Ken Grauer, MD

MARCH 23, 2023

A series of cardiac arrhythmias were seen during the course of her resuscitation — including the interesting arrhythmia shown in the long lead II of Figure-1. What is the cardiac rhythm shown in the long lead II rhythm strip? PEARL # 5: The simple act of labeling P waves can be invaluable for solving an arrhythmia.

Blog 78

Blog Tachycardia Arrhythmia Atrial Flutter 78

Ken Grauer, MD

APRIL 9, 2023

As discussed in ECG Blog #108 — AIVR generally occurs in one of the following C linical S ettings : i ) As a rhythm during cardiac arrest; ii ) In the monitoring phase of acute MI ( especially with inferior MI ) ; or , iii ) As a reperfusion arrhythmia ( ie, following thrombolysis, acute angioplasty, or spontaneous reperfusion ).

Blog 78

Blog Chest Pain Arrhythmia Cardiac Arrest 78

Dr. Smith's ECG Blog

MAY 5, 2023

Common explanations for unusual rhythms such as this one include: i ) Hyperkalemia ( or other severe electrolyte disorder ); ii ) Recent infarction/ischemia; iii ) Sleep apnea; iv ) Severe hypothyroidism; v ) Acute neurologic catastrophe (ie, stroke, bleed, trauma, tumor ); vi ) Some other toxicity.

Bradycardia 52

Bradycardia Cardiac Arrest Arrhythmia Pacemaker 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.

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52

Ken Grauer, MD

OCTOBER 27, 2023

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. Unfortunately, before this could be accomplished — the patient went into cardiac arrest.

Blog 101

Blog Pacemaker Bradycardia Arrhythmia 101

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

SEPTEMBER 7, 2020

Physicians initially attributed symptoms to “panic, anxiety or stress” in half of these patients, with women more likely than men to have their symptoms attributed to psychiatric causes (65% vs. 32%; P < 04). == MY Comment by K EN G RAUER, MD ( 9/7/2020 ): == Interesting case with thorough discussion by Dr. Smith on arrhythmia management.

Tachycardia 52

Tachycardia Heart Disease Dysrhythmia Ablation 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. Both ST segment and T wave alternans have been known to precede malignant ventricular arrhythmias. In patients with a long QT — T wave alternans may forebode impending Torsades de Pointes.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Ken Grauer, MD

JUNE 27, 2024

He developed cardiac arrest shortly after the ECG in Figure-1 was recorded. What is the most likely cause of this arrhythmia? Acute myocardial ischemia. Cardiac Sarcoidosis. Primary Cardiac Tumors and/or Cardiac Metastasis. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? Acute Myocarditis.

Blog 160

Blog Cardiac Arrest Sudden Cardiac Death Tachycardia 160

MIBHS

OCTOBER 31, 2024

This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Arrhythmias (Irregular Heartbeats) Persistent abnormal heart rhythms can disrupt the heart’s pumping efficiency, eventually causing it to enlarge to maintain blood flow.

Blood Pressure 52

Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

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." Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest.

Chest Pain 124

Chest Pain Ischemia Cardiac Arrest Blog 124

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?

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

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.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

JUNE 23, 2024

This was interpreted by the treating clinicians as not showing any evidence of ischemia. This is a critically important determination because of the 2017 AHA/ACC/HRS Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.

Chest Pain 118

Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 118

Dr. Smith's ECG Blog

APRIL 8, 2016

If there is polymorphic VT with a long QT on the baseline ECG, then generally we call that Torsades, but Non-Torsades Polymorphic VT can result from ischemia alone. IV administration of potassium is indicated when arrhythmias are present or hypokalemia is severe (potassium level of less than 2.5 mEq/L, from 1.9

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

MAY 3, 2024

When I was shown this ECG, I said it looks like such widespread ischemia that is might be a left main occlusion, or LM ischemia plus circumflex occlusion (high lateral and posterior OMI). Suffice it to say that, "The heart does whatever it will do when a patient is about to arrest". There is STE in aVR.

Cardiogenic Shock 127

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 127

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. Smith: This bizarre ECG looks like a post cardiac arrest ECG with probable acidosis or hyperkalemia in addition to OMI.

Ischemia 123

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 123

Wellnest

DECEMBER 21, 2022

Arrhythmia In simple words, arrhythmia refers to an irregular heartbeat. Cardiac arrest Cardiac arrest is a medical emergency in which the heart stops pumping blood to the body. Electrocardiogram, echocardiogram, and some other tests are done for patients with cardiac arrest.

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 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.

Cardiac Arrest 40

Cardiac Arrest Bradycardia Chest Pain Ischemia 40

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

This is the proposed mechanism of precipitation of arrhythmias in Brugada syndrome during febrile episodes. There is a potential risk for drug challenge in that life threatening ventricular arrhythmias could be precipitated. This leads to shortening of action potential duration. With proper precautions, risk can be reduced.

Sudden Cardiac Death 52

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

Dr. Smith's ECG Blog

JULY 22, 2023

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.

Chest Pain 91

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 91

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. Acute febrile illness. Hypothermia.

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 26, 2020

See these other related cases: A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB). Rather than AFib I suspect we are seeing a sinoventricular rhythm in ECG #1 with some sinus arrhythmia. Is this just right bundle branch block? large boxes, but then decreases and remains slightly irregular ).

Bradycardia 52

Bradycardia Ischemia Cardiac Arrest AFIB 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.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

While traditionally described as “benign early repolarization”, they have been associated with J wave syndromes along with Brugada syndrome, causing ventricular arrhythmias (1, 2). Occurrence of “J Waves” in 12-Lead ECG as a Marker of Acute Ischemia and Their Cellular Basis. Indian Pacing Electrophysiol J 2004 Antzelevitch C, Yan G.

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52