Embolism, Tachycardia and Ultrasound

Wide Complex Tachycardia -- VT, SVT, or A Fib with RVR? If SVT, is it AVNRT or AVRT?

Dr. Smith's ECG Blog

MARCH 28, 2024

male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Bedside ultrasound showed volume depletion and no pulmonary edema. SVT with aberrancy?

Tachycardia

Tachycardia Atrial Fibrillation AFIB Atrial Flutter

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

Bedside cardiac ultrasound showed moderately decreased LV function. CT of the chest showed no pulmonary embolism but bibasilar infiltrates. Even with tachycardia and a paced QRS duration of ~0.16 She was intubated. J Am Coll Cardiol.

Tachycardia

Tachycardia Cardiomyopathy Blog Bradycardia

Acute artery occlusion -- which one?

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

It shows sinus tachycardia with right bundle branch block. Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock). In patients with narrow QRS ( not this patient), this pattern is highly suggestive of acute pulmonary embolism. Both were wrong.

Cardiogenic Shock

Cardiogenic Shock Ultrasound Tachycardia Pulmonary

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

MORE WEBINARS

A man in his 50s with shortness of breath

Dr. Smith's ECG Blog

MARCH 26, 2024

Here is his ECG: Original image, suboptimal quality Quality improved with PM Cardio digitization The ECG is highly suggestive of acute right heart strain, with sinus tachycardia, S1Q3T3, and T wave inversions in anterior and inferior with morphology consistent with acute right heart strain. Moreover, there is tachycardia.

Chest Pain

Chest Pain Embolism Pulmonary Ischemia

Acute Dyspnea and Right Bundle Branch Block

Dr. Smith's ECG Blog

NOVEMBER 17, 2023

Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema. A Closer LOOK at the ECG in Figure-1: The ECG in Figure-1 shows sinus tachycardia — with QRS widening due to complete RBBB.

Aneurysm

Aneurysm Stents Stent Chest Pain

Two patients with chest pain and RBBB: do either have occlusion MI?

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Smith comment: before reading anything else, this case screamed pulmonary embolism to me. I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. There is sinus tachycardia at ~100/minute.

Chest Pain

Chest Pain STEMI Pulmonary Embolism

"Pericarditis" strikes again

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Patients with pulmonary embolism or aortic dissection who have normal variant ST elevation are at high risk of being diagnosed with pericarditis when what they have is far more serious!! Beware a negative Bedside ultrasound. You diagnose pericarditis at your peril! Acute MI is frequently misdiagnosed as pericarditis. Pericarditis?

Pericarditis

Pericarditis Chest Pain Aortic Blog

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

JUNE 17, 2024

He was started on a heparin drip and CTA of the chest was ordered to rule out pulmonary embolism. This is a case like many others posted (see list below) and the EKG from the patient’s original presentation can be quickly recognized as diagnostic for pulmonary embolism. Now another, with ultrasound. In fact, Kosuge et al.

Chest Pain

Chest Pain Embolism Pulmonary Tachycardia

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

Dr. Smith's ECG Blog

OCTOBER 10, 2022

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. Now another, with ultrasound. On epinephrine and norepinephrine drips."

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

We can see enough to make out that the rhythm is sinus tachycardia. Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW.

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. Clinically — despite an initial 2-fold increased troponin, the normal bedside Echo was reassuring against OMI or pulmonary embolism. This sinus tachycardia ( at ~130/minute ) — is consistent with the patient’s worsening clinical condition, with development of cardiogenic shock.

Cardiac Arrest

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock

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

Dr. Smith's ECG Blog

APRIL 8, 2015

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). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Good History and Physical exam, including a.

Arrhythmia

Arrhythmia Outcomes Chest Pain Risk Factors

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

Dr. Smith's ECG Blog

APRIL 9, 2025

On arrival in the ED, a bedside ultrasound showed poor LV function (as predicted by the Queen of Hearts) with diffuse B-lines. LAD: type III-IV vessel with a proximal thrombotic or embolic occlusion (TIMI 0 flow). I don't know what the device algorithm interpretation stated. Initial BP was 120/96, HR 102, SpO2 98%. Angiogram: 2.

Defibrillator

Defibrillator Cardiac Arrest Myocardial Infarction STEMI

A woman in her 40s with acute chest pain and shortness of breath

Dr. Smith's ECG Blog

NOVEMBER 21, 2024

Smith : This is classic for pulmonary embolism (PE). Acute pulmonary embolism was confirmed on CT angiogram: The patient did well. See our other acute right heart strain / pulmonary embolism cases: A man in his 50s with shortness of breath Another deadly triage ECG missed, and the waiting patient leaves before being seen.

Chest Pain

Chest Pain Embolism Pulmonary Tachycardia

Cardiovascular Update

Wide Complex Tachycardia -- VT, SVT, or A Fib with RVR? If SVT, is it AVNRT or AVRT?

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

Acute artery occlusion -- which one?

Webinars

A man in his 50s with shortness of breath

Acute Dyspnea and Right Bundle Branch Block

Two patients with chest pain and RBBB: do either have occlusion MI?

"Pericarditis" strikes again

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

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

Extreme shock and cardiac arrest in COVID patient

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

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

A woman in her 40s with acute chest pain and shortness of breath

Stay Connected