Dr. Smith's ECG Blog

DECEMBER 16, 2018

Wide-complex tachycardia: VT or aberrant, or "other?" A wide-complex tachycardia in an older patient must immediately suggest ventricular tachycardia. Sinus tachycardia with aberrancy was unlikely as the rate was consistently 150 bpm, without spontaneous variation. And indeed the QRS morphology strongly supported VT (e.g.

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Tachycardia Atrial Flutter AFIB Atrial Fibrillation 52

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. Sometimes what appears to be thrombus on angiogram is not actually thrombus.

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Ischemia Atrial Flutter Arrhythmia Tachycardia 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

Multifocal Atrial Tachycardia 2. 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? Sinus with multifocal PACs 3. Sinus with multifocal PVCs 4.

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AMS Cardiology

JANUARY 16, 2024

Cardioversion is used to correct abnormal heart rhythms, also known as arrhythmias. Electrical cardioversion may be recommended for you if you have certain types of arrhythmias, such as: Atrial fibrillation (AFib): This is the most common type of arrhythmia, and it can cause symptoms like dizziness, fatigue, and difficulty breathing.

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Atrial Fibrillation Heart Rhythm AFIB Atrial Flutter 52

Dr. Smith's ECG Blog

JULY 5, 2024

There is a regular wide complex tachycardia. Remember : Adenosine is safe in Regular Wide Complex Tachycardia. Rather, from this one: Very Fast Very Wide Complex Tachycardia Ideally, one would cardiovert. PEARL #1: The most commonly overlooked arrhythmia is AFlutter ( A trial F lutter ).

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Atrial Flutter Tachycardia Atrial Fibrillation AFIB 98

Dr. Smith's ECG Blog

DECEMBER 23, 2019

Initial ECG in the ED: Presenting ECG : Wide-complex tachycardia at a rate about 200. This is overwhelmingly likely to be ventricular tachycardia, even if only age and medical history are considered. Nevertheless, the widths of both the QRS complex and the RS duration are similar in both the old ECG and the tachycardia.

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Tachycardia Atrial Flutter Cardiomyopathy Atrial Fibrillation 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. The Initial ECG in Today's Case: As per Dr. Meyers — the initial ECG in today's case shows sinus tachycardia with bifascicular block ( = RBBB/LAHB ). Sinus Tachycardia ( common in any trauma patient. ). QTc prolongation.

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Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 109

Dr. Smith's ECG Blog

MARCH 11, 2020

Therefore — the rhythm in ECG #1 is almost certain to be AFib ( A trial F ibrillation ) , seen here with a “rapid” ventricular response. Under normal conditions with AFib — the refractory period of the AV node does not allow more than 150-to-200 impulses/minute to be conducted to the ventricles.

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AFIB Tachycardia Atrial Fibrillation Arrhythmia 52

Ken Grauer, MD

FEBRUARY 18, 2023

The finding of a fairly regular, wide tachycardia without clear sign of atrial activity ( especially when seen in an acutely symptomatic patient ) — should immediately prompt a diagnosis of VT until proven otherwise. These findings suggest that instead of VT — the rhythm in Figure-1 is AFib with a fairly rapid ventricular response.

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Dr. Smith's ECG Blog

JUNE 1, 2020

MY THOUGHTS on ECG #1: My initial impression on looking at the ECG in Figure-1 — was that the rhythm was either rapid AFib in a patient with WPW — or — PMVT ( P oly M orphic VT ). The reason I initially thought the underlying rhythm was AFib — is that no atrial activity is seen in any lead and the rhythm “looks” irregular. See text ).

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Tachycardia AFIB Blog Heart Disease 52

EMS 12-Lead

APRIL 28, 2022

Initial vital signs include: NIBP 99/58 HR 150-160 (trend) RR 10 (spontaneous, but shallow) SpO2 86 (RA) BBS CTA The initial rhythm strip is attached: Figure 1 There is a wide complex tachycardia of varying morphology, amplitude, and R-R cycle length. The rS configuration in Lead I displays a persistent rightward axis.

