Remove Bradycardia Remove Defibrillator Remove Stenosis
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What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

Angiography : LMCA — 90-99% osteal stenosis. LCx — 50-69% stenosis of the 1st marginal branch; with 100% distal LCx occlusion. He required multiple defibrillations within a period of a few hours. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation.

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

Dr. Smith's ECG Blog

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.

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See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

The arrhythmia spontaneously converted before defibrillation was achieved. Below is a still image with the red arrow indicating the subtotal LMCA stenosis. 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 ).

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A man with chest pain off and on for two days, and "No STEMI" at triage.

Dr. Smith's ECG Blog

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.

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Chest pain, and Cardiology didn't take the hint from the ICD

Dr. Smith's ECG Blog

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?