Dr. Smith's ECG Blog

MAY 5, 2023

Krantz et al authored a State-of-the-Art Review on Cardiovascular Complications of Opioid Use ( JACC 77(2):205-223, 2021 ) — in which mechanisms from Opioid Overdose that detail arrhythmia production ( up to cardiac arrest ) are elucidated — thereby providing an explanation for the unusual arrhythmias in today's case.

Bradycardia 52

Bradycardia Cardiac Arrest Arrhythmia Pacemaker 52

Dr. Smith's ECG Blog

JULY 21, 2024

However, he suddenly developed a series of malignant ventricular arrhythmias. Below are printouts of some of the arrhythmias recorded. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. The arrhythmia starts with a PVC having a short coupling interval.

Arrhythmia 132

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 132

HeartRhythm

APRIL 30, 2024

Insertable cardiac monitors (ICMs) are used widely for long term monitoring and diagnosis of various cardiac arrhythmia. Among them, bradycardia and pause detection could be erroneous during sleep as the heart rate may slow down significantly leading to potential inappropriate diagnosis.

Bradycardia 40

Bradycardia Arrhythmia 40

Dr. Smith's ECG Blog

JANUARY 26, 2020

Her vital signs were within normal limits except for bradycardia at 55 bpm. It is probably sinus bradycardia with very small/depressed P-waves and prolonged PR interval. P EARL # 4 In my opinion, it is not worth wasting time trying to figure out the specific rhythm diagnosis of a bradycardia when there is hyperkalemia.

Bradycardia 52

Bradycardia Ischemia Cardiac Arrest AFIB 52

Dr. Smith's ECG Blog

JANUARY 2, 2025

Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. As described above by Dr. Smith Pacing in today's case is an effective intervention as doing so prevents the bradycardia and pauses that are likely to precipitate additional episodes of Torsades de Pointes. (

Tachycardia 117

Tachycardia Cardiomyopathy Blog Bradycardia 117

Dr. Smith's ECG Blog

JUNE 5, 2024

IMPRESSION: The finding of sinus bradycardia with 1st-degree AV block + marked sinus arrhythmia + the change in PR interval from beat #5-to-beat #6 — suggests a form of vagotonic block ( See My Comment in the October 9, 2020 post in Dr. Smith's ECG Blog ). Initial high sensitivity troponin I returned at 6ng/L (normal 0.20

Chest Pain 124

Chest Pain Blog Cardiac Arrest Cardiomyopathy 124

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

Altered Mental Status, Bradycardia == MY Comment , by K EN G RAUER, MD ( 2/2 /2024 ): == Dr. Meyers began today’s case with the clinical challenge of asking you to identify the underlying cause of ECG #2. -- Read this ECG -- Osborn Waves and Hypothermia (this is the "Figure" above) What does LBBB look like in severe hypothermia?

Blog 139

Blog Cardiac Arrest Atrial Fibrillation Bradycardia 139

Ken Grauer, MD

JUNE 2, 2023

to 1828 msec. ) — which corresponds to a variation in the rate of sinus bradycardia from 36-to-33/minute. This makes sense given that the underlying rhythm in today's case appears to be marked sinus bradycardia and arrhythmia , with a ventricular escape rhythm appearing when the SA node rate drops below 33/minute.

Blog 78

Blog Bradycardia Arrhythmia Tachycardia 78

Frontiers in Cardiovascular Medicine

DECEMBER 19, 2023

Background The rising adoption of wearable technology increases the potential to identify arrhythmias. Those with arrhythmias or non-diagnostic EKGs were sent 7-day monitors. The EHR was reviewed after 3 years to determine if participants developed arrhythmias. Mean age was 50.5 (SD years, and 46 (53.3%) were female.

Blood Pressure 64

Blood Pressure Atrial Fibrillation AFIB Arrhythmia 64

Dr. Smith's ECG Blog

JUNE 27, 2024

EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. Limiting one's interpretation to marked bradycardia with high-grade AV block in need of pacing in this patient with multiple syncopal epiosodes — more than suffices for "the quick answer". Figure-3: I've labeled ECG #3.

Blog 121

Blog Pacemaker Bradycardia Tachycardia 121

Heart BMJ

JUNE 17, 2024

Learning objectives To review the potential arrhythmia complications during pregnancy and puerperium in women with and without known cardiovascular disease. To recognise arrhythmia conditions associated with a high risk of pregnancy-related cardiac complications for which intervention before considering pregnancy is appropriate.

Arrhythmia 45

Arrhythmia Bradycardia Document Tachycardia 45

Dr. Smith's ECG Blog

MARCH 22, 2024

I will leave more detailed rhythm discussion to the illustrious Dr. Ken Grauer below, but this use of calipers shows that the rhythm interpretation is: Sinus bradycardia with a competing (most likely junctional) rhythm. preceding each of the fascicular beats — indicating a faster rate for the escape rhythm compared to the sinus bradycardia ).

