Bradycardia, Cardiomyopathy and Ischemia

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

JANUARY 2, 2025

And of course Ken's comments at the bottom) An elderly obese woman with cardiomyopathy, Left bundle branch block, and chronic hypercapnea presented hypoxic with altered mental status. I do not see OMI here and all trops were only minimally elevated, consistent with either chronic injury from cardiomyopathy or with acute injury from sepsis.

Tachycardia

Tachycardia Cardiomyopathy Blog Bradycardia

Normal angiogram one week prior. Must be myocarditis then?

Dr. Smith's ECG Blog

JUNE 5, 2024

The ECG does not show any definite signs of ischemia. I thought the complete lack of QTc prolongation and anatomic localization of ECG findings made Takotsubo cardiomyopathy unlikely. It is unclear if the patient was pain free at this time. Initial high sensitivity troponin I returned at 6ng/L (normal 0.20

Chest Pain

Chest Pain Blog Cardiac Arrest Cardiomyopathy

A 20-something woman with cardiac arrest.

Dr. Smith's ECG Blog

OCTOBER 18, 2023

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. Most such rhythms in the setting of ischemia are VF and will not convert without defibrillation. Echo revealed normalized function.

Cardiac Arrest

Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia

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Right Precordial T-wave Inversion

Dr. Smith's ECG Blog

DECEMBER 5, 2016

Description Sinus bradycardia. There is ST elevation in V2 and V3 There are inverted T-waves in V2 and V3 There are prominent U-waves in V2 and V3 Many responders were worried about ischemia or hypertrophic cardiomyopathy. This short QT at least makes ischemia all but impossible. There is high voltage.

Chest Pain

Chest Pain Ischemia Myocardial Infarction Bradycardia

Wide complex tachycardia and hypotension in a 50-something with h/o cardiomyopathy -- what is it?

Dr. Smith's ECG Blog

JUNE 23, 2023

A 50-something male with unspecified history of cardiomyopathy presented in diabetic ketoacidosis (without significant hyperkalemia) with a wide complex tachycardia and hypotension. The fact that he has a cardiomyopathy argues for a more typical ventricular tachycardia, as does the absence of rSR' in lead V1. It is regular.

Tachycardia

Tachycardia Cardiomyopathy Arrhythmia Diabetes

What kind of AV block is this? And why does she develop Ventricular Tachycardia?

Dr. Smith's ECG Blog

JANUARY 23, 2024

Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). The granulomatous inflammation affects the heart, causing an infiltrative cardiomyopathy The most common manifestations of cardiac sarcoidosis are atrioventricular (AV) block and ventricular tachyarrhythmias (VT).

Tachycardia

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death

Syncope and Block

EMS 12-Lead

JUNE 1, 2022

Such findings would normally suggest primary ischemia with concomitant surveillance of coronary occlusion, but these ST/T changes might very well be secondary to the Escape mechanism at hand. LBBB is typically the result of preexisting hypertrophy, ischemic heart disease, or cardiomyopathy. 5] Isnard, R. & Pousset, F.

Heart Failure

Heart Failure Myocardial Infarction Bradycardia Chest Pain

Why is ECG machine use? What diseases can EKG monitor detect?

Wellnest

DECEMBER 21, 2022

A fast heartbeat is called tachycardia, while a slow heartbeat is called bradycardia in medical terms. Poor blood supply Ischemia, or inadequate blood supply to the heart, is an abnormality that can be detected in an ECG test. Arrhythmia In simple words, arrhythmia refers to an irregular heartbeat.

Cardiac Arrest

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation

This was texted to me in real time. The patient has acute chest pain.

Dr. Smith's ECG Blog

JULY 5, 2023

Here was my answer: "Not ischemia. Instead — my thoughts were as follows: The rhythm is sinus , with marked bradycardia and a component of sinus arrhythmia. This was texted to me in real time. The patient has acute chest pain. What do you think? Maybe HOCM or another form of LVH. I would not activate cath lab.

Chest Pain

Chest Pain STEMI Congenital Heart Disease Heart Disease

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

Dr. Smith's ECG Blog

APRIL 15, 2019

But when the clinical presentation is sepsis, one must entertain the possibility that the ST elevation is due to demand ischemia, or some other process, and exacerbated by tachycardia. It is prudent to treat the other conditions, get the heart rate controlled, and repeat the ECG.

Tachycardia

Tachycardia STEMI Chest Pain Ischemia

Unconscious + STEMI criteria: activate the cath lab?

Dr. Smith's ECG Blog

JANUARY 21, 2023

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. There is marked sinus bradycardia. What do you think? Pacing Clin Electrophysiol.

STEMI

STEMI Bradycardia Arrhythmia Cardiac Arrest

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

Within ten minutes, she developed bradycardia, hypotension, and ST changes on monitor. Repeat ECG was obtained immediately, just 24 minutes after the prior ECG: Given the context, my top differential diagnosis would be stress cardiomyopathy AKA takotsubo. Bradycardia and heart block are very common in RCA OMI.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Acute coma, then Sudden PEA arrest in front of paramedics, with STEMI?

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

By ECG alone: it is suspicious for stress cardiomyopathy, or takotsubo, due to the diffuse ST Elevation: II, III, aVF AND I and aVL. Subarachnoid hemorrhage causes extreme central catecholamine output, resulting in stress cardiomyopathy, just like takotsubo. This is unusual in acute OMI. she had severe pulmonary edema.

STEMI

STEMI Hemorrhage Cardiac Arrest Tachycardia

Electrical instability in a healthy 50 year old. How to manage?

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

Whenever I see PVCs with the morphology and axis seen in todays case I always look for signs of AC ( Arrhythmogenic Cardiomyopathy ). Arrhythmogenic cardiomyopathy often manifests with PVCs from the RV. The ECG in Figure-1 however, shows no signs of arrhythmogenic cardiomyopathy. Therefore A different approach is needed.

Tachycardia

Tachycardia Arrhythmia Atrial Flutter Ablation

Cardiovascular Update

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Normal angiogram one week prior. Must be myocarditis then?

A 20-something woman with cardiac arrest.

Webinars

Right Precordial T-wave Inversion

Wide complex tachycardia and hypotension in a 50-something with h/o cardiomyopathy -- what is it?

What kind of AV block is this? And why does she develop Ventricular Tachycardia?

Syncope and Block

Why is ECG machine use? What diseases can EKG monitor detect?

This was texted to me in real time. The patient has acute chest pain.

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

Unconscious + STEMI criteria: activate the cath lab?

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Acute coma, then Sudden PEA arrest in front of paramedics, with STEMI?

Electrical instability in a healthy 50 year old. How to manage?

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