Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). After good ECMO flow was established, she was successfully defibrillated. There is sinus bradycardia with one PVC. An elderly woman had sudden ventricular fibrillation. The K was normal.

Defibrillator 52

Defibrillator Circulation Plaque Cardiac Arrest 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc. Then the patient would have been taken to the critical care area with a defibrillator at his side while waiting for the cath lab to be ready. MY Thoughts on the ECG in Figure-1: The rhythm in ECG #1 is sinus bradycardia at ~50-55/minute.

Chest Pain 135

Chest Pain Defibrillator STEMI Coronary Artery Disease 135

All About Cardiovascular System and Disorders

APRIL 17, 2024

Recurrent ventricular tachycardia in spite of radiofrequency catheter ablation needs an implantable cardioverter defibrillator. Those at risk of recurrent VT with previous myocardial infarction and left ventricular dysfunction also need an implantable defibrillator.

Tachycardia 52

Tachycardia Defibrillator Congenital Ischemia 52

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. She spontaneously converted (Defibrillation was not performed). This is what T-waves look like when there is a long QT."

Cardiac Arrest 122

Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia 122

EMS 12-Lead

MARCH 30, 2024

Learning points: TCP is primarily recommended for bradycardia that does not respond to atropine, or other agents. As this case shows, electrical capture isn't always possible at lower currents, especially with pads placed in a standard anterolateral "defibrillation" position.

Cardiac Arrest 124

Cardiac Arrest Pacemaker Pulmonary Bradycardia 124

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. As per Dr. Nossen — today's initial ECG ( LEFT tracing in Figure-2 ) shows sinus bradycardia with QRS widening due to bifascicular block ( RBBB/LAHB ). Just prior to arrival he fell out of consciousness with the below ECG on the monitor.

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Dr. Smith's ECG Blog

APRIL 6, 2018

EMS report was that the patient had unknown down time with unwitnessed arrest, found initially in VFib arrest, defibrillated x1 followed by PEA arrest alternating with asystolic arrest during transport. Upon closer inspection, the defibrillator's monitor had assigned a spike for every large T wave as well as every QRS complex.

Cardiac Arrest 52

Cardiac Arrest Tachycardia Defibrillator ICU 52

Dr. Smith's ECG Blog

JUNE 19, 2023

Soon afterward, the patient’s symptoms return along with lightheadedness, bradycardia, and hypotension. The patient has also developed sinus bradycardia, which may result from right coronary artery ischemia to the SA node. The Queen of Hearts agrees: Around this time his initial high sensitivity troponin I resulted at 231 ng/L.

Chest Pain 52

Chest Pain STEMI Cardiogenic Shock Bradycardia 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

After resuscitation and defibrillation , there were no more episodes of TdP. Below is the patient’s 12 lead ECG following defibrillation. Of note — the QT interval of beat #5 ( blue line ) is markedly prolonged compared to the QT interval in the beginning of the tracing ( red line ). What does this ECG tell you?

Cardiac Arrest 68

Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 68

Wellnest

JUNE 19, 2023

Similarly, you may use our , app to adjust the paper speed along with amplification to read the slightest changes, especially for conditions like tachycardia and bradycardia. Along with it, a guideline-based algorithm helps identify implantable cardioverter defibrillators.

Technology 52

Technology Cardiac Arrest Innovation Coronary Artery Disease 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. On arrival, CPR was continued and core temperature was measured at 18° C (64.4° A 12-lead ECG was recorded: There is sinus rhythm with RBBB and right axis deviation.

Cardiac Arrest 40

Cardiac Arrest Bradycardia Chest Pain Ischemia 40

EMS 12-Lead

MARCH 19, 2023

Despite immediate chest compressions, and multiple rounds of defibrillation, he could not be resuscitated. As crews were assessing the ECG he further elucidated that his pain was provoked during exertion with posterior radiation towards the intrascapular region, and associated with activity-limiting dyspnea.

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). For example — bradycardia and AV conduction disturbances are not uncommon with Hyperkalemia , with these conduction disturbances most often resolving once serum K+ is corrected. The biopsy was consistent with cardiac sarcoidosis.

