DAIC

JANUARY 15, 2024

Euan Ashley (Stanford University) Safety Oversight of decentralized trials — Leanne Madre (Medable) Remote Arrhythmia Monitoring from an Academic Perspective — Greg Marcus (UCSF) Do Remote Heart-Monitoring Devices Work? REACT, LOOP etc.

Research 116

Research Academic Best Practices Technology 116

Dr. Smith's ECG Blog

MARCH 15, 2023

Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. 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 ). But when you see this, you should suspect that the AV node is not well.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

JULY 5, 2024

A formal ultrasound later showed reasonably good LV function, and so he later received carvedilol and diltiazem, Unfortunately, those led to hypotension at 80/40 with a HR 40. PEARL #1: The most commonly overlooked arrhythmia is AFlutter ( A trial F lutter ). As a result — We can not rule out VT on the basis of this single ECG.

Atrial Flutter 112

Atrial Flutter Tachycardia Atrial Fibrillation AFIB 112

Dr. Smith's ECG Blog

JANUARY 5, 2024

On intravascular ultrasound (IVUS), the mid RCA plaque was described as "cratered, inflamed, and bulky," and the OM plaque was described as "bulky with evidence of inflammation and probably ulceration." Additional findings: No ST elevation." They also documented "Reproducible chest tenderness."

Angina 119

Angina Plaque Document Stents 119

Dr. Smith's ECG Blog

AUGUST 3, 2018

Here was his prehospital ECG, which I viewed immediately while the resident performed cardiac ultrasound: What do you think? Here is the cardiac ultrasound which the resident performed as I viewed the ECG: This shows a huge pericardial effusion. Therefore, we performed ultrasound-guided pericardiocentesis. Is is sinus?

Chest Pain 40

Chest Pain Tachycardia Atrial Flutter Ultrasound 40

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound. What does a heart look like on ultrasound when the EKG looks like that? Here you go: It's not the world's greatest cardiac ultrasound video, but it does appear to show poor function and low volume. They transported to the ED.

Cardiac Arrest 40

Cardiac Arrest Tachycardia Nursing Ultrasound 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

JUNE 17, 2018

Other nonspecific findings may include P wave abnormalities, PR segment deviations, and atrial arrhythmias — though none of these findings are seen in a majority of patients. Electrical alternans is generally only seen with a large pericardial effusion. ii ) All 3 of the ECGs in this case manifest Schamroth’s S ign !

Chest Pain 52

Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. Both ST segment and T wave alternans have been known to precede malignant ventricular arrhythmias. This patient is only pseudo-stable.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

MARCH 6, 2023

Regional wall motion abnormality-inferolateral (this is the formal ultrasound location of a posterior wall motion abnormality). Therefore, the rhythm in ECG #2 is a marked sinus arrhythmia — which was not clinically important, and which resolved within minutes by the time ECG #3 was recorded. Here is a case from a while back.

Chest Pain 52

Chest Pain STEMI Stenosis Blog 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., A emergent cardiology consult can be helpful for equivocal cases. This finding does not alter the need to pursue emergent reperfusion, although it might suggest a poorer prognosis.”[3]

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 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. It is a benign arrhythmia which requires no specific treatment. Possible mechanisms of ventricular arrhythmias elicited by ischemia followed by reperfusion. What is the rhythm?

Chest Pain 106

Chest Pain Arrhythmia Myocardial Infarction STEMI 106

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. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. The arrhythmia starts with a PVC having a short coupling interval.

Arrhythmia 130

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 130

DAIC

APRIL 9, 2024

It is also published in Heart Rhythm , the official journal of the HRS, Journal of Arrhythmia , the official journal of the APHRS, and Journal of Interventional Cardiac Electrophysiology , the official journal of the LAHRS. Antiarrhythmic drugs are advised for some patients to prevent arrhythmia recurrences early after the procedure.

