Remove Dysrhythmia Remove Heart Failure Remove Tachycardia
article thumbnail

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

Dr. Smith's ECG Blog

Permanent pacer placement Later, a biventricular pacer was placed for " Cardiac Resynchronization Therapy (CRT) " (This is indicated for patients with LBBB and QRS duration > 130 ms and heart failure and vastly improves heart failure). Even with tachycardia and a paced QRS duration of ~0.16 J Am Coll Cardiol.

article thumbnail

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

See here for management of Polymorphic Ventricular Tachycardia , which includes Torsades. Could the dysrhythmias have been prevented? Severe hypokalemia in the setting of STEMI or dysrhythmias is life-threatening and needs very rapid treatment. Heart failure leading to death was related to all subclasses of PVC.

STEMI 52
article thumbnail

Diffuse ST depression, and ST elevation in aVR. Left main, right?

Dr. Smith's ECG Blog

Opinions vary widely on the K level at which a patient must be admitted on a monitor because of the risk of ventricular dysrhythmias. My rationale is that if the K is affecting the ECG, then it is affecting the electrical milieu and can result in serious dysrhythmias. Until some real data is available, my opinion is this: 1.

article thumbnail

Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

In cardiogenic shock, fluid may worsen the pulmonary edema associated with acute heart failure, but may still be required to support the hemodynamic status of the patient. Hypotension may of course be a result of a brady- or tachydysrhythmia. 2) Hypoxia, including poisons of oxidative phosphorylation such as HS, CO, CN.

article thumbnail

New Onset Heart Failure and Frequent Prolonged SVT. What is it? Management?

Dr. Smith's ECG Blog

Here was his ED ECG: There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities. NT-proBNP values less than 300 pg/ml have a 99% negative predictive value for excluding congestive heart failure. A cutoff of 1200 pg/ml for patients with a normal eGFR is very specific for heart failure.

article thumbnail

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

If the patient has Abnormal Vital Signs (fever, hypotension, tachycardia, or tachypnea, or hypoxemia), then these are the primary issue to address, as there is ongoing pathology which must be identified. to 22.7), a history of congestive heart failure (OR: 5.3, Most physicians will automatically be worried about these symptoms.

article thumbnail

What is this rhythm? And why rhythm problems are easier for the Emergency Physician than acute coronary occlusion (OMI).

Dr. Smith's ECG Blog

Smith comments : Wide complex tachycardia. The differential diagnosis of WCT is: 1) Sinus tachycardia with "aberrancy" (in this case RBBB and LAFB), but there are no P-waves and the QRS morphology is not typical of simple RBBB/LAFB. Also, if the rate is constant, not wavering up and down, it is highly unlikely to be sinus tachycardia.