Bradycardia and Stenosis - Cardiovascular Update

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

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

Dr. Smith's ECG Blog

JULY 21, 2024

Angiography : LMCA — 90-99% osteal stenosis. LCx — 50-69% stenosis of the 1st marginal branch; with 100% distal LCx occlusion. There was no evidence bradycardia leading up to the runs of PMVT ( as tends to occur with Torsades ). The image shows the impella device in place. RCA — 100% proximal occlussion.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

A woman in her 50s with multiple episodes of syncope

Dr. Smith's ECG Blog

JUNE 27, 2024

EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. Limiting one's interpretation to marked bradycardia with high-grade AV block in need of pacing in this patient with multiple syncopal epiosodes — more than suffices for "the quick answer".

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Head Up Tilt Test (HUTT)

All About Cardiovascular System and Disorders

MARCH 23, 2024

In usual syncope, there could be a fall in blood pressure, bradycardia, and there are various types, which will be described. The most common is mixed type, in which, in the tilted position, the person develops both bradycardia and hypotension and usually there is a syncope. Various types of responses can occur to head up tilt test.

Blood Pressure

Blood Pressure Bradycardia POTS Tachycardia

Carotid Artery Stenting for Heavily Calcified Lesions Using a Scoring Balloon: A Report of 2 Cases

Stroke: Vascular and Interventional Neurology

FEBRUARY 6, 2024

They had dense calcifications at the lesions, stenosis rates of 95% (near occlusion) and 86% according to the North American Symptomatic Carotid Endarterectomy Trial criteria, and calcification arcs of 270° and 360°, respectively. After postdilatation, the stenosis rates decreased to 21% and 23%, respectively.

Stents

Stents Stent Stenosis Bradycardia

Abstract 4134483: How succesfully can we presribe the 'four pillars' of medications for patients with heart failure with reduced LV systolic function?

Circulation

NOVEMBER 11, 2024

Reasons for not prescibing or discontinuing were: CKD 6, severe aortic stenosis 5, asthma 3, symptomatic bradycardia 5, hypotension 3, type1 diabetes 2, syncope 1, Raynauds 1, patient choice 8 and 6 patients died before all appropriate medications could be initiated. In 10 cases no clinical reason could be identified.It

Heart Failure

Heart Failure Outpatient Bradycardia Nursing

A man with chest pain off and on for two days, and "No STEMI" at triage.

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. The Queen of Hearts agrees: Around this time his initial high sensitivity troponin I resulted at 231 ng/L.

Chest Pain

Chest Pain STEMI Cardiogenic Shock Bradycardia

Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

Dr. Smith's ECG Blog

OCTOBER 15, 2024

Angiography revealed a 30% nonobstructive stenosis of the mid LAD. He had multiple episodes of bradycardia and nonsustained ventricular tachycardia. There was a 70% culprit stenosis of the first obtuse marginal branch in a right dominant system. Serial high sensitivity troponin T (URL 15 ng/L) values were negative and stagnant.

Chest Pain

Chest Pain STEMI Echocardiogram Stents

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Below is a still image with the red arrow indicating the subtotal LMCA stenosis. 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 video below shows the coronary angiography. Pressors could gradually be tapered within 24 hours.

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

A Middle Aged Male diagnosed with Gastroesophageal Reflux

Dr. Smith's ECG Blog

JULY 16, 2022

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. Here is the old ECG from 6 years prior: Notice the inferior T-waves have normal size here.

Chest Pain

Chest Pain Bradycardia Blog Critical Care

Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Dr. Smith's ECG Blog

JANUARY 5, 2024

The ECG shows sinus bradycardia but is otherwise normal. The LAD has diffuse disease with a few areas of moderate stenosis but no flow-limiting lesions. Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The following ECG was obtained.

