AFIB Blog Ischemia 
Ken Grauer, MD
MARCH 29, 2023
M Y T houghts on the ECG in Figure-1: I have presented similar ECGs to the one in today's tracing on several occasions ( most recently in ECG Blog #284 ). M y I MPRESSION : The rhythm in Figure -1 is almost certain to be very rapid AFib in a patient with WPW. The patient was hemodynamically stable in association with this rhythm. (
Ken Grauer, MD
MAY 26, 2023
This ST depression appears to be maximal in leads V3-to-V5 — which could reflect acute posterior OMI ( O cclusion-based M yocardial I nfarction ) — most probably with multi -vessel disease ( ie, diffuse subendocardial ischemia suggested by the ST depression with ST elevation in aVR>V1 ). ECG Blog #316 — The patient died.
Ken Grauer, MD
FEBRUARY 18, 2023
These findings suggest that instead of VT — the rhythm in Figure-1 is AFib with a fairly rapid ventricular response. Since the rhythm is supraventricular (ie, AFib ) — we can accurately assess QRS morphology. Shark Fin" ST segment elevation is most often a sign of severe transmural ischemia that results from acute coronary occlusion.
Dr. Smith's ECG Blog
FEBRUARY 2, 2024
See our other blog posts of hypothermia and Osborn waves -- Massive Osborn Waves of Severe Hypothermia (23.6 The rhythm is irregularly irregular, and appears to be AFib with a fairly slow ventricular response ( overall rate <70/minute ) — although marked baseline artifact renders the search for atrial activity futile.
Ken Grauer, MD
JANUARY 13, 2024
For more regarding ECG criteria for LVH — See the ADDENDUM below and/or ECG Blog #73 and ECG Blog #245. My written interpretation on a tracing such as this one would read, "Marked LVH and 'strain' and/or ischemia — with need for clinical correlation." WPW Cardiac arrhythmias ( including AFib ).
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. First , there can simply be diffuse ST depressions (which obligates reciprocal STE in aVR) associated with tachycardia which are not indicative of ischemia.
Dr. Smith's ECG Blog
JULY 14, 2024
In addition — there is transmural ischemia of the septum , most often resulting from occlusion proximal to the 1st septal perforator branch of the LAD. The rhythm in both tracings in Case #2 shows AFib with a controlled ventricular response ( with a PVC in the 2nd tracing ).
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