Dr. Smith's ECG Blog

APRIL 2, 2024

I was there and said, "No, I think this is all due to severe chronic cardiomyopathy and cardiac arrest due to primary ventricular fibrillation, not due to ACS." _ Why did I say that? Here is the troponin profile overnight: This is consistent with cardiac arrest without acute coronary occlusion. l/min cardiac output.

Tachycardia 132

Tachycardia Pacemaker Cardiac Arrest Cardiomyopathy 132

Med Page Today

AUGUST 27, 2024

(MedPage Today) -- FDA alerted to Inari Medical's recall of instructions for use (IFU) of the ClotTriever XL catheter, 30 mm, following reports of injury and death due to entrapped devices or pulmonary emboli. A 3-month physical activity intervention.

Cardiac Arrest 52

Cardiac Arrest Cholesterol Pulmonary 52

Journal of the American Heart Association

DECEMBER 20, 2024

Cardiogenic shock after outofhospital cardiac arrest (OHCA) can be due to transient myocardial stunning but also reflect the increasing severity of ongoing heart failure. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed a division of cardiogenic shock into 5 phenotypes, with cardiac arrest being a modifier.

Cardiac Arrest 45

Cardiac Arrest Cardiogenic Shock Hospital Myocardial Infarction 45

Frontiers in Cardiovascular Medicine

DECEMBER 20, 2023

Massive pulmonary embolism (MPE) carries significant 30-day mortality and is characterized by acute right ventricular failure, hypotension, and hypoxia, leading to cardiovascular collapse and cardiac arrest.

Embolism 56

Embolism Pulmonary Cardiac Arrest Hemorrhage 56

MIBHS

OCTOBER 31, 2024

Chronic Pulmonary Disease Lung diseases like chronic obstructive pulmonary disease (COPD) can lead to pulmonary hypertension, which in turn can cause the right side of the heart to enlarge, a condition known as cor pulmonale.

Blood Pressure 52

Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

Frontiers in Cardiovascular Medicine

MAY 12, 2024

BackgroundAcute pulmonary embolism (APE) is a common and potentially fatal cardiovascular disease that can lead to sudden cardiac arrest in severe cases. For patients with concurrent main pulmonary artery embolism and bleeding, balloon pulmonary angioplasty may be an option.

Embolism 40

Embolism Pulmonary Hemorrhage Cardiac Arrest 40

Circulation

NOVEMBER 28, 2023

The critical care management of patients after cardiac arrest is burdened by a lack of high-quality clinical studies and the resultant lack of high-certainty evidence. Critical care management is crucial in patients after cardiac arrest and affects outcome. Voting was anonymous and web based.

Critical Care Management 40

Critical Care Management Critical Care Cardiac Arrest Nursing 40

EMS 12-Lead

MARCH 30, 2024

This false electrical capture may have made cardiac arrest recognition difficult, and the re-arrest may have gone unrecognized for an unknown amount of time. The receiving staff suspects pulmonary embolism due to S1Q3T3 on the ECG and administers TPA. On ED arrival ROSC is achieved.

Cardiac Arrest 124

Cardiac Arrest Pacemaker Pulmonary Bradycardia 124

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

and the patient was converted to veno-venous (V-V) ECMO due to persistent pulmonary insufficiency. Clinically — despite an initial 2-fold increased troponin, the normal bedside Echo was reassuring against OMI or pulmonary embolism. He remained supported on an intraaortic balloon pump. Here they are: Learning Points: 1.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

ECG Cases

OCTOBER 18, 2021

The post EM Quick Hits 33 Polytrauma Tips & Tricks, Toxic Megacolon, ECG in PE, Patch Calls, CT Before LP, Nebulized Ketamine appeared first on Emergency Medicine Cases.

Cardiac Arrest 52

Cardiac Arrest Embolism Pulmonary Ultrasound 52

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 prompted cath lab activation. On arrival to the ED, this ECG was recorded: What do you think?

Cardiac Arrest 109

Cardiac Arrest STEMI Ischemia SCAD 109

European Journal of Heart Failure

DECEMBER 13, 2023

Patients with significant pulmonary oedema or aortic valve (AV) closure during venoarterial extracorporeal membrane oxygenation (VA-ECMO) were randomized to early left ventricular (LV) unloading or conventional strategy groups (1:1). The primary endpoint was the rate of weaning from VA-ECMO during index admission. vs. 1.7 ± 0.6

Aortic valve 75

Aortic valve Cardiac Arrest Pulmonary Heart Transplant 75

Circulation: Cardiovascular Interventions

JANUARY 20, 2025

BACKGROUND:The aim of this study was to examine the impact of early versus delayed catheter-based therapies (CBTs) on clinical outcomes in patients with acute intermediate-risk pulmonary embolism (PE).METHODS:This Secondary outcomes included a composite of 30-day mortality, resuscitated cardiac arrest, and hemodynamic instability.

