Ken Grauer, MD

JUNE 27, 2024

He developed cardiac arrest shortly after the ECG in Figure-1 was recorded. IMPRESSION: Given the presence of a wide tachycardia — with 2 distinct QRS morphologies, and no sign of P waves — a presumed diagnosis of B i D irectional Ventricular Tachycardia has to be made. What is the most likely cause of this arrhythmia?

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Blog Cardiac Arrest Sudden Cardiac Death Tachycardia 160

HeartRhythm

AUGUST 27, 2024

With increased genetic testing, sudden cardiac arrest (SCA) survivors who carry variants in the cardiac ryanodine receptor (RYR2) gene but do not have the pathognomonic findings of catecholaminergic polymorphic ventricular tachycardia (CPVT) on exercise testing were identified.

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Cardiac Arrest Exercise Tachycardia 40

Dr. Smith's ECG Blog

APRIL 6, 2018

Written by Pendell Meyers, with edits by Steve Smith Thanks to my attending Nic Thompson who superbly led this resuscitation We received a call that a middle aged male in cardiac arrest was 5 minutes out. There is a regular, wide complex, (mostly) monomorphic tachycardia. He was estimated to be in his 50s, with no known PMHx.

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Cardiac Arrest Tachycardia Defibrillator ICU 52

HeartRhythm

JULY 29, 2024

For long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT), this stems both from prior guidelines that considered beta-blockers (a cornerstone of LQTS and CPVT treatment) to be a contraindication to allergen immunotherapy (AIT) and from hesitancy to use epinephrine during anaphylaxis, out of fear of triggering a LQTS- (..)

Cardiac Arrest 40

Cardiac Arrest Tachycardia 40

Circulation

OCTOBER 27, 2023

BACKGROUND:In severely affected patients with catecholaminergic polymorphic ventricular tachycardia, beta-blockers are often insufficiently protective. The primary end point was AEs, defined as sudden cardiac death, sudden cardiac arrest, appropriate implantable cardioverter defibrillator shock, and arrhythmic syncope.

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Tachycardia Sudden Cardiac Death Defibrillator Cardiac Arrest 40

Ken Grauer, MD

MARCH 23, 2023

What is the cardiac rhythm shown in the long lead II rhythm strip? Figure-1: The initial ECG in today’s case — obtained from an elderly woman following successful resuscitation from cardiac arrest. ( C ASE C onclusion : I lack detailed follow-up from today's case — other than knowing that the Atrial Tachycardia was controlled.

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Blog Tachycardia Arrhythmia Atrial Flutter 78

Dr. Smith's ECG Blog

JULY 24, 2018

We received 4 ECGs, including his baseline on file, and three from today, including triage, peri-arrest, and post-ROSC (sorry for the poor quality due to scanning). Prior ECG on file: Sinus tachycardia, imperfect baseline, otherwise unremarkable. Unfortunately, this was not recognized at this time.

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Cardiac Arrest Chest Pain Tachycardia ICU 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

This sinus tachycardia ( at ~130/minute ) — is consistent with the patient’s worsening clinical condition, with development of cardiogenic shock. Elevated troponin does not, however, guide any treatment strategies to minimize myocardial injury. The limb lead artifact ( from the “culprit” RA extremity ) had resolved.

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Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

HeartRhythm

SEPTEMBER 10, 2023

A few decades ago all sudden cardiac arrests with documented ventricular fibrillation (VF) and structurally normal hearts were diagnosed as idiopathic ventricular fibrillation (IVF).

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Electrocardiogram Sudden Cardiac Death Cardiac Arrest Document 40

Frontiers in Cardiovascular Medicine

DECEMBER 18, 2023

Cardiac sarcoidosis (CS), a rare condition characterized by non-caseating granulomas, can manifest with symptoms such as atrioventricular block and ventricular tachycardia (VT), as well as mimic inherited cardiomyopathies. A 48-year-old male presented with recurrent VT. Genetic testing identified a pathogenic mutation in PKP2.

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Cardiomyopathy Cardiac Arrest Electrophysiology Defibrillator 69

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?

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Blog Cardiac Arrest Pulmonary AFIB 78

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. T wave alternans is a harbinger of cardiac instability and TdP. (3) No ischemic ST changes.