Chest Pain 116

Chest Pain STEMI Bradycardia Ischemia 116

Open Heart

JULY 28, 2023

Introduction The incidence of arrhythmia in heart failure with non-reduced ejection fraction (HFnon-rEF) in patients who have a history of hospitalisation is unclear. Methods and analysis This is a multicentre single arm study to evaluate the usefulness of ILR for detecting arrhythmia.

Atrial Fibrillation 40

Atrial Fibrillation Arrhythmia Heart Failure Tachycardia 40

Journal of Cardiovascular Electrophysiology

DECEMBER 7, 2023

Abstract Background Programed ventricular stimulation (PVS) is a risk stratification tool in patients at risk for adverse arrhythmia outcomes. Patients with negative PVS may yet be at risk for adverse arrhythmia-related events, particularly in the presence of symptomatic ventricular arrhythmias (VA).

Arrhythmia 40

Arrhythmia Outcomes Bradycardia Bicuspid/Mitral 40

Dr. Smith's ECG Blog

AUGUST 9, 2024

There are three mechanisms of arrhythmia: automatic, re-entry, and triggered. The most common triggered arrhythmia is Torsades de Pointes. It is a benign arrhythmia which requires no specific treatment. Possible mechanisms of ventricular arrhythmias elicited by ischemia followed by reperfusion. Do not treat AIVR.

Chest Pain 109

Chest Pain Arrhythmia Myocardial Infarction STEMI 109

Dr. Smith's ECG Blog

JULY 5, 2018

during which sinus bradycardia and arrhythmia are seen but not to a degree that produces symptoms. The easy way to remember the arrhythmias most commonly associated with SSS is to think of what one might expect if the SA node became sick. The indication for pacemaker placement with SSS is symptomatic bradycardia.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Bradycardia Pacemaker 52

HeartRhythm

FEBRUARY 27, 2024

Bradyarrhythmias including sinus bradycardia and atrioventricular (AV) block are frequently encountered in endurance athletes especially at night.

Bradycardia 40

Bradycardia Electrophysiology Pacemaker Arrhythmia 40

HeartRhythm

APRIL 30, 2024

It is recognized that LQTS in the fetus may present as sinus bradycardia (SB), functional 2:1 atrioventricular block and ventricular arrhythmias (VA). Due to variable phenotypic expression a prolonged QT interval on a 12-lead ECG is not always present.

Sudden Cardiac Death 40

Sudden Cardiac Death Bradycardia Arrhythmia 40

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ). NOTE: Prediction of cardiac contusion "severity" on the basis of cardiac arrhythmias and ECG findings — is an imperfect science. RBBB in blunt chest trauma seems to be indicative of several RV injury. QTc prolongation.

Tachycardia 116

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 116

MIBHS

JANUARY 31, 2025

Early detection of conditions like AFib, bradycardia, or tachycardia allows patients to address issues before they become critical. Risk Reduction Data from wearables can identify potential risks, such as undiagnosed arrhythmias or hypertension, allowing healthcare teams to address these issues before surgery.

Heart Rhythm 52

Heart Rhythm Technology AFIB Exercise 52

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Other cardiac-related causes for syncope associated with acute MI may include malignant ventricular arrhythmias and bradyarrhythmias including AV block. The "good news" — is that a cardiac-related cause of syncope is unlikely if the initial ECG is normal, and cardiac monitoring in the ED fails to reveal significant arrhythmia.

Chest Pain 115

Chest Pain Aneurysm Stent Stents 115

Ken Grauer, MD

JANUARY 20, 2024

Looking first at the long-lead II rhythm strip — there is significant bradycardia , with a heart R ate just under 40/minute. But the point to emphasize — is that it should only take seconds to recognize that there is bradycardia from significant AV block. = Would you approve her for a nonemergent surgical procedure?

Blog 94

Blog Bradycardia STEMI Download 94

Dr. Smith's ECG Blog

JANUARY 31, 2019

== P EARL # 1: The easiest way to instantly enhance your arrhythmia interpretation skills is by using calipers. The cardiologist who does not regularly use calipers for interpretation of complex arrhythmias is a cardiologist who will miss the diagnosis on more than a few occasions. Using calipers will NOT slow you down.

Bradycardia 52

Bradycardia Pacemaker Arrhythmia Tachycardia 52

All About Cardiovascular System and Disorders

MARCH 17, 2024

It can automatically detect life threatening ventricular arrhythmias and treat them, either with a shock or, sometimes by overdrive pacing. And, after the shock, if there is bradycardia, it can be covered by these two pacing electrodes, one at the tip, and one proximal to it. These are high voltage, defibrillator shock coils.

Myocardial Infarction 52

Myocardial Infarction Defibrillator Sudden Cardiac Death Arrhythmia 52

Heart BMJ

DECEMBER 15, 2023

Reflex syncope is defined as a transient loss of consciousness due to a neurally mediated reflex causing sudden-onset vasodilation and bradycardia, leading to a steep decrease in blood pressure and cerebral hypoperfusion. Thus, once the aetiology is established, further diagnostic tests are seldom performed.

