HeartRhythm

JUNE 19, 2023

Conduction system pacing (CSP), including both left bundle branch area pacing (LBBAP) and His-bundle pacing (HBP) has been proposed as an alternative therapy option for patients with indication for cardiac pacing to treat bradycardia or heart failure.

Physiology 40

Physiology Bradycardia Heart Failure 40

Ken Grauer, MD

SEPTEMBER 15, 2024

Some of the leads are not labeled — and I don’t know if any 2 make up a complete ECG — but clinically, that really isn’t important since your patient has heart failure from cardiomyopathy and NOT and acute infarction. There definitel are periods of bradycardia (so pacing may be needed for that). Beats #3 and 6 look like PVCs.

Arrhythmia 78

Arrhythmia Heart Failure Bradycardia Pacemaker 78

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. NT-pro-BNP peaked at 4831, consistent with heart failure. This is what T-waves look like when there is a long QT."

Cardiac Arrest 122

Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia 122

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. Neverthelss, his anterior wall was saved and he had normal ejection fraction without heart failure.

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Chest Pain STEMI Bradycardia Ischemia 114

Dr. S. Venkatesan MD

OCTOBER 26, 2024

Unfortunately ,there appears to be a herd mentality, gradually creeping in to many of us, to jump over from traditional RV /RA pacing to the bundle branch area pacing , as an alternative to CRT or even regular bradycardia pacing. There is less compelling academic reasons for this change, than we think.

Cardiomyopathy 40

Cardiomyopathy Bradycardia Academic Transplant 40

Dr. Smith's ECG Blog

JANUARY 22, 2020

There are 3 etiologies I always think of with bradycardia and AV block: 1. While the diagnosis of SSS may become readily apparent early on in many patients clear indication for pacing usually does not become established until there is profound, symptomatic bradycardia usually requiring pauses of at least 3.0 Hyperkalemia.

Pulmonary 52

Pulmonary AFIB Atrial Fibrillation Pacemaker 52

EMS 12-Lead

MARCH 19, 2023

He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. Breath sounds were clear in all lung fields. No appreciable skin pallor. He reported to be a social drinker, but used tobacco products daily.

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 52

All About Cardiovascular System and Disorders

APRIL 14, 2024

Use of drugs producing bradycardia like beta blockers in stages III and IV may precipitate low output state. One situation is decompensated advanced systolic heart failure with large left ventricle. In stage IV, this restrictive filling pattern remains fixed even during Valsalva maneuver. Stage IV is considered as advanced.

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Bicuspid/Mitral Pulmonary Atrial Fibrillation Ultrasound 52

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

Here are inferior leads, and aVL, magnified: A closer inspection of the inferior leads and aVL Sinus bradycardia. A right heart cath revealed increased right heart pressures and a similarly timed echo revealed mild right heart failure. I had no history on the case and no prior ECG for comparison. What do you think?

Chest Pain 52

Chest Pain Critical Care Article Pacemaker 52

Dr. Smith's ECG Blog

MARCH 2, 2019

Does this patient have hypertension and/or heart failure that has worsened? In my experience, Ive seen U waves not only with low K+/low Mg++ but also in patients with bradycardia, LVH, and sometimes in normal subjects. This might be a common scenario given this patients demographics and his underlying disease ).

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Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52

Dr. Smith's ECG Blog

MARCH 15, 2023

Baseline bradycardia in endurance athletes limits the use of ß-blockers. Emergency providers only see the “tip of the iceberg” of this huge number of AFib episodes — which consists of patients who call EMS or present to the ED with new-onset palpitations, heart failure exacerbation, acute stroke ( or other symptom related to their AFib ).

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

DAIC

JANUARY 19, 2024

Our collaboration with Orchestra BioMed will explore how cardiac pacing can go beyond management of bradycardia and conduction disease to treat hypertension as well,” said Robert C. This leaves a gap in the care of these patients and increases their risk for heart attack, stroke and heart failure progression. Kowal, M.D.,

Pacemaker 105

Pacemaker Hypertension Blood Pressure Kidney Disease 105

Circulation

NOVEMBER 11, 2024

Introduction:European, American and UK guidelines all endorse the prescription of the 'four pillars' of treatment (ACE/ARBs, b-blockers, MRAs and SGLT2 inhibitors) for heart failure with reduced LV systolic function (HFrEF). Circulation, Volume 150, Issue Suppl_1 , Page A4134483-A4134483, November 12, 2024.

Heart Failure 40

Heart Failure Outpatient Bradycardia Nursing 40

European Journal of Heart Failure

NOVEMBER 22, 2023

Rates of guideline-directed medical therapy (GDMT) prescription in real-world patients with severe heart failure (HF) with reduced ejection fraction (HFrEF), reasons for underdosing and association with outcome. However, real-world data on GDMT use, dose, and prognostic implications are lacking.

