Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. The patient’s angiogram should have been expedited, but the EKG change was not recognized as recurrence of transmural ischemia.

Chest Pain 119

Chest Pain Blog Hospital Tachycardia 119

Dr. Smith's ECG Blog

JULY 27, 2023

His prehospital ECG showed "inferior" ST depression and high voltage, with tachycardia. I suspected no OMI, that this could be due to LVH plus tachycardia. Conclusion: Type II MI probable due to hypoxia and tachycardia from resp arrest and amphetamine use. On arrival to the ED, the patient was diaphoretic, tachycardic.

Tachycardia 52

Tachycardia Ischemia Cardiac Arrest Echocardiogram 52

Dr. Smith's ECG Blog

MAY 1, 2023

edits by Meyers A woman in her 60s with a history of chronic atrial fibrillation on Eliquis, ESRD on hemodialysis, type-II diabetes mellitus, prior CVA, hypertension, and hyperlipidemia presented to the emergency department with multiple complaints after missing dialysis. Tachycardia and ST Elevation. She was discharged home.

Atrial Flutter 52

Atrial Flutter Tachycardia Arrhythmia Blog 52

Dr. Smith's ECG Blog

JULY 1, 2019

Although as a general rule, there should be no ST elevation in RBBB in the absence of ischemia, there sometimes is ST elevation that looks like this. If the ECG findings are truly new compared to a baseline (unavailable), this could suggest persistent ECG findings of ischemia, meaning poor downstream perfusion ("no reflow" phenomenon).

Chest Pain 52

Chest Pain Ischemia STEMI Blog 52

Dr. Smith's ECG Blog

AUGUST 14, 2023

The flutter waves can conceal or mimic ischemic repolarization findings, but here I don't see any obvious findings of OMI or subendocardial ischemia. Chronic RVH is due to chronic pulmonary hypertension, and these patients are extremely difficult to manage when they are acutely ill. The rhythm is 2:1 atrial flutter.

Chest Pain 52

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter 52

Dr. Smith's ECG Blog

MARCH 2, 2019

Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? Ischemia b. ST depression: is it ischemia? Does this patient have hypertension and/or heart failure that has worsened? It was a baseline finding in 62% of patients, usually due to LVH.

Sickle Cell Disease 52

Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52

Dr. Smith's ECG Blog

APRIL 17, 2023

In addition to sinus tachycardia, the only abnormalities listed by the computer were "low voltage, precordial leads" and "anteroseptal infarct, old.Q He was mildly tachycardic (105-110 bpm) and hypertensive (157/92 mm Hg) on arrival. Cardiologist interpretation: "Technically does not meet STEMI criteria but concerning for ischemia."

Chest Pain 52

Chest Pain STEMI Document Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

The patient stated he had a long history of well-controlled hypertension for which he was compliant with his ACE-inhibitor. These findings are concerning for inferior wall ischemia with possible posterior wall involvement. He was also treated for erectile dysfunction but had not taken any medications recently.

Chest Pain 52

Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

He was hypertensive and tachycardic, with mildly increased work of breathing. In some cases the ischemia can be seen "through" the flutter waves, whereas in other cases the arrhythmia must be terminated before the ischemia can be clearly distinguished. 2) Tachycardia to this degree can cause ST segment changes in several ways.

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. His wife contacted the ambulance service after the patient experienced an episode of loss of consciousness.

Cardiogenic Shock 127

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 127

EMS 12-Lead

APRIL 21, 2022

There is appreciable STE aVR with near-global STD that appropriately maximizes in Leads II and V5, and thus suggesting a circumstance of generic, diffusely populated, circumferential subendocardial ischemia versus occlusive coronary thrombus. [1] The patient was found to be hypertensive and treated accordingly.

Ischemia 52

Ischemia Myocardial Infarction Blog Coronary Angiogram 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

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. The rhythm is atrial fibrillation. The QRS complex is within normal limits.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

APRIL 8, 2016

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. See here for management of Polymorphic Ventricular Tachycardia , which includes Torsades. If there is a pulse, you would call it Torsades. Serum potassium level (range 2.5

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Higher troponin correlated with more history of heart failure, diabetes, and hypertension, as well as higher D-dimer, and nearly all inflammatory markers. Use of objective evidence of myocardial ischemia to facilitate the diagnostic and prognostic distinction between type 2 myocardial infarction and myocardial injury.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

MARCH 3, 2025

A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chest pain and shortness of breath. The status of the patients chest pain at this time is unknown : EKG 1, 1300: There is sinus tachycardia and artifact of low and high frequency. This was written by Hans Helseth.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

DECEMBER 16, 2024

But it also shows a massive area of total ischemia in the LAD territory: CT shows the infarct The CT is with contrast, which increases density (which looks more white). Most dissections which cause coronary ischemia are into the RCA ostium ("ostium" = locations of takeoff of the vessel). No ECG was recorded after pain resolution.

Chest Pain 104

Chest Pain STEMI Aortic Ultrasound 104

Dr. Smith's ECG Blog

JANUARY 24, 2025

Written by Willy Frick A 52 year old man with hypertension, dyslipidemia, and seropositive rheumatoid arthritis (a risk factor for CAD) presented with acute substernal chest pressure with diaphoresis which woke him from sleep just after midnight. Ventricular tachycardia?) Severe ischemia can be present even when the chest pain is gone.

Chest Pain 123

Chest Pain STEMI Risk Factors Coronary Artery Disease 123

Dr. Smith's ECG Blog

JANUARY 21, 2025

This ECG was recorded: It is difficult to appreciate P-waves, but I believe this is sinus tachycardia. Time 7 hours lead reversal There is limb lead reversal (QRS in I and aVL are now inverted), but nevertheless one can see that the ischemia appears to have resolved. He was put on BiPAP. A Chest X-ray did not show pulmonary edema.

Chest Pain 61

Chest Pain STEMI Tachycardia Myocardial Infarction 61

Dr. Smith's ECG Blog

NOVEMBER 21, 2024

A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation.

Chest Pain 111

Chest Pain Embolism Pulmonary Tachycardia 111

Dr. Smith's ECG Blog

APRIL 18, 2025

Written by Hans Helseth, with edits and comments by Smith and Grauer An 84 year old man with chronic hypertension and CKD presented to a primary care clinic. There is sinus tachycardia with PVCs displaying various degrees of fusion ( See Ken Grauer's comment for below for a more detailed analysis of this rhythm ).

Chest Pain 80

Chest Pain Cardiac Arrest Tachycardia ICU 80