Dr. Smith's ECG Blog

JULY 21, 2024

This progressed to electrical storm , with incessant PolyMorphic Ventricular Tachycardia ( PMVT ) and recurrent episodes of Ventricular Fibrillation ( VFib ). There was no evidence bradycardia leading up to the runs of PMVT ( as tends to occur with Torsades ). He required multiple defibrillations within a period of a few hours.

Arrhythmia 132

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 132

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. The Initial ECG in Today's Case: As per Dr. Meyers — the initial ECG in today's case shows sinus tachycardia with bifascicular block ( = RBBB/LAHB ). Sinus Tachycardia ( common in any trauma patient. ).

Tachycardia 116

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 116

Dr. Smith's ECG Blog

OCTOBER 18, 2023

During the night, while on telemetry, the patient became bradycardic, with periods of isorhythmic AV dissociation (nodal escape rhythm alternating with sinus bradycardia), and there were sporadic PVCs. The above ECGs show the initiation and continuation of a polymorphic ventricular tachycardia.

Cardiac Arrest 124

Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia 124

MIBHS

JANUARY 31, 2025

This blog explores the ways wearable technology can help track heart health, the advantages it offers, and how it contributes to better outcomes for those requiring surgical intervention. Early detection of conditions like AFib, bradycardia, or tachycardia allows patients to address issues before they become critical.

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Heart Rhythm Technology AFIB Exercise 52

Dr. Smith's ECG Blog

OCTOBER 7, 2019

Both of these features make inferior + RV MI by far the most likely ( Pseudoanteroseptal MI is another name for this ) There is also sinus bradycardia and t he patient is in shock with hypotension. A narrow complex bradycardia without any P-waves is also likely to respond to atropine, as it may be a junctional rhythm.

Bradycardia 40

Bradycardia Cardiogenic Shock STEMI Ischemia 40

Dr. Smith's ECG Blog

DECEMBER 16, 2018

Wide-complex tachycardia: VT or aberrant, or "other?" A wide-complex tachycardia in an older patient must immediately suggest ventricular tachycardia. Sinus tachycardia with aberrancy was unlikely as the rate was consistently 150 bpm, without spontaneous variation. second ), in which the tachycardia is sustained.

Tachycardia 52

Tachycardia Atrial Flutter AFIB Atrial Fibrillation 52

Dr. Smith's ECG Blog

DECEMBER 23, 2019

Initial ECG in the ED: Presenting ECG : Wide-complex tachycardia at a rate about 200. This is overwhelmingly likely to be ventricular tachycardia, even if only age and medical history are considered. Nevertheless, the widths of both the QRS complex and the RS duration are similar in both the old ECG and the tachycardia.

Tachycardia 52

Tachycardia Atrial Flutter Cardiomyopathy Atrial Fibrillation 52

Dr. Smith's ECG Blog

JUNE 23, 2023

A 50-something male with unspecified history of cardiomyopathy presented in diabetic ketoacidosis (without significant hyperkalemia) with a wide complex tachycardia and hypotension. Analysis: there is a wide complex tachycardia. This was the interpretation I put into the system: WIDE COMPLEX TACHYCARDIA. It is regular.

Tachycardia 52

Tachycardia Cardiomyopathy Arrhythmia Diabetes 52

Dr. Smith's ECG Blog

OCTOBER 25, 2023

ECG is consistent with severe hypokalemia and/or hypomagnesemia causing prolonged QT (QU) at high risk of Torsades (which is polymorphic ventricular tachycardia in the setting of a long QT interval). Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest. Is it STEMI?

Ischemia 125

Ischemia Chest Pain Cardiac Arrest Blog 125

Dr. Smith's ECG Blog

APRIL 15, 2019

Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. I said I think there is a fixed stenosis in the LAD and the tachycardia and stress caused a type 2 STEMI.

Tachycardia 40

Tachycardia STEMI Chest Pain Ischemia 40

Dr. Smith's ECG Blog

JULY 5, 2018

My Comment , by K EN G RAUER, MD ( 7/5/2018 ): This blog post provides an excellent example of how a patient with SSS ( = S ick S inus S yndrome ) may present. during which sinus bradycardia and arrhythmia are seen but not to a degree that produces symptoms. The indication for pacemaker placement with SSS is symptomatic bradycardia.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Bradycardia Pacemaker 52

Dr. Smith's ECG Blog

FEBRUARY 27, 2023

We've presented numerous examples of hyperkalemia on Dr. Smith's ECG Blog. Descriptive analysis of the ECG in today's case reveals a regular, narrow tachycardia at ~130/minute , without clear sign of sinus P waves. But the rate is ~130/minute — which is a bit fast for sinus tachycardia. WHY Isn't the QRS Wide?