Atrial Fibrillation 105

Atrial Fibrillation Ablation Heart Rhythm Blood Clot 105

Dr. Smith's ECG Blog

JUNE 2, 2023

My bedside ultrasound was of insufficient quality, but showed somewhat reduced overall EF, distended IVC without respiratory variation, no pericardial effusion, and diffuse bilateral B lines. == What do you think of her ECG? Of Note: This patient was hemodynamically stable without palpitations at the time ECG #1 was recorded.

Tachycardia 96

Tachycardia Cardiomyopathy Electrocardiogram Article 96

Dr. Smith's ECG Blog

APRIL 8, 2016

Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. IV administration of potassium is indicated when arrhythmias are present or hypokalemia is severe (potassium level of less than 2.5 malignant ventricular arrhythmias are present), rapid replacement of potassium is required.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Cardiometabolic Health Congress

AUGUST 8, 2024

Key contributions: Advanced cardiac imaging (e.g., high-sensitivity troponin, NT-proBNP) in risk stratification Utilization of advanced echocardiographic techniques (e.g.,

Education 59

Education Cardiovascular Disease Diabetes Kidney Disease 59

Dr. Smith's ECG Blog

JANUARY 15, 2024

A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW. Jenkins and Frick — I offer 3 additional examples of artifactual distortion ( excerpted from my ECG Blog ) — that resulted in arrhythmia misdiagnosis.

Chest Pain 63

Chest Pain Blog Arrhythmia Critical Care 63

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. Although there is no long lead rhythm strip — it is noteworthy that there is marked sinus arrhythmia in ECG #1. This finding is easy to overlook because of the lack of a long lead II … Perhaps this marked sinus arrhythmia reflects increased vagal tone?

STEMI 40

STEMI Angina Myocardial Infarction Plaque 40

Dr. Smith's ECG Blog

OCTOBER 28, 2023

Further ultrasound showed no B-lines (no pulmonary edema). WPW Cardiac arrhythmias ( especially AFib ). There is very little filling, and thus very poor stroke volume. The heart rate is too fast for this poor filling. Preload must be increased and the heart rate slowed in order to allow more LV filling.

Preserved Ejection Fraction 56

Preserved Ejection Fraction Sudden Cardiac Death Chest Pain Heart Failure 56

Dr. Smith's ECG Blog

MARCH 6, 2020

A bedside POC cardiac ultrasound was done: Findings: Decreased left ventricular systolic function. By this I mean — that it includes all arrhythmias in which the rate is “ T achycardic” ( ie, ≥100/minute in an adult ) — and , in which the rhythm is “ S upra V entricular” ( ie, originating at or above the AV node ).

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Circulation

NOVEMBER 11, 2024

We computed a Vascular Disease (VasD) score, integrating the presence of carotid plaque (CP) on carotid ultrasound, known coronary artery disease (CAD), and myocardial ischemia (MyI). Subsequently, patients were followed for 5.5 Survival curves depicted a rising risk of the outcome corresponding to increasing VasD scores (Figure 1).Conclusions:The

Exercise 40

Exercise Coronary Artery Disease Ultrasound Plaque 40

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. orthostatic vitals b. Mukarram, M.,

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

A bedside cardiac ultrasound revealed grossly normal to hyperdynamic systolic function with no obvious areas of wall motion abnormalities. Conclusion of this paper: Fever is a great risk factor for arrhythmia events in Brugada Syndrome patients. This was recorded about 30 minutes later: Same A previous ECG was obtained and was normal.

Sudden Cardiac Death 52

Sudden Cardiac Death Heart Rhythm Article Tachycardia 52

Dr. Smith's ECG Blog

APRIL 9, 2025

On arrival in the ED, a bedside ultrasound showed poor LV function (as predicted by the Queen of Hearts) with diffuse B-lines. If breakthrough ventricular arrhythmias occurred, additional 50-mg boluses were given every 5 minutes, as needed to a maximum of 325 mg. I don't know what the device algorithm interpretation stated.

Defibrillator 63

Defibrillator Cardiac Arrest Myocardial Infarction STEMI 63