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 112

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 112

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

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

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 106

Chest Pain Cardiac Arrest Blog Cardiomyopathy 106

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

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?

Cardiac Arrest 132

Cardiac Arrest Blog Atrial Fibrillation AFIB 132

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 119

Blog Pacemaker Bradycardia Tachycardia 119

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 98

Blog Bradycardia STEMI Download 98

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 85

Chest Pain Arrhythmia Myocardial Infarction STEMI 85

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 111

Chest Pain Bradycardia STEMI Ischemia 111

Circulation: Arrhythmia and Electrophysiology

NOVEMBER 10, 2023

Circulation: Arrhythmia and Electrophysiology, Ahead of Print. Serious AEs were rare; 1 patient in the etripamil arm experienced transient severe bradycardia and syncope, assessed as due to hyper-vagotonia.Conclusions:Intranasal etripamil 70 mg reduced VR and improved symptom-relief and treatment-satisfaction.

Atrial Fibrillation 40

Atrial Fibrillation Bradycardia Electrophysiology Arrhythmia 40

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 Myocardial Infarction 52

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 106

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 106

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.

Stroke 73

Stroke Strokes Chest Pain Cardiomyopathy 73

All About Cardiovascular System and Disorders

MAY 2, 2024

Athlete’s bradycardia due to increased parasympathetic tone and decreased sympathetic tone is a well-known observation. Though sinus bradycardia is usual, other abnormalities like sinus arrhythmia, sinus arrest, wandering atrial pacemaker and coronary sinus rhythm have been described.

Exercise 40

Exercise Cardiomyopathy Blood Pressure Physiology 40

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

JANUARY 21, 2023

This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern. ECG met STEMI criteria and was labeled STEMI by computer interpretation.

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52

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.

Cardiac Arrest 52

Cardiac Arrest Technology Coronary Artery Disease Innovation 52

Open Heart

JULY 17, 2023

Cardiac accumulation triggers local tissue injury, electrical instability and arrhythmia. Objective We conducted a systematic review evaluating AF burden and bradycardia requiring permanent pacemaker (PPM) implantation and report any predictive risk factors identified. Study outcomes included AF or bradycardia requiring therapy.

Bradycardia 52

Bradycardia Atrial Fibrillation Pacemaker Risk Factors 52

Dr. Smith's ECG Blog

JULY 16, 2022

The computer called "Sinus Bradycardia" only (implying that everything else is normal. The overreading Cardiologist called it only "Sinus Bradycardia" with no other findings. The rhythm in Figure-1 is sinus bradycardia and arrhythmia. These features are subtle — but they are definitely present and important to recognize.

Chest Pain 52

Chest Pain Bradycardia Blog Critical Care 52

Wellnest

DECEMBER 21, 2022

Arrhythmia In simple words, arrhythmia refers to an irregular heartbeat. A fast heartbeat is called tachycardia, while a slow heartbeat is called bradycardia in medical terms. If your heart beats too slowly, too quickly, or irregularly, an ECG will easily detect it.

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

Dr. Smith's ECG Blog

DECEMBER 5, 2023

A repeat ECG was performed as adult cardiology was asked to evaluate the patient for emerget PCI: Sinus bradycardia with persistent elevation in the inferior leads with reciprocal depression in aVL Patient was taken to cath lab with adult cardiology which revealed normal coronary arteries without evidence of occlusion MI. As per Drs.

