Arrhythmia Ischemia Physiology 
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 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
OCTOBER 13, 2022
2] Conduction through the accessory pathway can be intermittent (with different degrees of pre-excitation), and affected by ischemia. 3] So a patient with WPW can have the pattern induced by ischemia, and there is also a report of a patient with pre-existing WPW which was “ablated” by myocardial infarction after an LAD occlusion.[4]
Dr. Smith's ECG Blog
JULY 3, 2020
Either could be a result of myocardial contusion There is some minimal ST depression -- this could represent ischemia What else is there that could use therapy immediately? Or, much less likely, it could be a very accelerated escape rhythm from the posterior fascicle. There is a very long ST segment resulting in a very long QT.
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.
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