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.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

APRIL 24, 2015

Here was his initial ED ECG: There is atrial fibrillation with a rapid ventricular response. ST depression is common BOTH after resuscitation from cardiac arrest and during atrial fib with RVR. and repeat the ECG, to see if the apparent ischemia persists. A middle-aged male had a V Fib arrest. This was done.

Cardiac Arrest 52

Cardiac Arrest Defibrillator Atrial Fibrillation Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 26, 2015

Due to bradycardia, a 12-lead ECG was obtained: There is atrial fibrillation at a rate of 54. Slow atrial fibrillation implies an sick AV node, or one affected by electrolytes, ischemia, or medications/drugs. This patient was found with a bottle of alcohol and altered mental status. His breath alcohol was 0.259.

Atrial Fibrillation 52

Atrial Fibrillation Bradycardia Ischemia 52

Dr. Smith's ECG Blog

AUGUST 17, 2022

Atrial fib may cause Occlusion mimic." ACUTE MI (I allowed Acute MI to be in the report because I knew there would be an elevated troponin from ischemia, which is the definition of acute MI -- but in this case it would most likely be a Type 2 MI from tachycardia) There is also LA-RA lead reversal.

Atrial Fibrillation 52

Atrial Fibrillation Ischemia AFIB Tachycardia 52

Circulation: Cardiovascular Quality & Outcomes

JANUARY 8, 2024

We quantified PFO closure among individuals with ≥2 years of preprocedure coverage to establish indications, classified hierarchically as stroke/systemic embolism, migraine, transient ischemia attack, or other.Results:We identified 5315 patients undergoing PFO closure (51.8% for transient ischemia attack, 8.8% female, 29.2%≥60

Atrial Fibrillation 40

Atrial Fibrillation Embolism Ischemia Strokes 40

Dr. Smith's ECG Blog

JANUARY 9, 2024

She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. Are you confident there is no ischemia? The heart rate could be compatible with that of a 2:1 conducted atrial flutter. Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)?

Tachycardia 119

Tachycardia Electrophysiology Atrial Flutter Ischemia 119

All About Cardiovascular System and Disorders

MARCH 25, 2024

Pediatric exercise testing may be used for evaluation of various disorders of cardiac rhythm rather than for inducible ischemia as in adults. This measurement has been correlated with those made at electrophysiology study and may predict the potential risk of rapid anterograde conduction if the person develops atrial fibrillation.

Exercise 52

Exercise Pediatrics Congenital Tachycardia 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

The rhythm is nearly regular, but there are no P-waves (it is too regular to be atrial fibrillation). So, in this patient with incessant ventricular fibrillation that has been converted, there is now a supraventricular rhythm with RBBB. Was this: 1) ACS with ischemia and spontaneous reperfusion? at the time of the ECG.

Cardiac Arrest 52

Cardiac Arrest Ischemia Defibrillator Electrocardiogram 52

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. Conduction and refractoriness alternans may be seen with WPW-related as well as AV Nodal-dependent reentr y tachycardias — atrial fibrillation — acute pulmonary embolus — myocardial contusion — and severe LV dysfunction.

Tachycardia 130

Tachycardia Cardiac Arrest ICU Blog 130

Circulation

NOVEMBER 11, 2024

Analyses of cardiovascular magnetic resonance imaging (MRI) in the MESA cohort have shown that LV sphericity is an important mode of variation in cardiac structure that is associated with ischemia, heart failure, and atrial fibrillation. Ldsc heritability was 29.7% for sphericity in diastole and 26.0% for sphericity in systole.

Atrial Fibrillation 40

Atrial Fibrillation Ischemia Heart Failure Circulation 40

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Atrial fibrillation is also a predictor of worse outcomes in this case (Alborzi). Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think?

Tachycardia 115

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. Anything more on history?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

DAIC

FEBRUARY 29, 2024

24 will focus on the following three current guideline updates: American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines 2023 Atrial Fibrillation Guideline - Pharmacology II: Strokes vs. Bleeds, What Do the Guidelines Tell Us About Practical Management in A-fib? The Guidelines Sessions at ACC.24

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Smith's ECG Blog

JANUARY 22, 2020

She previously had Atrial fibrillation with LBBB. This shows atrial fibrillation. The fact that the response is regular proves that the atrial fibrillation is NOT conducting. When atrial fib conducts, the ventricular rate must always be irregular. There was no evidence of ischemia.

