Dr. Smith's ECG Blog

AUGUST 6, 2024

Written by Magnus Nossen with Edits by Grauer and Smith The ECGs in today’s case are from 3 different patients all presenting with new-onset CP ( Chest Pain ). NOTE #1: Sinus tachycardia is not usually seen in an uncomplicated acute MI. All ECGs were recorded by EMS, and transferred to a PCI capable center for evaluation.

Chest Pain 105

Chest Pain Ischemia Pericarditis Tachycardia 105

Dr. Smith's ECG Blog

MAY 25, 2024

An elderly dialysis patient presented with chest pain. Here is her ECG: Regular Wide Complex Tachycardia. Here is her ECG: Regular Wide Complex Tachycardia. Could it be atrial tachycardia with RBBB and LPFB aberrancy? Here it is: There is sinus with normal conduction, very different from her tachycardia.

Tachycardia 128

Tachycardia Atrial Fibrillation Dysrhythmia Chest Pain 128

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 134

Tachycardia Chest Pain Academic Arrhythmia 134

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 128

Tachycardia Cardiac Arrest Ablation Research 128

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. There is sinus tachycardia at ~100/minute. Vitals were normal.

Chest Pain 75

Chest Pain STEMI Pulmonary Embolism 75

Dr. Smith's ECG Blog

JANUARY 27, 2024

Written by Jesse McLaren, comments by Smith A 55 year old with a history of NSTEMI presented with two hours of exertional chest pain, with normal vitals. See these posts: Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab? What do you think?

Chest Pain 118

Chest Pain STEMI Aneurysm Stents 118

Dr. Smith's ECG Blog

JANUARY 8, 2024

Let me tell you about her hospitalization, discharged 1 day prior, but it was at another hospital (I wish I had the ECG from that hospitalization): The patient is 40 years old and presented to another hospital with chest pain and SOB. She had been sitting doing work when she experienced "waves of chest tightness". Sats were 88%.

Chest Pain 72

Chest Pain Pulmonary Embolism STEMI 72

Dr. Smith's ECG Blog

JUNE 28, 2023

A prehospital 12-lead was recorded: There is a regular wide complex tachycardia. The computer diagnosed this as Ventricular Tachycardia. There is a wide complex regular tachycardia at a rate of 226. Toothache, incidental Wide Complex Tachycardia Could it be fascicular VT or Bundle Branch VT ( i.e., idiopathic VT )?

Tachycardia 98

Tachycardia Ultrasound Heart Disease Atrial Fibrillation 98

Dr. Smith's ECG Blog

FEBRUARY 16, 2024

He had no chest pain or shortness of breath. But it is not disorganized enough to be polymorphic ventricular tachycardia. Learning Points: Wide complex irregularly irregular tachycardias include PMVT, AF with WPW, and AF with aberrancy. See our other cases of AF with WPW: A young man with another episode of tachycardia.

Tachycardia 137

Tachycardia Atrial Fibrillation Chest Pain Blood Pressure 137

Dr. Smith's ECG Blog

NOVEMBER 9, 2023

A 60-something yo female presented w/ exertional chest pain for 3 days. Pain was 8/10 and constant. She has been experiencing progressively worsening exertional dyspnea and chest tightness mostly when climbing up flights of stairs since early September. But the patient has active chest pain.

Chest Pain 79

Chest Pain Echocardiogram Blog Ischemia 79

Dr. Smith's ECG Blog

JUNE 17, 2018

A middle-aged patient with lung cancer had presented to clinic complaining of generalized malaise, cough, and chest pain. There is sinus tachycardia. Symptoms other than chest pain (malaise, cough in a cancer patient) 2. Sinus tachycardia, which exaggerates ST segments and implies that there is another pathology.

Chest Pain 52

Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

JAMA Cardiology

AUGUST 20, 2024

A woman in her mid-20s presented with acute fever, chest pain, and exertional dyspnea. Electrocardiogram results showed sinus tachycardia, QRS widening, low-voltage complexes, and ST-segment elevation. What would you do next?

Electrocardiogram 87

Electrocardiogram Chest Pain Tachycardia 87

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Read this post: Idiopathic Ventricular Tachycardias for the EM Physician 2. Ken notes AV dissociation.

