Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock). As per Dr. Frick — sinus tachycardia is usually not seen with acute OMI unless the patient is in cardiogenic shock. Additionally, there is borderline right axis deviation. Both were wrong.

Cardiogenic Shock 128

Cardiogenic Shock Ultrasound Tachycardia Pulmonary 128

Frontiers in Cardiovascular Medicine

JANUARY 10, 2024

Methods We retrospectively analyzed data of 171 consecutive patients treated for OHCA using ECPR in our cardiac arrest center from the years 2016 to 2022. The primary reason for OHCA was an acute coronary event (72%) followed by primary arrhythmia (9%) and non-ischemic cardiogenic shock (6.7%).

Cardiac Arrest 59

Cardiac Arrest Cardiogenic Shock Hospital Arrhythmia 59

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. Meyers and Smith illustrate 20 example cases vs "look-alikes" of Swirl ( with my synthesis of "Swirl" ECG findings in My Comment on that post ) from October 15, 2022.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Journal of the American Heart Association

MARCH 21, 2025

However, the association of socioeconomic vulnerability and outcomes after hospitalization is uncertain.Methods and ResultsAmerican Heart Association COVID19 Cardiovascular Disease Registry hospitalizations between March 1, 2020, and June 30, 2022, linked with Medicare feeforservice claims, were analyzed.

COVID-19 40

COVID-19 Medicare Cardiogenic Shock Hospital 40

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Heparin bolus (4000u), infusion Plan for rate control 25 mg IV diltiazem given HR = 143 25 mg IV repeat dose diltiazem given HR = 143 Diltiazem drip 10 mg/ hr for ~20 min HR remained 140 - 155 Then the patient developed Cardiogenic shock and echo had poor contractility Amiodarone load given. Patient intubated.

Tachycardia 139

Tachycardia Cardiogenic Shock Angina Blog 139

Dr. Smith's ECG Blog

OCTOBER 8, 2024

A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. For more on Precordial Swirl — See the October 15, 2022 post in Dr. Smith's ECG Blog ). She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD. She could not be resuscitated.

Cardiac Arrest 123

Cardiac Arrest Myocardial Infarction STEMI Cardiogenic Shock 123

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The notes now refer to the patient being in cardiogenic shock, on pressors. hours from presentation, where he was found to have an acute thrombotic LAD occlusion which was stented with resulting TIMI 3 flow, but still the patient was in severe cardiogenic shock. Published 2022 Feb 20. 2022;Available from: [link] 7.

Chest Pain 83

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Circulation: Cardiovascular Quality & Outcomes

JANUARY 5, 2024

Admissions to CICUs with the highest tertile of CCRx utilization had a greater burden of comorbidities, had more diagnoses of ST–elevation myocardial infarction, cardiac arrest, or cardiogenic shock, and had higher Sequential Organ Failure Assessment scores. in low, intermediate, and high CCRx tertiles, respectively.

Critical Care 40

Critical Care Cardiogenic Shock Academic Cardiac Arrest 40

Ken Grauer, MD

OCTOBER 25, 2024

See the October 15, 2022 post ( including My Comment at the bottom of the page ) — for review and illustration of the concept of " Precordial Swirl " ( due to proximal LAD OMI ). = A DDENDUM ( 10/26/2024 ) : I excerpted what follows below from My Comment in the August 12, 2022 post in Dr. Smith's ECG Blog ). =

Blog 94

Blog Chest Pain STEMI Cardiogenic Shock 94

Dr. Smith's ECG Blog

MAY 30, 2023

The April 17, 2022 post ( Leads V1,V2 misplacement ). The May 24, 2022 post ( LA-LL reversal ). The May 26, 2022 post ( LA-LL reversal ). The August 17, 2022 post ( LA-RA reversal ). The November 19, 2020 post ( LA-LL reversal ). The November 27, 2021 post ( LA-RA reversal ).

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

DAIC

FEBRUARY 29, 2024

24: Joint American College of Cardiology/Journal of the American College of Cardiology Late-Breaking Clinical Trials (Session 402) Saturday, April 6 9:30 – 10:30 a.m.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Although ECG signs of acute PE typically involve inferior and/or anterior lead ST depression/T wave inversion — on occasion, there can be ST elevation ( Gheith et al — Cureus 14(9): e29249, 2022 — and — Siddiqa et al — Am J Case Reports 21: e927923-6, 2020 ). When seen — such ST elevation is typically seen in anterior leads.

