Defibrillator and Embolism - Cardiovascular Update

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). After good ECMO flow was established, she was successfully defibrillated. Here is a case of ECMO defibrillation with near shark fin that was due to proximal LAD occlusion. The K was normal.

Defibrillator

Defibrillator Circulation Plaque Cardiac Arrest

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

JANUARY 2, 2025

CT of the chest showed no pulmonary embolism but bibasilar infiltrates. Because she has cardiomyopathy and ventricular dysrhythmias, the pacer included an Implanted Cardioverter-Defibrillator (ICD) Echo 6 days later after CRT: Normal estimated left ventricular ejection fraction. She was intubated. No wall motion abnormality.

Tachycardia

Tachycardia Cardiomyopathy Blog Bradycardia

50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

Today's case reminds us of the intuitive logic that if a patient has a shockable arrest ( ie, VFib ) — and following successful defibrillation shows evidence of acute OMI ( even if STEMI criteria are not necessarily fulfilled ) — that such patients have much to gain from immediate cath with PCI. (

Cardiac Arrest

Cardiac Arrest STEMI Ischemia SCAD

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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

NOVEMBER 30, 2022

She was defibrillated and resuscitated. Transient and partial thrombosis at the site of a non-obstructive plaque with subsequent spontaneous fibrinolysis and distal embolization may be one of the mechanisms responsible for the occurrence of MINOCA. Smith: this ECG and clinical presentation is diagnostic of LAD Occlusion.

Plaque

Plaque Chest Pain Thrombosis Stenosis

Abstract 4139677: A rare case of ventriculobronchial fistula caused by an epicardial defibrillator patch

Circulation

NOVEMBER 11, 2024

Background:Epicardial patch defibrillators (EPDs) were commonly implanted in the 1990s for secondary prevention of sudden cardiac death. Despite empiric bronchial artery embolization, hemoptysis persisted. Circulation, Volume 150, Issue Suppl_1 , Page A4139677-A4139677, November 12, 2024.

Defibrillator

Defibrillator Cardiac Arrest Sudden Cardiac Death Coronary Angiogram

Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment

MIBHS

OCTOBER 31, 2024

Implantable Cardioverter-Defibrillator (ICD) to help manage dangerous heart rhythms. Blood Clots: An enlarged heart is more prone to developing blood clots, which can lead to stroke or pulmonary embolism. Coronary Artery Bypass Surgery for those with blocked arteries, improving blood flow to the heart muscle.

Blood Pressure

Blood Pressure Blood Clot Heart Valves Heart Rhythm

Transcutaneous Pacing: Part I

EMS 12-Lead

MARCH 30, 2024

The receiving staff suspects pulmonary embolism due to S1Q3T3 on the ECG and administers TPA. As this case shows, electrical capture isn't always possible at lower currents, especially with pads placed in a standard anterolateral "defibrillation" position. On ED arrival ROSC is achieved.

Cardiac Arrest

Cardiac Arrest Pacemaker Pulmonary Bradycardia

Direct Oral Anticoagulants for Stroke Prevention in Patients with Device-Detected Atrial Fibrillation: A Study-Level Meta-Analysis of the NOAH-AFNET 6 and ARTESiA Trials

Circulation

NOVEMBER 11, 2023

Oral anticoagulation also reduced a composite of cardiovascular death, all-cause stroke, peripheral arterial embolism, myocardial infarction or pulmonary embolism (RR 0.85, 95% CI 0.73-1.00, We used random-effects models for meta-analysis and rated the quality of evidence using the GRADE framework. I2=0%; moderate-quality evidence).

Atrial Fibrillation

Atrial Fibrillation Strokes Stroke Embolism

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

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). CT angiogram showed extensive saddle pulmonary embolism.

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

JANUARY 15, 2024

Then, part of the thrombus embolized into the LCx causing an inferoposterolateral OMI. (As Rhythm C: This telemetry strip from an older adult was initially thought to need defibrillation. Putting all the data together, the patient likely suffered an anterior OMI in the days or weeks prior to presentation.

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

Dr. Smith's ECG Blog

APRIL 9, 2025

We rapidly defibrillated her, and with return of normal sinus rhythm. Several minutes later the patient developed V-fib again > 200J defibrillation with return to NSR. Rapid sequence intubation was performed for airway protection in setting of recurrent V-fib and defibrillations. Chest X-ray also showed pulmonary edema.

Defibrillator

Defibrillator Cardiac Arrest Myocardial Infarction STEMI

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

Dr. Smith's ECG Blog

MARCH 25, 2025

In this case, you should get a second defibrillator and perform double sequential external defibrillation (DSED). Simply attach a second defibrillator as shown in the diagram below and deliver max shocks from both devices simultaneously. In the second case, the patient never converted meaning the shock did not do its job at all.

Chest Pain

Chest Pain Ischemia Plaque Stents

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

Dr. Smith's ECG Blog

MARCH 8, 2025

Third, a slow motion segment showing delayed, brisk filling of the PDA due to dislodgment of a thrombus from contrast injection and distal embolization. A distal RCA lesion ( blue arrow ), Delayed brisk filling of an initially occluded PDA due to a thrombus dislodged during injection which embolized distally. SanzRuiz, R., McLeod, S.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Webinars

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

Abstract 4139677: A rare case of ventriculobronchial fistula caused by an epicardial defibrillator patch

Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment

Transcutaneous Pacing: Part I

Direct Oral Anticoagulants for Stroke Prevention in Patients with Device-Detected Atrial Fibrillation: A Study-Level Meta-Analysis of the NOAH-AFNET 6 and ARTESiA Trials

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

Noisy, low amplitude ECG in a patient with chest pain

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

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

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