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Tachycardia Cardiac Arrest ICU Blood Pressure 120

Ken Grauer, MD

JUNE 14, 2024

The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. The rhythm is regular — at a rate just over 100/minute = sinus tachycardia ( ie, the R-R interval is just under 3 large boxes in duration ). Should you activate the cath lab?

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Blog STEMI Cardiac Arrest Tachycardia 135

Dr. Smith's ECG Blog

APRIL 15, 2019

Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. 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.

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Tachycardia STEMI Chest Pain Ischemia 52

Wellnest

DECEMBER 21, 2022

A fast heartbeat is called tachycardia, while a slow heartbeat is called bradycardia in medical terms. Cardiac arrest Cardiac arrest is a medical emergency in which the heart stops pumping blood to the body. Electrocardiogram, echocardiogram, and some other tests are done for patients with cardiac arrest.

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Wellnest

JUNE 19, 2023

Similarly, you may use our , app to adjust the paper speed along with amplification to read the slightest changes, especially for conditions like tachycardia and bradycardia. AI recognizing cardiac arrests in emergency calls. Recently, hospitals have failed to identify 25% of cases of cardiac arrest.

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Dr. Smith's ECG Blog

NOVEMBER 11, 2022

There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!) Plus recommendations from a 5-member panel on cardiac arrest. This feature is invaluable for assessing QRS morphology with wide tachycardias in the differentiation between SVT vs VT rhythms.

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Dr. Smith's ECG Blog

NOVEMBER 30, 2019

Is it ventricular tachycardia (VT) due to hyperK or is it a supraventricular rhythm with hyperK? Here are other posts on hyperK, large calcium doses for hyperK, and ventricular tachycardia in hyperK Weakness, prolonged PR interval, wide complex, ventricular tachycardia Very Wide and Very Fast, What is it? How would you treat?

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Dr. Smith's ECG Blog

FEBRUARY 27, 2023

Descriptive analysis of the ECG in today's case reveals a regular, narrow tachycardia at ~130/minute , without clear sign of sinus P waves. But the rate is ~130/minute — which is a bit fast for sinus tachycardia. So IF this is sinus tachycardia with a sinoventricular rhythm — then we have to explain WHY the rate is this fast.

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Dr. Smith's ECG Blog

JULY 21, 2024

This progressed to electrical storm , with incessant PolyMorphic Ventricular Tachycardia ( PMVT ) and recurrent episodes of Ventricular Fibrillation ( VFib ). The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker. He required multiple defibrillations within a period of a few hours.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 112

Dr. Smith's ECG Blog

JULY 27, 2023

His prehospital ECG showed "inferior" ST depression and high voltage, with tachycardia. I suspected no OMI, that this could be due to LVH plus tachycardia. Conclusion: Type II MI probable due to hypoxia and tachycardia from resp arrest and amphetamine use. On arrival to the ED, the patient was diaphoretic, tachycardic.

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Tachycardia Ischemia Cardiac Arrest Echocardiogram 52

Dr. Smith's ECG Blog

APRIL 29, 2020

A 60-something woman presented after a witnessed cardiac arrest. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. Final Diagnosis: Cardiac Arrest due to Torsades from long QT of unknown etiology.

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Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

He had multiple cardiac arrests with ROSC regained each time. Then there is loss of pulses with continued narrow complex on the monitor ("PEA arrest") Learning Points: Sudden witnessed Cardiac Arrest due to ACS is almost always due to dysrhythmia. This patient arrested shortly after hospital arrival.

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Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

Here is his 12-lead: There is a wide complex tachycardia with a rate of 257, with RBBB and LPFB (right axis deviation) morphology. Read about Fascicular VT here: Idiopathic Ventricular Tachycardias for the EM Physician Case Continued He was completely stable, so adenosine was administered. See Learning point 1 below. Arch Intern Med.

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Tachycardia Heart Disease Ablation Dysrhythmia 52

EMS 12-Lead

JULY 24, 2023

Category 2 : An increase in myocardial oxygen demand due to tachycardia, elevated ventricular afterload (BP or aortic stenosis), or increased wall stretch (admittedly this latter is more complicated) or a decrease in oxygen supply due to hypotension, anemia, hypoxia, or a combination of all of the above. This results in Type I MI.

