Blog, Bradycardia and Echocardiogram

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

JANUARY 2, 2025

Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. EKG with paced complexes shown below shows much narrower QRS complex and echocardiogram showed improved LV systolic function primarily due to improvement in LV dyssynchrony. (J The plan: 1. Place temporary pacemaker 3.

Tachycardia

Tachycardia Cardiomyopathy Blog Bradycardia

A woman in her 50s with multiple episodes of syncope

Dr. Smith's ECG Blog

JUNE 27, 2024

EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. Smith comment: Go here for a comprehensive blog post on syncope and link to the most detailed version of the Canadian Syncope Rule: Emergency Department Syncope Workup. See these blog posts.

Blog

Blog Pacemaker Bradycardia Tachycardia

A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Hopefully a repeat echocardiogram will be performed outpatient. I've copied KEY points from My Comment in the August 6, 2022 post in Dr. Smith's ECG Blog — regarding the answer to this question. Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ). No cardiac MRI was done.

Tachycardia

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia

Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

Dr. Smith's ECG Blog

OCTOBER 15, 2024

Additionally, a bedside echocardiogram showed no wall motion abnormality and normal LV function. He had multiple episodes of bradycardia and nonsustained ventricular tachycardia. A formal echocardiogram for patient 2 showed normal LV size, wall thickness, and global systolic function.

Chest Pain

Chest Pain STEMI Echocardiogram Stents

A Middle Aged Male diagnosed with Gastroesophageal Reflux

Dr. Smith's ECG Blog

JULY 16, 2022

The computer called "Sinus Bradycardia" only (implying that everything else is normal. The overreading Cardiologist called it only "Sinus Bradycardia" with no other findings. Here is the post PCI EKG: And a few hours after that: The post PCI echocardiogram showed: Normal estimated left ventricular ejection fraction, 57%.

Chest Pain

Chest Pain Bradycardia Blog Critical Care

A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

The diagnosis was a bit hard to find in the chart, and the echocardiogram did only stated "assymetric hypertrophy." For MORE on Some of the Concepts I Comment On: Re the ECG findings in HCM ( H ypertrophic C ardio M yopathy ) — See My Comment at the bottom of the page in the October 28, 2023 post in Dr. Smith's ECG Blog.

Strokes

Strokes Stroke Chest Pain Cardiomyopathy

Right Precordial T-wave Inversion

Dr. Smith's ECG Blog

DECEMBER 5, 2016

Description Sinus bradycardia. First because I have a good eye on ECGs of endurance athletes Second because I see a lot of these tracings Third because the stress test determines the disappearance of ECG abnor malities found at rest Fourth because the echocardiogram is normal Fifth and last, the clinical presentation speaks clearly."

Chest Pain

Chest Pain Ischemia Myocardial Infarction Bradycardia

A man with chest pain off and on for two days, and "No STEMI" at triage.

Dr. Smith's ECG Blog

JUNE 19, 2023

Soon afterward, the patient’s symptoms return along with lightheadedness, bradycardia, and hypotension. The patient has also developed sinus bradycardia, which may result from right coronary artery ischemia to the SA node. The Queen of Hearts agrees: Around this time his initial high sensitivity troponin I resulted at 231 ng/L.

Chest Pain

Chest Pain STEMI Cardiogenic Shock Bradycardia

See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

DECEMBER 22, 2022

He visited an outpatient clinic for it and an echocardiogram and exercise stress test was normal. His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. In the meantime, cardiology consultant sees the patient and performs a bedside echocardiogram which revealed no major wall motion abnormalities.

STEMI

STEMI Chest Pain Myocardial Infarction Electrocardiogram

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

An echocardiogram was done. As we've discussed on numerous other posts in Dr. Smith's ECG Blog ( See My Comment at the bottom of the page in the May 5, 2022 post) — a growing number of conditions other than Brugada Syndrome have been found to temporarily produce a Brugada-1 ECG pattern. Is there also Brugada?

Arrhythmia

Arrhythmia Blog Chest Pain Cardiac Arrest

A Patient with Vertigo

Dr. Smith's ECG Blog

JULY 26, 2023

5 years ago Similar Previous formal echocardiogram Inferior posterior with dyskinesis "Dyskinesis" is the technical echo term for LV aneurysm. Over time, T-waves normalize in the absence of new OMI. So upright T-waves in the presentation ECG do NOT mean there is any re-occlusion.

Aneurysm

Aneurysm Chest Pain STEMI Bradycardia

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

A formal echocardiogram was completed the next day and again showed a normal ejection fraction without any focal wall motion abnormalities to suggest CAD. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab.

Heart Rhythm

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

APRIL 8, 2015

PVCs N ot generally considered abnormal ECG findings: Isolated PAC, First Degree AV Block, Sinus bradycardia at a rate of 35-45, and Nonspecific ST-T abnormalities (even if different from a previous ECG). Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful.

Arrhythmia

Arrhythmia Outcomes Risk Factors Chest Pain

Electrical instability in a healthy 50 year old. How to manage?

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

There are 2 main options: Overdrive pacing could be considered and in the right clinical situation, this is often effective for reducing ventricular arrhythmias ( especially in the case of preventing pause induced or bradycardia-induced arrhythmias in association with QTc prolongation ). Try a different kind of antiarrhythmic.

Tachycardia

Tachycardia Arrhythmia Atrial Flutter Ablation

Cardiovascular Update

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

A woman in her 50s with multiple episodes of syncope

A teenager involved in a motor vehicle collision with abnormal ECG

Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

A Middle Aged Male diagnosed with Gastroesophageal Reflux

A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?

Right Precordial T-wave Inversion

A man with chest pain off and on for two days, and "No STEMI" at triage.

See OMI vs. STEMI philosophy in action

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

A Patient with Vertigo

Hyperthermia and ST Elevation

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Electrical instability in a healthy 50 year old. How to manage?

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