Dr. Smith's ECG Blog

OCTOBER 9, 2012

A middle-aged woman with a history of hypertension presented with typical chest pain. Her BP was 160/80. Here was her presenting ECG, with chest pain: Inferior leads show hyperacute T-waves and reciprocal STD in aVL, with a reciprocally hyperacute T-wave in aVL. This is all but diagnostic of inferior OMI. There is also subtle STE in V1-V3.

Chest Pain 52

Chest Pain Bradycardia STEMI Hypertension 52

Physiologically Speaking

JULY 26, 2024

For participants who slept just 5 hours per night, hypertension risk increased by 29%, depression risk increased by 64%, and anxiety risk increased by 46%. One last important finding regarding sleep duration was the J-shaped association between nightly sleep duration and the risk of hypertension, anxiety, and depression.

Chronic Disease 64

Chronic Disease Physiology Atrial Flutter Atrial Fibrillation 64

Ken Grauer, MD

SEPTEMBER 15, 2024

Perhaps the patient has pulmonary hypertension and/or tricuspid regurgitation? There definitel are periods of bradycardia (so pacing may be needed for that). Hope this helps — :) ECG-3 — I see sinus bradycardia and arrhythmia. RED arrows show what looks to be sinus P waves that are HUGE !!!!

Arrhythmia 78

Arrhythmia Bradycardia Heart Failure Pacemaker 78

Dr. Smith's ECG Blog

JANUARY 13, 2024

A few days later, midodrine and fludrocortisone were held due to hypertension and the patient was discharged. This is supported by the PT note which described a palpably irregular pulse with pauses and marked bradycardia. Cardiology was consulted, and the note said "no arrhythmias on telemetry or pacer interrogation."

Pacemaker 110

Pacemaker Bicuspid/Mitral Blood Pressure Bradycardia 110

EMS 12-Lead

MARCH 19, 2023

Vital signs were noted to be unremarkable with respect to any hypo-hypertensive crisis, hypoxia, etc. He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. Fire/EMS crews found him clammy and uncomfortable.

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 52

Dr. Smith's ECG Blog

JUNE 19, 2024

Case An 82 year old man with a history of hypertension presented to the ED with chest pain at 1211. Three months prior to this presentation, he received a pacemaker for severe bradycardia and syncope due to sinus node dysfunction. This is another case sent by the undergraduate (who is applying to med school) who works as an EKG tech.

Chest Pain 60

Chest Pain Pericarditis Pacemaker STEMI 60

All About Cardiovascular System and Disorders

APRIL 14, 2024

Tricuspid regurgitation jet velocity and pulmonary regurgitation end diastolic velocity indicating pulmonary hypertension are also taken as surrogates of left atrial pressure in the absence of pulmonary disease. Use of drugs producing bradycardia like beta blockers in stages III and IV may precipitate low output state.

Bicuspid/Mitral 52

Bicuspid/Mitral Pulmonary Atrial Fibrillation Ultrasound 52

DAIC

JANUARY 19, 2024

The BACKBEAT pivotal study will evaluate the efficacy and safety of atrioventricular interval modulation (“AVIM”) therapy (also known as BackBeat CNT), for the treatment of pacemaker-indicated patients with uncontrolled hypertension despite the use of antihypertensive medications. Orchestra BioMed and Medtronic, Inc. Kowal, M.D., Kowal, M.D.,

Pacemaker 105

Pacemaker Hypertension Blood Pressure Kidney Disease 105

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. NOTE: We do not know how long ago this baseline tracing was done!

Sickle Cell Disease 52

Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52

EMS 12-Lead

MAY 15, 2024

Initial vitals show hypertension (175/85), Atrial Fibrillation with RVR as seen in Figure 1 , hypercapnia (99mmHg), and SPO2 of 100%. Crew notifies the received ED of an incoming post-arrest patient and notes a sinus bradycardia on their monitor, as seen in Figure 2. Epinephrine administered intravenously.

Atrial Fibrillation 132

Atrial Fibrillation Bradycardia Pacemaker Cardiac Arrest 132

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. 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 ). The syncope lasted about 2-3 minutes according to his wife.

Cardiogenic Shock 127

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 127

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. MY Thoughts on the ECG in Figure-1: The rhythm in ECG #1 is sinus bradycardia at ~50-55/minute. It is unknown when this pain recurred and became constant.

Chest Pain 134

Chest Pain Defibrillator STEMI Coronary Artery Disease 134

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

JUNE 19, 2023

Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen Smith A 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. Here is his triage ECG which was obtained at 20:34 during active pain.

Chest Pain 52

Chest Pain STEMI Cardiogenic Shock Bradycardia 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

Written by Jesse McLaren An 80 year old patient with diabetes/hypertension/ cirrhosis had a recent increase in candesartan for their hypertension, and was also on spirolactone and nadolol. Theres no prior ECG to compare - but the bradycardia, prolonged PR and peaked T waves could all be from hyperkalemia. Take away 1.

Bradycardia 117

Bradycardia Cardiac Arrest Hypertension ICU 117

Dr. Smith's ECG Blog

JANUARY 15, 2025

Case A 68 year old man with a medical history of hypertension, hyperlipidemia, and CAD with stent deployment in the RCA presented to the emergency department with chest pain. A post-cath EKG was recorded at 0719: The computer interpretation read Sinus bradycardia, otherwise normal ECG. The troponin peaked at 0.4

Chest Pain 67

Chest Pain Stents Stent Risk Factors 67