Tachycardia 140

Tachycardia Cardiogenic Shock Angina Coronary Angiogram 140

Dr. Smith's ECG Blog

JUNE 11, 2023

Written by Bobby Nicholson MD and Pendell Meyers A man in his 30s presented to the ED for evaluation of chest pain and palpitations. The ECGs show a wide complex, irregularly irregular tachycardia. At this point, the patient had been symptomatic for almost 5 hours, appeared unwell with chest pain and diaphoresis.

Tachycardia 98

Tachycardia Atrial Fibrillation Chest Pain Blood Pressure 98

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage.

Chest Pain 140

Chest Pain Embolism Pulmonary Tachycardia 140

Dr. Smith's ECG Blog

JANUARY 9, 2024

She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. She presented to the emergency department after a couple of days of chest discomfort. Answer : The ECG above shows a regular wide complex tachycardia. Cardiac output (CO) was being maintained by the tachycardia.

Tachycardia 120

Tachycardia Electrophysiology Atrial Flutter Ischemia 120

Dr. Smith's ECG Blog

FEBRUARY 6, 2023

Sent by anonymous, written by Pendell Meyers A man in his 60s presented with acute chest pain with diaphoresis. The Importance of the History: As noted above — the onset of chest pain in today's case was acute. He had received aspirin and nitroglycerin by EMS, with some improvement. His vitals were within normal limits.

Chest Pain 52

Chest Pain Physiology Blog Stents 52

Dr. Smith's ECG Blog

MARCH 1, 2023

Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. The chest pain was described as sharp and radiated to both arms. During active chest pain an ECG was recorded: Meyers ECG interpretation: Sinus tachycardia, normal QRS complex, STD in V2-V6, I, II, III and aVF.

Chest Pain 52

Chest Pain Ischemia Tachycardia Stenosis 52

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 65

Chest Pain Blog Arrhythmia Critical Care 65

Dr. Smith's ECG Blog

MARCH 1, 2024

The tachycardia was gone by the time paramedics arrived. But syncope or seizure alone, without chest pain, is not enough to call it Wellens syndrome. Without chest pain, the pretest probability is not very high. With the chest pain history, this is now Wellens' syndrome. There was tongue biting.

Chest Pain 110

Chest Pain Myocardial Infarction Tachycardia Stenosis 110

Dr. Smith's ECG Blog

MAY 16, 2023

Sent by Dan Singer MD, written by Meyers, edits by Smith A man in his late 30s presented with acute chest pain and normal vitals except tachycardia at about 115 bpm. Dr. Singer sent this to me with just the information: "~40 year old with acute chest pain". Anxiety is a common cause of chest pain with tachycardia.

Chest Pain 52

Chest Pain Pericarditis Tachycardia STEMI 52

Dr. Smith's ECG Blog

AUGUST 3, 2018

In the evening, a middle-aged man complained of chest pain at the nursing home. His chest pain was vague. He mentioned "cancer" and "chest". He mentioned "cancer" and "chest". There is a narrow complex tachycardia at a rate of 130. He was awake, with a pulse of 130 and BP of 50/30. Is is sinus?

Chest Pain 40

Chest Pain Tachycardia Atrial Flutter Ultrasound 40

Dr. Smith's ECG Blog

MARCH 4, 2023

This one is far more specific, as it is combined with sinus tachycardia and some T-wave inversion in V1-V3. and tachycardia, 1.8. Finally , they found that S1Q3T3, precordial T-wave inversions V1-V4, and tachycardia were independent predictors of PE. This is a classic S1Q3T3. Most S1Q3T3 is not due to PE. incomplete RBBB 1.7

Chest Pain 52

Chest Pain Embolism Tachycardia Pulmonary 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding.

Chest Pain 52

Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

DECEMBER 14, 2016

A middle aged male presented at midnight after 14 hours of constant, severe substernal chest pain, radiating to his throat and to bilateral jaws, and associated with diaphoresis. The pain was not positional, pleuritic, or reproducible. It was not relieved by anything. He had no previous medical history. Is it STEMI or NonSTEMI?

Chest Pain 52

Chest Pain STEMI Aortic Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

Sinus tachycardia has many potential causes. This is especially true for the elderly patient with sinus tachycardia. What is the cause of the sudden tachycardia? She had a very elevated troponin T at 12,335 ng/L at the time of presentation. The patient in today’s case suddenly became tachycardic while sleeping.

