Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Acute MI per se usually does not depress cardiac function and blood pressure enough to cause syncope ( Mostafa et al — J Com Hosp Intern Med Perspect 13(4):9-12, 2023 - ). Other cardiac-related causes for syncope associated with acute MI may include malignant ventricular arrhythmias and bradyarrhythmias including AV block.

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Chest Pain Aneurysm Stents Stent 114

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

link] == MY Comment , by K EN G RAUER, MD ( 11/11 /2023 ): == From a learning standpoint — I LOVED this case because it illustrates in many ways how some patients simply "do not read the textbook before they come to the ED". I added, "Makes me wonder if this could be myocarditis in a younger adult — maybe even with sinus arrhythmia."

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Stroke Strokes Chest Pain Cardiomyopathy 70

Dr. Smith's ECG Blog

MAY 26, 2023

Severely ill patients from any etiology can have very abnormal ECGs = My Comment by K EN G RAUER, MD ( 5/26 /2023 ): = There are more questions than answers in today's case. It will not always be possible to be 100% certain about the etiology of an arrhythmia from the single "snapshot" we get from a 10-second rhythm strip.

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Cardiogenic Shock Arrhythmia Blog Education 98

Ken Grauer, MD

DECEMBER 23, 2023

KEY Point: Knowing that the most commonly overlooked arrhythmia is AFlutter — suggests that the BEST way to avoid missing the diagnosis of AFlutter is simply to THINK of AFlutter whenever you have a regular SVT at a rate close to 150/minute ( in which you do not clearly see upright sinus P waves in lead II ).

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Blog Tachycardia Tricuspid Atrial Flutter 173

Ken Grauer, MD

OCTOBER 27, 2023

That said — obvious findings include: i ) Marked bradycardia! — L addergram I llustration : At this point — I needed to work out, and then draw a laddergram that I could then verify to ensure a plausible mechanism for today's arrhythmia. The rhythm in Figure-1 is complex — and defies precise interpretation without careful study.

Blog 100

Blog Pacemaker Bradycardia Arrhythmia 100

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

Learning points : Takotsubo can lead to cardiac arrest from ventricular arrhythmia. I have periodically called attention to examples of the Ashman phenomenon as they occur in Dr. Smith's ECG Blog ( See My Comments in the January 5, 2020 post — the June 17, 2020 post — and the March 30, 2023 post , among others ).

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Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 67

Dr. Smith's ECG Blog

MARCH 15, 2023

My Comment by K EN G RAUER, MD ( 3/15 /2023 ): = I found today’s case highly instructive in highlighting a number of important aspects regarding the presentation and initial treatment of a patient who presents to the ED with new AFib. Baseline bradycardia in endurance athletes limits the use of ß-blockers. 25, 2022 ).

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Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

JANUARY 5, 2024

The ECG shows sinus bradycardia but is otherwise normal. Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The documentation does not describe any additional details of the history. The following ECG was obtained. ECG 1 What do you think?

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Angina Plaque Document Stents 120

Dr. Smith's ECG Blog

JANUARY 13, 2024

Cardiology was consulted, and the note said "no arrhythmias on telemetry or pacer interrogation." This is supported by the PT note which described a palpably irregular pulse with pauses and marked bradycardia. The final cardiology recommendation was to increase fludrocortisone and midodrine.

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Pacemaker Bicuspid/Mitral Blood Pressure Bradycardia 110

Dr. Smith's ECG Blog

JULY 5, 2023

Instead — my thoughts were as follows: The rhythm is sinus , with marked bradycardia and a component of sinus arrhythmia. WPW Cardiac arrhythmias ( especially AFib ). In this case, QOH was incorrect , saying "OMI High confidence." QRS amplitude is dramatically increased in a number of leads. Abnormal ST-T wave abnormalities.

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Chest Pain STEMI Congenital Heart Disease Heart Disease 52

Dr. Smith's ECG Blog

JULY 30, 2023

The RCA usually supplies the SA and AV nodes, so RCA OMIs can present with heart blocks and bradycardias like in this case. == MY Comment , by K EN G RAUER, MD ( 7/30 /2023 ): == There are numerous important points that are brought out by today’s case. PEARL # 5 — Complete AV dissociation is not the same as 3rd-degree AV block!

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Chest Pain Ischemia STEMI Arrhythmia 52

Dr. Smith's ECG Blog

JUNE 23, 2023

The patient later settled into sinus bradycardia. The amiodarone was discontinued and the patient did well. == MY Comment , by K EN G RAUER, MD ( 6/23 /2023 ): == From an academic standpoint — I love WCT ( W ide- C omplex T achycardia ) rhythms. I focus my comments on some additional thoughts that add to his excellent discussion.

