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A man in his 60s with syncope and ST depression. What does the ECG mean?

Dr. Smith's ECG Blog

ECG is consistent with severe hypokalemia and/or hypomagnesemia causing prolonged QT (QU) at high risk of Torsades (which is polymorphic ventricular tachycardia in the setting of a long QT interval). The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. Is it STEMI?

Ischemia 120
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A middle aged man with unwitnessed cardiac arrest

Dr. Smith's ECG Blog

There is a regular, wide complex, (mostly) monomorphic tachycardia. The differential of wide, regular, monomorphic tachycardia is: VT or SVT with aberrancy, all +/- hyperkalemia (see diagrams below). He made it to the ICU, however the patient unfortunately expired approximately 24 hours after ICU admission.

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Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Dr. Smith's ECG Blog

After initiating treatment for hyperkalemia, repeat ECG showed resolution of Brugada pattern: The ECG shows sinus tachycardia. He was admitted to the ICU and transferred emergently to a facility where he could undergo emergent dialysis as a part of further evaluation and management. The QRS is narrow and T waves are much less peaked.

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Could you have prevented this young man's cardiac arrest?

Dr. Smith's ECG Blog

Prior ECG on file: Sinus tachycardia, imperfect baseline, otherwise unremarkable. Sinus tachycardia with unequivocal evidence of hyperkalemia, including widened QRS with "pulled apart" morphology (widened QRS) compared to baseline, as well as clearly peaked T-waves. He required a low dose norepinephrine drip to maintain BP.