Remove Defibrillator Remove Echocardiogram Remove Stenosis
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Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. Why?

Dr. Smith's ECG Blog

Again, it is common to have an ECG that shows apparent subendocardial ischemia after resuscitation from cardiac arrest, after defibrillation, and after cardioversion. An echocardiogram showed: Left ventricular hypertrophy concentric. An echocardiogram showed: Left ventricular hypertrophy concentric. This was done.

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Cardiac Arrest, acute ST elevation and depression superimposed on LVH, but NOT due to ACS

Dr. Smith's ECG Blog

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. An echocardiogram confirmed aortic stenosis with a large pressure gradient. This young male had ventricular fibrillation during a triathlon. On his bib it stated that he had a congenital heart disorder. His initial ECG is shown here.

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Cardiac arrest: even after the angiogram, the diagnosis is not always clear

Dr. Smith's ECG Blog

She was found to be in ventricular fibrillation and was defibrillated 8 times without a single, even transient, conversion out of fibrillation. She was immediately intubated during continued compressions, then underwent a 9th defibrillation, which resulted in an organized rhythm at 42 minutes after initial arrest. References : 1.

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A man with chest pain off and on for two days, and "No STEMI" at triage.

Dr. Smith's ECG Blog

During angiogram in the cath lab, the patient suffered two episodes of ventricular fibrillation for which he was successfully defibrillated. Angiogram showed a culprit lesion of 100% stenosis to the right coronary artery and 100% stenosis of the right posterior descending artery, both with TIMI 0 flow.

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Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

She was defibrillated and resuscitated. Here is the cath report: Echocardiogram: There is severe hypokinesis of entire LV apex and apical segment of all the walls. Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting." ng/mL by 4th generation and older assays.)

Plaque 52
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What Lies Beneath

EMS 12-Lead

We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG. Indeed, bedside Echocardiogram revealed severe left ventricular impairment of Takotsubo cardiomyopathy. The coronary angiogram revealed no critical stenosis, or acute plaque ulceration.

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Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

While awaiting transfer to the cath lab, STAT echocardiogram was performed and showed LVEF 30-35%, as well as anterior, inferior, and apical hypokinesis, and apical thrombus. In addition, the top left blue arrow indicates a section in the LAD with a severe stenosis, likely the culprit for the prior L A D occlusion which has since recanalized.