Bradycardia, Cardiac Arrest and STEMI

How will you save this critically ill patient? A fundamental and lifesaving ECG interpretation that everyone must recognize instantly.

Dr. Smith's ECG Blog

FEBRUARY 22, 2024

See our other countless hyperkalemia cases below: General hyperkalemia cases: A 50s year old man with lightheadedness and bradycardia Patient with Dyspnea. A woman with near-syncope, bradycardia, and hypotension What happens if you do not recognize this ECG instantly? HyperKalemia with Cardiac Arrest. With a twist.

Cardiac Arrest

Cardiac Arrest Bradycardia Tachycardia Chest Pain

Unconscious + STEMI criteria: activate the cath lab?

Dr. Smith's ECG Blog

JANUARY 21, 2023

ECG met STEMI criteria and was labeled STEMI by computer interpretation. 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.

STEMI

STEMI Bradycardia Arrhythmia Cardiac Arrest

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

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. There was no evidence bradycardia leading up to the runs of PMVT ( as tends to occur with Torsades ). Principal adverse cardiac effects of Quinidine include QRS widening and QTc prolongation. The below ECG was recorded.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation.

Dr. Smith's ECG Blog

DECEMBER 15, 2015

In any case, there is bradycardia. It was a PEA or bradyasystolic arrest , not a shockable rhythm. Although most cardiac arrest from MI is due to ventricular fibrillation, some is due to high grade AV block, and so this could indeed be due to large acute STEMI. No shock was ever delivered. Sixth: Severe shock (e.g.,

STEMI

STEMI Embolism Pulmonary Ultrasound

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

MAY 19, 2020

There is sinus bradycardia with one PVC. There is "Shark Fin morphology" I saw this and thought for certain that this was going to be an LAD or left main occlusion as etiology of arrest, and etiology of profound ST Elevation in I, II, aVL, and V3-V6, and ST depression in III, V1 and V2. She then had a 12-lead: What do you think?

Defibrillator

Defibrillator Circulation Plaque Cardiac Arrest

What are these hyperacute T waves, with STE and T-wave inversion in aVL, and STD in inferior leads?

Dr. Smith's ECG Blog

FEBRUARY 27, 2023

See many examples of Pseudo STEMI due to hyperkalemia at these two posts: Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life. No followup EKG was recorded!!

Tachycardia

Tachycardia Document Blog Bradycardia

A Middle-Aged male with Chest Pain and an Unusual ECG

Dr. Smith's ECG Blog

MAY 6, 2019

If it is STEMI, it would have to be RBBB with STEMI. This ECG pattern may be diagnostic of B rugada S yndrome IF seen in association with: i ) a history of cardiac arrest; polymorphic VT; or of non-vagal syncope; and / or ii ) a positive family history of sudden death at an early age; and / or iii ) a similar ECG in relatives.

Chest Pain

Chest Pain STEMI Ischemia Myocardial Infarction

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

Dr. Smith's ECG Blog

APRIL 15, 2019

A prehospital ECG was recorded (not shown and not seen by me) which was worrisome for STEMI. A previous ECG from 4 years prior was normal: This looks like an anterior STEMI, but it is complicated by tachycardia (which can greatly elevate ST segments) and by the presentation which is of fever and sepsis.

Tachycardia

Tachycardia STEMI Chest Pain Ischemia

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Dr. Smith's ECG Blog

MAY 5, 2022

Despite the clinical context, Cardiology was consulted due to concerns for a "STEMI". 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. With a twist.

Chest Pain

Chest Pain Bradycardia Cardiac Arrest STEMI

A man in his 60s with syncope and ST depression. What does the ECG mean?

Dr. Smith's ECG Blog

OCTOBER 25, 2023

Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest. A New Seizure in a Healthy 20-something More cases of long QT not measured correctly by computer (these are all fascinating ECGs/cases): Bupropion Overdose Followed by Cardiac Arrest and, Later, ST Elevation.

Ischemia

Ischemia Chest Pain Cardiac Arrest Blog

Cardiologist declines taking patient to the cath lab. Patient dies.

Dr. Smith's ECG Blog

OCTOBER 11, 2020

The provider contacted cardiology to discuss the case, but cardiology "didn't think it was a STEMI, didn't think he needed emergent cath." About two hours after admission, he suffered a cardiac arrest (whether it was VF/VT or PEA is not available) and expired. The whole paradigm is literally called "STEMI" vs. "NSTEMI."

Chest Pain

Chest Pain STEMI Blog Tachycardia

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. Bicarb 20, Lactate 4.2,

Heart Rhythm

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiac arrest in sleep. Regardless of further evaluation, she should avoid bradycardia, AV nodal blockers, Na channel blockers, and fevers. --If Syncope and ST Segment Elevation.

Sudden Cardiac Death

Sudden Cardiac Death Heart Rhythm Article Tachycardia

Cardiovascular Update

How will you save this critically ill patient? A fundamental and lifesaving ECG interpretation that everyone must recognize instantly.

Unconscious + STEMI criteria: activate the cath lab?

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

Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation.

1 hour of CPR, then ECMO circulation, then successful defibrillation.

What are these hyperacute T waves, with STE and T-wave inversion in aVL, and STD in inferior leads?

A Middle-Aged male with Chest Pain and an Unusual ECG

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

A man in his 60s with syncope and ST depression. What does the ECG mean?

Cardiologist declines taking patient to the cath lab. Patient dies.

Hyperthermia and ST Elevation

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

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