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Angina Ischemia Coronary Angiogram Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Thirty-six patients (36%) presented with cardiac arrest, and 78% (28/36) underwent emergent angiography. Systematic Assessment of the ECG in Figure-1: My Descriptive Analysis of ECG findings in Figure-1 is as follows: Sinus tachycardia at ~110/minute. Results Emergent angiography was performed in 80% (79/99) of patients.

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Ischemia STEMI Stenosis Coronary Artery Disease 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

The relationship between J wave and ventricular tachycardia during Takotsubo cardiomyopathy. The final letter in the SLOWED mnemonic is " D " for "Dead" ( resulting from VT/VF or asystolic cardiac arrest ). Occurrence of “J Waves” in 12-Lead ECG as a Marker of Acute Ischemia and Their Cellular Basis.

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STEMI Bradycardia Arrhythmia Cardiac Arrest 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

The ECG shows sinus tachycardia, a narrow, low voltage QRS with alternating amplitudes, no peaked T waves, no QT prolongation, and some minimal ST elevation in II, III, and aVF (without significant reciprocal STD or T wave inversion in aVL). It is difficult to tell if there is collapse during diastole due to the patient’s tachycardia.

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Pericarditis Tachycardia Ultrasound Blood Pressure 52

Dr. Smith's ECG Blog

OCTOBER 8, 2023

Smith: This bizarre ECG looks like a post cardiac arrest ECG with probable acidosis or hyperkalemia in addition to OMI. The patient died of cardiogenic shock within 24 hours despite mechanical circulatory support. Below the J-point is marked out showing the ST pathologic deviations. What was the pH and K?

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Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 108

Ken Grauer, MD

APRIL 9, 2023

NOTE: As discussed in detail in ECG Blog #108 — " A IVR" is an "enhanced" ventricular ectopic rhythm that occurs faster than the intrinsic ventricular escape rate ( which is typically between 20-40/minute ) — but slower than hemodynamically significant Ventricular Tachycardia ( ie, VT at rates >130-140/minute ).

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Blog Chest Pain Arrhythmia Cardiac Arrest 78

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

Type 2/3 ECG which gets converted to type 1 pattern with sodium channel blockers have 2 points.

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Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

Dr. Smith's ECG Blog

OCTOBER 25, 2023

ECG is consistent with severe hypokalemia and/or hypomagnesemia causing prolonged QT (QU) at high risk of Torsades (which is polymorphic ventricular tachycardia in the setting of a long QT interval). Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest.

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Ischemia Chest Pain Cardiac Arrest Blog 111

Dr. Smith's ECG Blog

JANUARY 8, 2024

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG == MY Comment , by K EN G RAUER, MD ( 12/31 /2023 ): == My only hope about today's tragic case — is that the involved providers learn from mistakes made. KEY Findings in ECG #1 include the following: Sinus tachycardia at ~110/minute. Junctional tachycardia? ).

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Chest Pain Pulmonary Embolism STEMI 74

Open Heart

JULY 6, 2022

Among patients with cLQTS, a severe cLQTS disease manifestation was associated with workforce detachment 1 year after diagnosis (compared with asymptomatic patients; aborted cardiac arrest OR 20.4 (95% to 249.9); ventricular tachycardia/syncope OR 10.9 (95% 95% CI, 1.7 95% CI, 1.1 to 110.5)).

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Congenital Cardiac Arrest Tachycardia 52

Dr. Smith's ECG Blog

MAY 5, 2022

After initiating treatment for hyperkalemia, repeat ECG showed resolution of Brugada pattern: The ECG shows sinus tachycardia. Steve, what do you think of this ECG in this Cardiac Arrest Patient?" A woman in her 50s with dyspnea and bradycardia A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB).

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Chest Pain Bradycardia Cardiac Arrest STEMI 52

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Other than tachycardia, Other than slight tachycardia, vitals were within normal limits (including oxygen saturation). About two hours after admission, he suffered a cardiac arrest (whether it was VF/VT or PEA is not available) and expired. The rhythm in ECG #1 is sinus tachycardia at 115-120/minute.

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Chest Pain STEMI Blog Tachycardia 52

Ken Grauer, MD

OCTOBER 6, 2023

Examples of conditions notorious for producing arrhythmias that "do not obey the rules" include: i ) Hyperkalemia ( See ECG Blog #275 ) ; ii ) Cardiac arrest ; and , iii ) Vagotonic Block ( See ECG Blog #61 ).

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