Dr. Smith's ECG Blog

JULY 30, 2023

The STD maximal in V1-V4 is diagnostic of acute transmural posterior wall ischemia, most likely due to posterior OMI. Subendocardial ischemia does not localize, and subendocardial ischemia presents with STD maximal in V5-6, II, and STE in aVR. Subendocardial ischemia does not localize.

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Chest Pain Ischemia STEMI Arrhythmia 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ). Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think?

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Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

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.

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All About Cardiovascular System and Disorders

APRIL 17, 2024

Ventricular tachycardia is a potentially life threatening cardiac arrhythmia. Monomorphic ventricular tachycardia in the setting of acute myocardial ischemia can also be treated by intravenous lignocaine bolus followed by infusion. If the rate is very fast, hemodynamic deterioration can occur rapidly.

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Tachycardia Defibrillator Congenital Ischemia 52

Ken Grauer, MD

OCTOBER 27, 2023

That said — obvious findings include: i ) Marked bradycardia! — This suggests ischemia of uncertain duration. 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. be regular! —

Blog 101

Blog Pacemaker Bradycardia Arrhythmia 101

Dr. Smith's ECG Blog

JANUARY 22, 2020

There are 3 etiologies I always think of with bradycardia and AV block: 1. There was no evidence of ischemia. In addition to ruling out rate-slowing medication serum electrolyte disorders and/or ischemia/infarction as potential causes of bradyarrhythmias one should also rule out hypothyroidism + sleep apnea. Hyperkalemia.

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Dr. Smith's ECG Blog

MARCH 15, 2023

Baseline bradycardia in endurance athletes limits the use of ß-blockers. These include: i ) Use of rate-slowing medication ( ie, ß-blockers, digoxin, verapamil/diltiazem, etc. ) ; ii ) Acute or recent infarction or ischemia; iii ) Hypothyroidism; iv ) Neurologic injury; v ) Electrolyte disturbance; and , vi ) Sleep apnea. 25, 2022 ).

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Dr. Smith's ECG Blog

JULY 16, 2022

If you put the inferior and posterior findings together, it is diagnostic of OMI This was read as "inferior ischemia" without any other information by Dr. Richard Gray and as probable reperfused inferior-posterior OMI much later by both me and Pendell Meyers, also without any clinical information.

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Chest Pain Bradycardia Blog Critical Care 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

He has a family history concerning for arrhythmia. Given the circumstances of his car crash, we presume it was due to an underlying arrhythmia. He has a family history concerning for arrhythmia with his father requiring some sort of device (PPM, ICD, unclear) at a young age.

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Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

OCTOBER 15, 2024

Additionally, his cardiac telemetry monitor showed runs of accelerated idioventricular rhythm, a benign arrhythmia often associated with coronary reperfusion. Whether these EKGs show myocarditis, a normal variant, or something else, they are overall not typical of transmural ischemia of the anterior or high lateral walls.

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Chest Pain STEMI Echocardiogram Stents 116

Dr. Smith's ECG Blog

OCTOBER 13, 2022

2] Conduction through the accessory pathway can be intermittent (with different degrees of pre-excitation), and affected by ischemia. 3] So a patient with WPW can have the pattern induced by ischemia, and there is also a report of a patient with pre-existing WPW which was “ablated” by myocardial infarction after an LAD occlusion.[4]

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Chest Pain Myocardial Infarction Ischemia STEMI 52

Dr. Smith's ECG Blog

JULY 5, 2023

Here was my answer: "Not ischemia. Instead — my thoughts were as follows: The rhythm is sinus , with marked bradycardia and a component of sinus arrhythmia. WPW Cardiac arrhythmias ( especially AFib ). This was texted to me in real time. The patient has acute chest pain. What do you think? I would not activate cath lab.

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Dr. Smith's ECG Blog

APRIL 29, 2020

Therefore, she underwent temporary pacemaker placement and overdrive pacing at a rate of 90 bpm to keep the heart rate up in order to prevent these PVCs triggering ventricular arrhythmia. Hypokalemia was unlikely because she continued to have ventricular arrhythmia despite of correcting electrolytes. Acute ischemia?

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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.