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Tachycardia Cardiomyopathy Arrhythmia Diabetes 52

Dr. Smith's ECG Blog

JANUARY 15, 2023

My Comment by K EN G RAUER, MD ( 1/15 /2023 ): = For many reasons — I thought today's post by Dr. Smith to be highly insightful and extremely useful to any provider charged with interpreting emergency ECGs. The rhythm in ECG #1 is sinus bradycardia and arrhythmia. Hillinger et al.

Chest Pain 52

Chest Pain Blog Bradycardia Stents 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

VT is the second most common presenting arrhythmia. Vaso or inotropic medications are not harmless, and can precipitate life threatening arrhythmias. It is common with 2nd- and 3rd-degree AV block to see a " ventriculophasic " sinus arrhythmia. AV block is the first manifestation of CS in more than 30% of patients.

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Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. As per Dr. Nossen — today's initial ECG ( LEFT tracing in Figure-2 ) shows sinus bradycardia with QRS widening due to bifascicular block ( RBBB/LAHB ). The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization.

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Dr. Smith's ECG Blog

OCTOBER 8, 2023

The rhythm is uncertain ( ie, We only see 4 beats — because the same 4 beats are repeated in limb and chest leads — but in lead II there appears to be sinus bradycardia and arrhythmia plus a P wave with a PR interval too short to conduct preceding beat #1 — therefore need for a longer period of monitoring ).

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Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 122

Dr. Smith's ECG Blog

OCTOBER 25, 2023

Syncope and Bradycardia Syncope in a 20-something woman Long QT: Do not trust the computerized QT interval when the QT is long An Alcoholic Patient with Syncope Cardiac Arrest. Another diagnostic ECG of a potentially deadly condition == MY Comment , by K EN G RAUER, MD ( 10/19 /2023 ): == Today's excellent case discussion by Drs.

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Chest Pain Ischemia Cardiac Arrest Blog 123

Dr. Smith's ECG Blog

MARCH 24, 2023

There’s sinus bradycardia, first degree AV block, normal axis, delayed R wave progression, and normal voltages. Hyperacute T waves are deflating, suggesting reperfusion but there is still reciprocal change in I/aVL and ST depression in V2, and the bradycardia is worse. Below is the ECG. What do you think? Take home 1.

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Chest Pain STEMI Bradycardia Ischemia 52

Ken Grauer, MD

OCTOBER 4, 2024

To improve visualization — I've digitized the original ECG using PMcardio ) MY Thoughts on the ECG in Figure-1: This is a challenging tracing to interpret — because there is marked bradycardia with an irregular rhythm and a change in QRS morphology. Was there a family history of sudden death or significant arrhythmia?

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Blog Bradycardia Arrhythmia Pacemaker 100

Dr. Smith's ECG Blog

MAY 23, 2022

Patient 2 : 55 year old with 5 hours of chest pain radiating to the shoulder, with nausea and shortness of breath ECG: sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. Smith : The fact that the ECG did not evolve is further proof that this was the baseline ECG. nearly identical to the first case).

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Chest Pain Pericarditis STEMI Arrhythmia 52

Dr. S. Venkatesan MD

NOVEMBER 22, 2024

We don’t need to think deep, to realize, modalities which take on this arrhythmia head-on has a minuscule role at the population level. 2023 Sep 29;15(9). Simple measures, optimal BP, like weight reduction, (Atrial interstitial fat shedding) , relaxation can prevent 90% of AF burden.

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Atrial Fibrillation Arrhythmia Risk Factors Bradycardia 52

Dr. Smith's ECG Blog

FEBRUARY 18, 2025

As I emphasized in My Comment in the February 27, 2023 post in Dr. Smith's ECG Blog some patients may develop everything except QRS widening. Among the "lessons" from today's case are the following: Although many patients follow the "textbook sequence" of ECG changes with their hyperkalemia a significant percentage of patients do not.

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Blood Pressure Blog Cardiac Arrest Bradycardia 63

Dr. Smith's ECG Blog

DECEMBER 5, 2023

A repeat ECG was performed as adult cardiology was asked to evaluate the patient for emerget PCI: Sinus bradycardia with persistent elevation in the inferior leads with reciprocal depression in aVL Patient was taken to cath lab with adult cardiology which revealed normal coronary arteries without evidence of occlusion MI. World J Pediatr.

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Pediatrics Pericarditis COVID-19 Congenital Heart Disease 120

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

The possibility of an ischemic cause of the ventricular arrhythmia has to be considered! Below in Figure-5 is a 10-minute continuous lead II recording on oral Flecainide, now showing sinus bradycardia without a single PVC! A workup was undertaken in search of a cause of the patient's ventricular arrhythmia. No PVCs are seen.

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Tachycardia Arrhythmia Ablation Atrial Flutter 72

Dr. Smith's ECG Blog

JANUARY 21, 2023

This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern. 2004 = My Comment by K EN G RAUER, MD ( 1/21 /2023 ): = I thought today's case by Drs.

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STEMI Bradycardia Arrhythmia Cardiac Arrest 52