Dr. Smith's ECG Blog

OCTOBER 23, 2023

Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. The described rhythm was an irregular, wide complex rhythm. Circulation. 2001 Nov 27;104(22):2722-7.

Tachycardia 131

Tachycardia Cardiac Arrest ICU Blog 131

Ken Grauer, MD

OCTOBER 21, 2023

PEARL # 1: Although seeing an elevated Troponin would provide additional support for immediate cardiac catheterization — the clinical reality is that the initial Troponin reading will not always be elevated in patients with acute coronary occlusion ( See March 24, 2023 post in Dr. Smith's ECG Blog ).

Blog 98

Blog Chest Pain Ischemia STEMI 98

Dr. Smith's ECG Blog

JULY 27, 2023

hours ECG: Not much change hs troponin I peaks at 500 ng/L 8 hours Next morning Urine drug screen: Amphetamine, Methamphetamine, Fentanyl, Fentanyl metabolite Formal Bubble Contrast Echocardiogram: Indications for Study: Silent Ischemia. Conclusion: Type II MI probable due to hypoxia and tachycardia from resp arrest and amphetamine use.

Tachycardia 52

Tachycardia Ischemia Cardiac Arrest Echocardiogram 52

Dr. Smith's ECG Blog

AUGUST 19, 2023

They had had twice the rate of cardiac arrest and twice the in-hospital mortality[1] In another study of patients diagnosed with STEMI, those on dialysis experienced delayed reperfusion and double the mortality.[2] They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS.

Chest Pain 98

Chest Pain STEMI Myocardial Infarction Blog 98

Dr. Smith's ECG Blog

MAY 5, 2023

= Case Presentation by K EN G RAUER, MD ( 5/5 /2023 ): — Edits by Drs. Meyers & Smith. = Dr. Smith was reading ECGs — and he sent myself and Dr. Meyers the tracing shown in Figure-1. At the time we did not yet know the history. What do YOU think? Figure-1: The initial ECG in today's case. No history yet.

Bradycardia 52

Bradycardia Cardiac Arrest Arrhythmia Pacemaker 52

Ken Grauer, MD

OCTOBER 27, 2023

This suggests ischemia of uncertain duration. Unfortunately, before this could be accomplished — the patient went into cardiac arrest. She was successfully resuscitated — with a post-arrest rhythm similar to that seen in Figure-1. Cardiac cath did not reveal significant coronary disease!

Blog 101

Blog Pacemaker Bradycardia Arrhythmia 101

Ken Grauer, MD

MARCH 23, 2023

What is the cardiac rhythm shown in the long lead II rhythm strip? Figure-1: The initial ECG in today’s case — obtained from an elderly woman following successful resuscitation from cardiac arrest. ( To improve visualization — I've digitized the original ECG using PMcardio ). What about the 1 2- L ead E CG ?

Blog 78

Blog Tachycardia Arrhythmia Atrial Flutter 78

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A prior ECG was available for comparison: Normal One might be tempted to interpret the ST depression as ischemia, but as Smith says, "when the QT is impossibly long, think of hypokalemia and a U-wave rather than T-wave." Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest.

Chest Pain 124

Chest Pain Ischemia Cardiac Arrest Blog 124

Dr. Smith's ECG Blog

OCTOBER 8, 2023

Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. Smith: This bizarre ECG looks like a post cardiac arrest ECG with probable acidosis or hyperkalemia in addition to OMI.

Ischemia 123

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 123

Dr. Smith's ECG Blog

MAY 3, 2024

When I was shown this ECG, I said it looks like such widespread ischemia that is might be a left main occlusion, or LM ischemia plus circumflex occlusion (high lateral and posterior OMI). Suffice it to say that, "The heart does whatever it will do when a patient is about to arrest". There is STE in aVR.

Cardiogenic Shock 127

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 127

DAIC

JANUARY 23, 2024

Food and Drug Administration (FDA) approved the first anti-inflammatory therapeutic option to reduce cardiac event risk in patients with established cardiac risk factors. As of June 2023, the U.S. Accessed November 8, 2023. Accessed January 18, 2023. AGEPHA Pharma FZ LLC; 2023. 12 Colchicine, 0.5

Cardiovascular Disease 111

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease 111

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

Brugada Syndrome: Diagnosis and Risk Stratification Hello friends, this is the modified version of my talk at Indian Heart Rhythm Society Conference, New Delhi, 2023, on Brugada Syndrome. Hope you will enjoy this session. These are the conditions which have to be considered or excluded as they can sometimes manifest Brugada pattern on ECG.

Sudden Cardiac Death 52

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

Dr. Smith's ECG Blog

JULY 22, 2023

2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm, 15(9): 1394-1401. [7] 7] American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

Chest Pain 91

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 91

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

The patient was unconscious BEFORE the cardiac arrest, at the same time that she had strong pulses. Therefore, cardiac arrest is NOT the etiology of the coma. More cases here to highlight: [link] Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab? OMI is a clinical diagnosis.

STEMI 88

STEMI Hemorrhage Cardiac Arrest Tachycardia 88

Dr. Smith's ECG Blog

JANUARY 13, 2025

Unexplained cardiac arrest or documented VF/polymorphic VT: +3 3. Unexplained sudden cardiac death (3 categories) (+0.5 - +2) 4. Among potential conditions that may produce Brugada Phenocopy are infarction and ischemia. Ischemia or infarction. Cardiac arrest. Clinical History 2.a. Family History 3.a.

Chest Pain 71

Chest Pain Cardiac Arrest Ischemia Sudden Cardiac Death 71

Dr. Smith's ECG Blog

JANUARY 21, 2023

Occurrence of “J Waves” in 12-Lead ECG as a Marker of Acute Ischemia and Their Cellular Basis. Occurrence of "J waves" in 12-lead ECG as a marker of acute ischemia and their cellular basis. 2004 = My Comment by K EN G RAUER, MD ( 1/21 /2023 ): = I thought today's case by Drs. Pacing Clin Electrophysiol.

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52