Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Pads were placed with ultrasound guidance, so they were in the correct position. No adenosine was given (if you believe it is SVT, this is worth a try). However, this is not SVT. If it is VT, adenosine is safe but not effective. What to do now? If you believe it is SVT, then try adenosine. Patient intubated.

Tachycardia 140

Tachycardia Cardiogenic Shock Angina Coronary Angiogram 140

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) Self-expanding Versus Balloon-expandable Transcatheter Aortic Valve Replacement in Patients with Small Aortic Annuli: Primary Outcomes from the Randomized Smart Trial Effect of Edetate Disodium Based Chelation Infusions on Cardiovascular Events in Post-MI Patients with Diabetes: The TACT2 Trial Long-term Beta-blocker Treatment (..)

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

JULY 18, 2014

Case Continued 2 days later the patient became increasingly tachycardic, hypotensive, ashen, clammy (in cardiogenic shock) and had a new murmur. Rupture can be either free wall rupture (causing tamonade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock.

STEMI 52

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

JUNE 11, 2021

Thirty minutes later the first Troponin I came back elevated at 650 ng/L (normal <26), and bedside ultrasound found anteroseptal akinesia. But by this time the patient went into cardiogenic shock and passed away. But it didn’t meet traditional Sgarbossa criteria so the cath lab was not activated.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

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. As for the ECG, it could represent OMI, but RBBB is also a clue that it may be PE. There is sinus tachycardia at ~100/minute.

Chest Pain 77

Chest Pain STEMI Pulmonary Embolism 77

Dr. Smith's ECG Blog

JUNE 17, 2018

I have always said that tachycardia should argue against acute MI unless there is cardiogenic shock or 2 simultaneous pathologies. Sinus tachycardia, which exaggerates ST segments and implies that there is another pathology. We showed this in a recent analysis of UTROPIA data (see abstract below).

Chest Pain 52

Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. RVMI explains part of the shock. If it did not do so, norepinephrine would be indicated to maintain systolic BP As for the escape rhythm: It is narrow complex, and therefore it is in the His bundle or above (not below the His bundle).

Chest Pain 86

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 86

Dr. Smith's ECG Blog

OCTOBER 7, 2019

Why is the patient in shock? He was in profound cardiogenic shock. They did not have an ultrasound on the ambulance (some local crews are starting to utilize POC limited US in our service areas). There is an obvious inferior STEMI, but what else? This STE is diagnostic of Right Ventricular STEMI (RV MI).

Bradycardia 40

Bradycardia Cardiogenic Shock STEMI Ischemia 40

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. Assessment was severe sudden cardiogenic shock. Clinically — the patient was felt to be in cardiogenic shock. This sinus tachycardia ( at ~130/minute ) — is consistent with the patient’s worsening clinical condition, with development of cardiogenic shock.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

APRIL 24, 2020

Just prior to transport, the patient became confused and agitated and, although blood pressure and pulse were OK, I was worried about cardiogenic shock. Diagnosis : Posterior MI, right? We intubated him. Cath lab The BP was 70/40 on arrival to the cath lab and received a balloon pump and norepinephrine.

Ischemia 52

Ischemia Chest Pain Stenosis Cardiogenic Shock 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW. We can see enough to make out that the rhythm is sinus tachycardia.

Chest Pain 67

Chest Pain Blog Critical Care Arrhythmia 67

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock. Type 2 is more difficult to appreciate on angiography than type 1. Lobo et al. where more than 3/4 of cases were NSTEMI).

Chest Pain 52

Chest Pain SCAD STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., A emergent cardiology consult can be helpful for equivocal cases. Left main? 3-vessel disease? Knotts et al.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52