Chest Pain, Defibrillator and Tachycardia

Exploring Potential New Treatment for Ventricular Tachycardia

DAIC

JUNE 19, 2024

Cingolani, director of Cardiogenetics and Preclinical Research in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, is exploring new ways to help patients with ventricular tachycardia (VT), a recurring, abnormally fast and irregular heartbeat that starts in the lower chambers, or ventricles, of the heart.

Tachycardia

Tachycardia Cardiac Arrest Ablation Research

Very fast regular tachycardia: 2 ECGs from the same patient. What is going on?

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

This was written by Magnus Nossen, from Norway, with comments and additions by Smith A 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. An ECG was recorded immediately and is shown below.

Tachycardia

Tachycardia Chest Pain Academic Arrhythmia

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. Just as important is pretest probability: did the patient report chest pain prior to collapse? See these related cases: Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. They started CPR.

Cardiac Arrest

Cardiac Arrest Ischemia Tachycardia Defibrillator

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Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

JANUARY 15, 2024

They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They described the chest pain as severe, crushing, and non-radiating. We can see enough to make out that the rhythm is sinus tachycardia. It was not worse with exertion or relieved by rest.

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

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

Dr. Smith's ECG Blog

JANUARY 23, 2024

There was no chest pain. Shortly after isoprenalin infusion was initiated, there were short runs of ventricular tachycardia. She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). This was written by Magnus Nossen The patient is a female in her 50s. She was feeling fine prior to the last seven days.

Tachycardia

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death

A 20-something woman with cardiac arrest.

Dr. Smith's ECG Blog

OCTOBER 18, 2023

The chest pain quickly subsided. 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. The patient was given chest compressions while waiting for the cardiac arrest team to arrive.

Cardiac Arrest

Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia

ECG Blog #434 — WHY Did this Patient Arrest?

Ken Grauer, MD

JUNE 14, 2024

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 ). Continuing with assessment of ECG #1 in Figure-2: The rhythm is sinus tachycardia at ~110/minute. A series of VFib episodes followed — each time with successful defibrillation.

Blog

Blog STEMI Cardiac Arrest Tachycardia

Palpitations while awaiting CABG

Dr. Smith's ECG Blog

JUNE 14, 2024

Written by Willy Frick A 57 year old man with was admitted to the hospital with chest pain. The team immediately paged cardiology, concerned for polymorphic ventricular tachycardia. Since sinus conducted QRS complexes cannot co-exist together with ventricular tachycardia, this must all be artifact.

Atrial Fibrillation

Atrial Fibrillation Tachycardia Blog Chest Pain

What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. He required multiple defibrillations within a period of a few hours. What do you think?

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

OCTOBER 20, 2024

He woke up alert and with chest pain which he also had experienced intermittently over the previous few days. The history in today's case with sudden loss of consciousness followed by chest pain is very suggestive of ACS and type I ischemia as the cause of the ECG changes. What do you think?

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. CPR was initiated immediately. This is a quiz.

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

Dr. Smith's ECG Blog

APRIL 29, 2020

She was never defibrillated. A recent similar case: A 40-something with chest pain. A useful classification of WCT ( W ide- C omplex T achycardia ) rhythms — separates them into those that are mono morphic ( with similar QRS morphology during the tachycardia ) vs those that are poly morphic ( in which QRS morphology varies ).

Cardiac Arrest

Cardiac Arrest Defibrillator Ischemia Tachycardia

Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab. The patient was defibrillated, and then taken to the nearest ED where ECG #1 was obtained ( Figure-1 ). MY Thoughts on ECG #1: The rhythm is sinus tachycardia at 105-110/minute.

STEMI

STEMI Hospital Blog Defibrillator

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. At cath, he immediately had incessant Torsades de Pointes requiring defibrillation 7 times and requiring placement of a transvenous pacer for overdrive pacing at a rate of 80. See here for management of Polymorphic Ventricular Tachycardia , which includes Torsades.

