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20-something with huge verapamil overdose and cardiogenic shock

Dr. Smith's ECG Blog

A 20-something presented after a huge verapamil overdose in cardiogenic shock. This was a very complex case and the details are too much for an ECG Blog, but suffice it to say that, s hortly thereafter, the patient had an asystolic arrest and was resuscitated. The initial K was 3.0 mEq/L and ionized calcium was 5.5

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See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. This patient is actively dying from a left main coronary artery OMI and cardiac arrest from VT/VF or PEA is imminent!

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A man in his 50s with unwitnessed VF arrest, defibrillated to ROSC, and no STEMI criteria on post ROSC ECG. Should he get emergent angiogram?

Dr. Smith's ECG Blog

Written by Pendell Meyers A man in his 50s was found by his family in cardiac arrest of unknown duration. Meyers and Smith in the October 15, 2022 post of Dr. Smith's ECG Blog ). His family started CPR and called EMS, who arrived to find him in ventricular fibrillation. Restoration of sinus rhythm is evident in Figure-1.

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Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

Lactate was 20, POC Cardiac US showed EF estimated at 30%, and formal echo showed EF of only 15%, and a normal RV. Assessment was severe sudden cardiogenic shock. NOTE: For those interested — I review in detail determination of the artifact “culprit extremity” in My Comment in the September 27, 2019 post of Dr. Smith’s ECG Blog.

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Sudden shock with a Nasty looking ECG. What is it?

Dr. Smith's ECG Blog

Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock. Suffice it to say that, "The heart does whatever it will do when a patient is about to arrest".

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How terrible can it be to fail to recognize OMI? To whom is OMI Obvious or Not Obvious?

Dr. Smith's ECG Blog

About 45 minutes after the second EKG, the patient was found in cardiac arrest. A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. Later the next day, she went into cardiac arrest again. By the time I saw the repeat EKG, the patient was already in cardiac arrest.

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What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. As we've often emphasized on Dr. Smith's ECG Blog — it is rare in practice to see LMCA occlusion, because most such patients die before reaching the hospital. RCA — 100% proximal occlussion.