Bradycardia, Ischemia and Myocardial Infarction

56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.

Dr. Smith's ECG Blog

APRIL 14, 2024

No ischemia. Case continued Another ECG was recorded 3 hours later, still 1/10 pain: There is sinus bradycardia with RBBB. This is a conundrum, because it is clear that the patient is having an acute MI, the ECG is dynamic, but the pain is very mild and there is no ECG evidence of active transmural ischemia.

Chest Pain

Chest Pain Ischemia Myocardial Infarction Ultrasound

Ventricular Tachycardia Management

All About Cardiovascular System and Disorders

APRIL 17, 2024

Monomorphic ventricular tachycardia in the setting of acute myocardial ischemia can also be treated by intravenous lignocaine bolus followed by infusion. Predisposing causes for ventricular tachycardia like ischemia and electrolyte imbalance has to be treated simultaneously to prevent recurrence.

Tachycardia

Tachycardia Defibrillator Congenital Ischemia

7 steps to missing posterior Occlusion MI, and how to avoid them

Dr. Smith's ECG Blog

JANUARY 3, 2022

Sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. 2] Here there is no posterior ST elevation, but the anterior ST depression is also less—so it is dynamic, confirming acute ischemia. What do you think? But it is still STEMI negative.

STEMI

STEMI Myocardial Infarction Chest Pain Ischemia

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Chest pain and anterior ST depression. What’s the cause(s)?

Dr. Smith's ECG Blog

OCTOBER 13, 2022

WPW, previous Q wave MI, and acute coronary occlusion Depending on the location of the accessory pathway, WPW pattern can mimic ventricular hypertrophy (including RVH or LVH) or myocardial infarction (including anterior, inferior, lateral or posterior MI) [1]. Wolff-Parkinson-White syndrome ‘cured’ by myocardial infarction?

Chest Pain

Chest Pain Myocardial Infarction Ischemia STEMI

A female in her 60s who was lucky to get expert ECG interpretation

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. I had no history on the case and no prior ECG for comparison. What do you think? The T-wave in lead III is slightly tall and broad (increased area under the curve) compared to its QRS complex.

Chest Pain

Chest Pain Critical Care Article Pacemaker

Why do we NOT name Occlusion MI (OMI) after an EKG finding? (In contrast to STEMI, which is named after ST Elevation)

Dr. Smith's ECG Blog

JUNE 1, 2022

Here is his ECG: There is no clear evidence of OMI or ischemia. The Initial ECG in Today's Case: ECG #1 showed sinus bradycardia at a rate slightly under 60/minute — normal intervals — slight left axis ( about -15 degrees ) — and no chamber enlargement. A 40-something male with no previous cardiac disease presented with chest pain.

Chest Pain

Chest Pain STEMI Myocardial Infarction Bradycardia

12 Example Cases of Use of 3- and 4-variable formulas, plus Simplified Formula, to differentiate normal STE from subtle LAD occlusion

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation Myocardial Infarction. Patient presentation is important This was a 60-something with acute chest pain: There is sinus bradycardia at a rate of 44. In case you were wondering about the T-waves and bradycardia, the K was normal.

Chest Pain

Chest Pain STEMI Bradycardia Stenosis

Chest pain, and Cardiology didn't take the hint from the ICD

Dr. Smith's ECG Blog

JANUARY 23, 2023

Triage physician interpretation: -sinus bradycardia -lateral ST depressions While there are lateral ST depressions (V5, V6) the deepest ST depressions are in V4. Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia).

Chest Pain

Chest Pain Blog Stenosis Myocardial Infarction

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

OCTOBER 7, 2019

Both of these features make inferior + RV MI by far the most likely ( Pseudoanteroseptal MI is another name for this ) There is also sinus bradycardia and t he patient is in shock with hypotension. A narrow complex bradycardia without any P-waves is also likely to respond to atropine, as it may be a junctional rhythm.

Bradycardia

Bradycardia STEMI Cardiogenic Shock Ischemia

46 year old with chest pain develops a wide complex rhythm -- see many examples

Dr. Smith's ECG Blog

AUGUST 9, 2024

AIVR is not always the result of significant pathology, but is classically associated with the reperfusion phase of acute myocardial infarction. Similarly, the OMI paradigm respects ACS as a dynamic process in which ECG changes reflect the phase of myocardial injury and risk stratify which patients may benefit from emergent PCI.

Chest Pain

Chest Pain Arrhythmia Myocardial Infarction STEMI

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

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. Literature on Hypokalemia as a risk for ventricular fibrillation in acute myocardial infarction.

