Arrhythmia, Chest Pain and Pacemaker

46 year old with chest pain develops a wide complex rhythm -- see many examples

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. The patient continued having chest pain. There are three mechanisms of arrhythmia: automatic, re-entry, and triggered.

Chest Pain

Chest Pain Arrhythmia Myocardial Infarction STEMI

A man in his 40s with acute chest pain. What do you think?

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

Sent by anonymous, written by Pendell Meyers, reviewed by Smith and Grauer A man in his 40s presented to the ED with HTN, DM, and smoking history for evaluation of acute chest pain. He was eating lunch when he had sudden onset chest pressure, 9/10, radiating to his back, with sweating and numbness in both hands.

Chest Pain

Chest Pain Tachycardia STEMI Blog

A 50-something with chest pain. Is there OMI? And what is the rhythm?

Dr. Smith's ECG Blog

MARCH 22, 2024

Written by Willy Frick A man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. His ECG is shown: What do you think? What do you think?

Chest Pain

Chest Pain STEMI Bradycardia Ischemia

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An elderly patient with syncope, dyspnea, and weakness, but no Chest Pain, and mild hyperkalemia

Dr. Smith's ECG Blog

MAY 21, 2023

Here is the first ED ECG: COMPUTER INTERPRETATION: Electronic Atrial Pacemaker. Whenever a patient does not have chest pain, the pre-test probability of OMI is diminished. Of course SOB, jaw pain, shoulder pain, etc can be a result of OMI, but the pretest probability is less and so you must scrutinize further.

Chest Pain

Chest Pain Pacemaker Atrial Fibrillation Blog

A man in his 70s with chest pain during a bike ride

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding.

Chest Pain

Chest Pain Pulmonary ACE Inhibitor Pacemaker

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Dr. Smith's ECG Blog

APRIL 8, 2022

There is a patient with persistent chest pain and an initial troponin I over 52 ng/L; 52 ng/L has an approximate 70% PPV for acute type I MI in a chest pain patient. Pain was severe and persistent. CT angiography chest assessing for PE and dissection negative. Heparin drip was initiated. Is there STEMI?

Chest Pain

Chest Pain SCAD STEMI Blog

ECG Blog #399 — Which Laddergram is Correct?

Ken Grauer, MD

OCTOBER 13, 2023

She was hemodynamically stable — and did not have chest pain, lightheadedness or syncope. Is a pacemaker needed? 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 )? This is consistent with a slight sinus arrhythmia.

Blog

Blog Arrhythmia Bradycardia Download

What are treatment options for this rhythm, when all else fails?

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.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

Later, I found old ECGs: 5 month prior in clinic: V5 and V6 look like OMI 9 months prior in clinic with no chest symptoms: V5 and V6 look like OMI 1 year prior in the ED with chest pain: V5 and V6 sure look like a STEMI For this ECG and chest pain in the ED, the Cath lab activated. But the angiogram was clean.

Strokes

Strokes Stroke Chest Pain Cardiomyopathy

What kind of AV block is this? And why does she develop Ventricular Tachycardia?

Dr. Smith's ECG Blog

JANUARY 23, 2024

There was no chest pain. 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.

Tachycardia

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death

ECG Blog #401 — What Kind of Block?

Ken Grauer, MD

OCTOBER 27, 2023

My Immediate Impression — was that this elderly woman with a several week history of symptoms would most likely leave the hospital with a pacemaker. Given this patient's older age — if nothing "fixable" is found, she most likely has SSS ( S ick S inus S yndrome ) and will need a pacemaker ( See ECG Blog #342 for more on SSS ).

Blog

Blog Pacemaker Bradycardia Arrhythmia

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

JANUARY 9, 2024

She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. She presented to the emergency department after a couple of days of chest discomfort. Learning points *A patient with tachydysrhythmia and chest discomfort needs immediate rhythm or rate control. small squares in width (260ms).

Tachycardia

Tachycardia Electrophysiology Atrial Flutter Ischemia

Why is ECG machine use? What diseases can EKG monitor detect?

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.

Cardiac Arrest

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation

I'm so sorry when medics get abused for activating the cath lab

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Case: The call was an elderly gentleman who was at home when he experienced a sudden onset of vague chest discomfort along with nausea, and left arm aching. He has a pacemaker for an unknown arrhythmia reason, and has a hx of a PE but is not anti-coagulated currently. It was central and constant.

Chest Pain

Chest Pain Myocardial Infarction Pacemaker Cardiogenic Shock

What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

Dr. Smith's ECG Blog

MARCH 15, 2023

She did notice something slightly wrong subjectively, but had no palpitations, chest pain, or SOB, or any other symptom. 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 ). She was on no medications. Potassium was normal.

