Dr. Smith's ECG Blog

JUNE 27, 2021

If this STD were due to LVH or to subendocardial ischemia, rather than posterior OMI, it would be maximal in V5 and V6. By itself these would not be diagnostic as they do not have typical morphology (flat T-waves, possible atrial repolarization wave to account for ST depression). ng/mL, and another ECG was recorded and was identical.

Myocardial Infarction 40

Myocardial Infarction Ischemia STEMI Pulmonary 40

Dr. Smith's ECG Blog

JULY 14, 2023

My interpretation was: RBBB with hyperacute T-waves in V4-V6 that are all but diagnostic of LAD occlusion vs. post ROSC ischemia. The patient had ROSC and maintained it. A 12-lead ECG was obtained: What do you think? Regional wall motion abnormality--apical anterior, mid anteroseptal, apical septal, and apical inferior akinesis.

Cardiac Arrest 98

Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 98

Dr. Smith's ECG Blog

JULY 16, 2024

Here I put arrows: Arrows shows slow atrial flutter waves. These mimic ST Elevation. But there is no STE. Of course the Queen knows it is not OMI: Click here to sign up for Queen of Hearts Access Here are other cases of the same: A 50 year old man with sudden altered mental status and inferior STE. Would you give lytics? Arrhythmia?

Atrial Flutter 60

Atrial Flutter Chest Pain Tachycardia Arrhythmia 60

Dr. Smith's ECG Blog

AUGUST 3, 2018

Re-entrant tachycardias (atrial flutter, PSVT, AVRT, VT) have constant regular heart rates, whereas sinus tachycardia will usually gradually change rate with differing conditions (for instance, after infusion of fluid and BP increase, sinus tach rate might decrease from 130 to 125, for instance). So there is a re-entrant rhythm.

Chest Pain 40

Chest Pain Tachycardia Atrial Flutter Ultrasound 40

Dr. Smith's ECG Blog

MAY 8, 2023

LAFB, atrial flutter, anterolateral STEMI(+) OMI. EKG shown here: LAFB with no clear signs of OMI or ischemia. At 20 minutes from initial ECG, the patient's native rhythm spontaneously usurped the rhythm from the pacemaker: No knowledge or guidelines needed to see the OMI findings now! No labs were performed.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Ken Grauer, MD

MARCH 23, 2023

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. PEARL # 3: At this point — the most time-efficient step for solving today's rhythm will be to determine the nature of atrial activity.

Blog 78

Blog Tachycardia Arrhythmia Atrial Flutter 78

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. There are no P waves preceding the QRS complexes, and no clear flutter waves.

Tachycardia 52

Tachycardia Atrial Flutter Dysrhythmia Ablation 52

Dr. Smith's ECG Blog

AUGUST 14, 2023

The rhythm is 2:1 atrial flutter. The flutter waves can conceal or mimic ischemic repolarization findings, but here I don't see any obvious findings of OMI or subendocardial ischemia. The bedside echo showed a large RV (Does this mean there is a pulmonary embolism as the etiology?) Lots of info here.

Chest Pain 52

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter 52

Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

The Differential Diagnosis is: SVT with aberrancy(#) [AVNRT vs. WPW (also called AVRT*)] Atrial flutter with 1:1 conduction, with aberrancy VT coming from the anterior fascicle ( fascicular VT )@ *AVRT = AV Reciprocating Tachycardia (Tachycardic loop that uses both the AV node and an accessory pathway.

Tachycardia 52

Tachycardia Heart Disease Ablation Dysrhythmia 52

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

Written by Jesse McLaren A 65 year old with a history of atrial flutter, CABG and end-stage renal disease on dialysis presented with 3 days of fluctuating chest pain, which was ongoing at triage. The first ECG was labeled “anterior subendocardial ischemia”, but subendocardial ischemia does not localize. What do you think?

Chest Pain 116

Chest Pain STEMI Atrial Flutter Ischemia 116

Dr. Smith's ECG Blog

MARCH 6, 2020

There is a large peaked P-wave in lead II (right atrial enlargement) There is left axis deviation consistent with left anterior fascicular block. There is no evidence of infarction or ischemia. There is atrial activity before every QRS, but that activity has negative polarity, so it is not sinus rhythm.

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Evidence of acute ischemia (may be subtle) vii. ST segment and T wave abnormalities consistent with or possibly related to myocardial ischemia. And these findings come from OESIL , EGSYS , and Sarasin studies: i: Non-sinus rhythm ii: SVT or VT (obviously, and this makes for an abnormal vital sign anyway) iii. Left BBB vi. LVH or RV d.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

DECEMBER 20, 2024

No evidence for ischemia jumps out. Cardioversion is most beneficial for reentrant arrhythmias ( e.g. VT, atrial flutter, AVNRT, atrial fibrillation) because it terminates the reentry circuit. He said he had had three episodes of chest pain that day while urinating. ECG 1 What do you think?

Chest Pain 103

Chest Pain Tachycardia Pacemaker Defibrillator 103

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. You have given IV MgSO4 a fast acting -blocker and IV amiodarone bolus and infusion. The possibility of an ischemic cause of the ventricular arrhythmia has to be considered! Troponin T was negative on admission and on repeat blood draw.

Tachycardia 73

Tachycardia Arrhythmia Atrial Flutter Ablation 73