Dr. Smith's ECG Blog

JULY 16, 2022

This middle aged male with h/o GERD but also h/o stents presented to the ED with chest pain. The computer called "Sinus Bradycardia" only (implying that everything else is normal. The overreading Cardiologist called it only "Sinus Bradycardia" with no other findings. The rhythm in Figure-1 is sinus bradycardia and arrhythmia.

Chest Pain 52

Chest Pain Bradycardia Blog Critical Care 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

Sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. It was a 60yo with a history of stents to the circumflex and right coronary arteries, who presented with 9 hours of fluctuating central chest pain. What do you think? But it is still STEMI negative.

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52

Dr. Smith's ECG Blog

JUNE 28, 2019

60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. It was stented. The patient had a p rior h istory of MI + stents. This is sinus bradycardia. More likely, these T waves probably reflect ischemia of uncertain age. Time zero What do you think? Pericarditis?

Chest Pain 52

Chest Pain Pericarditis Stents Stent 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. The patient was then taken to the cath lab an found to have a proximal RCA 100% thrombotic occlusion which was successfully stented. 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

NOVEMBER 3, 2017

After many hours, the decided that it was appropriate to do an angiogram and they found a distal LAD occlusion which was opened and stented. Patient presentation is important This was a 60-something with acute chest pain: There is sinus bradycardia at a rate of 44. Why bradycardia? It was stented. STE60V3 = 2.5

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

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 40

Bradycardia STEMI Cardiogenic Shock Ischemia 40

Dr. Smith's ECG Blog

OCTOBER 8, 2023

The patient was referred immediately for cath which revealed RCA occlusion that was stented. Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. There is ST depression in V1.

Ischemia 122

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 122

Dr. Smith's ECG Blog

JUNE 19, 2023

Soon afterward, the patient’s symptoms return along with lightheadedness, bradycardia, and hypotension. The patient has also developed sinus bradycardia, which may result from right coronary artery ischemia to the SA node. Two stents were placed with resultant TIMI 3 flow.

Chest Pain 52

Chest Pain STEMI Cardiogenic Shock Bradycardia 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. This was stented. The corrected QT interval is extremely long, about 500 ms.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

MARCH 19, 2025

Case submitted by Andrew Grimes, Advanced Care paramedic, with additions from Jesse McLaren and Smith An 84-year-old male with a notable cardiac history (CABG, multiple stents) woke at 0500hrs with pressure in his chest, diaphoresis, and light-headedness. He had a 100% RCA occlusion which was stented.

Chest Pain 116

Chest Pain STEMI Stents Stent 116

Dr. Smith's ECG Blog

APRIL 6, 2025

His rhythm on telemetry seemed to be sinus bradycardia vs junctional rhythm. There is Transmural ischemia of Occlusion MI. Spectral CT This spectral CT image really highlights the dense transmural ischemia of the posterior wall. Here you can also see that there is dense ischemia of the RV. What do you think?

Blood Pressure 111

Blood Pressure Cardiogenic Shock Ischemia Cardiac Arrest 111

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. After stent deployment, we often see improvement in the ST-T within seconds or minutes. Here is the final angiogram following placement of a stent in the ostial RCA.

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75