Embolism 40

Embolism Pulmonary Outcomes Cardiac Arrest 40

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

JANUARY 2, 2025

Bedside cardiac ultrasound showed moderately decreased LV function. CT of the chest showed no pulmonary embolism but bibasilar infiltrates. See this post: How a pause can cause cardiac arrest 2. She was intubated. The plan: 1. Place temporary pacemaker 3. Discontinue amiodarone, since it prolongs the QT 4.

Tachycardia 116

Tachycardia Cardiomyopathy Blog Bradycardia 116

Ken Grauer, MD

JULY 9, 2023

Blood was drawn , and the patient was promptly placed in a room to be seen — but on entering, the ED physician found her unresponsive in cardiac arrest. Do you see any indication on this ECG of WHY this patient was about to arrest? Is there any indication on this ECG of WHY this patient shortly after had a cardiac arrest?

Blog 78

Blog Cardiac Arrest Pulmonary AFIB 78

Dr. Smith's ECG Blog

JANUARY 8, 2024

Smith interpretation: This is highly likely to be due to extreme right heart strain and is nearly diagnostic of pulmonary embolism. What is the clear diagnosis and reason for arrest? It is of course pulmonary embolism. No d-dimer or CT pulmonary angiogram was done when they discovered that she had normal coronary arteries.

Chest Pain 71

Chest Pain Pulmonary Embolism STEMI 71

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. Cardiac Motion Alternans — is the result of cardiac movement rather than electrical alternation.

Tachycardia 130

Tachycardia Cardiac Arrest ICU Blog 130

Ken Grauer, MD

JUNE 6, 2023

I've previously discussed the interesting correlation of a qR pattern in lead V1 in patients with RVH — as strongly suggesting associated pulmonary hypertension ( See ECG Blog #234 and Blog #248 ). Unfortunately — the patient abruptly developed hypoxemia, followed by cardiac arrest with PEA. He could not be resuscitated.

Blog 78

Blog Pulmonary Hypertension Aortic 78

Circulation

NOVEMBER 11, 2024

This case highlights such a scenario.Case:A 75-year-old female with a history of cardiac arrest 30 years ago presented with shortness of breath and left leg swelling. She experienced massive hemoptysis, leading to respiratory and cardiac arrest, but was resuscitated. Bronchoscopy revealed clots in the left lower lobe.

Defibrillator 40

Defibrillator Cardiac Arrest Sudden Cardiac Death Coronary Angiogram 40

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Smith comment: before reading anything else, this case screamed pulmonary embolism to me. I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram.

Chest Pain 73

Chest Pain STEMI Pulmonary Embolism 73

Dr. Smith's ECG Blog

APRIL 8, 2016

Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. If cardiac arrest from hypokalemia is imminent (i.e., As I indicated above, in our cardiac arrest case, after pushing 40 mEq, the K only went up to 4.2 He appeared to be in shock. mEq/L, from 1.9

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 4, 2021

The patient was slightly tachypneic and mildly hypoxic in the stabilization room and therefore the physicians obtained a CT pulmonary angiogram as well as aortogram to rule out dissection and PE. The initial Abbott hs troponin I returned at 52 ng/L (Upper reference limit for males is less than or equal to 34 ng/L). (Our

Ischemia 40

Ischemia Pulmonary STEMI Chest Pain 40

Dr. Smith's ECG Blog

DECEMBER 15, 2015

It makes pulmonary embolism (PE) very likely. The small LV implies very low LV filling pressures, which implies low pulmonary venous pressure. First, what kind of arrest was this? It was a PEA or bradyasystolic arrest , not a shockable rhythm. Possible, but huge pulmonary embolism is more likely. What is going on?

STEMI 40

STEMI Embolism Pulmonary Ultrasound 40

Cardiometabolic Health Congress

JULY 17, 2024

February 2024 FDA Approvals: Innovations in Cardiovascular Interventions XACT Carotid Stent System (Approved: 02/07/2024) This approval expands the indications to be used during a Transcarotid Artery Revascularization (TCAR) procedure to prevent future strokes.