Chest Pain 73

Chest Pain STEMI Pulmonary Embolism 73

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He was in cardiogenic shock requiring an impella for several days after cath. No further troponins were measured. He was taken to the cath lab where he was found to have acute total occlusion of his saphenous vein graft to his RCA, which was stented. Such is the situation in today's post by Drs. Plate and Meyers.

Chest Pain 52

Chest Pain Cardiac Arrest Cardiogenic Shock Heart Attack 52

Dr. Smith's ECG Blog

OCTOBER 6, 2023

His included cardiogenic shock, V Tach, AV block. This poor echo can be seen even after very good reperfusion because myocardium that is still viable can be "stunned" and take weeks to recover. But the ECG is telling us that the myocardium will probably not recover. Such large infarcts have many complications.

Aneurysm 66

Aneurysm Chest Pain Cardiogenic Shock Blog 66

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important. == MY Comment, by K EN G RAUER, MD ( 11/4 /2022 ): == Our thanks to Drs.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

MAY 8, 2023

This was several months after the 2022 ACC Guidelines adding modified Sgarbossa criteria as a STEMI equivalent in ventricular paced rhythm). Queen of Hearts interpretation: The cardiologist initially was not convinced, stating the ECG was not diagnostic or could not be diagnostic because it was paced. Modified Sgarbossa Criteria Refresher!

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). The October 21, 2022 post — for " artifactual VT". The ECG has a lot of artifact, and the amplitude is very small, making interpretation challenging. We can see enough to make out that the rhythm is sinus tachycardia.

Chest Pain 64

Chest Pain Blog Arrhythmia Critical Care 64

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Institutional Coronary Artery Bypass Case Volumes and Outcomes European Journal of Heart Failure October 2023 Makoto Mori Robotic Mitral Valve Repair for Degenerative Mitral Regurgitation The Annals of Thoracic Surgery August 2023 Carlos Diaz-Castrillion Volume-Failure to Rescue Relationship in Acute Type A Aortic Dissections: An Analysis of The Society (..)

Research 52

Research Coronary Artery Bypass Graft Aortic valve Congenital 52

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Institutional Coronary Artery Bypass Case Volumes and Outcomes European Journal of Heart Failure October 2023 Makoto Mori 1 Robotic Mitral Valve Repair for Degenerative Mitral Regurgitation The Annals of Thoracic Surgery August 2023 Carlos Diaz-Castrillion 2 Volume-Failure to Rescue Relationship in Acute Type A Aortic Dissections: An Analysis of The (..)

Research 52

Research Coronary Artery Bypass Graft Aortic valve Congenital 52

Dr. Smith's ECG Blog

JANUARY 11, 2025

See our other cases with similar patters, to burn this deep into your brain files: Smith : In my experience, these cases of LAD OMI with RBBB and LAFB are either about to arrest, post-arrest, and/or in cardiogenic shock. The ST Elevation is NOT typical. It is ofen downsloping This one is also a wide complex tachycardia.

Cardiogenic Shock 137

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest 137

European Journal of Heart Failure

DECEMBER 1, 2024

Abstract Aims Left ventricular unloading by percutaneous microaxial flow-pump devices has been shown to improve survival in patients with cardiogenic shock (CS). Between June 2022 and April 2024, 20 patients with CS (64 ± 8.9 years, Summary of key study outcomes. The objective of the study is to examine whether Impella 5.0/5.5

Cardiogenic Shock 40

Cardiogenic Shock Heart Transplant Outcomes Transplant 40

Dr. Smith's ECG Blog

MARCH 27, 2025

Shes in impella dependent cardiogenic shock w new renal failure. "And they hit the carotid trying to place an Impella, caused a big hematoma where she had precipitous airway occlusion. Just awful all around. Ill check for updates and other ekgs when I log in later today." Post cath ekg here.

Ischemia 106

Ischemia Chest Pain Cardiogenic Shock Heart Failure 106

Dr. Smith's ECG Blog

MARCH 25, 2025

They can only be distinguished by: 1) if there are pulses, then it is not VF 2) if it spontaneously resolves, then it is not VF, with rare exceptions DOSE VF , New England Journal 2022 Remember that in the trial DOSE VF, pre-hospital use of DSED increased the likelihood of survival to hospital discharge by 17.1% in absolute terms!

Chest Pain 63

Chest Pain Ischemia Plaque Stent 63

Dr. Smith's ECG Blog

MARCH 3, 2025

Whenever there is tachycardia, I am skeptical of OMI unless it has led to severely compromised ejection fracction with cardiogenic shock. However, there is also significant tachycardia , with heart rate of 116, and known hypoxia. Or I suspect that there is OMI simultaneous with another pathology.

Tachycardia 74

Tachycardia Pulmonary Chest Pain Stenosis 74