Remove Dysrhythmia Remove Heart Failure Remove Ultrasound
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

Bedside cardiac ultrasound showed moderately decreased LV function. 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).

article thumbnail

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

Dr. Smith's ECG Blog

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

article thumbnail

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

Dr. Smith's ECG Blog

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. A bedside POC cardiac ultrasound was done: Findings: Decreased left ventricular systolic function.

article thumbnail

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. Could the dysrhythmias have been prevented? Severe hypokalemia in the setting of STEMI or dysrhythmias is life-threatening and needs very rapid treatment. He was managed medically with Clopidogrel. Learning Points: 1.

STEMI 52
article thumbnail

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

Dr. Smith's ECG Blog

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). heart auscultation (aortic stenosis); c. Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade.