Dr. Smith's ECG Blog

JANUARY 23, 2024

Shortly after isoprenalin infusion was initiated, there were short runs of ventricular tachycardia. Figure-3: Diagnostic considerations for a patient who presents in AV block ( adapted from Mangi et al — StatPearls, 2021 ). She was started on isoprenalin (isoproterenol). The above ECG initially shows AV block.

Tachycardia 88

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 88

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 ). The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker. He required multiple defibrillations within a period of a few hours.

Arrhythmia 116

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 116

Dr. Smith's ECG Blog

JULY 10, 2021

Be careful to differentiate bifid T waves from other pathologic conditions such as hypokalemia (which can cause a U wave with prolonged QU interval) or non-conducted P waves hidden within the T wave. == MY Comment by K EN G RAUER, MD ( 7/10/2021 ): == Our appreciation to Dr. Runyon for this case.

Echocardiogram 52

Echocardiogram Pediatrics Heart Disease Article 52

Dr. Smith's ECG Blog

AUGUST 17, 2022

ACUTE MI (I allowed Acute MI to be in the report because I knew there would be an elevated troponin from ischemia, which is the definition of acute MI -- but in this case it would most likely be a Type 2 MI from tachycardia) There is also LA-RA lead reversal. The November 27, 2021 post ( LA-RA reversal ).

Atrial Fibrillation 52

Atrial Fibrillation Ischemia AFIB Tachycardia 52

EMS 12-Lead

MAY 8, 2022

2] But there is also Sinus Tachycardia! This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2] Even the preserved QRS duration is at risk of imminent death. & Schocken, D.

ACE Inhibitor 52

ACE Inhibitor Ischemia Physiology STEMI 52

Dr. Smith's ECG Blog

OCTOBER 19, 2022

(Ken Grauer points out that this 5th beat appears to be due to an early atrial beat and that these early beats continue for a few beats, suggesting a short run of atrial tachycardia.) and the 2021 YouTube Review by ICU Advantage on "Temporary Pacemakers: Modes and Basic Settings".

Pacemaker 52

Pacemaker Physiology ICU Blog 52

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 106

Tachycardia Blog Sudden Cardiac Death Arrhythmia 106

EMS 12-Lead

APRIL 21, 2022

pre-existing, stable atherosclerosis) amidst any state of global duress – to include hypertension, hypoxia, tachycardia, hypotension, sepsis, and GI bleed, for example. There may even be significant overlap between these factors. The patient was found to be hypertensive and treated accordingly. Journal of Electrocardiology, 61 ; 41-46. [3]

Ischemia 52

Ischemia Myocardial Infarction Blog Coronary Angiogram 52

Journal of Cardiovascular Electrophysiology

DECEMBER 1, 2023

Patients with SP or AVB, 21 years of age or younger, who underwent CNA between 2015 and 2021 were included. with one documented SP after termination of atrial tachycardia at the 3-month follow-up. Objective Describe the methodology and role of CNA for treatment of pediatric patients with functional AVB or SP. The median age was 18.9

Pediatrics 40

Pediatrics Document Bradycardia Pacemaker 40

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

This is ischemic ST depression, and could be due to increasing tachycardia, with a heart rate over 130, but that is unlikely given that the patient is now complaining of crushing chest pain and that there was tachycardia all along. There is widespread ST depression. Figure-1: Comparison of the first 2 ECGs in today's case.

Chest Pain 105

Chest Pain Ischemia Echocardiogram Myocardial Infarction 105

Circulation: Cardiovascular Quality & Outcomes

FEBRUARY 8, 2024

All costs are reported in 2021 US dollars. The mean cost per hospital discharge was the highest for peripheral vascular disease ($33 700 [95% CI, $33 300–$34 000]) and ventricular tachycardia/ventricular fibrillation ($32 500 [95% CI, $32 100–$32 900]).

Cardiovascular Disease 40

Cardiovascular Disease Hospital Inpatient Cerebrovascular Disease 40

EMS 12-Lead

APRIL 28, 2022

Initial vital signs include: NIBP 99/58 HR 150-160 (trend) RR 10 (spontaneous, but shallow) SpO2 86 (RA) BBS CTA The initial rhythm strip is attached: Figure 1 There is a wide complex tachycardia of varying morphology, amplitude, and R-R cycle length. Chapter 10: Recurrent Ventricular Tachycardia (pg. 2] Viskin, S., 4] Surawicz, B.

Tachycardia 52

Tachycardia AFIB Coronary Artery Bypass Graft Arrhythmia 52

Dr. Smith's ECG Blog

JULY 19, 2024

2021;Available from: [link] Other references: Lindow T, Mokhtari A, Nyström A, Koul S, Smith SW, Ekelund U. Harry Mond — that outlines a user-friendly approach to — “Where Am I Pacing From?” — as can be determined based on the appearance of the 12-lead ECG ( See CardioScan — May 5, 2021 ). Ann Emerg Med [Internet].

Chest Pain 105

Chest Pain Myocardial Infarction Pacemaker STEMI 105

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 November 27, 2021 post ( LA-RA reversal ). The February 11, 2020 post ( LA-RA reversal ). The March 18, 2020 post ( LA-RA reversal ).

Blog 93

Blog Ischemia Tachycardia Physiology 93

Dr. Smith's ECG Blog

MAY 5, 2022

After initiating treatment for hyperkalemia, repeat ECG showed resolution of Brugada pattern: The ECG shows sinus tachycardia. A Very Wide Complex Tachycardia. The November 27, 2021 post ( LA-RA reversal ). He also received insulin with D50, sodium bicarbonate, and kayexalate for hyperkalemia. What is the Rhythm?

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52