Tachycardia 52

Tachycardia Document Blog Bradycardia 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

As per Dr. Nossen — today's initial ECG ( LEFT tracing in Figure-2 ) shows sinus bradycardia with QRS widening due to bifascicular block ( RBBB/LAHB ). There is marked, diffuse ST segment depression in ECG #1.

Cardiogenic Shock 130

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 130

Dr. Smith's ECG Blog

AUGUST 9, 2024

This has been discussed many times before on this blog. In-depth discussion is beyond the scope of this blog. Automatic activity refers to enhanced pacemaking function (typically from a non sinus node source), for example atrial tachycardia. The rhythm is AIVR -- accelerated idioventricular rhythm. Do not treat AIVR.

Chest Pain 108

Chest Pain Arrhythmia Myocardial Infarction STEMI 108

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Other than tachycardia, Other than slight tachycardia, vitals were within normal limits (including oxygen saturation). Like other cases on this blog who died before cath was done, I cannot prove that this patient had OMI. Sent by anonymous, written by Pendell Meyers A middle aged man presented with acute shortness of breath.

Chest Pain 52

Chest Pain STEMI Blog Tachycardia 52

Dr. Smith's ECG Blog

OCTOBER 15, 2024

He had multiple episodes of bradycardia and nonsustained ventricular tachycardia. Serial high sensitivity troponin T (URL 15 ng/L) values were negative and stagnant. Patient 1 remained in the hospital overnight. He went to the cath lab at 0900 the next morning. It was stented.

Chest Pain 117

Chest Pain STEMI Echocardiogram Stents 117

Dr. Smith's ECG Blog

MAY 5, 2022

After initiating treatment for hyperkalemia, repeat ECG showed resolution of Brugada pattern: The ECG shows sinus tachycardia. ST elevation in aVL with reciprocal ST depression in the inferior leads Shock, bradycardia, ST Elevation in V1 and V2. He also received insulin with D50, sodium bicarbonate, and kayexalate for hyperkalemia.

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52

Conquering CHD

JULY 11, 2023

A rapid heartbeat (tachycardia) can increase the workload on your heart, while a slow heartbeat (bradycardia) can cause fatigue and dizziness. It’s crucial to monitor your blood pressure regularly and report any significant changes to your healthcare provider so they can adjust the dosage of the medication accordingly.

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Congenital Heart Disease Congenital Heart Disease Blood Clot 52

Dr. Smith's ECG Blog

OCTOBER 8, 2023

I completely agree with Dr. Nossen that in this patient with new CP and sinus tachycardia with LAHB — that the T waves in each of the inferior leads are hyperacute ( ie, clearly disproportionately "bulky" given size of the QRS in these leads ). — and which other patient(s) need to be seen as soon as possible to figure out what is going on?

Ischemia 124

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 124

Dr. Smith's ECG Blog

JANUARY 31, 2019

This phenomenon is best known as, A V D issociation b y D efault ie, default of the sinus pacemaker due to marked sinus bradycardia, which transiently allows the AV nodal escape pacemaker to take over. Instead, as we state above the rhythm is sinus bradycardia with marked sinus arrhythmia. Close follow-up is essential.

Bradycardia 52

Bradycardia Pacemaker Arrhythmia Tachycardia 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

I have periodically called attention to examples of the Ashman phenomenon as they occur in Dr. Smith's ECG Blog ( See My Comments in the January 5, 2020 post — the June 17, 2020 post — and the March 30, 2023 post , among others ). But there are 3 other wide beats in the tachycardia that begins with beat #6 ( = beats #7; 13,14 ).

Cardiac Arrest 69

Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 69

Dr. Smith's ECG Blog

APRIL 8, 2016

There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Torsades in acquired long QT is much more likely in bradycardia because the QT interval following a long pause is longer still. See here for management of Polymorphic Ventricular Tachycardia , which includes Torsades.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

JULY 24, 2018

Prior ECG on file: Sinus tachycardia, imperfect baseline, otherwise unremarkable. Sinus tachycardia with unequivocal evidence of hyperkalemia, including widened QRS with "pulled apart" morphology (widened QRS) compared to baseline, as well as clearly peaked T-waves.

Cardiac Arrest 52

Cardiac Arrest Tachycardia Chest Pain ICU 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

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. Sinus Tachycardia ( common in any trauma patient. ).

