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.

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Chest Pain Tachycardia STEMI Blog 130

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

It shows sinus tachycardia with right bundle branch block. 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. Both were wrong.

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Cardiogenic Shock Ultrasound Tachycardia Pulmonary 127

Ken Grauer, MD

APRIL 13, 2024

Because of this, it is uncommon to see sinus tachycardia with a prolonged PR interval. And I wish I had record of ECG monitoring just before — and during — and just after the rhythm changes from the regular tachycardia in ECG #1 — to the bigeminal rhythm in ECG #2. This is precisely what we see in Figure-6.

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Blog Tachycardia Pulmonary Arrhythmia 116

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

Sinus tachycardia has many potential causes. This is especially true for the elderly patient with sinus tachycardia. What is the cause of the sudden tachycardia? She had a very elevated troponin T at 12,335 ng/L at the time of presentation. The patient in today’s case suddenly became tachycardic while sleeping.

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Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Journal of Cardiovascular Electrophysiology

JANUARY 4, 2024

Abstract Introduction The utility of ablation index (AI) to guide ventricular tachycardia (VT) ablation in patients with structural heart disease is unknown. Methods Consecutive patients ( n  = 103) undergoing initial VT ablation at a single center from 2017 to 2022 were evaluated.

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Ablation Tachycardia Outcomes Heart Disease 40

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

Frontiers in Cardiovascular Medicine

JANUARY 28, 2024

Sacubitril/valsartan can improve outcomes for patients with heart failure and ventricular tachycardia, but few studies examined whether it can reduce recurrence or improve cardiovascular outcomes in patients with persistent atrial fibrillation after catheter ablation.

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Atrial Fibrillation Heart Failure Ablation Electrocardiogram 64

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 April 17, 2022 post ( Leads V1,V2 misplacement ). The May 5, 2022 post ( LA-RA reversal ).

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Blog Ischemia Tachycardia Physiology 111

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?

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Blog Tachycardia Ablation 98

Frontiers in Cardiovascular Medicine

FEBRUARY 17, 2025

The primary endpoint was any AF or atrial tachycardia recurrence at 12 and 24 month follow up.Resultsthe study cohort was composed by 138 patients (mean age was 5911 years, 38% female) and successful PVI was achieved in 100% of cases. Procedural data and electrophysiology (EP) laboratory times were systematically collected and analyzed.

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Atrial Fibrillation Ablation Laboratory Electrophysiology 52

Dr. Smith's ECG Blog

JUNE 27, 2024

EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. It is hard to make out P waves but you can see them best in V2, and notches in the T waves in other leads - this is a sinus tachycardia with a very long PR interval indicating first degree block.

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Blog Pacemaker Bradycardia Tachycardia 120

Dr. Smith's ECG Blog

OCTOBER 21, 2022

Artifact can obscure the rhythm or cause misdiagnosis of rhythms such as atrial fibrillation, ventricular tachycardia, and ventricular fibrillation. Instead — lead III tells us that the underlying rhythm is sinus tachycardia at 100-105/minute.

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Tachycardia Atrial Fibrillation Defibrillator Blog 52

Open Heart

OCTOBER 16, 2024

This study analysed the circadian variation of SCA in the Chinese community.

Cardiac Arrest 52

Cardiac Arrest Tachycardia Hospital 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 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

MAY 14, 2022

Here is his ED ECG: Regular Wide Complex Tachycardia at a rate of 229 First : What do you want to do? Before getting into analysis, a regular wide complex tachycardia could be 1. ventricular tachycardia ( VT ) or 2. AV reciprocating tachycardia ( AVRT , antidromic WPW) or 3. Next : What do you think is the ECG diagnosis?

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Tachycardia Electrophysiology Blog Ablation 52

Dr. Smith's ECG Blog

JULY 16, 2024

Tachycardia and ST Elevation. == MY Comment , by K EN G RAUER, MD ( 7/7 /2024 ): == Among the most rewarding type of case for me during my days working in the ED — would be seeing a patient who presented with acute CP ( C hest P ain ) — who I would be able to “cure” simply by recognizing and treating their arrhythmia. Would you give lytics?

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Atrial Flutter Chest Pain Tachycardia Arrhythmia 59

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. African Flag Sign that is not quite fulfilled here ).

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Chest Pain Ischemia Pericarditis Tachycardia 104

Dr. Smith's ECG Blog

JANUARY 8, 2024

I’ve previously reviewed specific ECG findings to look for ( See My Comment at the bottom of the page in the September 1, 2020 post — the March 4, 2023 post — and, in the March 6, 2022 post , among others. KEY Findings in ECG #1 include the following: Sinus tachycardia at ~110/minute. Junctional tachycardia? ).

Chest Pain 71

Chest Pain Pulmonary Embolism STEMI 71

Open Heart

OCTOBER 13, 2022

Methods This retrospective cohort study included all ACS patients aged≥18 years who were admitted to Dr. Hasan Sadikin Central General Hospital from January 2018 to January 2022. The area under the curve (AUC) among PADMA, GRACE, C-ACS and ProACS risk scores was compared using the fisher Z test.

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Hospital Cerebrovascular Disease Tachycardia 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

Dr. Smith's ECG Blog

MARCH 4, 2023

This one is far more specific, as it is combined with sinus tachycardia and some T-wave inversion in V1-V3. and tachycardia, 1.8. Finally , they found that S1Q3T3, precordial T-wave inversions V1-V4, and tachycardia were independent predictors of PE. This is a classic S1Q3T3. Most S1Q3T3 is not due to PE. incomplete RBBB 1.7

Chest Pain 52

Chest Pain Embolism Tachycardia Pulmonary 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

This usually represents posterior OMI, but in tachycardia and especially after cardiac arrest, this could simply be demand ischemia, residual subendocardial ischemia due to the low flow state of the cardiac arrest. The April 8, 2022 post by Drs. This prompted cath lab activation. There is profound ST depression maximal in V1-V4.

