2024, Arrhythmia and Bradycardia - Cardiovascular Update

Challenging Arrhythmias — MIS-C Case Report (9-16.1-2024) - NOT_YET_FINISHED

Ken Grauer, MD

SEPTEMBER 15, 2024

== Review of ECG Rhythms — MIS-C Case Report ( 9/5 /2024 ): == What follows below are my first impressions of the ECG rhythms sent to me from the Case Report by Dimah Jarmakani et al — of a 12-year old boy with MIS-C ( M ultisystem I nflammatory S yndrome in C hildren ). Hope this helps — :) ECG-3 — I see sinus bradycardia and arrhythmia.

Arrhythmia

Arrhythmia Bradycardia Heart Failure Pacemaker

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

JANUARY 2, 2025

Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. Smith Pacing in today's case is an effective intervention as doing so prevents the bradycardia and pauses that are likely to precipitate additional episodes of Torsades de Pointes. ( The plan: 1. J Am Coll Cardiol.

Tachycardia

Tachycardia Cardiomyopathy Blog Bradycardia

What is this ECG finding? Do you understand it before you hear the clinical context?

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

Altered Mental Status, Bradycardia == MY Comment , by K EN G RAUER, MD ( 2/2 /2024 ): == Dr. Meyers began today’s case with the clinical challenge of asking you to identify the underlying cause of ECG #2. -- Read this ECG -- Osborn Waves and Hypothermia (this is the "Figure" above) What does LBBB look like in severe hypothermia?

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Blog Cardiac Arrest Atrial Fibrillation Bradycardia

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A woman in her 50s with multiple episodes of syncope

Dr. Smith's ECG Blog

JUNE 27, 2024

EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. Limiting one's interpretation to marked bradycardia with high-grade AV block in need of pacing in this patient with multiple syncopal epiosodes — more than suffices for "the quick answer". Figure-3: I've labeled ECG #3.

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Blog Pacemaker Bradycardia Tachycardia

A 50-something with chest pain. Is there OMI? And what is the rhythm?

Dr. Smith's ECG Blog

MARCH 22, 2024

I will leave more detailed rhythm discussion to the illustrious Dr. Ken Grauer below, but this use of calipers shows that the rhythm interpretation is: Sinus bradycardia with a competing (most likely junctional) rhythm. That is, until the 7th R wave which comes a little bit sooner than expected. Given the R-R interval = 1160 msecs.

Chest Pain

Chest Pain STEMI Bradycardia Ischemia

Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Click here to sign up for Queen of Hearts Access == MY Comment , by K EN G RAUER, MD ( 9/11 /2024 ): == Among the important concepts brought out by today's case are the following: #1) — Is acute OMI a common cause of syncope ? #2) Former resident: "The biggest piece for me was the size of the T waves in relation to everything else.

Chest Pain

Chest Pain Aneurysm Stents Stent

A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Retrieved July 2, 2022, from [link] == MY Comment , by K EN G RAUER, MD ( 2/4 /2024 ): == Today's case by Dr. Meyers provides insight with regard to sequential evolution of serial ECGs during the course of cardiac contusion. Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ).

Tachycardia

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia

ECG #413 — A Pre-Op ECG in an ASx Patient

Ken Grauer, MD

JANUARY 20, 2024

Looking first at the long-lead II rhythm strip — there is significant bradycardia , with a heart R ate just under 40/minute. But the point to emphasize — is that it should only take seconds to recognize that there is bradycardia from significant AV block. = Would you approve her for a nonemergent surgical procedure?

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Blog Bradycardia STEMI Download

ECG Blog #416 — Is the Rhythm and ECG related?

Ken Grauer, MD

FEBRUARY 9, 2024

Whatever the specific etiology of today's arrhythmia is, the “good news” is — that this rhythm will most probably improve with reperfusion of the "culprit" artery. That said — I found today's arrhythmia fascinating, and worthy of more in-depth analysis. Using calipers facilitates the process.

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Blog Arrhythmia STEMI Bradycardia

ECG Blog #439 — How Many Possibilities?

Ken Grauer, MD

JULY 18, 2024

Most of the time with AV block — the atrial rhythm will be regular ( or at least almost regular — if there is an underlying sinus arrhythmia ). PEARL # 5: As noted above — today's arrhythmia appears to represent some form of 2nd-degree AV block. Figure-4: I needed to draw a laddergram.

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Blog Arrhythmia Bradycardia Pacemaker

A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

The Queen of Hearts AI app will hopefully be FDA approved in Q1 of 2024. I added, "Makes me wonder if this could be myocarditis in a younger adult — maybe even with sinus arrhythmia." It is already approved in Europe. YOU HAVE THE OPPORTUNITY TO GET EARLY ACCESS TO THE PM Cardio AI BOT!! Figure-1: The initial ECG in today's case.