Pulmonary 52

Pulmonary AFIB Atrial Fibrillation Pacemaker 52

Dr. Smith's ECG Blog

SEPTEMBER 24, 2023

The medical care providers ascribed the patient's chest pain to new onset atrial fibrillation with rapid ventricular response after having viewed the ECG. The presentation ECG does show atrial fibrillation. No further episodes of atrial fibrillation occurred during monitoring. The first ECG is shown below.

Chest Pain 85

Chest Pain Atrial Fibrillation AFIB Myocardial Infarction 85

Dr. Smith's ECG Blog

JUNE 28, 2023

It is dangerous in WPW with atrial fibrillation. In Atrial Fibrillation, the tachycardia will always be irregularly irregular. In Atrial fib with WPW, there will be polymorphic QRS complexes (in this case, all QRS complexes are identical). VT is not harmed by adenosine, When is adenosine dangerous?

Tachycardia 98

Tachycardia Ultrasound Heart Disease Atrial Fibrillation 98

Stroke Journal

FEBRUARY 1, 2024

Objective:Forward head posturing (FHP) has been associated with chronic anatomic vertebral artery disturbances possibly leading to posterior circulation ischemia. Stroke, Volume 55, Issue Suppl_1 , Page ATP252-ATP252, February 1, 2024. The data supporting FHP as a true risk factor of posterior circulation stroke has not been well established.

Risk Factors 40

Risk Factors Circulation Atrial Fibrillation Ischemia 40

Stroke Journal

FEBRUARY 1, 2024

Successful recanalization was defined as Thrombolysis in Cerebral Ischemia score ≥2b. ICAD group had lower atrial fibrillation frequency, lower BNP levels, more M1 occlusions, and fewer M2 occlusions compared to the Embolic group.

Outcomes 40

Outcomes Embolism Atrial Fibrillation Thrombolysis 40

Stroke Journal

FEBRUARY 1, 2024

The primary efficacy end point was achievement of modified Thrombolysis in Cerebral Ischemia (mTICI) reperfusion scores of ≥2b on first pass. Group C patient were more likely to have renal disease and atrial fibrillation (P<0.05). The total cohort was trichotomized into 3 groups (A, B, C) based on M1 tortuosity tertiles.

Atrial Fibrillation 40

Atrial Fibrillation Thrombolysis Ischemia Hemorrhage 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionTransient Ischemic Attack (TIA) is a common neurologic condition characterized by temporary, focal cerebral ischemia that results in reversible neurological deficits without tissue infarction. Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023.

Diabetes 40

Diabetes Coronary Artery Disease Atrial Fibrillation Dementia 40

Cardiomatics

JULY 14, 2022

A recent study published in Nature / Scientific Reports aimed to detect the rate of atrial fibrillation (AF) and further cardiac arrhythmias after acute ischemic stroke. The authors of the study stated that rhythm disturbances may also lead to brain ischemia. “AF

Arrhythmia 52

Arrhythmia Strokes Stroke Reimbursement 52

Dr. Smith's ECG Blog

MAY 1, 2023

edits by Meyers A woman in her 60s with a history of chronic atrial fibrillation on Eliquis, ESRD on hemodialysis, type-II diabetes mellitus, prior CVA, hypertension, and hyperlipidemia presented to the emergency department with multiple complaints after missing dialysis. Case written by Brandon Friedman M.D., She was discharged home.

Atrial Flutter 52

Atrial Flutter Tachycardia Arrhythmia Blog 52

Society of Thoracic Surgeons - Allied Health

FEBRUARY 14, 2023

CABG and Concomitant Ablation for Atrial Fibrillation, Left Atrial Appendage Management – How I Do It Niv Ad, MD (Silver Spring, MD, USA) 7:57 a.m. Posterior Pericardiotomy to Prevent Postoperative Atrial Fibrillation and How I Do It Mario Gaudino, MD, PhD, MSCE (New York, NY, USA) 8:05 a.m.

Coronary Artery Bypass Graft 52

Coronary Artery Bypass Graft Atrial Fibrillation Outcomes Stent 52

Dr. Smith's ECG Blog

APRIL 24, 2022

Here is her post-cardioversion ECG: ECG#2 - Immediately post cardioversion: Appropriate ST depression maximal in V5-6 and lead II, secondary to subendocardial ischemia, likely residual from the preceding tachycardia. This allows greater specificity for determining the extent of high lateral and inferior lead ischemia or infarction.

