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A 50-something with Regular Wide Complex Tachycardia: What to do if electrical cardioversion does not work?

Dr. Smith's ECG Blog

Heparin bolus (4000u), infusion Plan for rate control 25 mg IV diltiazem given HR = 143 25 mg IV repeat dose diltiazem given HR = 143 Diltiazem drip 10 mg/ hr for ~20 min HR remained 140 - 155 Then the patient developed Cardiogenic shock and echo had poor contractility Amiodarone load given. Patient intubated.

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Critical Left Main

EMS 12-Lead

It’s judicious, then, to arrange for coronary angiogram. Coronary occlusion, however, might be present concurrently with subendocardial ischemia on the time-zero ECG, or evolve into such. Proximal LAD disease with/without a) and b) It seemed quite apparent that this was an Acute Coronary Syndrome. Coronary Angiogram 1.

Angina 52
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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Aortic angiogram did not reveal aortic dissection. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis.

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A man with chest pain off and on for two days, and "No STEMI" at triage.

Dr. Smith's ECG Blog

The patient is started on epinephrine infusion for cardiogenic shock and cardiology took the patient to the cath lab. During angiogram in the cath lab, the patient suffered two episodes of ventricular fibrillation for which he was successfully defibrillated. Just another NSTEMI.

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90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. We investigated the incidence of an acutely occluded coronary in patients presenting with STE-aVR with multi-lead ST depression. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease?