Dr. Smith's ECG Blog

OCTOBER 20, 2024

Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. This patient is actively dying from a left main coronary artery OMI and cardiac arrest from VT/VF or PEA is imminent!

Cardiogenic Shock 129

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 129

Journal of the American Heart Association

DECEMBER 20, 2024

BackgroundCardiogenic shock complicating acute myocardial infarction is associated with a high mortality rate. Cardiogenic shock after outofhospital cardiac arrest (OHCA) can be due to transient myocardial stunning but also reflect the increasing severity of ongoing heart failure.

Cardiac Arrest 45

Cardiac Arrest Cardiogenic Shock Hospital Myocardial Infarction 45

European Journal of Heart Failure

DECEMBER 13, 2023

Impella and venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with acute myocardial infarction-related cardiogenic shock (AMICS). Impella patients were older (34% vs. 13% >75 years, p  < 0.001) and less frequently presented after an out-of-hospital cardiac arrest (18% vs. 40%, p  < 0.001).

Cardiogenic Shock 40

Cardiogenic Shock Myocardial Infarction Cardiac Arrest Hospital 40

Journal of the American Heart Association

JANUARY 19, 2024

BackgroundVenoarterial extracorporeal membrane oxygenation (ECMO) provides full hemodynamic support for patients with cardiogenic shock, but optimal timing of ECMO initiation remains uncertain. Among 8619 patients (median, 56.7 women), the median duration from admission to ECMO initiation was 14 (5–32) hours. 1.36];P=0.004).

Cardiogenic Shock 40

Cardiogenic Shock Outcomes Cardiac Arrest Hospital 40

Frontiers in Cardiovascular Medicine

JULY 21, 2024

Data regarding the effectiveness and safety of invasive therapies such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) in this patient population remains controversial.

Embolism 59

Embolism Cardiogenic Shock Pulmonary Cardiac Arrest 59

Frontiers in Cardiovascular Medicine

JANUARY 15, 2024

Introduction The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (eCPR) has emerged as a treatment option for selected patients who are experiencing refractory cardiac arrest (CA).

Cardiogenic Shock 64

Cardiogenic Shock Cardiac Arrest BMI Coronary Artery Disease 64

Dr. Smith's ECG Blog

JULY 9, 2024

Written by Pendell Meyers A man in his 50s was found by his family in cardiac arrest of unknown duration. His family started CPR and called EMS, who arrived to find him in ventricular fibrillation. 15 minutes after EMS arrival, after at least 6 defibrillations, the patient achieved sustained ROSC.

Defibrillator 109

Defibrillator STEMI Cardiac Arrest Cardiogenic Shock 109

Dr. Smith's ECG Blog

MAY 3, 2024

Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock. Suffice it to say that, "The heart does whatever it will do when a patient is about to arrest".

Cardiogenic Shock 121

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 121

Dr. Smith's ECG Blog

JULY 14, 2010

She arrived comatose and in cardiogenic shock and the following ECG was recorded. Before EMS arrived, she had "seizure activity" and became unresponsive. She was defibrillated successfully from ventricular fibrillation and developed a perfusing rhythm. She was intubated.

Cardiac Arrest 52

Cardiac Arrest Cardiogenic Shock Chest Pain Defibrillator 52

Journal of Cardiothoracic Surgery

DECEMBER 29, 2024

Veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) is commonly used for patients with cardiac arrest, cardiogenic shock, or heart failure and is a life-saving technique. Computed tomography angiogr.

Cardiogenic Shock 40

Cardiogenic Shock Cardiac Arrest Heart Failure 40

DAIC

APRIL 8, 2024

milla1cf Mon, 04/08/2024 - 18:07 April 8, 2024 — Implantation of the Impella CP micro-axial flow pump in the hours after a heart attack significantly increased the rate of survival at six months among people suffering cardiogenic shock, according to a study presented at the American College of Cardiology ’s Annual Scientific Session.

Heart Attack 52

Heart Attack Heart attacks Cardiogenic Shock Catheterization Laboratory 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Lactate was 20, POC Cardiac US showed EF estimated at 30%, and formal echo showed EF of only 15%, and a normal RV. Assessment was severe sudden cardiogenic shock. Clinically — the patient was felt to be in cardiogenic shock. They recorded an EC G: New ST Elevation. What is it? There is STE in V2-V6.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

OCTOBER 8, 2024

About 45 minutes after the second EKG, the patient was found in cardiac arrest. A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. Later the next day, she went into cardiac arrest again. By the time I saw the repeat EKG, the patient was already in cardiac arrest.

Cardiac Arrest 115

Cardiac Arrest Myocardial Infarction STEMI Cardiogenic Shock 115

Circulation

NOVEMBER 11, 2024

The primary outcome was all-cause in-hospital mortality while secondary outcomes included acute kidney injury/hemodialysis (AKI/HD), cardiogenic shock, cardiac arrest, mechanical ventilation, length of stay, and total charges.Results:Among 1,557,344 HFpEF patients, 21,655 (1.4%) were on opioids chronically.

Preserved Ejection Fraction 40

Preserved Ejection Fraction Inpatient Cardiogenic Shock Heart Failure 40

Open Heart

JUNE 5, 2024

SMuRF-less patients were more likely to present with cardiac arrest (6.6% vs 50.8%, p<0.001) and were more likely to experience postprocedural cardiogenic shock (4.5% Mean age was similar for patients with and without SMuRFs (63 years), and fewer females were SMuRF-less (19.8% vs 25.4%, p<0.001).

Cardiogenic Shock 52

Cardiogenic Shock Myocardial Infarction Outcomes Coronary Artery Disease 52

Frontiers in Cardiovascular Medicine

DECEMBER 11, 2024

BackgroundPercutaneous extracorporeal membrane oxygenation (ECMO) is administered to pediatric patients with cardiogenic shock or cardiac arrest. The traditional method uses focal echocardiography to complete the left ventricular measurement.

Pediatrics 52

Pediatrics Cardiogenic Shock Cardiac Arrest Echocardiogram 52

Frontiers in Cardiovascular Medicine

OCTOBER 8, 2024

The primary outcome was 30-day MACE, including all-cause death, recurrent myocardial infarction, urgent target vessel revascularization, stroke, cardiogenic shock, and cardiac arrest (CA).

Chest Pain 52

Chest Pain Cardiogenic Shock Cardiac Arrest Myocardial Infarction 52

Circulation: Heart Failure

MARCH 8, 2024

A secondary analysis evaluated outcomes for severe HF hospitalizations (cardiogenic shock, cardiac arrest, and mechanical ventilation). Circulation: Heart Failure, Ahead of Print. of centers), 525 037 (18.3%) were admissions to ATCs (5.5% of centers), and 15 541 (0.5%) were transferred to ATCs.

Heart Failure 40

Heart Failure Cardiogenic Shock Outcomes Cardiac Arrest 40

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. LAD — 100% proximal occlusion; with 70-89% mid-vessel narrowing. LCx — 50-69% stenosis of the 1st marginal branch; with 100% distal LCx occlusion. RCA — 100% proximal occlussion.

Arrhythmia 128

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 128

Journal of the American Heart Association

JANUARY 16, 2025

Procedural intubation was associated with increased 30day death (OR, 4.79 [95% CI, 3.296.96];P&lt;0.01).

Cardiogenic Shock 40

Cardiogenic Shock Cardiac Arrest Outcomes 40

Circulation: Cardiovascular Interventions

FEBRUARY 20, 2024

NH-IMRangiowas calculated based on standard coronary angiographic views with 3-dimensional-modeling and computational analysis of the coronary flow.RESULTS:Overall, ECC (a composite of cardiovascular death, cardiogenic shock, acute heart failure, life-threatening arrhythmias, resuscitated cardiac arrest, left ventricular thrombus, post-ST-segment–elevation (..)

