Cardiomyopathy, Defibrillator and Ischemia

Resuscitated from ventricular fibrillation. Should the cath lab be activated?

Dr. Smith's ECG Blog

JULY 25, 2024

He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. The ECG shows severe ischemia, possibly posterior OMI. But cardiac arrest is a period of near zero flow in the coronary arteries and causes SEVERE ischemia. It takes time for that ischemia to resolve. They started CPR.

Cardiac Arrest

Cardiac Arrest Ischemia Tachycardia Defibrillator

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

JANUARY 2, 2025

And of course Ken's comments at the bottom) An elderly obese woman with cardiomyopathy, Left bundle branch block, and chronic hypercapnea presented hypoxic with altered mental status. I do not see OMI here and all trops were only minimally elevated, consistent with either chronic injury from cardiomyopathy or with acute injury from sepsis.

Tachycardia

Tachycardia Cardiomyopathy Blog Bradycardia

A 20-something woman with cardiac arrest.

Dr. Smith's ECG Blog

OCTOBER 18, 2023

She spontaneously converted (Defibrillation was not performed). Most such rhythms in the setting of ischemia are VF and will not convert without defibrillation. There was hyperkinesis of the basal segments and findings were interpreted as typical of takotsubo cardiomyopathy. Below is the ECG one month after discharge.

Cardiac Arrest

Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia

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Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment

MIBHS

OCTOBER 31, 2024

This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Cardiomyopathy Cardiomyopathy is a condition that affects the heart muscle, causing it to become enlarged, thick, or rigid. Implantable Cardioverter-Defibrillator (ICD) to help manage dangerous heart rhythms.

Blood Pressure

Blood Pressure Blood Clot Heart Valves Heart Rhythm

50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

This usually represents posterior OMI, but in tachycardia and especially after cardiac arrest, this could simply be demand ischemia, residual subendocardial ischemia due to the low flow state of the cardiac arrest. This rules out subendocardial ischemia and is diagnostic of posterior OMI. V4-5 continue to show STD.

Cardiac Arrest

Cardiac Arrest STEMI Ischemia SCAD

Does this T wave pattern mean anything?

Dr. Smith's ECG Blog

OCTOBER 23, 2023

She was successfully revived after several rounds of ACLS including defibrillation and amiodarone. Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. On arrival to the ED the patient was intubated with normal vital signs.

Tachycardia

Tachycardia Cardiac Arrest ICU Blog

Why ICDs are less effective in Non Ischemic DCM ?

Dr. S. Venkatesan MD

FEBRUARY 20, 2024

Tackling SCD was in God’s domain, until the brilliance of Dr. Michel Mirowski shrunk the defibrillator and implanted it under the chest in 1980. (Dr. 2020) The un-disputable fact is ischemic DCM has a target to treat, though it is termed as cardiomyopathy. SCD is the leading cause of mortality in heart failure. N Engl J Med.

Defibrillator

Defibrillator Heart Failure Sudden Cardiac Death Cardiomyopathy

Seizure in a 30 something

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Arrhythmogenic cardiomyopathy Long QT syndrome Hypertrophic cardiomyopathy. This episode self terminated before defibrillation was possible. There are a number of things to look for in an ECG that can hint at arrhythmia as the cause of an apparent seizure. I measure the RR interval at 795ms and the QT interval at 475ms.

Tachycardia

Tachycardia Blog Sudden Cardiac Death Arrhythmia

What kind of AV block is this? And why does she develop Ventricular Tachycardia?

Dr. Smith's ECG Blog

JANUARY 23, 2024

Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). Discussion : The initial ECG in today's case is pathological for any patient, especially for a 50-year old previously heathy female.

Tachycardia

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death

Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?

Dr. Smith's ECG Blog

OCTOBER 20, 2013

She was never seen to be in ventricular fibrillation and was never defibrillated. This ECG is diagnostic of diffuse subendocardial ischemia. Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. With ventilations and epinephrine, she regained a pulse. BP gradually rose.

Cardiac Arrest

Cardiac Arrest STEMI Hemorrhage Hospital

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. by making it clear to everyone that this is NOT an EKG that one sees with takotsubo cardiomyopathy. The impact of ST-segment elevation on the prognosis of patients with Takotsubo cardiomyopathy. Smith: this ECG and clinical presentation is diagnostic of LAD Occlusion.

Plaque

Plaque Chest Pain Thrombosis Stenosis

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

Repeat ECG was obtained immediately, just 24 minutes after the prior ECG: Given the context, my top differential diagnosis would be stress cardiomyopathy AKA takotsubo. It is possible there is microvascular dysfunction producing residual transmural ischemia. She was defibrillated perhaps 25 times. We will never know for certain.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Acute coma, then Sudden PEA arrest in front of paramedics, with STEMI?

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

By ECG alone: it is suspicious for stress cardiomyopathy, or takotsubo, due to the diffuse ST Elevation: II, III, aVF AND I and aVL. Subarachnoid hemorrhage causes extreme central catecholamine output, resulting in stress cardiomyopathy, just like takotsubo. This is unusual in acute OMI. she had severe pulmonary edema.

STEMI

STEMI Hemorrhage Cardiac Arrest Tachycardia

Electrical instability in a healthy 50 year old. How to manage?

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

Whenever I see PVCs with the morphology and axis seen in todays case I always look for signs of AC ( Arrhythmogenic Cardiomyopathy ). Arrhythmogenic cardiomyopathy often manifests with PVCs from the RV. The ECG in Figure-1 however, shows no signs of arrhythmogenic cardiomyopathy. Therefore A different approach is needed.

Tachycardia

Tachycardia Arrhythmia Ablation Atrial Flutter

Cardiovascular Update

Resuscitated from ventricular fibrillation. Should the cath lab be activated?

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

A 20-something woman with cardiac arrest.

Webinars

Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment

50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Does this T wave pattern mean anything?

Why ICDs are less effective in Non Ischemic DCM ?

Seizure in a 30 something

What kind of AV block is this? And why does she develop Ventricular Tachycardia?

Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Acute coma, then Sudden PEA arrest in front of paramedics, with STEMI?

Electrical instability in a healthy 50 year old. How to manage?

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