Dr. Smith's ECG Blog

JANUARY 22, 2020

There was no evidence of ischemia. 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? We are not told how ischemia has been ruled out in this case. Hyperkalemia.

Pulmonary 52

Pulmonary AFIB Atrial Fibrillation Pacemaker 52

Dr. Smith's ECG Blog

MARCH 15, 2023

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. I therefore thought the significance of this finding in today’s case was uncertain.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

MAY 5, 2023

My thoughts were the following: ECGs #1 and #2 showed a completely unreliable sinus pacemaker, with presumed high-grade 2nd-degree AV block — and frequent resultant pauses of over 2 seconds ( that would have been even longer had it not been for intermittent relief from the atrial escape focus ). What Does this All Mean?

Bradycardia 52

Bradycardia Cardiac Arrest Arrhythmia Pacemaker 52

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. since sleep apnea is a readily treatable cause of nighttime bradycardia, as well as of other arrhythmias ).

Blog 78

Blog Bradycardia Arrhythmia Tachycardia 78

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?

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

These findings are concerning for inferior wall ischemia with possible posterior wall involvement. No arrhythmias occurred en route. It is also not a wandering pacemaker — because change in atrial pacing site is gradual with that disorder. Repeat ECG minutes later (one shown below) showed no significant change.

Chest Pain 52

Chest Pain Pulmonary ACE Inhibitor Pacemaker 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. 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.

Chest Pain 107

Chest Pain Arrhythmia Myocardial Infarction STEMI 107

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

JANUARY 23, 2024

Isoprenalin was discontinued, and a temporary transveous pacemaker was implanted. The patient stabilized following pacemaker placement. Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). VT is the second most common presenting arrhythmia.

Tachycardia 107

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

Wellnest

DECEMBER 21, 2022

Arrhythmia In simple words, arrhythmia refers to an irregular heartbeat. Poor blood supply Ischemia, or inadequate blood supply to the heart, is an abnormality that can be detected in an ECG test. ECG testing is also carried out to see how medicines work during treatment and the pacemaker's functioning.

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 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. He received a permanent pacemaker during the subsequent inpatient stay. Chapter 17: Ventricular Arrhythmias. References [1] Surawicz, B.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

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 101

Blog Bradycardia Arrhythmia Pacemaker 101

Dr. Smith's ECG Blog

APRIL 8, 2015

Evidence of acute ischemia (may be subtle) vii. Negative predictors of adverse outcome: Pacemaker Pre-syncope or "near-syncope," but there is still some small risk (5, 18) These last two are identified in studies, but I consider them dangerous signs and symptoms in their own right, as above: 10. Left BBB vi. Pathologic Q-waves viii.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

DECEMBER 20, 2024

No evidence for ischemia jumps out. How does a pacemaker accomplish RBBB morphology? Quick aside on device terminology (feel free to skip): A "single chamber" pacemaker is a device with only one lead. A "dual chamber" pacemaker is a device with an atrial lead and a ventricular lead. ECG 1 What do you think?

Chest Pain 102

Chest Pain Tachycardia Pacemaker Defibrillator 102

Ken Grauer, MD

FEBRUARY 21, 2025

PEARL # 2: Despite the challenge of assessing a ventricular rhythm for underlying ischemia and/or infarction there are primary ST-T wave changes that are seen in Figure-3 that suggest an ongoing acute event. I represent this in the laddergam shown in Figure-6. The above said Today's patient had other ideas.

Blog 138

Blog STEMI Hospital Pacemaker 138