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 72

Chest Pain STEMI Pulmonary Embolism 72

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 116

Chest Pain STEMI Aneurysm Stent 116

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 93

Electrocardiogram Chest Pain Tachycardia 93

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 70

Chest Pain Pulmonary Embolism STEMI 70

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

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

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 77

Chest Pain Echocardiogram Blog Ischemia 77

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 134

Tachycardia Atrial Fibrillation Chest Pain Blood Pressure 134

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

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 Stent 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 Stenosis Tachycardia 52

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 118

Tachycardia Electrophysiology Atrial Flutter Ischemia 118

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

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 108

Chest Pain Myocardial Infarction Tachycardia Stenosis 108

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 STEMI 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

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

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 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

HeartRhythm

MARCH 31, 2025

Inappropriate Sinus Tachycardia (IST), which affects 1-1.2% Symptoms include abnormally high heart rate of > 90 beats per minute, fatigue, chest pain and exercise intolerance. of the population, can be a debilitating condition in otherwise healthy younger patients.

Tachycardia 40

Tachycardia Chest Pain Exercise 40

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 Coronary Angiogram Pacemaker 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 123

Cardiac Arrest Ischemia Tachycardia Defibrillator 123

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

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

American College of Cardiology

NOVEMBER 5, 2024

A small proportion of patients with STEMI treated via primary PCI experienced late ventricular tachycardia (VT) or ventricular fibrillation (VF), occurring one or more days following the procedure, but late VT or VF with cardiac arrest occurred rarely, especially among patients with uncomplicated STEMI, according to a study published in JAMA Network (..)

STEMI 46

STEMI Chest Pain Cardiac Arrest Tachycardia 46

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 68

Chest Pain Embolism Pulmonary Ischemia 68

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 124

Hemorrhage Chest Pain Article AFIB 124

Dr. Smith's ECG Blog

NOVEMBER 9, 2012

A man in his 40's with a h/o coronary disease complained of sudden dizziness and chest pain. Alternatively, it could be posterior fascicular ventricular tachycardia. Either the PSVT was broken and restarted, or there is sinus tachycardia. Outcome: The etiology of the patient's sinus tachycardia was not discovered.

Tachycardia 52

Tachycardia Chest Pain Hemorrhage Hospital 52

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. He later developed mild continuous chest pain, that he describes as the sensation of someone standing on his chest. This ECG was recorded: What do you think? There is widespread ST depression.

Chest Pain 117

Chest Pain Ischemia Echocardiogram Myocardial Infarction 117

Dr. Smith's ECG Blog

OCTOBER 26, 2010

This 54 year old patient with a history of kidney transplant with poor transplant function had been vomiting all day when at 10 PM he developed severe substernal crushing chest pain. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. He had this ECG recorded. Are the lungs clear?

STEMI 52

STEMI Cardiogenic Shock Tachycardia Aneurysm 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2021

40-something yo who is on flecainide and diltiazem had sudden onset chest pain, palpitations, shortness of breath and diaphoresis : Rate is 220. It is a regular narrow complex tachycardia. Regular Narrow complex tachycardia, if not sinus tach, is AVNRT, AVRT, or atrial flutter with 1:1 or 2:1 conduction. What is the DDx?

Atrial Flutter 52

Atrial Flutter Tachycardia Chest Pain Ischemia 52

Dr. Smith's ECG Blog

DECEMBER 27, 2014

A male in his 60's called 911 for dizziness and chest pain, onset with exertion. Here is his initial rhythm strip (it is not a full 10 seconds): Wide complex tachycardia, rate 235 This is a very wide complex regular tachycardia at a rate of 235. It should be considered to be Ventricular Tachycardia and treated as such.

Atrial Flutter 52

Atrial Flutter Tachycardia Chest Pain Ischemia 52

Dr. Smith's ECG Blog

MARCH 11, 2012

Here was his initial ECG: Regular Wide Complex Tachycardia. Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Approach to Wide Complex Tachycardia Unstable – Shock it 12-lead if at all possible --Unstable defined by : Chest Pain Shock Hypotension Very dyspneic Pulmonary Edema Stable Get a 12-lead ECG Sinus?

Tachycardia 52

Tachycardia Chest Pain Pulmonary Blood Pressure 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

His previous echo one month prior shows the same thing: “consistent with old infarct in LAD vascular territory, with EF 45%” "I think there is something else causing his tachycardia which is exaggerating his EKG findings and mimicking an acute myocardial infarction." The patient spontaneously converted back to sinus tachycardia.

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

Dr. Smith's ECG Blog

MAY 7, 2024

A 30-something presented with chest pain, palpitations, and SOB. The two ECGs above were texted to me with the text: "Young Guy came in in SVT but now in and out of irregular wide complex tachycardia. -- not sure if polymorphic VT vs. a fib with WPW." He has had similar symptoms for 4 years, but has never been evaluated.

Atrial Fibrillation 129

Atrial Fibrillation AFIB Ablation Chest Pain 129