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The ECG does not show any definite signs of ischemia. Uncontrolled coronary spasm may be associated with serious arrhythmias , including cardiacarrest ( Looi et al — Postgrad Med, 2012 ; Tan et al — Eur Heart J Case Rep, 2018 ; Chevalier et al — JACC, 1998 ; Rodriguez-Manero — EP Europace, 2018 ).
A prior ECG was available for comparison: Normal One might be tempted to interpret the ST depression as ischemia, but as Smith says, "when the QT is impossibly long, think of hypokalemia and a U-wave rather than T-wave." Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management CardiacArrest.
The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?
There is no definite evidence of acute ischemia. (ie, Simply stated — t he patient was having recurrent PMVT without Q Tc prolongation, and without evidence of ongoing transmural ischemia. ( Some residual ischemia in the infarct border might still be present. Both episodes are initiated by an "R-on-T" phenomenon.
Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. Smith: This bizarre ECG looks like a post cardiacarrest ECG with probable acidosis or hyperkalemia in addition to OMI.
Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. See this post: How a pause can cause cardiacarrest 2. There is ventricular bigeminy with bizarre appearing wide T-waves See even more striking cases of this at the bottom of the post. The plan: 1.
A fast heartbeat is called tachycardia, while a slow heartbeat is called bradycardia in medical terms. CardiacarrestCardiacarrest is a medical emergency in which the heart stops pumping blood to the body. Electrocardiogram, echocardiogram, and some other tests are done for patients with cardiacarrest.
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. ECG met STEMI criteria and was labeled STEMI by computer interpretation.
Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Ischemia/infarction. Bradycardia. Hypothermia.
In any case, there is bradycardia. There is ST depression beyond the end of the wide QRS in I, II, aVF, and V4-V6, diagnostic of with subendocardial ischemia. First, what kind of arrest was this? It was a PEA or bradyasystolic arrest , not a shockable rhythm. There is no ST elevation. It can also be due to RV MI.
If a patient presents with chest pain and a normal heart rate, or with shockable cardiacarrest, then ischemic appearing ST elevation is STEMI until proven otherwise. It is prudent to treat the other conditions, get the heart rate controlled, and repeat the ECG.
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. Cardiacarrest was called and advanced life support was undertaken for this patient. Without an MRI, it is impossible to know.
A 60-something woman presented after a witnessed cardiacarrest. This is commonly found after epinephrine for cardiacarrest, but could have been pre-existing and a possible contributing factor to cardiacarrest. Final Diagnosis: CardiacArrest due to Torsades from long QT of unknown etiology.
Altered Mental Status, Bradycardia == MY Comment , by K EN G RAUER, MD ( 2/2 /2024 ): == Dr. Meyers began today’s case with the clinical challenge of asking you to identify the underlying cause of ECG #2. -- Read this ECG -- Osborn Waves and Hypothermia (this is the "Figure" above) What does LBBB look like in severe hypothermia?
Common explanations for unusual rhythms such as this one include: i ) Hyperkalemia ( or other severe electrolyte disorder ); ii ) Recent infarction/ischemia; iii ) Sleep apnea; iv ) Severe hypothyroidism; v ) Acute neurologic catastrophe (ie, stroke, bleed, trauma, tumor ); vi ) Some other toxicity.
Her vital signs were within normal limits except for bradycardia at 55 bpm. It is probably sinus bradycardia with very small/depressed P-waves and prolonged PR interval. See these other related cases: A patient with cardiacarrest, ROSC, and right bundle branch block (RBBB). Is this just right bundle branch block?
Hyperkalemia causes peaked T waves and the "killer B's of hyperkalemia", including bradycardia, broad QRS complexes, blocks of the AV node and bundle branches, Brugada morphology, and otherwise bizarre morphology including sine wave. Steve, what do you think of this ECG in this CardiacArrest Patient?" With a twist.
That said — obvious findings include: i ) Marked bradycardia! — This suggests ischemia of uncertain duration. Unfortunately, before this could be accomplished — the patient went into cardiacarrest. She was successfully resuscitated — with a post-arrest rhythm similar to that seen in Figure-1. be regular! —
U waves may also be found in patients with LVH and/or bradycardia , or occasionally as a normal variant. This is often quite challenging to recognize — but the finding of negative U waves in a patient with chest pain is highly suggestive of ischemia ! N OTE # 1 — U waves are not specific for hypokalemia!
In addition to a spontaneous or induced Brugada-1 ECG pattern, criteria for B rugada S yndrome require one or more of the following: History of cardiacarrest, of polymorphoic VT, or of non-vagal syncope — positive family history of sudden death at an early age — a similar ECG in close relatives.
These include ( among others ) — acute febrile illness — variations in autonomic tone — hypothermia — ischemia-infarction — malignant arrhythmias — cardiacarrest — and especially Hyperkalemia. Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ).
Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiacarrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ). Rituparna et al — as well as Chauhan and Brahma ( Int.
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