Tachycardia 107

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

Dr. Smith's ECG Blog

APRIL 8, 2016

There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Torsades in acquired long QT is much more likely in bradycardia because the QT interval following a long pause is longer still. The corrected QT interval is extremely long, about 500 ms.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

APRIL 29, 2020

She was never defibrillated. As was seen in this case — defibrillation and/or overdrive pacing may be needed. She was given 3 mg IV epinephrine and multiple rounds of ACLS over approximately 20 minutes. Her husband stated that she had not been feeling well in the past 2 weeks and c/o dizziness as well as diarrhea. What do you think?

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

MAY 6, 2019

Cardioversion/defibrillation. Bradycardia. A partial list includes the following: Certain drugs ( antiarrhythmics; calcium channel blockers; ß-blockers; antianginals; psychotropic medications; alcohol; cocaine; other drugs ). Acute febrile illness. Variations in autonomic tone. Hypothermia. Ischemia/infarction.

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Triage physician interpretation: -sinus bradycardia -lateral ST depressions While there are lateral ST depressions (V5, V6) the deepest ST depressions are in V4. When the ICD was finally interrogated, the syncopal events and shocks correlated with two VF events that were defibrillated successfully. Triage EKG: What do you think?

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

The designation Brugada “ P henocopy” is given when an otherwise healthy patient has none of the factors associated with Brugada Syndrome — but only develops a Brugada-1 ECG pattern as a result of one of the above conditions — and, resolves this Brugada-1 pattern once the precipitating condition has been corrected.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

MARCH 15, 2023

We examined the effect of ibutilide, a class III antiarrhythmic agent, on the energy requirement for atrial defibrillation and assessed the value of this agent in facilitating cardioversion in patients with atrial fibrillation that is resistant to conventional transthoracic cardioversion.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

All About Cardiovascular System and Disorders

MAY 21, 2024

Subcutaneous implantable cardioverter defibrillator was an innovation meant to reduce the lead related problems of conventional transvenous ICDs. But subcutaneous ICD cannot provide bradycardia and antitachycardia pacing as a transvenous ICD. A Modular Communicative Leadless Pacing-Defibrillator System. N Engl J Med.

Pacemaker 52

Pacemaker Defibrillator Bradycardia Arrhythmia 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Regardless of further evaluation, she should avoid bradycardia, AV nodal blockers, Na channel blockers, and fevers. --If Implantable Cardioverter-Defibrillator ), with long-term potential for device-related complications from the ICD, including inappropriate shocks?

Sudden Cardiac Death 52

Sudden Cardiac Death Heart Rhythm Article Tachycardia 52

Dr. Smith's ECG Blog

MARCH 8, 2025

Within ten minutes, she developed bradycardia, hypotension, and ST changes on monitor. Bradycardia and heart block are very common in RCA OMI. Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J. She was defibrillated perhaps 25 times.

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75

Journal of Cardiovascular Electrophysiology

NOVEMBER 10, 2024

ABSTRACT Introduction The subcutaneous implantable cardioverter defibrillator (S-ICD) is an alternative to a transvenous ICD in patients who meet the criteria for ICD implantation without concurrent need for cardiac pacing. The objective of this study is to examine the rates of and indications for S-ICD removal and extraction.

Bradycardia 40

Bradycardia Defibrillator Article 40

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Although we lack details of events that followed Dr. Smith makes the key point that had this arrest witnessed by the medic team been the result of an acute cardiac event ( therefore, presumably VT or VFib ) prompt defibrillation by on-the-scene medics would most probably have resuscitated her.

STEMI 89

STEMI Hemorrhage Cardiac Arrest Tachycardia 89

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

There are 2 main options: Overdrive pacing could be considered and in the right clinical situation, this is often effective for reducing ventricular arrhythmias ( especially in the case of preventing pause induced or bradycardia-induced arrhythmias in association with QTc prolongation ). Try a different kind of antiarrhythmic.

Tachycardia 72

Tachycardia Arrhythmia Ablation Atrial Flutter 72