AFIB 52

AFIB Tachycardia Atrial Fibrillation Blog 52

Dr. Smith's ECG Blog

AUGUST 28, 2020

This is ischemia until proven otherwise. ECG from 2 days later: Atrial Fibrillation now. A fixed stenosis in that other artery, especially in the context of hypotension from the occlusion of the first coronary artery, can lead to ischemia and very poor LV function and worsening shock. This explains the long QT.

Cardiogenic Shock 40

Cardiogenic Shock Chest Pain Ischemia Stenosis 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. Conduction and refractoriness alternans may be seen with WPW-related as well as AV Nodal-dependent reentr y tachycardias — atrial fibrillation — acute pulmonary embolus — myocardial contusion — and severe LV dysfunction.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

OCTOBER 25, 2022

We see a regular tachycardia with a narrow QRS complex and no evidence of OMI or subendocardial ischemia. The differential of a regular narrow QRS tachycardia is sinus tachycardia, SVT, and atrial flutter with regular conduction. This includes sinus tachycardia, atrial fibrillation or flutter, MAT, and others.

Tachycardia 52

Tachycardia Atrial Flutter Dysrhythmia Ablation 52

Frontiers in Cardiovascular Medicine

MARCH 18, 2025

Finally, we also emphasize the preclinical/clinical translational significance of neutrophil-targeted strategies.

Cardiovascular Disease 52

Cardiovascular Disease Atrial Fibrillation Atherosclerosis Ischemia 52

Dr. Smith's ECG Blog

AUGUST 3, 2018

The patient converted to atrial fibrillation. In pericardial tamponade, preload of the RV is critical, and this is impaired by atrial flutter, in which the atrial contribution to ventricular filling ("atrial kick") is impaired. Clinical course: We gave 0.15 Each step improved the patient's condition.

Chest Pain 40

Chest Pain Tachycardia Atrial Flutter Ultrasound 40

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

Chart review confirmed that he had been started on flecainide for atrial fibrillation. This new information makes the diagnosis of atrial flutter far more likely: first, atrial fibrillation and flutter are closely associated and, second, this makes a flutter rate of 200 bpm (with 1:1 conduction) quite likely.

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

Circulation

DECEMBER 28, 2023

BACKGROUND:Oral anticoagulation is suggested in patients with atrial fibrillation and a CHA2DS2-VASc score ≥1 (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65–74 years, and sex score). Circulation, Ahead of Print. Female sex was not considered a risk factor in any risk group.

Atrial Fibrillation 58

Atrial Fibrillation Heart Failure Risk Factors Diabetes 58

Stroke Journal

JANUARY 30, 2025

Background:Patients with atrial fibrillation were excluded from clinical trials evaluating carotid artery stent(CAS) or carotid endarterectomy (CEA).We We used the ICD-10 to identify patients hospitalized with diagnosis of stroke, TIA, or retinal ischemia with stenosis of carotid artery who underwent CAS or CEA. versus 18.8%

Atrial Fibrillation 40

Atrial Fibrillation Stent Stents Outcomes 40

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Dr. Smith's ECG Blog

OCTOBER 8, 2023

Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. The ECG does not show any signs of ischemia. True Positive ECG#2 : Also sinus rhythm. There is ST depression in V1.

Ischemia 122

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 122

Journal of the American Heart Association

APRIL 7, 2025

True MINOCA was defined by evidence of ischemia or infarction on CMR. MACEs included allcause death, recurrent myocardial infarction, stroke, heart failure, atrial fibrillation, and angina pectoris. CMR images were used to obtain LA and left ventricular strain via CMR feature tracking.

Myocardial Infarction 40

Myocardial Infarction Atrial Fibrillation Angina Ischemia 40

Journal of the American Heart Association

JANUARY 31, 2024

BackgroundThe optimal antithrombotic strategies for patients with atrial fibrillation who experience ischemic stroke (IS) despite direct oral anticoagulant (DOAC) therapy remain inconclusive. Journal of the American Heart Association, Ahead of Print.

Atrial Fibrillation 40

Atrial Fibrillation Strokes Stroke Hemorrhage 40

Heart 2023 Conference

APRIL 20, 2022

Harvard University Heart Letter) A clinical polygenic risk score test for diseases ranging from atrial fibrillation (AFib) to breast cancer was piloted by scientists. Avocado consumption of at least two servings per week is linked to a lower risk of cardiovascular disease.

Pulmonary 52

Pulmonary Hypertension AFIB COVID-19 52