Angina

Angina Plaque Document Stents

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

Angiogram showed a critical LAD thrombotic stenosis. The patient went to cath and had a distal LAD 99% stenosis with thrombus and TIMI-2 flow. Patient presentation is important This was a 60-something with acute chest pain: There is sinus bradycardia at a rate of 44. Why bradycardia? He underwent CABG. Peak was 8.1

Chest Pain

Chest Pain STEMI Bradycardia Stenosis

Inferior Subtle ST elevation: straight ST segment, but also no reciprocal ST depression in aVL: which is more important?

Dr. Smith's ECG Blog

JUNE 28, 2019

The cath lab was activated: Result: Thrombotic 95% stenosis at the ostium of a small LPL2 with 70% stenosis at the LPL2/LPDA bifurcation in the distal/AV groove Cx Tubular 70% stenosis in the mid-circumflex. (In This is sinus bradycardia. There was concern for aortic dissection, so a CT was done and was negative.

Chest Pain

Chest Pain Pericarditis Stents Stent

Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter's T-waves on prehospital ECG??

Dr. Smith's ECG Blog

JANUARY 28, 2018

Here is his previous ECG: This was my interpretation of the first ECG: Sinus bradycardia with less than 1mm ST elevation in V4-V6, elevated compared to the previous ECG, suggestive of lateral MI. There is evidence that de Winter's T-waves really represent a tiny trickle of blood through the thrombotic stenosis.

Pericarditis

Pericarditis Ischemia STEMI Chest Pain

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

MAY 19, 2020

There is sinus bradycardia with one PVC. distal stenosis or occluded small branches), and 3) nonischemic causes for myocyte injury (e.g., She then had a 12-lead: What do you think? The diagnosis of MINOCA should exclude: 1) other overt causes for elevated troponin (e.g., pulmonary embolism, sepsis, etc.), myocarditis).

Defibrillator

Defibrillator Circulation Plaque Cardiac Arrest

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. 90% stenosis of the proximal ramus intermedius, pre procedure TIMI II flow The ramus intermedius is a normal variant on coronary anatomy that arises between the LAD and LCX.

Chest Pain

Chest Pain Blog Stenosis Myocardial Infarction

Diffuse ST depression, and ST elevation in aVR. Left main, right?

Dr. Smith's ECG Blog

MARCH 2, 2019

found that such ECG findings only represented left main ACS in 14% of such ECGs: Only 23% of patients with the aVR STE pattern had any LM disease (fewer if defined as 50% stenosis). 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.

Sickle Cell Disease

Sickle Cell Disease Ischemia Dysrhythmia Chest Pain

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

Dr. Smith's ECG Blog

APRIL 15, 2019

I said I think there is a fixed stenosis in the LAD and the tachycardia and stress caused a type 2 STEMI. In this abstract from 2011, we found that 4%(4 of 99) type 2 MI and 38% of type 1 MI had ST Elevation. link] An angiogram was done: It showed no culprit and no coronary disease, but did show a myocardial bridge in the mid LAD.

Tachycardia

Tachycardia STEMI Chest Pain Ischemia

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

Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. 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). heart auscultation (aortic stenosis); c.

Arrhythmia

Arrhythmia Outcomes Risk Factors Chest Pain

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

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

A woman in her 50s with multiple episodes of syncope

Webinars

Head Up Tilt Test (HUTT)

Carotid Artery Stenting for Heavily Calcified Lesions Using a Scoring Balloon: A Report of 2 Cases

Abstract 4134483: How succesfully can we presribe the 'four pillars' of medications for patients with heart failure with reduced LV systolic function?

A man with chest pain off and on for two days, and "No STEMI" at triage.

Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

A Middle Aged Male diagnosed with Gastroesophageal Reflux

Three normal high sensitivity troponins over 4 hours with a "normal ECG"

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

Inferior Subtle ST elevation: straight ST segment, but also no reciprocal ST depression in aVL: which is more important?

Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter's T-waves on prehospital ECG??

1 hour of CPR, then ECMO circulation, then successful defibrillation.

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

Diffuse ST depression, and ST elevation in aVR. Left main, right?

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

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

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