Bradycardia Document Ischemia 
Dr. Smith's ECG Blog
MARCH 22, 2024
I will leave more detailed rhythm discussion to the illustrious Dr. Ken Grauer below, but this use of calipers shows that the rhythm interpretation is: Sinus bradycardia with a competing (most likely junctional) rhythm. The fact that R waves 2 through 6 are junctional does make ischemia more difficult to interpret -- but not impossible.
Dr. Smith's ECG Blog
JUNE 28, 2019
For coronary anatomy, see here: [link] This is the post intervention ECG: All ST Elevation is gone (more proof that it was all a result of ischemia) Formal Echo: Normal estimated left ventricular ejection fraction - 55%. This is sinus bradycardia. More likely, these T waves probably reflect ischemia of uncertain age.
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. CLICK HERE — for the ESC/ACC/AHA/WHF 2018 Consensus Document on the 4th Universal Definition of MI, in which these concepts are discussed and illustrated.
Dr. Smith's ECG Blog
JUNE 23, 2023
The patient later settled into sinus bradycardia. This likelihood of VT increases to at least 90% if the patient has documented underlying heart disease. He was started on amiodarone and had no more events. Next day, the cardiologists were convinced (I think correctly) that this was SVT with aberrancy that was triggered by DKA.
Dr. Smith's ECG Blog
JULY 21, 2024
There is no definite evidence of acute ischemia. (ie, In both tracings — an exceedingly fast PMVT is documented. Simply stated — t he patient was having recurrent PMVT without Q Tc prolongation, and without evidence of ongoing transmural ischemia. ( Some residual ischemia in the infarct border might still be present.
Dr. Smith's ECG Blog
AUGUST 9, 2024
He had no previously documented medical problems except polysubstance use. Possible mechanisms of ventricular arrhythmias elicited by ischemia followed by reperfusion. He reported a history of “Wolf-Parkinson-White” and “heart attack” but said neither had been treated. An ECG was obtained shortly after arrival: What do you think?
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.
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