Dr. Smith's ECG Blog

JANUARY 1, 2024

An initial electrocardiogram (ECG) is provided below. See My Comment at the bottom of the page in the May 19, 2020 post in Dr. Smith's Blog ). His current medication regimen includes apixaban, carvedilol, perindopril, spironolactone, torasemide, dapagliflozin, amiodarone, and ivabradine. What do you think? What is the rhythm?

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Tachycardia Blog Ischemia Heart Failure 113

Dr. Smith's ECG Blog

MARCH 14, 2024

This is obviously unreliable data, as Dr. Smith’s Blog has published 51 cases of OMI with ECGs labeled ‘normal’ , 35 of which were identified by the Queen of Hearts – with 10 examples here. Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review.

Chest Pain 120

Chest Pain STEMI Outcomes Electrocardiogram 120

Dr. Smith's ECG Blog

JULY 11, 2024

Because: 1) He has been reading this blog for a long time. The attending provider wrote “Agree with electrocardiogram interpretation”. Editorial Comment: I begin my thoughts on today's Blog post with the above reflections to provide perspective for my concerns about this case. 2) He is curious This is how Pendell got started.

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Outcomes Stenosis Outpatient Echocardiogram 113

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

Chest Pain Severity Rating Is a Poor Predictive Tool in the Diagnosis of ST-Segment Elevation Myocardial Infarction [link] Abstract Current ST-segment elevation myocardial infarction (STEMI) guidelines require persistent electrocardiogram ST-segment elevation, cardiac enzyme changes, and symptoms of myocardial ischemia.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 120

Dr. Smith's ECG Blog

MARCH 3, 2023

can cause ST-segment elevation (STE) on electrocardiogram (ECG), the distinction between them may be hard and complicated. Many researchers, including the editors of this blog, tried to develop such tools in the recent past and we have recommended their use in certain clinical scenarios in many posts on this blog.

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Chest Pain STEMI Download Blog 52

Dr. Smith's ECG Blog

JULY 31, 2020

In the hope of dispelling continued dependence on millimeter-based STEMI criteria — we’ve published numerous cases in recent years in Dr. Smith’s ECG Blog of acute OMI ( O cclusion-based M yocardial I nfarction ) , in which patients have benefited from acute reperfusion despite not satisfying “STEMI criteria”.

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STEMI Article Chest Pain Blog 52

Wellnest

AUGUST 3, 2023

Introduction to ECG Testing & Einthoven’s Triangle: The electrocardiogram (ECG) represents the heart’s electrical activity, resulting from the contraction (depolarization) and relaxation (repolarization) of the atrial and ventricular muscles. Let’s start with grasping the basics of electrocardiography.

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Electrocardiogram Heart attacks Heart Attack Blog 52

Dr. Smith's ECG Blog

JUNE 2, 2023

Usefulness of the Electrocardiogram in Establishing the Diagnosis and Prognosis of Arrhythmogenic Right Ventricular Cardiomyopathy Other References, from the above article: 1 FI Marcus Epsilon waves aid in the prognosis and risk stratification of patients with ARVC/D J Cardiovasc Electrophysiol, 26 (2015), pp. J Electrocardiol, 42 (2009), pp.

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Tachycardia Cardiomyopathy Electrocardiogram Article 95

Dr. Smith's ECG Blog

MAY 27, 2024

International evaluation of an artificial intelligence-powered electrocardiogram model detecting acute coronary occlusion myocardial infarction. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. IJC Heart and Vasc 2021 8. Herman et al. Eur Herat J Digital Health 2024

Chest Pain 123

Chest Pain STEMI Myocardial Infarction Ischemia 123

CineECG

AUGUST 22, 2023

That was a surprising finding, and it suggests that the CineECG could have more information than just a 12-lead electrocardiogram”… If you want to listen to the podcast here’s the link and if you just want to read the transcript here’s another link.

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Electrocardiogram Education Innovation Exercise 52

BoardVitals - Cardiovascular

MAY 1, 2017

Explanation: Shown electrocardiogram suggests left ventricular hypertrophy. Shown electrocardiogram suggests left ventricular hypertrophy. The post Hypertropic Cardiomyopathy: A Board Review Question Explained By Video appeared first on BoardVitals Blog. Hypertrophic cardiomyopathy is one of them. Start with a Free Trial.

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Cardiomyopathy Sudden Cardiac Death Bicuspid/Mitral Electrocardiogram 52

Wellnest

FEBRUARY 10, 2023

In this blog post, learn more about the advantages of a portable ECG device and how it can change how you track your heart health. Even if they are in a different place from the patient at the time of the test, medical professionals can quickly and conveniently check the electrocardiogram (ECG) results.