Blood Pressure 40

Blood Pressure Bradycardia Pacemaker Arrhythmia 40

Ken Grauer, MD

FEBRUARY 9, 2024

Whatever the specific etiology of today's arrhythmia is, the “good news” is — that this rhythm will most probably improve with reperfusion of the "culprit" artery. That said — I found today's arrhythmia fascinating, and worthy of more in-depth analysis. Using calipers facilitates the process.

Blog 105

Blog Arrhythmia STEMI Bradycardia 105

Dr. Smith's ECG Blog

JANUARY 23, 2024

VT is the second most common presenting arrhythmia. Vaso or inotropic medications are not harmless, and can precipitate life threatening arrhythmias. It is common with 2nd- and 3rd-degree AV block to see a " ventriculophasic " sinus arrhythmia. AV block is the first manifestation of CS in more than 30% of patients.

Tachycardia 109

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 109

Ken Grauer, MD

JULY 18, 2024

Most of the time with AV block — the atrial rhythm will be regular ( or at least almost regular — if there is an underlying sinus arrhythmia ). PEARL # 5: As noted above — today's arrhythmia appears to represent some form of 2nd-degree AV block. Figure-4: I needed to draw a laddergram.

Blog 86

Blog Arrhythmia Bradycardia Pacemaker 86

Ken Grauer, MD

OCTOBER 27, 2023

That said — obvious findings include: i ) Marked bradycardia! — L addergram I llustration : At this point — I needed to work out, and then draw a laddergram that I could then verify to ensure a plausible mechanism for today's arrhythmia. The rhythm in Figure-1 is complex — and defies precise interpretation without careful study.

Blog 101

Blog Pacemaker Bradycardia Arrhythmia 101

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

I added, "Makes me wonder if this could be myocarditis in a younger adult — maybe even with sinus arrhythmia." That said, despite the group beating — the rhythm is not consistent with AV Wenckebach. Figure-1: The initial ECG in today's case.

Strokes 71

Strokes Stroke Chest Pain Cardiomyopathy 71

All About Cardiovascular System and Disorders

APRIL 17, 2024

Ventricular tachycardia is a potentially life threatening cardiac arrhythmia. Polymorphic VT is managed by intravenous magnesium and measures to increase heart rate like pacing as it occurs most often in the setting of bradycardia and QT interval prolongation. If the rate is very fast, hemodynamic deterioration can occur rapidly.

Tachycardia 52

Tachycardia Defibrillator Congenital Ischemia 52

Ken Grauer, MD

DECEMBER 23, 2023

KEY Point: Knowing that the most commonly overlooked arrhythmia is AFlutter — suggests that the BEST way to avoid missing the diagnosis of AFlutter is simply to THINK of AFlutter whenever you have a regular SVT at a rate close to 150/minute ( in which you do not clearly see upright sinus P waves in lead II ).

Blog 175

Blog Tachycardia Tricuspid Atrial Flutter 175

Dr. Smith's ECG Blog

MAY 26, 2023

I focus my comments purely on a few sophisticated concepts in arrhythmia recognition — fully aware that specific rhythm disorders with calcium channel toxicity need not be treated per se, beyond providing cardiovascular support. It's always rewarding and mutually educational to discuss interesting aspects of arrhythmia interpretation.

Cardiogenic Shock 98

Cardiogenic Shock Arrhythmia Blog Education 98

Dr. Smith's ECG Blog

MARCH 15, 2023

Baseline bradycardia in endurance athletes limits the use of ß-blockers. The Role of Sinus Arrhythmia: I found it interesting to compare the long lead II rhythm strips in the 3 serial tracings from today’s case ( Figure-1 ). Note fairly marked irregularity of the R-R interval — indicative of definite sinus arrhythmia.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

Learning points : Takotsubo can lead to cardiac arrest from ventricular arrhythmia. Most Torsades is the result of a pause-dependent effect that predisposes to development of the malignant arrhythmia ( Dohadwala et al — Heart Rhythm Case Rep 3(2):115-119, 2017 ).

Cardiac Arrest 69

Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 69

Wellnest

JUNE 19, 2023

Similarly, you may use our , app to adjust the paper speed along with amplification to read the slightest changes, especially for conditions like tachycardia and bradycardia. Alternatively, it also helps enhance arrhythmia management with coronary artery disease. It improves the prediction model for myocardial scar mass.

Technology 52

Technology Cardiac Arrest Innovation Coronary Artery Disease 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. As per Dr. Nossen — today's initial ECG ( LEFT tracing in Figure-2 ) shows sinus bradycardia with QRS widening due to bifascicular block ( RBBB/LAHB ). The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization.

Cardiogenic Shock 130

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 130