Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. 1-4 Surprisingly, serial angiographic studies have revealed that the plaque at the site of the culprit lesion of a future acute myocardial infarction often does not cause stenosis that, as seen on the antecedent angiogram, is sufficiently severe to limit flow. Learning Points: 1.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

All About Cardiovascular System and Disorders

MARCH 20, 2024

The Y descent is shallow in tricuspid stenosis, and absent in cardiac tamponade. Thrombus can sometimes occur when there is a central venous catheter or a multiple pacemaker or defibrillator leads there that can cause thrombus formation. Right atrial hypertrophy as in tricuspid stenosis, pulmonary stenosis and pulmonary hypertension.

Tricuspid 52

Tricuspid Pericarditis VSD Heart Failure 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

When the ICD was finally interrogated, the syncopal events and shocks correlated with two VF events that were defibrillated successfully. 90% stenosis of the proximal ramus intermedius, pre procedure TIMI II flow The ramus intermedius is a normal variant on coronary anatomy that arises between the LAD and LCX.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

EMS 12-Lead

AUGUST 22, 2022

We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG. The coronary angiogram revealed no critical stenosis, or acute plaque ulceration. Paradoxically, though, the third green arrow identifies a QRS that is more narrow than the RBBB complexes surrounding it.

Tachycardia 52

Tachycardia Cardiomyopathy Electrophysiology ICU 52

Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. IF the initial ECG following successful defibrillation shows evidence of acute OMI — such patients have much to gain from immediate cath with PCI. The proof of this is that only 5% of patients enrolled had acute coronary occlusion.

Defibrillator 112

Defibrillator Cardiac Arrest STEMI Chest Pain 112

Dr. Smith's ECG Blog

JULY 21, 2024

Angiography : LMCA — 90-99% osteal stenosis. LCx — 50-69% stenosis of the 1st marginal branch; with 100% distal LCx occlusion. He required multiple defibrillations within a period of a few hours. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation.

Arrhythmia 130

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 130

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

The patient had 2 ventricular fibrillation arrests during transport, but was immediately defibrillated both times, and was awake in the ED, when the following ECG was recorded: The ST elevation has mostly resolved on this ECG, and were it not for the arrest and the prehospital ECG, this would not be a slam dunk diagnosis.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Defibrillator STEMI 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. Below is a still image with the red arrow indicating the subtotal LMCA stenosis. Just prior to arrival he fell out of consciousness with the below ECG on the monitor. ECG #3 The above ECG shows a polymorphic VT at a rate of about 180 BPM.

Cardiogenic Shock 127

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 127

Dr. Smith's ECG Blog

JUNE 19, 2023

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.

Chest Pain 52

Chest Pain STEMI Cardiogenic Shock Bradycardia 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

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. Rhythm C: This telemetry strip from an older adult was initially thought to need defibrillation. There are also diagonal branches which are not well visualized.

Chest Pain 63

Chest Pain Blog Arrhythmia Critical Care 63

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

He was defibrillated immediately and had return of normal mental status. They found an acute lesion of the LAD at the site of the prior stents, including 70% proximal LAD lesion and 95% mid-LAD stenosis with TIMI 3 flow at the time of cath. In the ambulance during transport, the patient suddenly suffered VF arrest.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Aneurysm 52

Dr. Smith's ECG Blog

DECEMBER 31, 2024

Soon after the witnessed occlusion, the patient suffered ventricular fibrillation arrest, from which he was immediately resuscitated with 1 defibrillation. The note documents that the first view of the LCX showed 99%, TIMI 2 flow, but then (before intervention) was seen to fully occlude in real time (100%, TIMI 0).

Ischemia 118

Ischemia Tachycardia Chest Pain STEMI 118