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Tachycardia AFIB Arrhythmia Coronary Artery Bypass Graft 52

Ken Grauer, MD

SEPTEMBER 13, 2024

I was sent the ECG shown in Figure-1 — being told only that providers on the case suspected AFib ( A trial Fib rillation ) with RBBB ( R ight B undle B ranch B lock ) aberrancy. QUESTIONS: Is the wide tachycardia that is seen best in the chest leads, too irregular to be VT ( V entricular T achycardia )? —

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Dr. Smith's ECG Blog

APRIL 24, 2022

The ECG there reportedly showed an irregular tachycardia, and the patient was immediately referred to the emergency room. Here is her ECG on arrival: There is a wide complex tachycardia that is irregularly irregular (this is difficult to determine at these very high rates). Vitals were within normal limits other than heart rate.

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AFIB Tachycardia Atrial Fibrillation Blog 52

Ken Grauer, MD

FEBRUARY 28, 2023

The ECG and long lead II rhythm strip in Figure-1 — was obtained from a COVID positive patient with persistent tachycardia not responding to Diltiazem. Figure-1: The initial ECG — obtained from a patient with persistent tachycardia. ( How would YOU interpret this tracing? How to manage the patient?

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Ken Grauer, MD

APRIL 13, 2024

Because of this, it is uncommon to see sinus tachycardia with a prolonged PR interval. P utting I t A ll T ogether: At this point in my assessment of today's rhythm — I fully acknowledge that I did not know for certain the etiology of this arrhythmia. Figure-3: How to assess for possible 2:1 atrial activity. =

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Blog Tachycardia Pulmonary Arrhythmia 118

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

Learning points : Takotsubo can lead to cardiac arrest from ventricular arrhythmia. But there are 3 other wide beats in the tachycardia that begins with beat #6 ( = beats #7; 13,14 ). The QTc then gradually shortened over the course of several days as is usual for stress cardiomyopathy.

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Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 68

AMS Cardiology

NOVEMBER 21, 2024

space-line Alcohol and ‘Holiday Heart Syndrome’ Holiday heart syndrome refers to episodes of supraventricular tachycardia: a sudden arrhythmia or irregularity in which the heart beats much faster than normal, explains Dr. Schuitema. Alcohol acts as a natural irritant to the heart muscle, says Dr. Tarditi.

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Dr. Smith's ECG Blog

JANUARY 15, 2024

We can see enough to make out that the rhythm is sinus tachycardia. Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW.

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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.

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Arrhythmia Blog Chest Pain Cardiac Arrest 52

Ken Grauer, MD

MARCH 12, 2023

What is unusual about this arrhythmia? Doing so suggests that the R-R interval of this exceedingly rapid arrhythmia is just a tiny amount over 1 large box — which corresponds to a ventricular rate just under 300/minute ( ie, between 290-300/minute ). How would YOU interpret the ECG in Figure-1 ?

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Ken Grauer, MD

JULY 9, 2023

PEARL #2: As cited in ECG Blog #252 — my favorite truism in arrhythmia interpretation is, "The commonest cause of a pause is a blocked PAC". ECG Blog #71 — Regarding the Ashman Phenomenon with AFib. The September 30, 2019 post in Dr. Smith’s ECG Blog — for an example of “MAT”, but without the tachycardia.

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Blog Cardiac Arrest Pulmonary AFIB 78

Dr. Smith's ECG Blog

OCTOBER 28, 2023

See this even more interesting and more dramatic and fascinating case: History of Hypertrophic Cardiomyopathy (HOCM), with Tachycardia and High Lactate = My Comment by K EN G RAUER, MD ( 10/28 /2023 ): = QUESTION: For clarity in Figure-1 — I've reproduced today's ECG without the long lead rhythm strip. Abnormal ST-T wave abnormalities.

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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. Systematic Assessment of the ECG in Figure-1: My Descriptive Analysis of ECG findings in Figure-1 is as follows: Sinus tachycardia at ~110/minute. The patient had mild but diffuse abdominal tenderness.

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

MARCH 6, 2020

Here was his ED ECG: There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities. An ECG was recorded: This shows a regular narrow complex tachycardia at a rate of about 160. See my quick review of atrial tachycardia below) The tachycardia spontaneously resolved. BP:143/99, Pulse 109, Temp 37.2 °C

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