Arrhythmia Ischemia Physiology 
Dr. Smith's ECG Blog
NOVEMBER 26, 2018
In some cases the ischemia can be seen "through" the flutter waves, whereas in other cases the arrhythmia must be terminated before the ischemia can be clearly distinguished. In this case, there is diffuse ischemic ST depression of subendocardial ischemia, of course with accompanying reciprocal STE in aVR.
Dr. Smith's ECG Blog
NOVEMBER 19, 2016
DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR. The ECG cannot diagnose the etiology of ischemia; it only the presence of ischemia, from whatever etiology.
Dr. Smith's ECG Blog
JANUARY 9, 2024
Are you confident there is no ischemia? Primary VT , and the VT with tachycardia is causing ischemia with chest discomfort (supply-demand mismatch/type 2 MI)? Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? Do you agree with this strategy? How can you better assess the ST segments?
Dr. Smith's ECG Blog
JANUARY 23, 2024
Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). VT is the second most common presenting arrhythmia. Vaso or inotropic medications are not harmless, and can precipitate life threatening arrhythmias. Usually the medical history will provide clues to the cause.
Dr. Smith's ECG Blog
JANUARY 6, 2024
In the days before I learned to look for OMI, back when I was counting ST elevation boxes, I used to save ischemia for last.) The atrial rate is around 120 beats per minute, which indicates high adrenergic state and physiologic distress! Never forget that sinus tachycardia is the scariest arrhythmia. The rate is near 80, normal.
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. At about this point in the process — I like to take a closer LOOK at the 12-lead tracing, to ensure there is no acute ischemia or infarction that might need immediate attention.
Dr. Smith's ECG Blog
DECEMBER 24, 2023
And superimposed subendocardial ischemia pattern, of course. While these do not alter emergency management of this patient's arrhythmia — They should be noted. It simply does not make physiologic sense to suddenly see an all-negative QRS complex in this most lateral chest lead. She was otherwise very stable during this rhythm.
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