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Tachycardia Cardiomyopathy Arrhythmia Diabetes 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. There is no definite evidence of acute ischemia. (ie, This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation.

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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.

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Bradycardia Ischemia Cardiac Arrest AFIB 52

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.

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Chest Pain Arrhythmia Myocardial Infarction STEMI 107

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?

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Dr. Smith's ECG Blog

OCTOBER 25, 2023

A prior ECG was available for comparison: Normal One might be tempted to interpret the ST depression as ischemia, but as Smith says, "when the QT is impossibly long, think of hypokalemia and a U-wave rather than T-wave." QUESTION #2: If it were not for the markedly prolonged QTc — Wouldn't ECG #1 look like diffuse subendocardial ischemia?

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Dr. Smith's ECG Blog

OCTOBER 8, 2023

Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. The ECG does not show any signs of ischemia. True Positive ECG#2 : Also sinus rhythm. There is ST depression in V1.

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Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 123

Dr. Smith's ECG Blog

JANUARY 23, 2024

Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). VT is the second most common presenting arrhythmia. Vaso or inotropic medications are not harmless, and can precipitate life threatening arrhythmias. Usually the medical history will provide clues to the cause.

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Dr. Smith's ECG Blog

APRIL 8, 2016

There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Torsades in acquired long QT is much more likely in bradycardia because the QT interval following a long pause is longer still. malignant ventricular arrhythmias are present), rapid replacement of potassium is required.

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STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 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. Poor blood supply Ischemia, or inadequate blood supply to the heart, is an abnormality that can be detected in an ECG test.

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Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

Dr. Smith's ECG Blog

MARCH 24, 2023

There’s sinus bradycardia, first degree AV block, normal axis, delayed R wave progression, and normal voltages. Hyperacute T waves are deflating, suggesting reperfusion but there is still reciprocal change in I/aVL and ST depression in V2, and the bradycardia is worse. Below is the ECG. What do you think? Take home 1.

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Chest Pain STEMI Bradycardia Ischemia 52

EMS 12-Lead

JUNE 1, 2022

Such findings would normally suggest primary ischemia with concomitant surveillance of coronary occlusion, but these ST/T changes might very well be secondary to the Escape mechanism at hand. Chapter 17: Ventricular Arrhythmias. 2] Although the clinical context in today’s case does not fit these descriptors for Type I OMI (e.g.

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Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiac arrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ). Rituparna et al — as well as Chauhan and Brahma ( Int.

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Cardiac Arrest Bradycardia Chest Pain Ischemia 40

Dr. Smith's ECG Blog

MAY 6, 2019

Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Ischemia/infarction. Bradycardia. Hypothermia.

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Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

Prior to Mizusawa's study, it was thought that the incidence of syncope, arrhythmia, or SCD in this cohort was low [7]. In light of the risk of arrhythmia events observed in the Mizusawa trial, a formal EP study might be reasonable to obtain in those with fever induced asymptomatic Brugada ECG changes to help risk stratify these patients.

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Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Ken Grauer, MD

OCTOBER 4, 2024

To improve visualization — I've digitized the original ECG using PMcardio ) MY Thoughts on the ECG in Figure-1: This is a challenging tracing to interpret — because there is marked bradycardia with an irregular rhythm and a change in QRS morphology. Was there a family history of sudden death or significant arrhythmia?

Blog 101

Blog Bradycardia Arrhythmia Pacemaker 101

Dr. Smith's ECG Blog

APRIL 8, 2015

Evidence of acute ischemia (may be subtle) vii. PVCs N ot generally considered abnormal ECG findings: Isolated PAC, First Degree AV Block, Sinus bradycardia at a rate of 35-45, and Nonspecific ST-T abnormalities (even if different from a previous ECG). Left BBB vi. Pathologic Q-waves viii. LVH or RV d. Abnormal but less worrisome: i.

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Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

The possibility of an ischemic cause of the ventricular arrhythmia has to be considered! That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. Below in Figure-5 is a 10-minute continuous lead II recording on oral Flecainide, now showing sinus bradycardia without a single PVC!

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Tachycardia Arrhythmia Atrial Flutter Ablation 72

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.

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