Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

Although one may have all kinds of ischemic findings as a result of cardiac arrest (rather than cause of cardiac arrest), this degree of ST elevation and HATW is all but diagnostic of acute proximal LAD occlusion. This rules out subendocardial ischemia and is diagnostic of posterior OMI. V4-5 continue to show STD.

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Cardiac Arrest STEMI Ischemia SCAD 110

Dr. Smith's ECG Blog

OCTOBER 4, 2010

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. ACS would be highly unusual in a young athlete, and given the information on his race bib, one must first suspect that the abnormal ST elevation is due to demand ischemia, not ACS. This young male had ventricular fibrillation during a triathlon.

Cardiac Arrest 52

Cardiac Arrest Ischemia Stenosis STEMI 52

Dr. Smith's ECG Blog

APRIL 29, 2020

A 60-something woman presented after a witnessed cardiac arrest. She was never defibrillated. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. Cardiac cath showed minimal disease. She recovered.

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Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. In terms of ischemia, there is both a signal of subendocardial ischemia (STD max in V5-V6 with reciprocal STE in aVR) AND a signal of transmural infarction of the inferior wall with Q wave and STE in lead III with reciprocal STD in I and aVL.

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Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

JUNE 21, 2023

You can subscribe for news and early access (via participating in our studies) to the Queen of Hearts here: [link] queen-form This EMS ECG was transmitted to the nearby Emergency Department where it was remotely reviewed by a physician, who interpreted it as normal, or at least without any features of ischemia or STEMI.

Chest Pain 98

Chest Pain Cardiac Arrest STEMI Defibrillator 98

Dr. Smith's ECG Blog

JANUARY 2, 2025

See this post: How a pause can cause cardiac arrest 2. It should be kept in mind that on occasions, beta-one agonist can result in increased ventricular ectopy e.g., in severe myocardial ischemia (by increasing myocardial demand), or sometimes with congenital long-QT syndrome. The plan: 1. Place temporary pacemaker 3.

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Tachycardia Cardiomyopathy Blog Bradycardia 116

MIBHS

OCTOBER 31, 2024

This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Implantable Cardioverter-Defibrillator (ICD) to help manage dangerous heart rhythms. Cardiac Arrest or Sudden Death: Cardiomegaly increases the risk of life-threatening arrhythmias, which can cause sudden cardiac arrest.

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Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?

Cardiogenic Shock 129

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 129

Dr. Smith's ECG Blog

JULY 21, 2024

He required multiple defibrillations within a period of a few hours. There is no definite evidence of acute ischemia. (ie, This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. Some residual ischemia in the infarct border might still be present.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. She was successfully revived after several rounds of ACLS including defibrillation and amiodarone.

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Tachycardia Cardiac Arrest ICU Blog 131

Dr. Smith's ECG Blog

DECEMBER 23, 2014

None of these findings are diagnostic of ischemia, but they should give you a high index of suspicion and prompt serial ECGs at a minimum. The patient was diagnosed with esophageal reflux and was being discharged by the nurse when he had a cardiac arrest. He was defibrillated. Ischemia comes and goes.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia STEMI 52

Dr. Smith's ECG Blog

APRIL 8, 2016

At cath, he immediately had incessant Torsades de Pointes requiring defibrillation 7 times and requiring placement of a transvenous pacer for overdrive pacing at a rate of 80. If there is polymorphic VT with a long QT on the baseline ECG, then generally we call that Torsades, but Non-Torsades Polymorphic VT can result from ischemia alone.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. Perhaps the bifascicular block ( RBBB/LPHB ) present on ECG #1 — but which resolved by ECG #2 — was also ischemic-related from the cardiac arrest.

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Cardiac Arrest Bradycardia Chest Pain Ischemia 40

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. Cardioversion/defibrillation.

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

This ECG is all but diagnostic of subepicardial ischemia of the anterior, lateral, and inferior walls, most likely due to Occlusion MI (OMI), probably of the LAD. In the ambulance during transport, the patient suddenly suffered VF arrest. He was defibrillated immediately and had return of normal mental status.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Aneurysm 52

Dr. Smith's ECG Blog

OCTOBER 3, 2017

After the second defibrillation the patient had an organized rhythm: Bradycardic escape/agonal rhythm, with large ST deviations. This means that they occur shortly after onset of occlusion, but also may be the last remaining sign of ischemia after ST elevation resolves (after reperfusion).

Chest Pain 52

Chest Pain STEMI Defibrillator Blog 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

Case submitted by Magnus Nossen MD from Norway, written by Pendell Meyers A man in his 50s with no pertinent medical history suffered a witnessed cardiac arrest. 12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC.

Ischemia 40

Ischemia Arrhythmia Defibrillator Chest Pain 40

Ken Grauer, MD

MARCH 23, 2023

She underwent cardiopulmonary resuscitation for VT/VFib — with ROSC ( R eturn O f S pontaneous C irculation ) following defibrillation and treatment with Epinephrine and Amiodarone. A series of cardiac arrhythmias were seen during the course of her resuscitation — including the interesting arrhythmia shown in the long lead II of Figure-1.

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Blog Tachycardia Arrhythmia Atrial Flutter 78

Dr. Smith's ECG Blog

JANUARY 30, 2019

In addition to a spontaneous or induced Brugada-1 ECG pattern, criteria for B rugada S yndrome require one or more of the following: History of cardiac arrest, of polymorphoic VT, or of non-vagal syncope — positive family history of sudden death at an early age — a similar ECG in close relatives.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. It is apparently fortunate that she had a cardiac arrest; otherwise, her ECG would have been ignored. Then they did an MRI: Patient underwent cardiac MRI on 10/4 that showed mildly reduced BiV systolic function. I need to innoculate you against the subsequent opinions below.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

DECEMBER 22, 2010

A 65 yo woman had felt ill for 36 hours, had seen her MD but without undergoing a cardiac evaluation. After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. Exact rhythm during arrest is uncertain. However, with widespread ST depression, this could also be due to diffuse subendocardial ischemia.

Cardiac Arrest 40

Cardiac Arrest Tachycardia STEMI Chest Pain 40

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

He was sent back to the waiting room, where he suffered a VF arrest. Defibrillation was performed, and ROSC was achieved. Smith comment: The patient was lucky to have a cardiac arrest. This distinction is further complicated because marked LVH may at times mask the ST-T wave changes of acute ischemia.

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Cardiac Arrest STEMI Blog Ischemia 87

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

The patient was unconscious BEFORE the cardiac arrest, at the same time that she had strong pulses. Therefore, cardiac arrest is NOT the etiology of the coma. More cases here to highlight: [link] Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab? OMI is a clinical diagnosis.

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STEMI Hemorrhage Cardiac Arrest Tachycardia 89