Dr. Sanjay Gupta

FEBRUARY 1, 2023

A lot of people have contacted me and asked me as to how to safely stop Beta blockers and therefore I thought I would do a quick blog on this subject. There have also been reports of heart failure status worsening and blood pressure going up excessively. This is termed as ‘Acute beta blocker withdrawal syndrome’.

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Dr. Smith's ECG Blog

OCTOBER 25, 2022

But adenosine only lasts for seconds, and if the dysrhythmia recurs, then the adenosine is gone. Prevent the initiation of the dysrhythmia -- this can be done with a beta blocker by prenenting PACS 2. Smith: should we give adenosine again? Adenosine worked. It converted the rhythm. We need to do one or both of two things: 1.

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Dr. Smith's ECG Blog

JUNE 11, 2023

The patient was admitted to the cardiology service with a plan for EP study, however the cardiologist during that visit thought that the ECG showed only LBBB, and thought that the patient's dysrhythmia was atrial fibrillation with LBBB, instead of atrial fibrillation with WPW. So he was simply discharged without EP study.

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Tachycardia Atrial Fibrillation Chest Pain Blood Pressure 88

Dr. Smith's ECG Blog

JULY 22, 2023

There were no dysrhythmias on cardiac monitor during observation. This discussion comes from this previous post: Hyperthermia and ST Elevation Discussion Brugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias. He was found to be influenza positive. Is there fever again?

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Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 70

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

Is it sinus or is it a supraventricular dysrhythmia? If rapid, that means that the depolarization is rapidly advancing and that it must be using conducting fibers (Purkinje fibers), and is therefore supraventricular.

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Dr. Smith's ECG Blog

JUNE 14, 2017

He has a great blog too: ECG Interpretation He is also well known on the Facebook EKG Club page , where you can learn tons about ECGs: Here is his response, with the first ECG labelled: Hello Steve & Avinash. It is commonly seen in the reperfusion setting. It appears to be benign in children as well (see references below). What is it?

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Dr. Smith's ECG Blog

DECEMBER 26, 2020

Likewise, in some cases of ischemia concealed by flutter waves, the ischemia can be seen despite the flutter waves, whereas in other cases the dysrhythmia must be terminated before the ischemia can be clearly distinguished. Even when flutter waves conceal true ST segment deviations, the cause and effect relationship may be unclear.

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Dr. Smith's ECG Blog

JULY 22, 2012

Blunt cardiac injury my result in : 1) Acute myocardial rupture with tamponade 2) Valve rupture (tricuspid, aortic, mitral) 3) Coronary thrombosis or dissection (and thus Acute MI) from direct coronary blunt injury 4) Dysrhythmias of all kinds. Localized bleeding from contusion could cause hemopericardium even without rupture.

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Dr. Smith's ECG Blog

OCTOBER 10, 2022

Then there is loss of pulses with continued narrow complex on the monitor ("PEA arrest") Learning Points: Sudden witnessed Cardiac Arrest due to ACS is almost always due to dysrhythmia.

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Dr. Smith's ECG Blog

MAY 27, 2012

The second explanation (AIVR), whether as a reperfusion dysrhythmia or not, seems most likely. A repeat ECG had sinus rhythm at a rate of 54 and normal conduction (no LBBB), and was completely normal with no ischemia. The slow sinus rate supports the notion that this could be rate-related BBB.

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Dr. Sanjay Gupta

DECEMBER 19, 2022

The heart is an electrical organ and occasionally the electrics can choose to malfunction and the patient may develop a heart rhythm disturbance or a dysrhythmia such as AF or SVT or VT. Cardiac CT is now widely available and to my mind the easiest way to know about the blood vessels of the heart. You can only diagnose it in retrospect.

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Dr. Smith's ECG Blog

JANUARY 30, 2019

The limb lead abnormalities appear to be part of the Brugada pattern, as described in this article: Inferior and Lateral Electrocardiographic RepolarizationAbnormalities in Brugada Syndrome Discussion Brugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias.

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Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

Meyers, Smith; Weingart wrote an extensive review on Idiopathic VT in the September 14, 2018 post of Dr. Smith’s ECG Blog. As a result — it’s worth briefly reviewing this entity of “ Idiopathic ” VT. My Comment at the bottom of this Sept. 14, 2018 post adds a series of PEARLS on “My Take” regarding this subject.

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Dr. Smith's ECG Blog

JANUARY 5, 2020

Atrial dysrhythmias, and atrial fi brillation in particular, are frequently misdiagnosed by computer algorithms and then by the physician who overreads them. M Y A NSWER: The issue of whether C omputerized E CG I nterpretations are “at fault” for an inaccurate ECG diagnosis has been addressed numerous times on this blog.

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Dr. Smith's ECG Blog

NOVEMBER 30, 2019

I could find very little literature on the treatment of severe life-threatening hypokalemia. There is particularly little on how to treat when the K is less than 2, and/or in the presence of acute MI.

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Dr. Smith's ECG Blog

APRIL 15, 2020

Inferior MI results in scar tissue which is a likely source of a re-entrant ventricular dysrhythmia. Here is the post-cardioversion ECG: There is sinus with RBBB There are inferior Q-waves suggesting old inferior MI. This would be the likely source of the VT.

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Dr. Smith's ECG Blog

FEBRUARY 8, 2015

I also believe that we physicians and medics are eager to treat dysrhythmias, and we want to see them even when they are not there. Dilated pupils and hypertension are a strong clue to sympathetic overload, but don't forget anticholinergic syndromes, including tricyclics!

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Dr. Smith's ECG Blog

JULY 31, 2018

Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. (For those of you who are accustomed to the units of high sensitivity troponin (ng/L), this is equivalent to 20,956.00 Again, cath lab was not activated. What does this troponin level mean?

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Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: In a large randomized trial of dopamine vs. norepinephrine (11) for shock which was published after the above-mentioned recommendations, dopamine had more adverse events (especially severe dysrhythmias, and especially atrial fibrillation).

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Dr. Smith's ECG Blog

MARCH 6, 2020

Here is one full text article on the topic from Clinical Cardiology 2008: Diagnostic Approach and Treatment Strategy in Tachycardia-induced Cardiomyopathy Atrial Tachycardia (AT): another SVT in the ED Rapid dysrhythmia from non-sinus focus above AV node. E CG # 2 in Figure-1 is from the October 16, 2019 post on Dr. Smith’s Blog.

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Dr. Smith's ECG Blog

APRIL 8, 2015

Dysrhythmia, pacer), 4) valvular heart disease, 5) FHx sudden death, 6) volume depletion, 7) persistent abnormal vitals, 8) primary CNS event __ 3) Mendu ML et al. Yield of Diagnostic Tests in Evaluating Syncopal Episodes in Older Patients Arch Intern Med 2009 Jul 27; 169:1299-1305.

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