STEMI

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

Otherwise vitals after intubation were only notable for tachycardia. An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. It was from a patient with chest pain: Note the obvious Brugada pattern. A rectal temperature was obtained which read 107.9 This patient ruled out for MI.

Heart Rhythm

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

Cardiac Arrest, hypotension, tachycardia

Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. Patients who present with chest pain or cardiac arrest and have an ECG diagnostic of STEMI could have myocardial rupture. 5 of 6 presented with chest pain and an ECG indicating reperfusion therapy, but were detected by bedside ultrasound.

Cardiac Arrest

Cardiac Arrest Tachycardia STEMI Chest Pain

The First 60 Minutes of a Heart Attack: The Golden Hour

Wellnest

JULY 19, 2023

When a person experiences a heart attack or myocardial infarction, they may feel chest pain and other symptoms in different parts of their body. The abnormal heart rhythms can further lead to death because of ventricular tachycardia and ventricular fibrillation. So, how do you recognize a heart attack?

Heart Attack

Heart Attack Heart attacks Blood Pressure Myocardial Infarction

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

Dr. Smith's ECG Blog

DECEMBER 5, 2019

There is sinus tachycardia and also a large R-wave in aVR. Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. Her temperature was 106 degrees. As part of the workup, she underwent an ECG.

Sudden Cardiac Death

Sudden Cardiac Death Heart Rhythm Article Tachycardia

Chest pain and rapid pacing followed by an unexplained wide complex tachycardia. Time for cardioversion?

Dr. Smith's ECG Blog

DECEMBER 20, 2024

Written by Willy Frick with edits by Ken Grauer An older man with a history of non-ischemic HFrEF s/p CRT and mild coronary artery disease presented with chest pain. He said he had had three episodes of chest pain that day while urinating. This is the shock coil and identifies this device as a defibrillator.

Chest Pain

Chest Pain Tachycardia Pacemaker Defibrillator

OMI? Subendocardial ischemia? Does it matter in this clinical context?

Dr. Smith's ECG Blog

DECEMBER 31, 2024

Written by Pendell Meyers A woman in her 70s with known prior coronary artery disease experienced acute chest pain and shortness of breath. The chest pain was described as severe pressure radiating to both shoulders. Vital signs were within normal limits. She presented to the Emergency Department at around 3.5

Ischemia

Ischemia Tachycardia Chest Pain STEMI

What is this rhythm? And why rhythm problems are easier for the Emergency Physician than acute coronary occlusion (OMI).

Dr. Smith's ECG Blog

MARCH 6, 2025

Smith comments : Wide complex tachycardia. The differential diagnosis of WCT is: 1) Sinus tachycardia with "aberrancy" (in this case RBBB and LAFB), but there are no P-waves and the QRS morphology is not typical of simple RBBB/LAFB. Also, if the rate is constant, not wavering up and down, it is highly unlikely to be sinus tachycardia.

Tachycardia

Tachycardia Dysrhythmia ICU Pulmonary

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

Dr. Smith's ECG Blog

MARCH 8, 2025

Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J. She was defibrillated perhaps 25 times. He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. SanzRuiz, R., Solis, J., & Verbeek, P.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Cardiovascular Update

Exploring Potential New Treatment for Ventricular Tachycardia

Very fast regular tachycardia: 2 ECGs from the same patient. What is going on?

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

Webinars

Noisy, low amplitude ECG in a patient with chest pain

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

A 20-something woman with cardiac arrest.

ECG Blog #434 — WHY Did this Patient Arrest?

Palpitations while awaiting CABG

What are treatment options for this rhythm, when all else fails?

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Hyperthermia and ST Elevation

Cardiac Arrest, hypotension, tachycardia

The First 60 Minutes of a Heart Attack: The Golden Hour

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

Chest pain and rapid pacing followed by an unexplained wide complex tachycardia. Time for cardioversion?

OMI? Subendocardial ischemia? Does it matter in this clinical context?

What is this rhythm? And why rhythm problems are easier for the Emergency Physician than acute coronary occlusion (OMI).

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

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