Ken Grauer, MD

MAY 20, 2023

This point is particularly relevant regarding ECG #2 — because sinus tachycardia is seen on this earlier ECG. In the October 15, 2022 post of Dr. Smith's ECG Blog — Drs. Smith and Meyers in their October 15, 2022 post on Precordial Swirl. What is P recordial S wirl ? NOTE: It's EASY to get fooled by LVH!

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Blog Chest Pain Ischemia STEMI 145

Dr. Smith's ECG Blog

JANUARY 6, 2024

Here, I do not see OMI (although the ECG is falsely STEMI positive with just over 1 mm STE in V1 and about 2.5 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. What do you think?

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Blog Ischemia Tachycardia STEMI 111

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. This progressed to electrical storm , with incessant PolyMorphic Ventricular Tachycardia ( PMVT ) and recurrent episodes of Ventricular Fibrillation ( VFib ). The below ECG was recorded. He required multiple defibrillations within a period of a few hours.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. aVR ST segment elevation: acute STEMI or not? aVR ST Segment Elevation: Acute STEMI or Not?

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

AUGUST 6, 2024

It definitely does not fulfill STEMI criteria, and I would argue that it would not lead to cath lab activation in most centers. NOTE #1: Sinus tachycardia is not usually seen in an uncomplicated acute MI. . == Below is the ECG of Patient #2 — as interpreted by the QOH. The ECG is diagnostic of occlusion myocardial infarction (OMI).

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Chest Pain Ischemia Pericarditis Tachycardia 104

Dr. Smith's ECG Blog

APRIL 17, 2023

The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)? In addition to sinus tachycardia, the only abnormalities listed by the computer were "low voltage, precordial leads" and "anteroseptal infarct, old.Q Physician: "No STEMI."

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Chest Pain STEMI Document Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 27, 2023

See many examples of Pseudo STEMI due to hyperkalemia at these two posts: Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life. But the rate is ~130/minute — which is a bit fast for sinus tachycardia. The patient was treated.

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Tachycardia Document Blog Bradycardia 52

Dr. Smith's ECG Blog

JULY 24, 2024

22:25 — What if you have a regular SVT ( = narrow-complex tachycardia ) without obvious P waves? ( 2:25 — Dr. Grauer: The 1st Error : Too many clinicians in 2024 are still stuck in the outdated millimeter-based STEMI Paradigm”. ). 19:50 — Not appreciating statistical odds! ( The 4 common causes? — The most commonly overlooked cause? )

Arrhythmia 52

Arrhythmia Blog Tachycardia CME 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

If you use quantitative end-tidal CO2 monitoring, there is never any need to waste time making sure that the endotracheal tube is correctly placed. == MY Comment, by K EN G RAUER, MD ( 10/10/2022 ): == Today’s case is a “Save”! Tachycardia is of course, quite common in patients following cardiac arrest.

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Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

MAY 10, 2023

Later, she developed chest pain again, and had this ECG recorded: Obvious Anterior OMI that is also a STEMI Coronary angiogram- --Right dominant coronary artery system --The left main artery was normal in appearance and free of obstructive disease. --The Thus, Wellens' syndrome should be thought of as a transient OMI or transient STEMI.

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Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

MAY 5, 2022

Despite the clinical context, Cardiology was consulted due to concerns for a "STEMI". After initiating treatment for hyperkalemia, repeat ECG showed resolution of Brugada pattern: The ECG shows sinus tachycardia. A Very Wide Complex Tachycardia. The April 17, 2022 post ( Leads V1,V2 placed too high ). What is the Rhythm?

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52

Dr. Smith's ECG Blog

MAY 19, 2022

T-wave inversions and dynamic ST elevation Tachycardia, hyperthyroid, and ST elevation. Anterior STEMI? Please see My Comment at the bottom of the page in the April 17, 2022 post of Dr. Smith's Blog — for concise review on how to quickly recognize too-high placement of the lead V1 and V2 electrodes. What is it?

Chest Pain 52

Chest Pain Exercise Pacemaker Coronary Angiogram 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2023

Diagnosis: Acute non-ST segment elevation MI (Non-STEMI, or NSTEMI) Second troponin returned at around 0200: 15,894 ng/L 0245 (unclear if ongoing pain or not) Inferoposterior (and lateral V5-6) reperfusion findings. There is sinus tachycardia at 100-105/minute. Admitted to the hospital service for further evaluation and management."

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Chest Pain Physiology Blog Stents 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

ECG met STEMI criteria and was labeled STEMI by computer interpretation. J waves can also be induced by Occlusion MI (5), STEMI mimics including takotsubo and myocarditis complicated by ventricular arrhythmias (6, 7), and subarachnoid hemorrhage with VF (8). Take home : Not all STEs are STEMIs or OMIs. What do you think?

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STEMI Bradycardia Arrhythmia Cardiac Arrest 52

Dr. Smith's ECG Blog

JANUARY 11, 2025

It is a wide complex regular tachycardia at a rate of 120. Is it ventricular tachycardia? I fear that many learners would also not easily recognize where the QRS actually ends, and I fear that some may think that this is ventricular tachycardia due to inability to distinguish QRS from ST segment. The ST Elevation is NOT typical.

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Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest 137

Dr. Smith's ECG Blog

MARCH 3, 2025

The status of the patients chest pain at this time is unknown : EKG 1, 1300: There is sinus tachycardia and artifact of low and high frequency. However, there is also significant tachycardia , with heart rate of 116, and known hypoxia. Supply-demand mismatch can cause ST Elevation (Type 2 STEMI). An EKG was immediately recorded.

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Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

JANUARY 24, 2025

Ventricular tachycardia?) Learning points: 40% of LAD OMI with TIMI-0 flow do NOT meet STEMI criteria (manuscript under consideration at Eur Ht. 20/53 did not meet STEMI criteria, but all showed OMI diagnosed by both Smith and the Queen of Hearts. He said it felt like "someone ripped [his] heart out." What do you think?

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Chest Pain STEMI Risk Factors Coronary Artery Disease 124

Dr. S. Venkatesan MD

JANUARY 22, 2025

The fear comes built in with the diagnosis often amplified by young felllows on call (& often times by senior consultants as well) It may appear real, from a clinical angle, but trust, when we deal with the whole gamut of so-called ACS (other than STEMI), there is indeed a benign face in many of them. 2022 Oct;38(10):1521-1524.

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Coronary Angiogram Chest Pain Anatomy Angina 52

Dr. Smith's ECG Blog

JANUARY 21, 2025

This ECG was recorded: It is difficult to appreciate P-waves, but I believe this is sinus tachycardia. It is correct that he did not have chest pain, but we must remember that fully 1/3 of full blown STEMI do not present with chest pain. This is extremely elevated for a type 2 MI and totally consistent with STEMI.

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Chest Pain STEMI Tachycardia Myocardial Infarction 61

Dr. Smith's ECG Blog

MARCH 8, 2025

Or, there could be mid-ventricular Takotsubo , in which there is poor function ( and ballooning ) o f the mid-LV, with good function at both the base and the apex and, still other anatomic possibilities ( See the June 24, 2014 post and My Comment in the July 21, 2022 post of Dr. Smith's ECG Blog regarding Takotsubo variant patterns ).

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75

Dr. Smith's ECG Blog

JANUARY 13, 2025

Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. If the QRS is prolonged, then the differential includes: 1. Hyperkalemia 2. Other drugs with sodium channel blockade: Tricyclic antidepressants.

Chest Pain 71

Chest Pain Cardiac Arrest Ischemia Sudden Cardiac Death 71