Dr. Smith's ECG Blog

JUNE 9, 2024

This is obviously severe hyperkalemia and the patient is near cardiac arrest. There was no IV access, so we obtained intraosseous (IO) access, but she arrested before we could give her all the calcium. Hyperkalemia and Cardiac Arrest Could you have prevented this young man's cardiac arrest?

Cardiac Arrest 101

Cardiac Arrest Defibrillator Cardiac Function Tachycardia 101

Open Heart

OCTOBER 16, 2024

Background The circadian variation pattern of sudden cardiac arrest (SCA) occurred in Chinese community including both community healthcare centres and primary hospitals remains unknown. This study analysed the circadian variation of SCA in the Chinese community.

Cardiac Arrest 52

Cardiac Arrest Tachycardia Hospital 52

Dr. Smith's ECG Blog

JANUARY 2, 2025

See this post: How a pause can cause cardiac arrest 2. Even with tachycardia and a paced QRS duration of ~0.16 There is ventricular bigeminy with bizarre appearing wide T-waves See even more striking cases of this at the bottom of the post. The plan: 1. Place temporary pacemaker 3. J Am Coll Cardiol.

Tachycardia 116

Tachycardia Cardiomyopathy Blog Bradycardia 116

HeartRhythm

APRIL 30, 2024

We have recently reported that chronic kidney disease (CKD) is associated with higher likelihood of sudden cardiac arrest (SCA) presenting with non-shockable rhythms (NSR) (pulseless electrical activity/asystole), as opposed to shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia).

Cardiac Arrest 40

Cardiac Arrest Kidney Disease Defibrillator Tachycardia 40

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.

Cardiac Arrest 52

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.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

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.

Cardiac Arrest 52

Cardiac Arrest Tachycardia Chest Pain ICU 52

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.

Blog 78

Blog Tachycardia Arrhythmia Atrial Flutter 78

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.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

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.

Tachycardia 131

Tachycardia Cardiac Arrest ICU Blog 131

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 110

Cardiac Arrest STEMI Ischemia SCAD 110

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?

Blog 155

Blog STEMI Cardiac Arrest Tachycardia 155

American College of Cardiology

NOVEMBER 5, 2024

A small proportion of patients with STEMI treated via primary PCI experienced late ventricular tachycardia (VT) or ventricular fibrillation (VF), occurring one or more days following the procedure, but late VT or VF with cardiac arrest occurred rarely, especially among patients with uncomplicated STEMI, according to a study published in JAMA Network (..)

STEMI 44

STEMI Chest Pain Cardiac Arrest Tachycardia 44

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.

Tachycardia 40

Tachycardia Sudden Cardiac Death Defibrillator Cardiac Arrest 40

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.

Chest Pain 124

Chest Pain Ischemia Cardiac Arrest Blog 124

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.

Cardiac Arrest 40

Cardiac Arrest Exercise Tachycardia 40

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

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.

Cardiomyopathy 69

Cardiomyopathy Cardiac Arrest Defibrillator Electrophysiology 69

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.

Tachycardia 40

Tachycardia STEMI Chest Pain Ischemia 40

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

DECEMBER 13, 2024

The 2019 ESC Guidelines for the management of patients with supraventricular tachycardia indicated that IV Amiodarone should not be considered in these populations. Regarding AFib with WPW: The very rapid heart rate and at times extremely short R-R intervals put the patient with AFib and WPW at risk of cardiac arrest from VFib.

AFIB 104

AFIB Atrial Fibrillation Tachycardia Blog 104

Journal of Cardiovascular Electrophysiology

FEBRUARY 10, 2025

Conclusions This study provides insight into predictors of RV pacing in ICD recipients without pacing needs at baseline.

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Defibrillator Cardiac Arrest Tachycardia Hypertension 40

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).

Electrocardiogram 40

Electrocardiogram Sudden Cardiac Death Cardiac Arrest Document 40

Dr. Smith's ECG Blog

OCTOBER 20, 2024

This patient is actively dying from a left main coronary artery OMI and cardiac arrest from VT/VF or PEA is imminent! Complete LMCA occlusion is associated with clinical shock and/or cardiac arrest. The arterial blood gas showed a lactic acidosis with a lactate level of 17mmol/L.

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 129

Dr. Smith's ECG Blog

APRIL 8, 2016

See here for management of Polymorphic Ventricular Tachycardia , which includes Torsades. 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 Could the dysrhythmias have been prevented? mEq/L, from 1.9

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

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? ).

Chest Pain 71

Chest Pain Pulmonary Embolism STEMI 71

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.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

FEBRUARY 2, 2017

Here is the ECG: Sinus tachycardia. If cardiac arrest from hypokalemia is imminent (i.e., CASE : Prehospital Cardiac Arrest due to Hypokalemia I recently had a case of prehospital cardiac arrest that turned out to be due to hypokalemia. This patient presented with severe DKA. What do you think?

Cardiac Arrest 52

Cardiac Arrest Dysrhythmia Arrhythmia Nursing 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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Blog Arrhythmia Cardiac Arrest Tachycardia 164

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.

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

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?

Cardiac Arrest 40

Cardiac Arrest Tachycardia Nursing Ultrasound 40

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.

Chest Pain 52

Chest Pain Cardiogenic Shock Tachycardia Ischemia 52

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.

Technology 52

Technology Cardiac Arrest Innovation Coronary Artery Disease 52

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.

Tachycardia 52

Tachycardia Heart Disease Dysrhythmia Ablation 52

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.

Tachycardia 52

Tachycardia Document Blog Bradycardia 52

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. There is sinus tachycardia at ~100/minute. 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 ). As per Dr.

Chest Pain 74

Chest Pain STEMI Pulmonary Embolism 74

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).

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52