Dr. Smith's ECG Blog

OCTOBER 18, 2023

The above ECGs show the initiation and continuation of a polymorphic ventricular tachycardia. Polymorphic ventricular tachycardia can be ischemic, catecholaminergic or related to QT prolongation. Most such rhythms in the setting of ischemia are VF and will not convert without defibrillation. Learning points: 1.

Cardiac Arrest 104

Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia 104

Dr. Smith's ECG Blog

OCTOBER 23, 2023

An Initial ECG was performed: Initial ECG: Sinus tachycardia with prolonged QT interval (QTc of 534 ms by Bazett). She was admitted to the ICU where subsequent ECGs were performed: ECG at 12 hours QTc prolongation, resolution of T wave alternans ECG at 24 hours Sinus tachycardia with normalized QTc interval. No ischemic ST changes.

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Tachycardia Cardiac Arrest ICU Blog 120

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. I said I think there is a fixed stenosis in the LAD and the tachycardia and stress caused a type 2 STEMI.

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Tachycardia STEMI Chest Pain Ischemia 52

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.

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Cardiac Arrest STEMI Ischemia SCAD 80

Dr. Smith's ECG Blog

DECEMBER 7, 2023

Given her lack of risk factors for coronary disease, and the fact that she was a 53 year old woman with compatible history and echo findings, stress cardiomyopathy rose to the top of my differential. Of course, stress cardiomyopathy is a diagnosis of exclusion. This proves effective treatment of the recurrent ischemia.

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SCAD Ischemia Coronary Artery Disease Cardiomyopathy 105

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Arrhythmogenic cardiomyopathy Long QT syndrome Hypertrophic cardiomyopathy. There is a run of polymorphic ventricular tachycardia — which given the QT prolongation, qualifies as Torsades de Points ( TdP ). There are a number of things to look for in an ECG that can hint at arrhythmia as the cause of an apparent seizure.

Tachycardia 104

Tachycardia Blog Sudden Cardiac Death Arrhythmia 104

Ken Grauer, MD

JULY 15, 2023

Given the rapid rate of the tachycardia and the amorphous shape of the QRS — the decision was made to sedate the patient and cardiovert. This phenomenon may sometimes be seen following an episode of a sustained tachycardia — in which marked ST-T wave abnormalities not due to infarction may be seen for a period of hours, or even days!

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Blog Coronary Angiogram Cardiomyopathy Ischemia 78

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 Dysrhythmia Ablation 52

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

Here was the ECG: There is sinus tachycardia. Our chief of cardiology, Gautam Shroff, interprets it differently and thinks this is indeed ischemia. I have summarized the m ajor e tiologic c ategories of acute myocarditis and inflammatory cardiomyopathies. This was sent by a reader. and K was normal.

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Cardiogenic Shock STEMI Pericarditis Blog 52

EMS 12-Lead

APRIL 28, 2022

Initial vital signs include: NIBP 99/58 HR 150-160 (trend) RR 10 (spontaneous, but shallow) SpO2 86 (RA) BBS CTA The initial rhythm strip is attached: Figure 1 There is a wide complex tachycardia of varying morphology, amplitude, and R-R cycle length. Chapter 10: Recurrent Ventricular Tachycardia (pg. 2] Viskin, S., 3] Murphy, M.

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Tachycardia AFIB Arrhythmia Coronary Artery Bypass Graft 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

Wellnest

DECEMBER 21, 2022

A fast heartbeat is called tachycardia, while a slow heartbeat is called bradycardia in medical terms. Poor blood supply Ischemia, or inadequate blood supply to the heart, is an abnormality that can be detected in an ECG test. Arrhythmia In simple words, arrhythmia refers to an irregular heartbeat.

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Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

Dr. Smith's ECG Blog

JULY 1, 2019

Although as a general rule, there should be no ST elevation in RBBB in the absence of ischemia, there sometimes is ST elevation that looks like this. If the ECG findings are truly new compared to a baseline (unavailable), this could suggest persistent ECG findings of ischemia, meaning poor downstream perfusion ("no reflow" phenomenon).

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Chest Pain Ischemia STEMI Blog 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

Occurrence of “J Waves” in 12-Lead ECG as a Marker of Acute Ischemia and Their Cellular Basis. The relationship between J wave and ventricular tachycardia during Takotsubo cardiomyopathy. Occurrence of "J waves" in 12-lead ECG as a marker of acute ischemia and their cellular basis. Pacing Clin Electrophysiol.

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STEMI Bradycardia Arrhythmia Cardiac Arrest 52

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

Dr. Smith's ECG Blog

APRIL 17, 2023

In addition to sinus tachycardia, the only abnormalities listed by the computer were "low voltage, precordial leads" and "anteroseptal infarct, old.Q Cardiologist interpretation: "Technically does not meet STEMI criteria but concerning for ischemia." 4) There is well formed J-point notching. Case 2: What do you think?

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Chest Pain STEMI Document Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Use of objective evidence of myocardial ischemia to facilitate the diagnostic and prognostic distinction between type 2 myocardial infarction and myocardial injury. This sinus tachycardia ( at ~130/minute ) — is consistent with the patient’s worsening clinical condition, with development of cardiogenic shock. Available from: [link] 9.

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Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

MARCH 6, 2020

Here was his ED ECG: There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities. There is no evidence of infarction or ischemia. The absence of any wall motion abnormality makes ischemic cardiomyopathy very unlikely. An ECG was recorded: This shows a regular narrow complex tachycardia at a rate of about 160.

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Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52