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Electrocardiogram Exercise Cardiac Arrest Heart Rhythm 52

Wellnest

AUGUST 31, 2023

This blog explores how medical devices are becoming useful for patient compliance in areas like precision diagnostics, real-time monitoring, targeted therapy, and enhanced patient experience by personalizing medicines. These medical devices collect essential data, analyze information, and deliver personalized medicine.

Technology 52

Technology Blood Pressure Electrocardiogram Blog 52

Dr. Smith's ECG Blog

MARCH 10, 2017

Safety of Computer Interpretation of Normal Triage Electrocardiograms. The Comparison of Physician to Computer Interpreted Electrocardiograms on ST-elevation Myocardial Infarction Door-to-balloon Times. It is not yet available, but this is your way to get on the list. link] Hughes KE et al. Acad Emerg Med 2017; 24(1): 120 – 24.

STEMI 52

STEMI Chest Pain Myocardial Infarction Electrocardiogram 52

BoardVitals - Cardiovascular

FEBRUARY 10, 2020

D) An electrocardiogram is most commonly normal in these patients. D) An electrocardiogram is most commonly normal in these patients. appeared first on BoardVitals Blog. (A) This condition is characterized by transient regional systolic dysfunction of the left ventricle (LV). (B) What is Takotsubo Cardiomyopathy?

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Cardiomyopathy Chest Pain Heart attacks Heart Attack 52

Dr. Smith's ECG Blog

DECEMBER 15, 2023

Below is the post -PCI electrocardiogram. For those in search of brief review of the Cabrera Format for ECG recording — Please check out My Comment at the bottom of the page in the October 26, 2020 post in Dr. Smith's ECG Blog. In the cath lab the patient was found to have a 100% occlusion of a small 1st marginal branch of the LCx.

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Chest Pain Blog Ischemia Risk Factors 61

Dr. Smith's ECG Blog

MARCH 17, 2023

Electromechanical association: a subtle electrocardiogram artifact. A very similar case to the one presented today appears in the January 17, 2023 post of Dr. Smith’s ECG Blog. Acute chest pain and a bizarre ECG Bizarre (Hyperacute??) T-waves More info on arterial pulse tapping artifact [link] Aslanger E, Yalin K. 2012;45(1):15-17.

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Chest Pain Coronary Angiogram Circulation Electrocardiogram 52

Dr. Smith's ECG Blog

JUNE 17, 2023

Physician accuracy in interpreting potential ST-segment elevation myocardial infarction electrocardiograms. I believe there is not quite enough STE for formal STEMI criteria, but some might measure 1.0 Journal of the American Heart Association 2013;2:e000268. Carley et al. What’s the point of ST elevation? Emerg Med J. 2002;19:126-128.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

OCTOBER 9, 2018

The utility of the triage electrocardiogram for the detection of ST-segment elevation myocardial infarction. For those of you who read this blog regularly: You will know that these are clearly hyperacute T-waves , diagnostic of proximal LAD occlusion. This paper was just published: Noll S. Am J Emerg Med 36(10):1771-1774. October 2018.

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Chest Pain STEMI Cardiac Arrest Blog 52

EMS 12-Lead

APRIL 21, 2022

Dedicated followers of the Smith ECG Blog know that the STD of true subendocardial ischemia does not localize, yet some of the examples listed below demonstrate the opposite, and were subsequently labeled “diffuse ischemia” or “generic subendocardial changes” as a diagnosis of convenience. However, the maximal STD in this case is V3.

Ischemia 52

Ischemia Myocardial Infarction Blog Coronary Angiogram 52

Dr. Smith's ECG Blog

JUNE 12, 2017

Laurence Katz and Jonathan Jones Safety of Computer Interpretation of Normal Triage Electrocardiograms (pages 120–124). The Comparison of Physician to Computer Interpreted Electrocardiograms on ST-elevation Myocardial Infarction Door-to-balloon Times. This one was not even so subtle!!! References : 1. Hug hes KE., January 2017.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. All electrocardiograms (ECGs) and coronary angiograms were blindly analyzed by experienced cardiologists. Harhash AA, Huang JJ, Reddy S, et al. aVR ST segment elevation: acute STEMI or not?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

Updates on the Electrocardiogram in Acute Coronary Syndromes. Electrocardiogram patterns in acute left main coronary artery occlusion. Therefore, to be safe, an internal defibrillator was placed. The patient was discharged neurologically intact. References : 1. Current Emergency and Hospital Medicine Reports (2013) 1:4352.