Heart Failure 40

Heart Failure Bradycardia Hospital Outcomes 40

American College of Cardiology

FEBRUARY 6, 2024

The following are key points to remember from a review article on cardiac implantable electronic devices (CIEDs), which include pacemakers for bradycardia, biventricular pacemakers for heart failure, and implantable cardioverter–defibrillators (ICDs) for the treatment of sudden cardiac death:

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Sudden Cardiac Death Pacemaker Bradycardia Defibrillator 51

HeartRhythm

APRIL 30, 2024

Introduction: Leadless pacemakers (LP) are increasingly utilized in pts with bradycardia and may be associated with better outcomes compared to right ventricular pacing (RVP). Conduction system pacing (CSP) with HBP or LBBAP have been associated with reduction in death or heart failure hospitalization (HFH).

Pacemaker 40

Pacemaker Bradycardia Outcomes Heart Failure 40

Open Heart

JULY 28, 2023

Introduction The incidence of arrhythmia in heart failure with non-reduced ejection fraction (HFnon-rEF) in patients who have a history of hospitalisation is unclear. The primary endpoint is new-onset 6 min or more persistent AF detected by ILR.

Atrial Fibrillation 40

Atrial Fibrillation Arrhythmia Heart Failure Tachycardia 40

EMS 12-Lead

JUNE 1, 2022

plaque disruption), the T waves still manifest markings of a previous state of suboptimal coronary flow that resolved: Type II supply-demand mismatch in the setting of extreme bradycardia. LBBB may be the precipitating cause of the heart failure syndrome, or may portend high mortality when identified in preexisting heart failure.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

Circulation: Cardiovascular Quality & Outcomes

FEBRUARY 8, 2024

Annual costs to the US health care system were estimated by multiplying the mean annual number of events by the mean total cost per discharge.RESULTS:The annual mean number of hospital discharges among CVD events was the highest for heart failure (1 087 000 per year) and cerebrovascular disease (800 600 per year).

Cardiovascular Disease 40

Cardiovascular Disease Hospital Inpatient Cerebrovascular Disease 40

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The patient spent a couple of days in the cardiac intensive care unit receiving treatment for acute heart failure and aspiration pneumonia. How did the Queen of Hearts do on today's ECGs? NT-proBNP was 3753ng/L There was transient liver enzyme elevation as is common with acute shock. Long term follow up is not available.

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

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. Heart failure leading to death was related to all subclasses of PVC.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

All About Cardiovascular System and Disorders

MARCH 17, 2024

And, after the shock, if there is bradycardia, it can be covered by these two pacing electrodes, one at the tip, and one proximal to it. So, after myocardial infarction, the risk is more of heart failure, than arrhythmic death. These are high voltage, defibrillator shock coils. That is one reason.

Myocardial Infarction 52

Myocardial Infarction Defibrillator Sudden Cardiac Death Arrhythmia 52

Dr. Smith's ECG Blog

APRIL 8, 2015

PVCs N ot generally considered abnormal ECG findings: Isolated PAC, First Degree AV Block, Sinus bradycardia at a rate of 35-45, and Nonspecific ST-T abnormalities (even if different from a previous ECG). Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Open Heart

NOVEMBER 11, 2024

Overall, a mixed cardioneuro phenotype was demonstrated including autonomic (75%), small (58%) and large fibre (46%) neuropathy largely predating a cardiac phenotype consisting of heart failure (63%), atrial arrhythmia (42%) and bradycardia (13%).

Heart Failure 52

Heart Failure Bradycardia Laboratory Cardiomyopathy 52

Dr. Smith's ECG Blog

MARCH 19, 2025

Despite the baseline artifact theres sinus bradycardia, convex ST elevation in III, reciprocal ST depression in aVL and possible anterior ST depression indicating inferoposterior OMI. Heres the Queen of Hearts interpretation, drawing attention especially to III and aVL: This patient does indeed need emergent intervention.

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Chest Pain STEMI Stents Stent 116

Dr. Smith's ECG Blog

DECEMBER 5, 2023

A repeat ECG was performed as adult cardiology was asked to evaluate the patient for emerget PCI: Sinus bradycardia with persistent elevation in the inferior leads with reciprocal depression in aVL Patient was taken to cath lab with adult cardiology which revealed normal coronary arteries without evidence of occlusion MI. .-

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Pediatrics Pericarditis COVID-19 Congenital Heart Disease 120

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. In addition to profound acute heart failure, the patient suffered from electrical storm. He told the patient this horrible news. We will never know for certain.

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75