STEMI

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia

What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

JULY 21, 2024

Troponin T peaked at 38,398 ng/L ( = a very large myocardial infarction, but not massive-- thanks to the pre-PCI spontaneous reperfusion, and rapid internvention!! ). There is no definite evidence of acute ischemia. (ie, Some residual ischemia in the infarct border might still be present.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

Right Precordial T-wave Inversion

Dr. Smith's ECG Blog

DECEMBER 5, 2016

Description Sinus bradycardia. There is ST elevation in V2 and V3 There are inverted T-waves in V2 and V3 There are prominent U-waves in V2 and V3 Many responders were worried about ischemia or hypertrophic cardiomyopathy. This short QT at least makes ischemia all but impossible. There is high voltage. This is a normal variant.

Chest Pain

Chest Pain Ischemia Myocardial Infarction Bradycardia

Syncope and Block

EMS 12-Lead

JUNE 1, 2022

Such findings would normally suggest primary ischemia with concomitant surveillance of coronary occlusion, but these ST/T changes might very well be secondary to the Escape mechanism at hand. Comparison of the QRS complex, ST-segment, and T-wave among patients with left bundle branch block with and without acute myocardial infarction.

Heart Failure

Heart Failure Myocardial Infarction Bradycardia Chest Pain

85 year old with chest pain, STEMI negative, then normal troponin but with relatively large delta: discharge?

Dr. Smith's ECG Blog

MARCH 24, 2023

There’s sinus bradycardia, first degree AV block, normal axis, delayed R wave progression, and normal voltages. Hyperacute T waves are deflating, suggesting reperfusion but there is still reciprocal change in I/aVL and ST depression in V2, and the bradycardia is worse. Below is the ECG. What do you think? Take home 1. second ).

Chest Pain

Chest Pain STEMI Bradycardia Ischemia

A Middle-Aged male with Chest Pain and an Unusual ECG

Dr. Smith's ECG Blog

MAY 6, 2019

Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Ischemia/infarction. Bradycardia. Hypothermia.

Chest Pain

Chest Pain STEMI Ischemia Myocardial Infarction

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

APRIL 8, 2015

Evidence of acute ischemia (may be subtle) vii. 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). Old myocardial infarction, 6. Left BBB vi. Pathologic Q-waves viii.

Arrhythmia

Arrhythmia Outcomes Chest Pain Risk Factors

Is it possible that this patient with acute chest pain and this ECG does not need emergent intervention?

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. Prevalence and outcome of patients with non-ST segment elevation myocardial infarction with occluded culprit artery - a systemic review and meta-analysis.

Chest Pain

Chest Pain STEMI Stents Stent

Unconscious + STEMI criteria: activate the cath lab?

Dr. Smith's ECG Blog

JANUARY 21, 2023

This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Clinical questions : Is this an occlusion myocardial infarction and does the patient need the cath lab? What do you think? Pacing Clin Electrophysiol.

STEMI

STEMI Bradycardia Arrhythmia Cardiac Arrest

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

Dr. Smith's ECG Blog

MARCH 8, 2025

Within ten minutes, she developed bradycardia, hypotension, and ST changes on monitor. If this were OMI, I would favor proximal RCA culprit (since that commonly produces inferolateral changes and occasionally produces anterior HATW from RV infarct ), but LAD is also possible. Bradycardia and heart block are very common in RCA OMI.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Cardiovascular Update

56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.

Ventricular Tachycardia Management

7 steps to missing posterior Occlusion MI, and how to avoid them

Webinars

Chest pain and anterior ST depression. What’s the cause(s)?

A female in her 60s who was lucky to get expert ECG interpretation

Why do we NOT name Occlusion MI (OMI) after an EKG finding? (In contrast to STEMI, which is named after ST Elevation)

12 Example Cases of Use of 3- and 4-variable formulas, plus Simplified Formula, to differentiate normal STE from subtle LAD occlusion

Chest pain, and Cardiology didn't take the hint from the ICD

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

46 year old with chest pain develops a wide complex rhythm -- see many examples

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

What are treatment options for this rhythm, when all else fails?

Right Precordial T-wave Inversion

Syncope and Block

85 year old with chest pain, STEMI negative, then normal troponin but with relatively large delta: discharge?

A Middle-Aged male with Chest Pain and an Unusual ECG

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Is it possible that this patient with acute chest pain and this ECG does not need emergent intervention?

Unconscious + STEMI criteria: activate the cath lab?

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

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