Myocardial Infarction 40

Myocardial Infarction STEMI Cardiogenic Shock Cardiac Arrest 40

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

About an hour later, he was then found on the floor in cardiac arrest in the ED. He underwent CPR and then was shocked out of VF. He was in cardiogenic shock requiring an impella for several days after cath. His initial troponin T was 15 ng/L (only two hours since pain onset). No further troponins were measured.

Chest Pain 52

Chest Pain Cardiac Arrest Cardiogenic Shock Heart Attack 52

Dr. Smith's ECG Blog

JUNE 11, 2021

But the lack of traditional Sgarbossa criteria is not reassuring enough for such high pretest probability (elderly patient with chest pain, out of hospital cardiac arrest and LBBB), and the Modified Sgarbossa Criteria confirms Occlusion MI in this case. But by this time the patient went into cardiogenic shock and passed away.

Chest Pain 52

Chest Pain Ischemia Cardiac Arrest Cardiogenic Shock 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

This pattern is essentially always accompanied by cardiogenic shock and high rates of VT/VF arrest, etc. The patient arrived to the ED in cardiogenic shock but awake. Plus recommendations from a 5-member panel on cardiac arrest. This one of the highest risk OMI patterns possible to see on an ECG.

Chest Pain 52

Chest Pain Cardiogenic Shock Tachycardia Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 8, 2023

The patient died of cardiogenic shock within 24 hours despite mechanical circulatory support. Smith: This bizarre ECG looks like a post cardiac arrest ECG with probable acidosis or hyperkalemia in addition to OMI. This patient at cath had a large CX occlusion with a massive troponin release. Troponin T >42.000ng/L.

Ischemia 116

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 116

Dr. Smith's ECG Blog

OCTOBER 17, 2024

There was 100% proximal LAD occlusion with TIMI 0 flow, and cardiac arrest in the cath lab. As often emphasized by Dr. Smith — sinus tachycardia is not a common finding with acute OMI unless something else is going on (ie, cardiogenic shock ). There is sinus tachycardia at ~100/minute.

Chest Pain 75

Chest Pain STEMI Pulmonary Embolism 75

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Thirty-six patients (36%) presented with cardiac arrest, and 78% (28/36) underwent emergent angiography. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? Knotts et al.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

EMS 12-Lead

JULY 24, 2023

Had such been the case, this patient would likely have been a prehospital cardiac arrest, or have been in profound cardiogenic shock at the time of ED arrival. Smith previously remarked, aVL and V2 ST-segments are often isoelectric. Ultimately, this was not acute coronary occlusion of the Left Main.

Angina 52

Angina Ischemia Coronary Angiogram Stenosis 52

Circulation

NOVEMBER 11, 2024

Regardless of CS type, Black patients were more likely to have cardiac arrest during hospitalization. Among AMI-CS hospitalizations, Black patients were less likely to receive IABP (aOR: 0.87, 95%CI: 0.82-0.93), 0.93), pLVAD (aOR: 0.79, 95%CI: 0.72-0.86), 0.86), PCI (aOR: 0.79, 95%CI: 0.75-0.84), 0.84), and CABG (aOR: 0.77, 95%CI: 0.71-0.83),

Myocardial Infarction 40

Myocardial Infarction Inpatient Cardiogenic Shock Cardiac Arrest 40

Circulation: Cardiovascular Quality & Outcomes

JANUARY 5, 2024

Admissions to CICUs with the highest tertile of CCRx utilization had a greater burden of comorbidities, had more diagnoses of ST–elevation myocardial infarction, cardiac arrest, or cardiogenic shock, and had higher Sequential Organ Failure Assessment scores. in low, intermediate, and high CCRx tertiles, respectively.

Critical Care 40

Critical Care Cardiogenic Shock Academic Cardiac Arrest 40

Dr. Smith's ECG Blog

JANUARY 11, 2025

See our other cases with similar patters, to burn this deep into your brain files: Smith : In my experience, these cases of LAD OMI with RBBB and LAFB are either about to arrest, post-arrest, and/or in cardiogenic shock. Plus recommendations from a 5-member panel on cardiac arrest.

Cardiogenic Shock 136

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest 136