Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Diagnosis : Atrial flutter with 1:1 conduction, with fast AV conduction made possible by sympathetic drive of exercise On arrival, we obtained another 12-lead: Unremarkable Further history: One month history of shortness of breath on exertion, denies palpitations, chest pain, orthopnea, leg swelling.

Atrial Flutter 64

Atrial Flutter Exercise AFIB Tachycardia 64

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma?

Tachycardia 109

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 109

Ken Grauer, MD

JANUARY 13, 2024

On the other hand — the ST elevation seen in lead V1 is perfectly consistent with LVH and LV "strain" ( ie, The shape of this ST-T wave in lead V1, in association with the deep S wave in this lead — is a mirror-image opposite picture of the typical expected appearance of LVH with "strain" in a lateral chest lead ).

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Blog Ischemia AFIB Hypertension 160

Dr. Smith's ECG Blog

MAY 3, 2024

Here are some cases of RBBB with LAFB: What is the Diagnosis in this 70-something with Chest Pain? Despite the irregularity of QRS complexes — this rhythm is not AFib — because at least some definite P waves are present ( RED arrows that I added at the bottom of ECG #1 ).

Cardiogenic Shock 116

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 116

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

He has a family history concerning for arrhythmia. Given the circumstances of his car crash, we presume it was due to an underlying arrhythmia. He has a family history concerning for arrhythmia with his father requiring some sort of device (PPM, ICD, unclear) at a young age. ST depression. Myocardial Contusion?

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chest pain. Failure to follow this advice will undoubtedly lead to overlooking subtle acute MIs — and , it will especially lead to misdiagnosing many cardiac arrhythmias ( as was done in this case ). How can you avoid overlooking this arrhythmia?

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Atrial Fibrillation Tachycardia Arrhythmia Pulmonary 52

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!! I focus my comments purely on a few sophisticated concepts in arrhythmia recognition — fully aware that specific rhythm disorders with calcium channel toxicity need not be treated per se, beyond providing cardiovascular support.

Cardiogenic Shock 90

Cardiogenic Shock Arrhythmia Blog Education 90

Dr. Smith's ECG Blog

OCTOBER 28, 2023

There was some dyspnea but no chest pain. Tall R wave in lead V1 and/or early transition in the chest leads ( reflecting increased "septal" forces ). WPW Cardiac arrhythmias ( especially AFib ). A young man presented with continuous prolonged generalized weakness, lightheadedness, and presyncope. Here is his ECG.

Preserved Ejection Fraction 74

Preserved Ejection Fraction Sudden Cardiac Death Heart Failure Chest Pain 74

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

This patient had many complaints including chest pain. This causes deadly arrhythmias and should be considered in patients with syncope and short QT 2. The disorder is rare — but it takes on importance as a potential cause of atrial and ventricular arrhythmias, including cardiac arrest. STEMI never has a very short QT.

Chest Pain 52

Chest Pain Cardiac Arrest STEMI Arrhythmia 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

9 Hours of Chest Pain and Deep Q-waves: Is it too late for Thrombolytics? As per Dr. Smith — this suggests that despite QRS widening, the rhythm in ECG #3 is AFib with a rapid ventricular response. Given that the patient was asymptomatic from these arrhythmias — there was time to contemplate additional measures.

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. His response: “subendocardial ischemia. See this case: what do you think the echocardiogram shows in this case?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

JANUARY 26, 2023

and if not — Is the rhythm “irregularly irregular”, as in AFib — or is there a pattern of “regular" irregularity in the form of group beating ? ). to diagnose almost any arrhythmia. What is the R ate? looking both at the atrial and ventricular rates IF these are different ). Is the rhythm R egular? (

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Pacemaker Chest Pain AFIB Blog 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2020

There was no chest pain — and all troponins were negative. The chart revealed that the arrhythmia was not new. Atrial arrhythmias ( especially AFib or AFlutter ). It turned out the patient had cardiac amyloidosis. The presenting complaint was cough and fever from mild Covid pneumonia. Prolonged QTc interval.

Atrial Flutter 52

Atrial Flutter Cardiomyopathy Chest Pain Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

The patient also has a history of AFib and HFmrEF ( = H eart F ailure with M inimally- R educed E jection F raction ). This patient presented to the ED “after a couple of days of chest discomfort”. For clarity in Figure-1 — I have reproduced and labeled this patient’s initial ECG. Why was it Wrong to Think the Rhythm was AFlutter?

Tachycardia 101

Tachycardia Electrophysiology Atrial Flutter Ischemia 101

Dr. Smith's ECG Blog

MARCH 6, 2020

This middle-aged man with no cardiac history but with significant history of methamphetamin and alcohol use presented with chest pain and SOB, worsening over days, with orthopnea. BP:143/99, Pulse 109, Temp 37.2 °C C (99 °F), Resp (!) 32, SpO2 95% On exam, he was tachypneic and had bibasilar crackles. This is a “ generic ” term.

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52