Pediatrics 112

Pediatrics Pericarditis COVID-19 Congenital Heart Disease 112

Ken Grauer, MD

OCTOBER 13, 2023

With P waves labeled — Isn't it now much easier to appreciate that the atrial rhythm is quite regular ( with no more than a slight sinus arrhythmia )? P utting I t A ll T ogether : The precise mechanism of today's arrhythmia is complex and difficult to determine. For those with a special interest in cardiac arrhythmias — READ ON! —

Blog 140

Blog Arrhythmia Bradycardia Download 140

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 177

Blog Tachycardia Tricuspid Atrial Flutter 177

EMS 12-Lead

JUNE 1, 2022

plaque disruption), the T waves still manifest markings of a previous state of suboptimal coronary flow that resolved: Type II supply-demand mismatch in the setting of extreme bradycardia. Chapter 17: Ventricular Arrhythmias. 2] Although the clinical context in today’s case does not fit these descriptors for Type I OMI (e.g.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Cardiomyopathy 52

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

Dr. Smith's ECG Blog

JULY 30, 2023

The RCA usually supplies the SA and AV nodes, so RCA OMIs can present with heart blocks and bradycardias like in this case. == MY Comment , by K EN G RAUER, MD ( 7/30 /2023 ): == There are numerous important points that are brought out by today’s case. PEARL # 5 — Complete AV dissociation is not the same as 3rd-degree AV block!

Chest Pain 52

Chest Pain Ischemia STEMI Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 5, 2024

The ECG shows sinus bradycardia but is otherwise normal. Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The documentation does not describe any additional details of the history. The following ECG was obtained. ECG 1 What do you think?

Angina 106

Angina Plaque Document Stents 106

Dr. Smith's ECG Blog

OCTOBER 8, 2023

The rhythm is uncertain ( ie, We only see 4 beats — because the same 4 beats are repeated in limb and chest leads — but in lead II there appears to be sinus bradycardia and arrhythmia plus a P wave with a PR interval too short to conduct preceding beat #1 — therefore need for a longer period of monitoring ).

Ischemia 108

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 108

Dr. Smith's ECG Blog

JUNE 23, 2023

The patient later settled into sinus bradycardia. The above said — Dr. Smith's approach to today's arrhythmia highlights a number of important points! Just because a regular WCT is VT does not necessarily mandate immediate cardioversion — IF the patient is hemodynamically stable and tolerating the arrhythmia.

Tachycardia 52

Tachycardia Cardiomyopathy Arrhythmia Diabetes 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

Dr. Smith's ECG Blog

DECEMBER 23, 2019

Although unfortunately there is no long lead II rhythm strip — RED arrows in ECG #2 highlight that sinus P waves ( the rhythm is sinus bradycardia and arrhythmia ) continue throughout the tracing , allowing us to establish with certainty the 7 sinus-conducted beats vs the 2 PVCs in this tracing.

Tachycardia 52

Tachycardia Atrial Flutter Cardiomyopathy Atrial Fibrillation 52

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 106

Blog Pacemaker Bradycardia Arrhythmia 106

All About Cardiovascular System and Disorders

MAY 21, 2024

But subcutaneous ICD cannot provide bradycardia and antitachycardia pacing as a transvenous ICD. It was a multinational study which enrolled patients at risk for sudden death from ventricular arrhythmias and the follow up period was 6 months. None of the deaths in the study were deemed to be arrhythmia related or procedure related.

Pacemaker 52

Pacemaker Defibrillator Bradycardia Arrhythmia 52

Dr. Smith's ECG Blog

MAY 6, 2019

Bradycardia. Finally — a detailed family history ( for early sudden death ) + a careful personal history ( for syncope/presyncope; malignant arrhythmia ) is in order. Acute febrile illness. Variations in autonomic tone. Hypothermia. Electrolyte imbalance ( hypokalemia; hyperkalemia ). Ischemia/infarction. Cardioversion/defibrillation.

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

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 110

Blog Arrhythmia STEMI Bradycardia 110

Dr. Smith's ECG Blog

JANUARY 15, 2023

The rhythm in ECG #1 is sinus bradycardia and arrhythmia. That said, in my opinion — the experienced emergency care provider should within seconds — recognize that if ECG #1 ( that I have reproduced in Figure-1 ) is obtained from a patient with new chest pain — that this tracing is diagnostic of acute OMI until proven otherwise!

Chest Pain 52

Chest Pain Blog Bradycardia Stents 52