Dr. Smith's ECG Blog

JULY 30, 2023

Written by Pendell Meyers A woman in her 50s presented with acute chest pain and lightheadedness since the past several hours. Here is her triage ECG during active symptoms: What do you think? The ED physician read this as "Normal sinus rhythm. Marked ST abnormality, possible anterior subendocardial injury."

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Chest Pain Ischemia STEMI Arrhythmia 52

Ken Grauer, MD

OCTOBER 13, 2023

She was hemodynamically stable — and did not have chest pain, lightheadedness or syncope. Even if we stopped here — We could conclude the following: There is marked bradycardia in today's rhythm ( ie, Heart rate in the low 30s ). QUESTIONS: HOW would you interpret the rhythm in Figure-1 ? Is this " high -grade" AV block?

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Blog Arrhythmia Bradycardia Download 158

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

Later, I found old ECGs: 5 month prior in clinic: V5 and V6 look like OMI 9 months prior in clinic with no chest symptoms: V5 and V6 look like OMI 1 year prior in the ED with chest pain: V5 and V6 sure look like a STEMI For this ECG and chest pain in the ED, the Cath lab activated. But the angiogram was clean.

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Stroke Strokes Chest Pain Cardiomyopathy 70

Ken Grauer, MD

JUNE 2, 2023

to 1828 msec. ) — which corresponds to a variation in the rate of sinus bradycardia from 36-to-33/minute. This makes sense given that the underlying rhythm in today's case appears to be marked sinus bradycardia and arrhythmia , with a ventricular escape rhythm appearing when the SA node rate drops below 33/minute.

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Blog Bradycardia Arrhythmia Tachycardia 78

Dr. Smith's ECG Blog

OCTOBER 18, 2023

The chest pain quickly subsided. During the night, while on telemetry, the patient became bradycardic, with periods of isorhythmic AV dissociation (nodal escape rhythm alternating with sinus bradycardia), and there were sporadic PVCs. Are you worried about OMI in this case? His response was: "I would not call it OMI.

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Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia 122

Dr. Smith's ECG Blog

MAY 26, 2023

And she does not know that this is an overdose; she thinks it is a patient with chest pain!! 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. 3 hours later, this was recorded at a K of 2.8

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Cardiogenic Shock Arrhythmia Blog Education 98

Dr. Smith's ECG Blog

JANUARY 5, 2024

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 ECG shows sinus bradycardia but is otherwise normal. The patient said his chest pain was 4/10, down from 8/10 on presentation. The following ECG was obtained.

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Angina Plaque Document Stents 120

Ken Grauer, MD

OCTOBER 27, 2023

That said — obvious findings include: i ) Marked bradycardia! — A DDENDUM ( 10/28/2023 ) : This 15 -minute ECG Video ( M edia P EARL # 52) — Reviews the 3 Types of 2nd-Degree AV Block — plus — the hard-to-define term of "high-grade" AV block. The rhythm in Figure-1 is complex — and defies precise interpretation without careful study.

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Blog Pacemaker Bradycardia Arrhythmia 100

Dr. Smith's ECG Blog

JULY 26, 2023

The combination of absence of chest pain and history of LV aneurysm made it easy to assess that this patient does not have acute OMI. In view of the History with the current admission ( ie, presenting to the ED for vertigo — with no new chest pain ) — I interpreted ECG #1 as no OMI.

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Aneurysm Chest Pain STEMI Bradycardia 52

Dr. Smith's ECG Blog

JANUARY 15, 2023

Even if you don't see the OMI, you can usually prevent such a long delay to reperfusion by recording serial ECGs every 15 minutes for a patient with persistent chest pain. The rhythm in ECG #1 is sinus bradycardia and arrhythmia. Hillinger et al. The lead that immediately caught my eye — is lead aVL.

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Chest Pain Blog Bradycardia Stents 52

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

After the heart rate increased slightly, here was the repeat ECG: Sinus bradycardia, only slightly faster rate than prior. See these similar cases: A man in his sixties with chest pain Why is there inferior ST elevation, and would you get posterior leads? Sudden CP and SOB with Inferior ST Elevation and in STE in V1.

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Blog Bradycardia Ischemia Exercise 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

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Chest Pain Defibrillator STEMI Coronary Artery Disease 135

Dr. Smith's ECG Blog

MARCH 15, 2023

She did notice something slightly wrong subjectively, but had no palpitations, chest pain, or SOB, or any other symptom. Baseline bradycardia in endurance athletes limits the use of ß-blockers. This middle-aged patient has a remote history of cardiac surgery as a young child for a "heart murmur". She was on no medications.

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Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

MARCH 24, 2023

Written by Jesse McLaren, with comments from Smith An 85 year old with a history of CAD presented with 3 hours of chest pain that feels like heartburn but that radiates to the left arm. There’s sinus bradycardia, first degree AV block, normal axis, delayed R wave progression, and normal voltages. Below is the ECG. Take home 1.

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Chest Pain STEMI Bradycardia Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

He woke up alert and with chest pain which he also had experienced intermittently over the previous few days. The history in today's case with sudden loss of consciousness followed by chest pain is very suggestive of ACS and type I ischemia as the cause of the ECG changes. What do you think?

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Dr. Smith's ECG Blog

OCTOBER 25, 2023

He did not have chest pain. Chest pain in high risk patient. 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. Here is his triage ECG: What do you think? Is it STEMI? What is going on here?

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Chest Pain Ischemia Cardiac Arrest Blog 123

Dr. Smith's ECG Blog

OCTOBER 8, 2023

All of the patients presented with chest pain , and they are all in triage. Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECG s that has not been overread by a physician. Which, if any, of these patients has OMI, with myocardium at risk and need for emergent PCI?

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Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 122

Dr. Smith's ECG Blog

JANUARY 23, 2024

There was no chest pain. For example — bradycardia and AV conduction disturbances are not uncommon with Hyperkalemia , with these conduction disturbances most often resolving once serum K+ is corrected. This was written by Magnus Nossen The patient is a female in her 50s. She was feeling fine prior to the last seven days.

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Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

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. Figure-1: The initial ECG in today's case. ( The QRS complex is wide ( ie, >0.10

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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. This was missed by the treating physician, but the chest pain resolved with aspirin.

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Chest Pain Pericarditis STEMI Arrhythmia 52

Dr. Smith's ECG Blog

APRIL 13, 2025

A man in his early 30s was walking when he developed central chest pain which was non-radiating, then had a syncopal event with bowel incontinence, and when he woke up he had ongoing chest pain. Notes never having symptoms like this before, pain is so severe its causing SOB. He called 911. As I wrote in that Nov.

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Dr. Smith's ECG Blog

DECEMBER 5, 2023

days of chest pain that started as substernal and crushing in nature awakening him from sleep and occasionally traveling to right side of neck. The pain was described as constant, worse with deep inspiration and physical activity, sometimes sharp. He reported 1.5 World J Pediatr. 2021 Aug;17(4):335-340. Epub 2021 May 20.

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Pediatrics Pericarditis COVID-19 Congenital Heart Disease 120

Dr. Smith's ECG Blog

MARCH 8, 2025

Within ten minutes, she developed bradycardia, hypotension, and ST changes on monitor. Bradycardia and heart block are very common in RCA OMI. He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. He told the patient this horrible news. European Heart Journal , 39 (22), 20322046.

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