Dr. Smith's ECG Blog

APRIL 29, 2020

She was never defibrillated. A useful classification of WCT ( W ide- C omplex T achycardia ) rhythms — separates them into those that are mono morphic ( with similar QRS morphology during the tachycardia ) vs those that are poly morphic ( in which QRS morphology varies ). Acute ischemia? What do you think?

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

Shortly after isoprenalin infusion was initiated, there were short runs of ventricular tachycardia. Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). The above ECG initially shows AV block.

Tachycardia 106

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 106

Ken Grauer, MD

JUNE 27, 2024

IMPRESSION: Given the presence of a wide tachycardia — with 2 distinct QRS morphologies, and no sign of P waves — a presumed diagnosis of B i D irectional Ventricular Tachycardia has to be made. Acute myocardial ischemia. Despite prolonged resuscitation with multiple defibrillation attempts — the patient could not be saved. =

Blog 159

Blog Cardiac Arrest Sudden Cardiac Death Tachycardia 159

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). What do you think?

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 ). He required multiple defibrillations within a period of a few hours. There is no definite evidence of acute ischemia. (ie, What do you think?

Arrhythmia 130

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 130

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

There is a run of polymorphic ventricular tachycardia — which given the QT prolongation, qualifies as Torsades de Points ( TdP ). This episode self terminated before defibrillation was possible. This run of TdP is initiated by a PVC — but it then self-terminates. Discussion : The patient in today’s case presented with "seizures".

Tachycardia 112

Tachycardia Blog Sudden Cardiac Death Arrhythmia 112

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. In terms of ischemia, there is both a signal of subendocardial ischemia (STD max in V5-V6 with reciprocal STE in aVR) AND a signal of transmural infarction of the inferior wall with Q wave and STE in lead III with reciprocal STD in I and aVL.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

APRIL 8, 2016

At cath, he immediately had incessant Torsades de Pointes requiring defibrillation 7 times and requiring placement of a transvenous pacer for overdrive pacing at a rate of 80. If there is polymorphic VT with a long QT on the baseline ECG, then generally we call that Torsades, but Non-Torsades Polymorphic VT can result from ischemia alone.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

Otherwise vitals after intubation were only notable for tachycardia. An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. She was ventilated by bag-valve-mask by EMS on arrival and was quickly intubated with etomidate and succinylcholine. A rectal temperature was obtained which read 107.9

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. However, with widespread ST depression, this could also be due to diffuse subendocardial ischemia. Everything is complicated by the arrest and hypotension: Is the ischemia caused by the instability, or the instability caused by the ischemia?

Cardiac Arrest 40

Cardiac Arrest Tachycardia STEMI Chest Pain 40

Dr. Smith's ECG Blog

DECEMBER 20, 2024

No evidence for ischemia jumps out. This is the shock coil and identifies this device as a defibrillator. CRT-D is cardiac resynchronization therapy with defibrillation capability, like the CXR above. CRT-P is cardiac resynchronization therapy with pacing only, without the ability to defibrillate. ECG 1 What do you think?

Chest Pain 101

Chest Pain Tachycardia Pacemaker Defibrillator 101

Dr. Smith's ECG Blog

DECEMBER 31, 2024

The ECG shows sinus rhythm with normal QRS complex morphology and significant subendocardial ischemia (SEI) pattern (ST depression in many leads, worst in lateral areas including leads II, V5-6, with reciprocal STE in aVR). Here is her ECG within 30 minutes of PCI: Improved, but still with ischemia. Pre-intervention. Post-intervention.

Ischemia 118

Ischemia Tachycardia Chest Pain STEMI 118

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

There was never ventricular fibrillation (VF) or ventricular tachycardia (VT), no shockable rhythm. Here is a similar case: Collapse, Ventricular Tachycardia, Cardioverted, Comatose on Arrival. Agitation, Confusion, and Unusual Wide Complex Tachycardia. There is sinus tachycardia at ~115/minute.

STEMI 88

STEMI Hemorrhage Cardiac Arrest Tachycardia 88

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

During observation in the ED the patient had multiple self-terminating runs of Non-Sustained monomorphic Ventricular Tachycardia (NSVT). That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. This patient very likely has some form of idiopathic ventricular tachycardia.

Tachycardia 71

Tachycardia Arrhythmia Ablation Atrial Flutter 71

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! She was defibrillated perhaps 25 times. Defibrillation strategies for refractory ventricular fibrillation. McLeod, S.

Cardiomyopathy 74

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 74