Academic Ischemia Tachycardia 
Dr. Smith's ECG Blog
NOVEMBER 26, 2018
In some cases the ischemia can be seen "through" the flutter waves, whereas in other cases the arrhythmia must be terminated before the ischemia can be clearly distinguished. 2) Tachycardia to this degree can cause ST segment changes in several ways. Again, not an expected outcome with diltiazem).
Dr. Smith's ECG Blog
OCTOBER 18, 2023
The above ECGs show the initiation and continuation of a polymorphic ventricular tachycardia. Polymorphic ventricular tachycardia can be ischemic, catecholaminergic or related to QT prolongation. Most such rhythms in the setting of ischemia are VF and will not convert without defibrillation.
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. This rules out subendocardial ischemia and is diagnostic of posterior OMI. V4-5 continue to show STD.
Dr. Smith's ECG Blog
JUNE 23, 2023
A 50-something male with unspecified history of cardiomyopathy presented in diabetic ketoacidosis (without significant hyperkalemia) with a wide complex tachycardia and hypotension. Analysis: there is a wide complex tachycardia. This was the interpretation I put into the system: WIDE COMPLEX TACHYCARDIA. It is regular.
Dr. Smith's ECG Blog
JULY 21, 2024
This progressed to electrical storm , with incessant PolyMorphic Ventricular Tachycardia ( PMVT ) and recurrent episodes of Ventricular Fibrillation ( VFib ). There is no definite evidence of acute ischemia. (ie, Distinction of PMVT vs VFib is an academic one in this case ). Both episodes are initiated by an "R-on-T" phenomenon.
Dr. Smith's ECG Blog
NOVEMBER 11, 2022
There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!) A repeat ECG was performed: An interesting mix of subendocardial ischemia pattern AND precordial swirl LAD OMI pattern. OMI and subendocardial ischemia patterns can both be present at the same time.
Dr. Smith's ECG Blog
APRIL 29, 2020
A useful classification of WCT ( W ide- C omplex T achycardia ) rhythms — separates them into those that are mono morphic ( with similar QRS morphology during the tachycardia ) vs those that are poly morphic ( in which QRS morphology varies ). PEARL #2 — Distinction between PMVT vs Torsades is more than academic. Acute ischemia?
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