Cardiogenic Shock 110

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 110

Dr. Smith's ECG Blog

FEBRUARY 22, 2024

There was concern that the rhythm might represent ventricular tachycardia, so lidocaine was given and one attempt at cardioversion was performed. A Very Wide Complex Tachycardia. EMS reportedly gave 4 grams of calcium (unknown whether CaCl or gluconate) and 50 mEq of sodium bicarbonate. What is the Rhythm? Use Lewis Leads!! What is it?

Cardiac Arrest 141

Cardiac Arrest Bradycardia Tachycardia Chest Pain 141

Dr. Smith's ECG Blog

JUNE 11, 2011

Only 5-13% of patients with chest pain and LBBB have MI; many fewer have coronary occlusion. Whenever you see tachycardia with bundle branch block, you should suspect that it is rate related BBB. However, he had a left bundle brach block with normal appropriate discordance on 3 EKGs. link] Shvilkin et al.

Chest Pain 52

Chest Pain Ischemia STEMI Tachycardia 52

Dr. Smith's ECG Blog

JULY 25, 2024

Just as important is pretest probability: did the patient report chest pain prior to collapse? Confirmation of sinus tachycardia should be easy to verify when the heart rate slows a little bit ( as the patient's condition improves ) — allowing clearer definition between the T and P waves. Then assume there is ACS.

Cardiac Arrest 126

Cardiac Arrest Ischemia Tachycardia Defibrillator 126

Dr. Smith's ECG Blog

MARCH 26, 2024

Here is his ECG: Original image, suboptimal quality Quality improved with PM Cardio digitization The ECG is highly suggestive of acute right heart strain, with sinus tachycardia, S1Q3T3, and T wave inversions in anterior and inferior with morphology consistent with acute right heart strain. Moreover, there is tachycardia.

Chest Pain 70

Chest Pain Embolism Pulmonary Ischemia 70

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

They had already cardioverted at 120 J, then 200 J, which resulted in the following: Ventricular Tachycardia They then cardioverted at 200 J which r esulted in the same narrow complex rhythm shown above, at 185 beats per minute. This would treat both SVT or sinus tachycardia. I suggested esmolol if the heart rate did not improve.

Tachycardia 52

Tachycardia Chest Pain Pharmacology Myocardial Infarction 52

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. This was written by Magnus Nossen The patient is a female in her 50s. She presented with a one week hx of «dizziness» and weakness. She was feeling fine prior to the last seven days.

Tachycardia 108

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 108

Dr. Smith's ECG Blog

MAY 19, 2022

Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chest pain and shortness of breath after finishing a 4-mile run. His symptoms of chest pain and shortness of breath were attributed to an asthma exacerbation during exercise.

Chest Pain 52

Chest Pain Exercise Pacemaker Coronary Angiogram 52

Dr. Smith's ECG Blog

NOVEMBER 16, 2010

Here are more examples of wide complex tachycardia: these are all a mix of ventricular tachycardia and SVT with aberrancy. This 51 yo male complained of chest pain, then had a v fib arrest. There is tachycardia, and there is a wide complex. This wide complex tachycardia could easily be misdiagnosed as V tach.

Tachycardia 52

Tachycardia Cardiogenic Shock Chest Pain STEMI 52

Dr. Smith's ECG Blog

MARCH 7, 2024

CT of chest showed the bullet path through his right lung but nowhere near his heart. There were times when it would be usurped by sinus tachycardia, then return to this rhythm. But he did get an EKG: What is this? There is a wide complex. It is irregular. It is not fast (cannot be VT).

Hemorrhage 127

Hemorrhage Chest Pain Article AFIB 127

Dr. Smith's ECG Blog

AUGUST 14, 2023

Written by Pendell Meyers, with some edits by Smith A man in his 40s with many comorbidities presented to the ED with chest pain, hypotension, dyspnea, and hypoxemia. An 80-something woman who presented with chest pain and dyspnea. Here is his triage ECG: What do you think? Lots of info here.

Chest Pain 52

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter 52

Dr. Smith's ECG Blog

JUNE 2, 2023

She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think? She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for a regular tachycardia, possible rales at both bases, some mild RUQ abdominal tenderness.

Tachycardia 95

Tachycardia Cardiomyopathy Electrocardiogram Article 95