Cardiac Arrest 109

Cardiac Arrest STEMI Ischemia SCAD 109

Journal of Cardiovascular Electrophysiology

DECEMBER 7, 2023

Abstract Introduction The use of flecainide and propafenone for medical cardioversion of atrial fibrillation (AF) and atrial flutter/intra-atrial reentrant tachycardia (IART) is well-described in adults without congenital heart disease (CHD). The unit of analysis was each episode of AF/IART.

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Congenital Heart Disease Atrial Fibrillation Congenital Heart Disease 40

EMS 12-Lead

AUGUST 22, 2022

From afar, there is gross tachycardia, cadence irregularities, and narrow QRS complexes that may, or may not, be Sinus in origin; and finally – a cacophony of wide complexes that might very well be ventricular in origin. McLaren : We’ve answered the first question – Sinus Tachycardia with episodic runs of wide QRS (RBBB morphology) and PVC’s.

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Tachycardia Electrophysiology Cardiomyopathy ICU 52

Dr. Smith's ECG Blog

FEBRUARY 27, 2023

Descriptive analysis of the ECG in today's case reveals a regular, narrow tachycardia at ~130/minute , without clear sign of sinus P waves. But the rate is ~130/minute — which is a bit fast for sinus tachycardia. So IF this is sinus tachycardia with a sinoventricular rhythm — then we have to explain WHY the rate is this fast.

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Tachycardia Document Blog Bradycardia 52

Dr. Smith's ECG Blog

APRIL 24, 2022

The ECG there reportedly showed an irregular tachycardia, and the patient was immediately referred to the emergency room. Here is her ECG on arrival: There is a wide complex tachycardia that is irregularly irregular (this is difficult to determine at these very high rates). Vitals were within normal limits other than heart rate.

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AFIB Tachycardia Atrial Fibrillation Blog 52

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 ). There is sinus tachycardia at ~100/minute. As per Dr.

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Chest Pain STEMI Pulmonary Embolism 73

Dr. Smith's ECG Blog

NOVEMBER 19, 2022

Another way that WPW can be concealed is in the very rare (~15% of all WPW patients) retrograde-only conduction, in which the accessory pathway ONLY allows retrograde conduction, which obviously wouldn't show a delta wave on sinus EKG but still predisposes the patient to re-entry tachycardias. And why is the PR interval not short? Khouzam RN.

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Tachycardia RN Atrial Fibrillation Cancer 52

Dr. Smith's ECG Blog

OCTOBER 15, 2024

It should be treated as such unless there is more information such as old or serial EKGs that can confirm a benign diagnosis, as BTWI patterns can mimic the South Africa Flag Sign (Compare this EKG to case 4 here: [link] com/2022/05/quiz-post-which- of-these-if-any-are-omi.html ). Patient 1 remained in the hospital overnight. It was stented.

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Chest Pain STEMI Echocardiogram Stent 116

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 April 17, 2022 post ( Leads V1,V2 misplacement ).

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Atrial Fibrillation Ischemia AFIB Tachycardia 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? ( 25:00 — The advantage of getting a 12-lead in an unknown tachycardia = “12 Leads are Better than One” ( = You have 12 leads to tell if the QRS is wide or narrow! ). ). 19:50 — Not appreciating statistical odds! ( The 4 common causes? —

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Arrhythmia Blog Tachycardia CME 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

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. A slightly prolonged QTc ( although this is difficult to assess given the tachycardia ).

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

Blunt Trauma in a Child 40-something male in a head-on Motor Vehicle Collision and Splenic Injury == MY Comment, by K EN G RAUER, MD ( 10/10 /2022 ): == Highly interesting post by Dr. Smith regarding a 30-something male with multiple injuries from a motor vehicle accident. Sinus Tachycardia ( common in any trauma patient. ).

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Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

MAY 19, 2022

T-wave inversions and dynamic ST elevation Tachycardia, hyperthyroid, and ST elevation. 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? Anterior STEMI? Activate the Cath Lab?

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Chest Pain Exercise Pacemaker Coronary Angiogram 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

The ECG shows sinus tachycardia, a narrow, low voltage QRS with alternating amplitudes, no peaked T waves, no QT prolongation, and some minimal ST elevation in II, III, and aVF (without significant reciprocal STD or T wave inversion in aVL). It is difficult to tell if there is collapse during diastole due to the patient’s tachycardia.

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Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

APRIL 17, 2023

In addition to sinus tachycardia, the only abnormalities listed by the computer were "low voltage, precordial leads" and "anteroseptal infarct, old.Q This is something that is hard to teach, but with hundreds of such cases, we have taught the artificial intelligence algorithm to recognize this. 4) There is well formed J-point notching.

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Chest Pain STEMI Document Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2023

There is sinus tachycardia at 100-105/minute. The scooped shape of this ST depression in lead V2 makes for a positive " Mirror " Test ( For my thoughts on the Mirror Test — See My Comment in the September 21, 2022 post in Dr. Smith's ECG Blog ). Figure-1: Comparison of the first 3 ECGs in today's case. Axis and intervals are normal.

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Chest Pain Physiology Blog Stent 52