Dr. Smith's ECG Blog

DECEMBER 26, 2023

I went to the patient's chart: Elderly woman with stuttering chest pain and SOB, and dizziness. This is a very typical ECG for Hypertrophic Cardiomyopathy. Tall R wave in lead V1 and/or early transition in the chest leads ( reflecting increased "septal" forces ). WPW Cardiac arrhythmias ( including AFib ).

Chest Pain 96

Chest Pain Cardiomyopathy Blog AFIB 96

Dr. Smith's ECG Blog

JULY 5, 2023

The patient has acute 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 ). This was texted to me in real time. What do you think? Here was my answer: "Not ischemia. Maybe HOCM or another form of LVH.

Chest Pain 52

Chest Pain STEMI Congenital Heart Disease Heart Disease 52

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 159

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?

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Tachycardia Electrophysiology Atrial Flutter Ischemia 122

Dr. Smith's ECG Blog

AUGUST 13, 2020

Instead, he complained of left chest "itchiness". He had a h/o ischemic cardiomyopathy and right MCA stroke. 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.

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

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.

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Preserved Ejection Fraction Sudden Cardiac Death Heart Failure Chest Pain 59

Dr. Smith's ECG Blog

NOVEMBER 15, 2020

There was no chest pain — and all troponins were negative. Atrial arrhythmias ( especially AFib or AFlutter ). Smith immediately knew he needed to find out what was going on with this patient! It turned out the patient had cardiac amyloidosis. The presenting complaint was cough and fever from mild Covid pneumonia.

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Atrial Flutter Cardiomyopathy Chest Pain Arrhythmia 52