Stroke

Stroke Strokes Chest Pain Cardiomyopathy

How a pause can cause cardiac arrest

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

Learning points : Takotsubo can lead to cardiac arrest from ventricular arrhythmia. Nossen highlights an important concept — namely pause -dependent precipitation of a malignant ventricular arrhythmia ( in this case Torsades de Pointes ).

Cardiac Arrest

Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation

Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

Dr. Smith's ECG Blog

OCTOBER 15, 2024

Additionally, his cardiac telemetry monitor showed runs of accelerated idioventricular rhythm, a benign arrhythmia often associated with coronary reperfusion. He had multiple episodes of bradycardia and nonsustained ventricular tachycardia. As expected, the patient reported total resolution of pain by the time he got to the ED.

Chest Pain

Chest Pain STEMI Echocardiogram Stents

Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Dr. Smith's ECG Blog

JANUARY 5, 2024

The ECG shows sinus bradycardia but is otherwise normal. Sometimes it can take 12 or 24 hours to see ECG evidence of reperfusion. == MY Comment , by K EN G RAUER, MD ( 1/4/ 2024 ): == Superb and thorough discussion by Dr. Frick of today's case! The documentation does not describe any additional details of the history.

Angina

Angina Plaque Document Stents

Orthostatic hypotension onset after invasive procedure?

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.

Pacemaker

Pacemaker Bicuspid/Mitral Blood Pressure Bradycardia

What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

JULY 21, 2024

However, he suddenly developed a series of malignant ventricular arrhythmias. Below are printouts of some of the arrhythmias recorded. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. The arrhythmia starts with a PVC having a short coupling interval.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

46 year old with chest pain develops a wide complex rhythm -- see many examples

Dr. Smith's ECG Blog

AUGUST 9, 2024

There are three mechanisms of arrhythmia: automatic, re-entry, and triggered. The most common triggered arrhythmia is Torsades de Pointes. It is a benign arrhythmia which requires no specific treatment. Possible mechanisms of ventricular arrhythmias elicited by ischemia followed by reperfusion. Do not treat AIVR.

Chest Pain

Chest Pain Arrhythmia Myocardial Infarction STEMI

What kind of AV block is this? And why does she develop Ventricular Tachycardia?

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.

Tachycardia

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

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.

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

Leadless pacemaker having wireless communication with subcutaneous ICD

All About Cardiovascular System and Disorders

MAY 21, 2024

But subcutaneous ICD cannot provide bradycardia and antitachycardia pacing as a transvenous ICD. It was a multinational study which enrolled patients at risk for sudden death from ventricular arrhythmias and the follow up period was 6 months. None of the deaths in the study were deemed to be arrhythmia related or procedure related.

Pacemaker

Pacemaker Defibrillator Bradycardia Arrhythmia

A man in his 30s with epigastric pain and chest pressure

Dr. Smith's ECG Blog

FEBRUARY 14, 2025

Vitals were within normal limits except bradycardia. Sinus bradycardia, normal QRS. These include the following: A fairly marked sinus arrhythmia with bradycardia, and almost the pattern of "group" beating in the long lead rhythm strip. See My Comment in the June 25, 2024 post for changes with LA-LL reversal ).

Bradycardia

Bradycardia STEMI Arrhythmia

2nd degree AV block: is this Mobitz I or II? And why the varying P-P intervals?

Dr. Smith's ECG Blog

NOVEMBER 11, 2024

Learning points: Mobitz I and Mobitz II can co-exist in the same patient at the same time Bedside maneuvers can help clarify the etiology of 2:1 AV block == MY Comment , by K EN G RAUER, MD ( 11/10 /2024 ): == Questions often arise regarding the various forms of 2nd-degree AV block. Did YOU See the 2:1 AV Block?

Arrhythmia

Arrhythmia Bradycardia Outpatient Pacemaker

Challenging Arrhythmias — MIS-C Case Report (9-16.1-2024) - NOT_YET_FINISHED

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

What is this ECG finding? Do you understand it before you hear the clinical context?

Webinars

A woman in her 50s with multiple episodes of syncope

A 50-something with chest pain. Is there OMI? And what is the rhythm?

Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!

A teenager involved in a motor vehicle collision with abnormal ECG

ECG #413 — A Pre-Op ECG in an ASx Patient

ECG Blog #416 — Is the Rhythm and ECG related?

ECG Blog #439 — How Many Possibilities?

A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?

How a pause can cause cardiac arrest

Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Orthostatic hypotension onset after invasive procedure?

What are treatment options for this rhythm, when all else fails?

46 year old with chest pain develops a wide complex rhythm -- see many examples

What kind of AV block is this? And why does she develop Ventricular Tachycardia?

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Leadless pacemaker having wireless communication with subcutaneous ICD

A man in his 30s with epigastric pain and chest pressure

2nd degree AV block: is this Mobitz I or II? And why the varying P-P intervals?

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