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. Place temporary pacemaker 3. There is ventricular bigeminy with bizarre appearing wide T-waves See even more striking cases of this at the bottom of the post. The plan: 1.

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Tachycardia Cardiomyopathy Blog Bradycardia 116

Dr. Smith's ECG Blog

JANUARY 13, 2024

Written by Willy Frick A man in his 70s with a history of HFrEF and sick sinus syndrome s/p dual chamber pacemaker placement was admitted for overnight observation following outpatient placement of a mitral valve clip. This is unambiguous evidence of pacemaker malfunction. Imagine the pacemaker is set at a minimum rate of 60.

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Pacemaker Bicuspid/Mitral Blood Pressure Bradycardia 110

Dr. Smith's ECG Blog

JUNE 27, 2024

EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. They knew she would need a pacemaker unless some transient and reversible cause was discovered. Once this happens, of course, the patient will require temporary or permanent pacemaker as soon as possible.

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Blog Pacemaker Bradycardia Tachycardia 120

Dr. Smith's ECG Blog

JULY 5, 2018

We admitted him for probable EP study and possible pacemaker. He underwent pacemaker placement and is doing fine. SSS is by far the most common reason for permanent pacemaker placement. during which sinus bradycardia and arrhythmia are seen but not to a degree that produces symptoms. Learning Points: 1.

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

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.

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Atrial Fibrillation Arrhythmia Heart Failure Tachycardia 40

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.

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Blog Bradycardia Arrhythmia Tachycardia 78

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. Automatic activity refers to enhanced pacemaking function (typically from a non sinus node source), for example atrial tachycardia. This has been discussed many times before on this blog.

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Chest Pain Arrhythmia Myocardial Infarction STEMI 107

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. That is, until the 7th R wave which comes a little bit sooner than expected. CLICK HERE — for more on fusion beats.

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Chest Pain STEMI Bradycardia Ischemia 114

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.

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Bradycardia Pacemaker Arrhythmia Tachycardia 52

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. The patient may need a pacemaker. But the point to emphasize — is that it should only take seconds to recognize that there is bradycardia from significant AV block. =

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Blog Bradycardia STEMI Download 95

Ken Grauer, MD

OCTOBER 27, 2023

That said — obvious findings include: i ) Marked bradycardia! — My Immediate Impression — was that this elderly woman with a several week history of symptoms would most likely leave the hospital with a pacemaker. The rhythm in Figure-1 is complex — and defies precise interpretation without careful study. be regular! —

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Blog Pacemaker Bradycardia Arrhythmia 103

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.

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Blood Pressure Bradycardia Pacemaker Arrhythmia 40

Dr. Smith's ECG Blog

JANUARY 23, 2024

Isoprenalin was discontinued, and a temporary transveous pacemaker was implanted. The patient stabilized following pacemaker placement. VT is the second most common presenting arrhythmia. Vaso or inotropic medications are not harmless, and can precipitate life threatening arrhythmias.

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Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

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.

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Blog Arrhythmia Bradycardia Pacemaker 87

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.

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Stroke Strokes Chest Pain Cardiomyopathy 70

Dr. Smith's ECG Blog

JANUARY 22, 2020

There are 3 etiologies I always think of with bradycardia and AV block: 1. She had a permanent pacemaker implanted. After pacer AND conversion to sinus rhythm: Computer diagnosis: IMPRESSION ELECTRONIC VENTRICULAR PACEMAKER ABNORMAL RHYTHM ECG What is missing from this interpretation? Hyperkalemia. Her K was normal 3.

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Pulmonary AFIB Atrial Fibrillation Pacemaker 52

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.

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Atrial Fibrillation AFIB Arrhythmia Exercise 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. ECG testing is also carried out to see how medicines work during treatment and the pacemaker's functioning.

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Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

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.

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Exercise Cardiomyopathy Blood Pressure Physiology 40

EMS 12-Lead

JUNE 1, 2022

He received a permanent pacemaker during the subsequent inpatient stay. 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. References [1] Surawicz, B.

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Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

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.

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Cardiac Arrest Defibrillator Ischemia Tachycardia 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?

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Blog Bradycardia Arrhythmia Pacemaker 103

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. of patients were free from leadless pacemaker related major complications.

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Pacemaker Defibrillator Bradycardia Arrhythmia 52

Dr. Smith's ECG Blog

APRIL 8, 2015

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). Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful.

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Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2025

If the block is not vagal in nature, the patient should receive a pacemaker. There was a randomized trial to determine whether pacemakers could benefit patients with vasovagal syncope, aptly named The North American Vasovagal Pacemaker Study (VPS). In the repeat study (VPS II), EVERY patient had an implanted pacemaker.

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Pacemaker Bradycardia Document Heart Rhythm 84

Ken Grauer, MD

NOVEMBER 30, 2024

To Emphasize: Regardless of whether the rhythm in Figure-1 represents 2nd- or 3rd-degree AV block — the overall ventricular rate is slow ( in the 40s/minute ) — so that IF this patient is symptomatic and no “fixable” cause of the bradycardia is found — pacing might still be needed. The "Longer" Answer: = What then is going on?

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Blog Arrhythmia Bradycardia Pacemaker 129

Dr. Smith's ECG Blog

NOVEMBER 11, 2024

The patient went for EP study and had prolonged HV interval which strongly supports placement of a pacemaker. He underwent dual chamber pacemaker implantation and did well. What follows is a "deep dive" into some of the intricacies of the 2nd-degree AV block for readers with an interest in advanced arrhythmia interpretation.

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Arrhythmia Bradycardia Outpatient Pacemaker 71