Tricuspid 59

Tricuspid Open-Heart Surgery Kidney Disease Pediatrics 59

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Compared with 2012‐2014, the 2015‐2019 cohort showed increased odds of ICH and shock while the odds of DVT, pulmonary embolism, pneumonia, and UTI were significantly lower. Odds of a mild disability outcome increased from 16% to 20%, OR 0.65 (0.57, 0.74), while mortality decreased from 15% to 12%, OR 0.69 (0.61, 0.78).

Stroke 40

Stroke Strokes Cardiac Arrest Inpatient 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

However, AKI patients had higher rates of deep vein thrombosis (6.36% vs. 3.54%, p < 0.01), pulmonary embolism (4.22% vs. 1.42%, p < 0.01), pneumonia (21.39% vs. 8.84%, p < 0.01), urinary tract infection (19.07% vs. 13.32%, p < 0.01), sepsis (20.27% vs. 4.18%, p < 0.01), acute myocardial infarction (12.14% vs. 3.21%, (..)

Hemorrhage 40

Hemorrhage Aneurysm Cardiac Arrest Myocardial Infarction 40

All About Cardiovascular System and Disorders

OCTOBER 25, 2023

CABANA Trial randomized 2204 patients with AF aged 65 years or more and those below 65 years with one or more risk factors for stroke for catheter ablation with pulmonary vein ablation or drug therapy with rate or rhythm control. Among the subjects of CABANA trial 35% had NYHA class above II at baseline. 2019 Apr 2;321(13):1261-1274.

Atrial Fibrillation 52

Atrial Fibrillation Heart Failure Ablation Cardiac Arrest 52

Dr. Smith's ECG Blog

MAY 19, 2020

I suspect this is Type 2 MI due to prolonged severe hypotension from cardiac arrest. pulmonary embolism, sepsis, etc.), PEARL: In my experience, cardiac rhythms observed during ( or shortly after ) cardiac arrest do not obey the usual rules for AV blocks and escape rhythms. myocarditis).

Defibrillator 52

Defibrillator Circulation Plaque Cardiac Arrest 52

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. These are the conditions which have to be considered or excluded as they can sometimes manifest Brugada pattern on ECG.

Sudden Cardiac Death 52

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

Dr. Smith's ECG Blog

JULY 27, 2023

The estimated pulmonary artery systolic pressure is 29 mmHg + RA pressure. Conclusion: Type II MI probable due to hypoxia and tachycardia from resp arrest and amphetamine use. SUMMARY Normal left ventricular cavity size. Normal estimated left ventricular ejection fraction. No wall motion abnormality.

Tachycardia 52

Tachycardia Ischemia Cardiac Arrest Echocardiogram 52

Dr. Smith's ECG Blog

APRIL 15, 2019

If a patient presents with chest pain and a normal heart rate, or with shockable cardiac arrest, then ischemic appearing ST elevation is STEMI until proven otherwise. The estimated pulmonary artery systolic pressure is 37 mmHg + RA pressure. Normal estimated left ventricular ejection fraction lower limits of normal.

Tachycardia 40

Tachycardia STEMI Chest Pain Ischemia 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Conduction and refractoriness alternans may be seen with WPW-related as well as AV Nodal-dependent reentr y tachycardias — atrial fibrillation — acute pulmonary embolus — myocardial contusion — and severe LV dysfunction. Cardiac Motion Alternans — is the result of cardiac movement rather than electrical alternation.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Circulation: Heart Failure

MARCH 5, 2025

During the hospitalization, they had higher rates of renal failure, pulmonary artery catheter use, and mechanical circulatory support use. This was consistent across subgroups of CS cause, age, sex, hospital location, mechanical circulatory support use, and presence of cardiac arrest.

Cardiogenic Shock 56

Cardiogenic Shock Hospital Outcomes Myocardial Infarction 56

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. she had severe pulmonary edema. More cases here to highlight: [link] Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?

STEMI 88

STEMI Hemorrhage Cardiac Arrest Tachycardia 88

Frontiers in Cardiovascular Medicine

JANUARY 6, 2025

The higher the RAR index, the higher the mortality.

Cardiac Arrest 52

Cardiac Arrest Risk Factors Pulmonary Research 52

Dr. Smith's ECG Blog

APRIL 9, 2025

Chest X-ray also showed pulmonary edema. 1) as far as I can tell, there is very little data on amiodarone for this indication 2) amiodarone has beta blockade effects which could be deleterious in a patient with large anterior MI with pulmonary edema and at risk for cardiogenic shock (and she did go into shock. Potassium was 4.5

Defibrillator 61

Defibrillator Cardiac Arrest Myocardial Infarction STEMI 61