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How a pause can cause cardiac arrest

Dr. Smith's ECG Blog

While on telemetry monitoring he suffered cardiac arrest and was resuscitated. What ECG finding may have contributed to (or precipitated) the cardiac arrest? Learning points : Takotsubo can lead to cardiac arrest from ventricular arrhythmia. There are no clear signs of OMI. There is a prolonged QTc.

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ECG Blog #385 — This Patient Arrested Soon After

Ken Grauer, MD

Blood was drawn , and the patient was promptly placed in a room to be seen — but on entering, the ED physician found her unresponsive in cardiac arrest. Do you see any indication on this ECG of WHY this patient was about to arrest? Is there any indication on this ECG of WHY this patient shortly after had a cardiac arrest?

Blog 78
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ECG Blog #381 — Why was the Troponin Normal?

Ken Grauer, MD

At some point ~1-2 hours after the initial ECG — the patient developed runs of VT, leading to cardiac arrest. ECG Blog #185 — Review of the P s, Q s, 3 R Approach for systematic rhythm interpretation. ECG Blog #271 — Reviews the concept of diffuse Subendocardial Ischemia. ECG Blog #316 — The patient died.

Blog 78
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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

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 He had multiple cardiac arrests with ROSC regained each time. This patient arrested shortly after hospital arrival.

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What is this ECG finding? Do you understand it before you hear the clinical context?

Dr. Smith's ECG Blog

See our other blog posts of hypothermia and Osborn waves -- Massive Osborn Waves of Severe Hypothermia (23.6 C), with Cardiac Echo -- A Pathognomonic ECG. His temperature was brought back to normal over time in the ICU. He was extubated and had normal neurologic function. He did well and was discharged.

Blog 132
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A 40 year old with nonspecific symptoms including dizziness

Dr. Smith's ECG Blog

Figure-2: A rapid method for estimating the QTc ( Figure from My Comment in the March 19, 2019 post in Dr. Smith's ECG Blog ). == Clinical Implications of a Short QTc: The differential diagnosis for today's tracing, with its short QTc ~360 msec. ) — but as can be seen, my estimate of ~360 msec.

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Sudden shock with a Nasty looking ECG. What is it?

Dr. Smith's ECG Blog

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. Suffice it to say that, "The heart does whatever it will do when a patient is about to arrest". RBBB + LAFB in the setting of ACS is very bad.