Dr. Smith's ECG Blog

MAY 26, 2023

A 20-something presented after a huge verapamil overdose in cardiogenic shock. Today's patient is a young male who presented in cardiogenic shock following a massive verapamil overdose. It's always rewarding and mutually educational to discuss interesting aspects of arrhythmia interpretation. The initial K was 3.0

Cardiogenic Shock 90

Cardiogenic Shock Arrhythmia Blog Education 90

Dr. Smith's ECG Blog

MAY 3, 2024

Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock. Today's patient did make it to the hospital — but was in cardiogenic shock, and despite valiant attempt at treatment, succumbed soon after.

Cardiogenic Shock 116

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 116

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. 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.

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

Because of the tachcardia, I would expect her to be very poor left ventricular function and maybe Cardiogenic shock. As per Dr. Smith — this suggests that despite QRS widening, the rhythm in ECG #3 is AFib with a rapid ventricular response. Old MI with persistent ST Elevation (LV aneurysm morphology) can look like acute MI 2.

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). Jenkins and Frick — I offer 3 additional examples of artifactual distortion ( excerpted from my ECG Blog ) — that resulted in arrhythmia misdiagnosis. We can see enough to make out that the rhythm is sinus tachycardia.

Chest Pain 64

Chest Pain Blog Critical Care Arrhythmia 64

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. See this case: what do you think the echocardiogram shows in this case? Left main? 3-vessel disease?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52