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.

AFIB 52

AFIB Tachycardia Atrial Fibrillation Arrhythmia 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. Atrial fibrillation is also a predictor of worse outcomes in this case (Alborzi). Sinus Tachycardia ( common in any trauma patient. ). He was intubated for altered mental status.

Tachycardia 109

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 109

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.

Tachycardia 52

Tachycardia Atrial Flutter Cardiomyopathy Atrial Fibrillation 52

Dr. Smith's ECG Blog

AUGUST 17, 2022

ACUTE MI (I allowed Acute MI to be in the report because I knew there would be an elevated troponin from ischemia, which is the definition of acute MI -- but in this case it would most likely be a Type 2 MI from tachycardia) There is also LA-RA lead reversal. The rhythm is rapid AFib. She had some fractures.

Atrial Fibrillation 52

Atrial Fibrillation Ischemia AFIB Tachycardia 52

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). Lead aVR seems to show the atrial activity clearly.

AFIB 52

AFIB Tachycardia Atrial Fibrillation Blog 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

Note: Due to the limited number of normally conducted beats — it is hard to be sure whether the underlying rhythm is sinus with baseline artefact or atrial fibrillation. Note: The patient while on telemetry had alternating atrial fibrillation, sinus rhythm with 1st degree AV block and also periods of Wenckebach conduction.

Cardiac Arrest 58

Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 58

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

Chart review confirmed that he had been started on flecainide for atrial fibrillation. This new information makes the diagnosis of atrial flutter far more likely: first, atrial fibrillation and flutter are closely associated and, second, this makes a flutter rate of 200 bpm (with 1:1 conduction) quite likely.

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 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. There is a large peaked P-wave in lead II (right atrial enlargement) There is left axis deviation consistent with left anterior fascicular block. See my quick review of atrial tachycardia below) The tachycardia spontaneously resolved.

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

Here is the computer interpretation: ATRIAL FIBRILLATION WITH RAPID VENTRICULAR RESPONSE WITH ABERRANT CONDUCTION OR VENTRICULAR PREMATURE COMPLEXES LEFT AXIS DEVIATION [QRS AXIS beyone -30] NONSPECIFIC ST and T-WAVE ABNORMALITY The over-reading physician confirmed this diagnosis, which is incorrect. It is not atrial fibrillation.

Atrial Fibrillation 52

Atrial Fibrillation Tachycardia Arrhythmia Pulmonary 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. Answer : The ECG above shows a regular wide complex tachycardia. Cardiac output (CO) was being maintained by the tachycardia.

Tachycardia 102

Tachycardia Electrophysiology Atrial Flutter Ischemia 102

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. The patient was placed on telemetry.

Ischemia 52

Ischemia STEMI Stenosis Coronary Artery Disease 52

Dr. Smith's ECG Blog

MAY 7, 2024

The two ECGs above were texted to me with the text: "Young Guy came in in SVT but now in and out of irregular wide complex tachycardia. -- not sure if polymorphic VT vs. a fib with WPW." Definitely atrial fibrillation. Probably WPW but is very slow for atrial fib withWPW. So this looks like WPW with Atrial fibrillation.

Atrial Fibrillation 119

Atrial Fibrillation AFIB Ablation Chest Pain 119

Dr. Smith's ECG Blog

JULY 5, 2024

There is a regular wide complex tachycardia. Remember : Adenosine is safe in Regular Wide Complex Tachycardia. Adenosine is only unsafe in atrial fibrillation with WPW , which presents with a very rapid rate, polymorphic QRS, and some very short RR intervals] Bedside echo showed poor LV fct. We want to avoid a stroke.

Atrial Flutter 98

Atrial Flutter Tachycardia Atrial Fibrillation AFIB 98

Dr. Smith's ECG Blog

AUGUST 13, 2020

His previous echo one month prior shows the same thing: “consistent with old infarct in LAD vascular territory, with EF 45%” "I think there is something else causing his tachycardia which is exaggerating his EKG findings and mimicking an acute myocardial infarction." Looks like atrial fibrillation. Cath lab was cancelled.

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

The rhythm is atrial fibrillation. I sent it to 2 of my ECG nerd colleagues with no clinical information whatsoever, who instantly said: "Looks like afib with subendocardial ischemia and right heart strain pattern." "I Tachycardia is of course, quite common in patients following cardiac arrest. The rhythm is rapid AFib.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52