Dr. Smith's ECG Blog

OCTOBER 20, 2024

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?

Cardiogenic Shock 127

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 127

Dr. Smith's ECG Blog

JANUARY 23, 2024

Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). Discussion : The initial ECG in today's case is pathological for any patient, especially for a 50-year old previously heathy female.

Tachycardia 106

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 106

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

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

MAY 6, 2019

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. Cardioversion/defibrillation.

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 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

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

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 88

STEMI Hemorrhage Cardiac Arrest Tachycardia 88

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. It is possible there is microvascular dysfunction producing residual transmural ischemia. She was defibrillated perhaps 25 times. He told the patient this horrible news.

Cardiomyopathy 74

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 74

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. Below in Figure-5 is a 10-minute continuous lead II recording on oral Flecainide, now showing sinus bradycardia without a single PVC! You have given IV MgSO4 a fast acting -blocker and IV amiodarone bolus and infusion. No PVCs are seen.

Tachycardia 71

Tachycardia Arrhythmia Ablation Atrial Flutter 71