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Cardiac Arrest Ischemia Defibrillator Electrocardiogram 52

Dr. Smith's ECG Blog

MAY 30, 2023

A 12-lead electrocardiogram, lead V4R , and leads V7-9 were recorded on admission. OTHER Examples of Lead Reversal on Dr. Smith's Blog: Technical errors featuring a variety of lead reversal placements remain a surprisingly common “mishap” of everyday practice.

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Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

Dr. Smith's ECG Blog

MARCH 31, 2023

That said — followers of Dr. Smith's ECG Blog have already seen numerous clinical cases that we have presented in which the PM Cardio AI Bot app. Grauer K, Kravitz L, Curry RW, Ariet M: Computerized Electrocardiogram Interpretations: Are They Useful for the Family Physician? What About the Initial ECG? J Am Bd Fam Prac 1:17-24, 1989.

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Chest Pain STEMI Blog Academic 52

Dr. Smith's ECG Blog

JULY 22, 2023

Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. Heart Rhythm, 13(7): 1515-1520. [2]: 2]: Junttila MJ, Gonzalez M, Lizotte E, Benito B, Vernooy K, Sarkozy A, Huikuri HV, Brugada P, Brugada J, Brugada R. Circulation, 117, 1890–1893. [3]: Brugada electrocardiographic pattern induced by fever.

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Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 91

Dr. Smith's ECG Blog

JANUARY 1, 2013

In Wung’s study, 81% of patients with greater than or equal to 1mm STE in posterior leads also had other significant STE on the 12-lead ECG, and 96% had some ST deviation. 3 However, 22-39% of patients experiencing posterior MI who have greater than or equal to 0.5mm STE in the posterior leads do not demonstrate STD in V1-V3.

STEMI 52

STEMI Ischemia Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

At the bottom of the post, I have re-printed the section on aVR in my article on the ECG in ACS from the Canadian Journal of Cardiology: New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department Case 1. Updates on the Electrocardiogram in Acute Coronary Syndromes.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

JANUARY 30, 2018

Electromechanical association: a subtle electrocardiogram artifact. Arterial pulse tapping artifact [link] This online article references the article below by Emre Aslanger, a great guy who occasionally corresponds with me about ECGs. Aslanger E, Yalin K. Journal of Electrocardiology. 2012;45(1):15-17. doi:10.1016/j.jelectrocard.2010.12.162.

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Dr. Smith's ECG Blog

MARCH 13, 2013

Below is from a quote from part of a piece on aVR which I wrote for Current Emergency and Hospital Medical Reports: " Updates on the electrocardiogram in Acute Coronary Syndromes. " Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute myocardial infarction.

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STEMI Myocardial Infarction Electrocardiogram Chest Pain 52

Dr. Smith's ECG Blog

DECEMBER 22, 2022

Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. Blood pressure: 130/80 mmHg, heart rate: 45/min, respiratory rate: 18/min, SaO2: %98, body temperature: normal.

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STEMI Chest Pain Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

Quote from the article: Since I do not know how to make a "degree" sign on this blog, I use "^" for degree sign : "Deviation of the mean electrical QRS axis of the heart in the frontal plane (A^QRS) from apparent normal values has been considered evidence of electrocardiographic abnormality. Journal of Electrocardiology 3(2):161-167; 1970.

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Dr. Smith's ECG Blog

JANUARY 5, 2020

A deep neural network for 12-lead electrocardiogram interpretation outperforms a conventional algorithm, and its physician over-read, in the diagnosis of atrial fibrillation. 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 10, 2017

Comment This paper has received some press recently: Safety of Computer Interpretation of Normal Triage Electrocardiograms The algorithm used was also the GE Marquette 12 SL. I don't know what her subsequent cardiac function was, but that is not the point of this post. But it could have been a disaster.

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Chest Pain Bradycardia Technology Electrocardiogram 52

Dr. Smith's ECG Blog

MAY 8, 2023

20 The primary objective of the Paced Electrocardiogram Requiring Fast Emergent Coronary Therapy (PERFECT) study was to compare the sensitivity and specificity of the MSC with those of the original Sgarbossa criteria for the diagnosis of occlusion myocardial infarction in patients with ventricular paced rhythm.

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GEMMS

MAY 22, 2024

Traditional tools like stethoscopes, blood pressure gauges, and electrocardiograms (ECG) are fundamental for standard diagnostic practices. Medical Devices Both traditional and emerging medical devices play crucial roles in advancing cardiac diagnosis.

Heart Disease 52

Heart Disease Blood Pressure Technology Innovation 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

You will note that it is essentially an unremarkable electrocardiogram except for some PACS. We have often referred to this almost magical m irror- i mage r elationship for ST-T waves in leads I II and aV L — which when present, means a cute i nferior O MI until you prove otherwise ( See My Comment on the 8/9/2018 SSmith Blog Post ).

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