Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. The patient’s angiogram should have been expedited, but the EKG change was not recognized as recurrence of transmural ischemia.

Chest Pain 119

Chest Pain Blog Hospital Tachycardia 119

Dr. Smith's ECG Blog

MARCH 2, 2019

Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? Ischemia b. ST depression: is it ischemia? It was a baseline finding in 62% of patients, usually due to LVH. Reference: Knotts RJ , Wilson JM, Kim E, Huang HD, Birnbaum Y.

Sickle Cell Disease 52

Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52

Dr. Smith's ECG Blog

APRIL 29, 2020

Angiogram --Minimal coronary atherosclerosis --No obstructive epicardial coronary artery disease or evidence of plaque rupture noted to explain prolonged QT or ventricular fibrillation cardiacarrest, suspect nonischemic mechanism Echo The estimated left ventricular ejection fraction is 45 %. Acute ischemia?

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

These findings are concerning for inferior wall ischemia with possible posterior wall involvement. He was taken emergently to the cardiac catheterization lab and found to have multi-vessel coronary artery disease with a near-occlusive culprit lesion in the RCA, possibly reperfused. No significant changes, ongoing pain.

Chest Pain 52

Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch).

Cardiogenic Shock 127

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 127

Dr. Smith's ECG Blog

JULY 21, 2024

This progressed to electrical storm , with incessant PolyMorphic Ventricular Tachycardia ( PMVT ) and recurrent episodes of Ventricular Fibrillation ( VFib ). There is no definite evidence of acute ischemia. (ie, If there had been ECG findings indicating reocclusion of the artery — an angiogram would have been warranted ).

Arrhythmia 130

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 130

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. ECG machine can also help diagnose coronary artery disease.

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 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.

Tachycardia 52

Tachycardia AFIB Arrhythmia Coronary Artery Bypass Graft 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" Here I explain: First, you don't know for certain what the state of the artery was at the time of the ECG.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

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. No evidence for ischemia jumps out. So the most likely rhythm in ECG 1 is ectopic atrial tachycardia. ECG 1 What do you think? Point 1: What is PVARP?

Chest Pain 101

Chest Pain Tachycardia Pacemaker Defibrillator 101

Dr. Smith's ECG Blog

MARCH 3, 2025

The status of the patients chest pain at this time is unknown : EKG 1, 1300: There is sinus tachycardia and artifact of low and high frequency. However, there is also significant tachycardia , with heart rate of 116, and known hypoxia. The patient was started on heparin for possible NSTEMI vs demand ischemia.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Cardiometabolic Health Congress

JANUARY 2, 2025

September 2024 Approvals Flurpiridaz F 18 Approval Date: September 27, 2024 Indication: A radioactive positron emission tomography (PET) tracer for imaging myocardial ischemia and infarction in adults with suspected or known coronary artery disease. Heart rate reduction within 10 minutes : Landiolol: 40%-90%.

Coronary Artery Disease 52

Coronary Artery Disease Stents Stent Innovation 52

Dr. Smith's ECG Blog

JANUARY 24, 2025

Ventricular tachycardia?) Severe ischemia can be present even when the chest pain is gone. He said it felt like "someone ripped [his] heart out." While walking into the ED, the patient had an episode of "dizziness" causing him to fall onto his stomach. What do you think? I sent this ECG to Dr. Smith and Dr. Meyers with no context.

Chest Pain 123

Chest Pain STEMI Risk Factors Coronary Artery Disease 123

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. One could argue or wonder if there is both subendocardial ischemia AND posterior OMI pattern, since the STD in V4 may be equal or possibly slightly worse proportionally than V6.

Ischemia 118

Ischemia Tachycardia Chest Pain STEMI 118

Dr. Smith's ECG Blog

MARCH 8, 2025

It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! Circumstances attending 100 sudden deaths from coronary artery disease with coroners necropsies. link] Park, J.,

Cardiomyopathy 74

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 74