Blog, Dysrhythmia and Ischemia - Cardiovascular Update

ECG Cases 45 ECG in Weakness and Neurological Symptoms

ECG Cases

SEPTEMBER 12, 2023

In this ECG Cases blog Dr. Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, (..)

Dysrhythmia

Dysrhythmia Atrial Fibrillation Embolism Ischemia

A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. See these publications for more information Overall, management for cardiac contusion is mostly supportive unless surgical complications develop, involving appropriate treatment of dysrhythmias and hemodynamic instability.

Tachycardia

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia

A 50 year old man with sudden altered mental status and inferior STE. Would you give lytics? Yes, but not because of the ECG!

Dr. Smith's ECG Blog

DECEMBER 26, 2020

We have also shown several cases in which atrial flutter hides true, active ischemia. 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.

Atrial Flutter

Atrial Flutter Ischemia STEMI Tachycardia

A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?

Dr. Smith's ECG Blog

DECEMBER 24, 2023

And superimposed subendocardial ischemia pattern, of course. Flecainide : This is a potentially dangerous Na channel blocker which can cause ventricular dysrhythmias including ventricular fibrillation. For more on AFlutter — Please check out My Comment in the November 12, 2019 post and the May 1, 2023 post in Dr. Smith's ECG Blog ).

Atrial Flutter

Atrial Flutter Blog Aortic Aortic valve

Back to basics: what is this rhythm? What are your options for treating this patient?

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. 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. Adenosine worked.

Tachycardia

Tachycardia Atrial Flutter Dysrhythmia Ablation

What is the rhythm? And is there new left bundle branch block (LBBB)?

Dr. Smith's ECG Blog

MAY 27, 2012

Is there ischemia? ECG Diagnosis is either : 1) junctional rhythm with new LBBB, and possibly ischemia 2) accelerated idoventricular rhythm with possible ischemia, and possibly related to restoration of normal perfusion. The second explanation (AIVR), whether as a reperfusion dysrhythmia or not, seems most likely.

Chest Pain

Chest Pain Ischemia Dysrhythmia STEMI

New Onset Heart Failure and Frequent Prolonged SVT. What is it? Management?

Dr. Smith's ECG Blog

MARCH 6, 2020

There is no evidence of infarction or ischemia. 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. H eart R ate C an H elp !

Heart Failure

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy

An athletic 30-something woman with acute substernal chest pressure

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. It they are static, then they are not due to ischemia. This is better evidence for ischemia than any other data point. Again, cath lab was not activated. What does this troponin level mean?

SCAD

SCAD Chest Pain Myocardial Infarction Ischemia

Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR. The ECG cannot diagnose the etiology of ischemia; it only the presence of ischemia, from whatever etiology.

Ischemia

Ischemia Cardiogenic Shock Aortic Stenosis

Young Man with a Heart Rate of 257. What is it and how to manage?

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. NOTE #3: In the context of a long QTc or ischemia — the finding of ST segment and/or T wave alternans may predict the occurrence of malignant ventricular arrhythmias. My Comment at the bottom of this Sept.

Tachycardia

Tachycardia Heart Disease Ablation Dysrhythmia

A man in his 70s with weakness and syncope

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?

Chest Pain

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

OCTOBER 10, 2022

In terms of ischemia, there is both a signal of subendocardial ischemia (STD max in V5-V6 with reciprocal STE in aVR) AND a signal of transmural infarction of the inferior wall with Q wave and STE in lead III with reciprocal STD in I and aVL. The rhythm is atrial fibrillation. The QRS complex is within normal limits. These include.

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

Hyperthermia and ST Elevation

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.

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

Evidence of acute ischemia (may be subtle) vii. 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. ST segment and T wave abnormalities consistent with or possibly related to myocardial ischemia. Left BBB vi.

Arrhythmia

Arrhythmia Outcomes Risk Factors Chest Pain

ECG Cases 45 ECG in Weakness and Neurological Symptoms

A teenager involved in a motor vehicle collision with abnormal ECG

A 50 year old man with sudden altered mental status and inferior STE. Would you give lytics? Yes, but not because of the ECG!

A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?

Back to basics: what is this rhythm? What are your options for treating this patient?

What is the rhythm? And is there new left bundle branch block (LBBB)?

New Onset Heart Failure and Frequent Prolonged SVT. What is it? Management?

An athletic 30-something woman with acute substernal chest pressure

Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Young Man with a Heart Rate of 257. What is it and how to manage?

A man in his 70s with weakness and syncope

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Hyperthermia and ST Elevation

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

Stay Connected