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

Otherwise vitals after intubation were only notable for tachycardia. An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. She was ventilated by bag-valve-mask by EMS on arrival and was quickly intubated with etomidate and succinylcholine. A rectal temperature was obtained which read 107.9

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

APRIL 29, 2020

A useful classification of WCT ( W ide- C omplex T achycardia ) rhythms — separates them into those that are mono morphic ( with similar QRS morphology during the tachycardia ) vs those that are poly morphic ( in which QRS morphology varies ). QUESTION Regarding ECG #5: WHAT ECG findings in ECG #5 predispose to development of Torsades?

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

NOVEMBER 18, 2019

U waves may also be found in patients with LVH and/or bradycardia , or occasionally as a normal variant. Y OU s hould h ave n oted the following additional ECG findings in ECG #1 : There is sinus tachycardia at ~100/minute in ECG #1. N OTE # 1 — U waves are not specific for hypokalemia! second ).

Chest Pain 52

Chest Pain Cardiac Arrest Bradycardia Ischemia 52

Dr. Smith's ECG Blog

MARCH 2, 2019

My L IST includes the following: i ) LVH with strain; ii ) Ischemia; iii ) Digoxin use; iv ) HypoKalemia and/or HypoMagnesemia; v ) Tachycardia; and , vi ) Any combination of i-thru-v. In my experience, Ive seen U waves not only with low K+/low Mg++ but also in patients with bradycardia, LVH, and sometimes in normal subjects.

Sickle Cell Disease 52

Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52

Dr. Smith's ECG Blog

APRIL 6, 2018

There is a regular, wide complex, (mostly) monomorphic tachycardia. The differential of wide, regular, monomorphic tachycardia is: VT or SVT with aberrancy, all +/- hyperkalemia (see diagrams below). Really wide tachycardia = VT or SVT with conduction abnormality + hyperkalemia, until proven otherwise.

Cardiac Arrest 52

Cardiac Arrest Tachycardia Defibrillator ICU 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

There is sinus tachycardia and also a large R-wave in aVR. Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. Her temperature was 106 degrees. As part of the workup, she underwent an ECG.

Sudden Cardiac Death 52

Sudden Cardiac Death Heart Rhythm Article Tachycardia 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern. This is the 2nd ECG from the February 8, 2022 post in Dr. Smith's ECG Blog ).

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52

Ken Grauer, MD

JANUARY 2, 2025

In view of the clinical history ( ie, that this patient had a history of longstanding AFlutter but as far as we know, no chest pain ) this ST-T wave change most likely reflects a "memory" effect , in which there will often be ST-T wave abnormalities that persist for hours ( up to a few days ) following a long period of a sustained tachycardia.

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Blog Chest Pain Bradycardia Tachycardia 168

Ken Grauer, MD

NOVEMBER 15, 2024

MY Thoughts on ECG #1: The rhythm is sinus bradycardia at a rate just under 60/minute. I've reviewed on many occasions in this ECG Blog — cases in which acute OMIs were overlooked and misdiagnosed as NSTEMI ( See ECG Blog #400 — among many others ). There is sinus tachycardia at ~100/minute — with diffuse ST-T wave depression.

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Blog Cardiomyopathy Hospital Tachycardia 164

Dr. Smith's ECG Blog

APRIL 8, 2015

If the patient has Abnormal Vital Signs (fever, hypotension, tachycardia, or tachypnea, or hypoxemia), then these are the primary issue to address, as there is ongoing pathology which must be identified. 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 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

During observation in the ED the patient had multiple self-terminating runs of Non-Sustained monomorphic Ventricular Tachycardia (NSVT). The intricacies of the different classes of antiarrhythmics and their mechanism of action extend beyond the scope of this blog. Potassium and magnesium serum levels were normal. No PVCs are seen.

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Tachycardia Arrhythmia Atrial Flutter Ablation 73

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

There was never ventricular fibrillation (VF) or ventricular tachycardia (VT), no shockable rhythm. Here is a similar case: Collapse, Ventricular Tachycardia, Cardioverted, Comatose on Arrival. Agitation, Confusion, and Unusual Wide Complex Tachycardia. There is sinus tachycardia at ~115/minute.

STEMI 89

STEMI Hemorrhage Cardiac Arrest Tachycardia 89

Dr. Smith's ECG Blog

MARCH 8, 2025

Within ten minutes, she developed bradycardia, hypotension, and ST changes on monitor. Bradycardia and heart block are very common in RCA OMI. There was indication of parasympathetic overdrive ( the acute inferior STEMI with profound bradycardia and junctional escape ). He told the patient this horrible news.

Cardiomyopathy 77

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 77