Atrial Fibrillation

Atrial Fibrillation AFIB Arrhythmia Exercise

ECG Blog #382 — What Does the Holter Show?

Ken Grauer, MD

JUNE 2, 2023

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. ie, with syncope-presyncope, fatigue, dyspnea, chest pain? ).

Blog

Blog Bradycardia Arrhythmia Tachycardia

Atrial fibrillation? Multifocal Atrial Tachycardia? Don't look at computer read until AFTER you interpret!

Dr. Smith's ECG Blog

JANUARY 5, 2020

This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chest pain. MAT has at least 3 distinct P-wave morphologies, but there is no single dominant pacemaker (i.e., How can you avoid overlooking this arrhythmia? The reasons for overlooking this arrhythmia are simple: True MAT is not a common rhythm.

Atrial Fibrillation

Atrial Fibrillation Tachycardia Arrhythmia Pulmonary

What is this Rhythm?

Dr. Smith's ECG Blog

JANUARY 26, 2023

to diagnose almost any arrhythmia. This may lead to a series of symptoms similar to “pacemaker syndrome” ( ie, dizziness, fatigue, light-headedness, presyncope/syncope, dyspnea and/or chest pain ). To EMPHASIZE: Using the Ps, Qs, 3R system does not slow you down. The rhythm is not completely R egular.

Pacemaker

Pacemaker Chest Pain AFIB Blog

Syncope and Block

EMS 12-Lead

JUNE 1, 2022

He received a permanent pacemaker during the subsequent inpatient stay. Smith and Myers found that in otherwise classic Wellens syndrome – that is, prior anginal chest pain that resolves with subsequent dynamic T wave inversions on the ECG – even the T waves of LBBB behave similarly. [2] Chapter 17: Ventricular Arrhythmias.

Heart Failure

Heart Failure Myocardial Infarction Bradycardia Chest Pain

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

Dr. Smith's ECG Blog

APRIL 29, 2020

A recent similar case: A 40-something with chest pain. 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. Is this inferior MI? There is a bigeminy with very Bizarre looking PVCs.

Cardiac Arrest

Cardiac Arrest Defibrillator Ischemia Tachycardia

ECG Blog #450 — A "Healthy" 30yo with Dizziness

Ken Grauer, MD

OCTOBER 4, 2024

IMPRESSION: Today’s initial ECG is a complex tracing that manifests marked sinus bradycardia and arrhythmia — underlying RBBB — and both junctional and ventricular escape beats when the heart rate drops below 50/minute. CAVEAT: Although many of these rhythms are seen in seemingly healthy individuals — these are not always benign arrhythmias.

Blog

Blog Bradycardia Arrhythmia Pacemaker

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). The most recent and probably best study is this: Canadian Syncope Arrhythmia Risk Score.

Arrhythmia

Arrhythmia Outcomes Risk Factors Chest Pain

Chest pain and rapid pacing followed by an unexplained wide complex tachycardia. Time for cardioversion?

Dr. Smith's ECG Blog

DECEMBER 20, 2024

Written by Willy Frick with edits by Ken Grauer An older man with a history of non-ischemic HFrEF s/p CRT and mild coronary artery disease presented with chest pain. He said he had had three episodes of chest pain that day while urinating. How does a pacemaker accomplish RBBB morphology? ECG 1 What do you think?

Chest Pain

Chest Pain Tachycardia Pacemaker Defibrillator

Cardiovascular Update

46 year old with chest pain develops a wide complex rhythm -- see many examples

A man in his 40s with acute chest pain. What do you think?

A 50-something with chest pain. Is there OMI? And what is the rhythm?

Webinars

An elderly patient with syncope, dyspnea, and weakness, but no Chest Pain, and mild hyperkalemia

A man in his 70s with chest pain during a bike ride

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

ECG Blog #399 — Which Laddergram is Correct?

What are treatment options for this rhythm, when all else fails?

A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?

What kind of AV block is this? And why does she develop Ventricular Tachycardia?

ECG Blog #401 — What Kind of Block?

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Why is ECG machine use? What diseases can EKG monitor detect?

I'm so sorry when medics get abused for activating the cath lab

What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

ECG Blog #382 — What Does the Holter Show?

Atrial fibrillation? Multifocal Atrial Tachycardia? Don't look at computer read until AFTER you interpret!

What is this Rhythm?

Syncope and Block

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

ECG Blog #450 — A "Healthy" 30yo with Dizziness

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Chest pain and rapid pacing followed by an unexplained wide complex tachycardia. Time for cardioversion?

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