2020 at the Massachusetts General Hospital linked to ICD treatment status. vs 65.4%, p<0.0001), more often white (87.5%

Defibrillator 52

Defibrillator Sudden Cardiac Death Myocardial Infarction Echocardiogram 52

Ken Grauer, MD

MAY 20, 2023

This point is particularly relevant regarding ECG #2 — because sinus tachycardia is seen on this earlier ECG. In Figure-4 — I've reproduced from the above cited June 20, 2020 post my schematic illustration of the ST-T wave appearance that may be seen in one or more lateral leads for demonstrating LV "strain".

Blog 145

Blog Chest Pain Ischemia STEMI 145

Dr. Smith's ECG Blog

MARCH 11, 2020

== MY Comment by K EN G RAUER, MD ( 3/12/2020 ): == A young adult presented to the ED with the “heart awareness” and the ECG shown in Figure-1 — but with no more than slight shortness of breath. DDx of Polymorphic wide tachycardia: 1. DDx of irregularly irregular wide complex tachycardia : 1. Wide complex tachycardia 2.

AFIB 52

AFIB Tachycardia Atrial Fibrillation Arrhythmia 52