Remove Bradycardia Remove Defibrillator Remove Stent
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A 50-something with chest pain.

Dr. Smith's ECG Blog

VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc. He has a h/o of 3 vessel disease and stents and his pain has been on and off for days. 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.

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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. Two stents were placed with resultant TIMI 3 flow.

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Distractions

EMS 12-Lead

He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. Despite immediate chest compressions, and multiple rounds of defibrillation, he could not be resuscitated. No appreciable skin pallor.

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STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

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. This was stented. The corrected QT interval is extremely long, about 500 ms.

STEMI 52
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Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

Within ten minutes, she developed bradycardia, hypotension, and ST changes on monitor. Bradycardia and heart block are very common in RCA OMI. After stent deployment, we often see improvement in the ST-T within seconds or minutes. Here is the final angiogram following placement of a stent in the ostial RCA.