Dr. Smith's ECG Blog

OCTOBER 8, 2023

Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECG s that has not been overread by a physician. Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. The ECG does not show any signs of ischemia. There are also J-waves.

Ischemia 123

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 123

Dr. Smith's ECG Blog

MARCH 30, 2014

One of my most talented readers is a health care assistant (a nursing assistant) who has taken a keen interest in ECGs. There is a junctional bradycardia. Furthermore, there are T-wave changes in V2 and V3 which are highly suggestive of ischemia, but difficult to localize: anterior? And they teach me a lot. right ventricular?

Outcomes 52

Outcomes Cardiogenic Shock STEMI Chest Pain 52

EMS 12-Lead

JUNE 1, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith [link] @SmithECGblog A 72 y/o Male experiences a syncopal episode while seated. Lead V2 shows RR’ QRS configuration, and although ST depression is otherwise expected here, the discordance is a bit excessive.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

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. It would be difficult to get a nurse to give it faster! Is 40 mEq too much?

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52