Dr. Smith's ECG Blog

MAY 6, 2019

The patient presented with chest pain. 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. Only 5-18% of ED patients with chest pain have a myocardial infarction of any kind. Is it Brugada pattern?

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Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

APRIL 29, 2020

A 60-something woman presented after a witnessed cardiac arrest. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. A recent similar case: A 40-something with chest pain. Is this inferior MI?

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

MIBHS

OCTOBER 31, 2024

Arrhythmias (Irregular Heartbeats) Persistent abnormal heart rhythms can disrupt the heart’s pumping efficiency, eventually causing it to enlarge to maintain blood flow. Cardiac Arrest or Sudden Death: Cardiomegaly increases the risk of life-threatening arrhythmias, which can cause sudden cardiac arrest.

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Circulation: Arrhythmia and Electrophysiology

JANUARY 29, 2024

Circulation: Arrhythmia and Electrophysiology, Ahead of Print. BACKGROUND:There is no specific treatment for sudden cardiac arrest (SCA) manifesting as pulseless electric activity (PEA) and survival rates are low; unlike ventricular fibrillation (VF), which is treatable by defibrillation.

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Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. However, he suddenly developed a series of malignant ventricular arrhythmias.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

OCTOBER 25, 2023

He did not have chest pain. Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest. Chest pain in high risk patient. Here is his triage ECG: What do you think? What does the ECG show? Also see the bizarre Bigeminy. Is it STEMI?

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Chest Pain Ischemia Cardiac Arrest Blog 124

Dr. Smith's ECG Blog

MAY 3, 2024

Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock. Here are some cases of RBBB with LAFB: What is the Diagnosis in this 70-something with Chest Pain?

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Cardiogenic Shock Cardiac Arrest Hospital Ischemia 127

MIBHS

JULY 31, 2024

Arrhythmias (Abnormal Heart Rhythms) Stress hormones can disrupt the signals that regulate your heartbeat, leading to arrhythmias – abnormal heart rhythms that cause your heart to beat too fast, too slow, or irregularly.

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Blood Pressure Heart Attack Heart attacks Heart Rhythm 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

He woke up alert and with chest pain which he also had experienced intermittently over the previous few days. The history in today's case with sudden loss of consciousness followed by chest pain is very suggestive of ACS and type I ischemia as the cause of the ECG changes. What do you think?

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Dr. Smith's ECG Blog

JULY 22, 2023

Written by Pendell Meyers A man in his 70s with no cardiac history presented with acute weakness, syncope, and fever. He denied chest pain or shortness of breath. In the clinical context of weakness and fever, without chest pain or shortness of breath, the likelihood of Brugada pattern is obviously much higher.

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Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 92

Wellnest

DECEMBER 21, 2022

If you experience any symptoms, such as chest pain, dizziness, unusual tiredness or fatigue, shortness of breath, or irregular heartbeat, your doctor would want you to go for an ECG test to find out the underlying cause. Arrhythmia In simple words, arrhythmia refers to an irregular heartbeat.

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Dr. Smith's ECG Blog

OCTOBER 8, 2023

All of the patients presented with chest pain , and they are all in triage. Smith: This bizarre ECG looks like a post cardiac arrest ECG with probable acidosis or hyperkalemia in addition to OMI. Which, if any, of these patients has OMI, with myocardium at risk and need for emergent PCI? What was the pH and K?

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Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 123

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. IV administration of potassium is indicated when arrhythmias are present or hypokalemia is severe (potassium level of less than 2.5 If cardiac arrest from hypokalemia is imminent (i.e., Most recent echo showed EF of 60%. He had recently had a NonSTEMI.

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STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Ken Grauer, MD

APRIL 9, 2023

No chest pain. Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chest pain. ( L ADDERGRAM I llustration : Clarification of the mechanism in today's arrhythmia is best explained by laddergram illustration ( Figure-5 ). How would YOU interpret the ECG in Figure-1 ?

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Blog Chest Pain Arrhythmia Cardiac Arrest 78

Wellnest

MARCH 12, 2023

It occurs when blood flow to the coronary arteries is restricted, frequently by a blood clot, which can harm the heart muscle and result in consequences like heart disease or sudden cardiac arrest. By being aware of the early warning symptoms, you can see potential cardiac issues before they worsen. A nauseous or stomach ache.

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Heart Disease Heart Attack Heart attacks Blood Pressure 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

Although in the context of chest pain such ST depression would be all but diagnostic of posterior OMI, one should make no conclusions in such an unusual case. This Transesophageal ED Echo was recorded: Cardiac POCUS.mov from Stephen Smith on Vimeo. In all leads, there is a 2nd wave after the initial QRS.

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Cardiac Arrest Bradycardia Chest Pain Ischemia 40

Dr. Smith's ECG Blog

MAY 26, 2023

And she does not know that this is an overdose; she thinks it is a patient with chest pain!! 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.

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Ken Grauer, MD

OCTOBER 27, 2023

Given the history of dyspnea on exertion over a several week period ( but no mention of chest pain ) — and — the finding of deep, symmetric T wave inversion in the anterior leads ( as per Pearl #2 ) — it is possible that the onset of her symptoms is the result of a "Silent MI" ( See ECG Blog #228 for more on "Silent" MI ).

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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. ST depression. Myocardial Contusion?

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Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. Thirty-six patients (36%) presented with cardiac arrest, and 78% (28/36) underwent emergent angiography.

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

It was from a patient with chest pain: Note the obvious Brugada pattern. Prior to Mizusawa's study, it was thought that the incidence of syncope, arrhythmia, or SCD in this cohort was low [7]. Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. There is no further workup at this time.

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Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

Case submitted by Magnus Nossen MD from Norway, written by Pendell Meyers A man in his 50s with no pertinent medical history suffered a witnessed cardiac arrest. 12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC.

Ischemia 40

Ischemia Arrhythmia Defibrillator Chest Pain 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? Both ST segment and T wave alternans have been known to precede malignant ventricular arrhythmias. She was noted to be tachycardic and her heart sounds were distant on physical exam.

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DAIC

APRIL 6, 2024

Chugh, the Pauline and Harold Price Chair in Cardiac Electrophysiology Research at Cedars-Sinai, investigates the causes of and potential treatments for abnormal heart rhythms, including sudden cardiac arrest. Experts Available The following experts also are available for interviews throughout ACC.24: 24: Christine M.

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Research Cardiac Arrest Electrophysiology Chest Pain 105

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

This patient had many complaints including chest pain. This causes deadly arrhythmias and should be considered in patients with syncope and short QT 2. The disorder is rare — but it takes on importance as a potential cause of atrial and ventricular arrhythmias, including cardiac arrest. Short QT syndrome.

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Chest Pain Cardiac Arrest STEMI Arrhythmia 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiac arrest in sleep. The patient denied any chest pain whatsoever, and a troponin at zero and 2 hours were both undetectable. We repeated the ECG: Brugada pattern is mostly resolved.

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Sudden Cardiac Death Heart Rhythm Article Tachycardia 52