Dr. Smith's ECG Blog

JANUARY 5, 2020

Multifocal Atrial Tachycardia 2. MAT almost always occurs in one of 2 common clinical scenarios : i ) Severe pulmonary disease ( ie, COPD, long-term asthma; pulmonary hypertension ) ; or , ii ) Acutely ill patients with multisystem disease ( ie, patients with sepsis; shock; electrolyte and/or acid-base disorders ).

Atrial Fibrillation 52

Atrial Fibrillation Tachycardia Arrhythmia Pulmonary 52

Heart BMJ

SEPTEMBER 16, 2024

She was noted to be in heart failure, with hypotension and tachycardia. Echocardiography demonstrated severe calcific mitral stenosis with pulmonary hypertension. With decompensated heart failure and adequate prior anticoagulation, the patient underwent direct current synchronised cardioversion for her arrhythmia.

Atrial Flutter 52

Atrial Flutter Bicuspid/Mitral Heart Failure Tachycardia 52

Ken Grauer, MD

APRIL 13, 2024

NOTE: For more on ECG recognition of RVH and/or pulmonary hypertension ( re the qR pattern in lead V1 ) — See ECG Blog #234 and Blog #248. Because of this, it is uncommon to see sinus tachycardia with a prolonged PR interval. This is precisely what we see in Figure-6. Unfortunately — I lack this information.

Blog 116

Blog Tachycardia Pulmonary Arrhythmia 116

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. The Initial ECG in Today's Case: As per Dr. Meyers — the initial ECG in today's case shows sinus tachycardia with bifascicular block ( = RBBB/LAHB ). Sinus Tachycardia ( common in any trauma patient. ).

Tachycardia 114

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 114

Dr. S. Venkatesan MD

APRIL 28, 2024

In all probability, this dilation is a form of atrial tachycardia and atrial cardiomyopathy. However, underlying lesions such as hypertension, mitral valve disease, COPD, ASD, and TR greatly influence the degree of atrial enlargement. However, in cases of lone AF, AF in hypertension, or chronic AF, both atria tend to dilate equally.

Atrial Fibrillation 75

Atrial Fibrillation Bicuspid/Mitral Pulmonary Ablation 75

Dr. Smith's ECG Blog

MARCH 9, 2024

Written by Willy Frick A 67 year old man with a history of hypertension presented with three days of chest pain radiating to his back. The constellation of dyspnea, tachycardia, and (relatively) low voltage on ECG should prompt immediate evaluation for pericardial effusion and tamponade. He had associated nausea, vomiting, and dyspnea.

Chest Pain 117

Chest Pain Pericarditis Aortic Echocardiogram 117

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

Sinus tachycardia has many potential causes. This is especially true for the elderly patient with sinus tachycardia. What is the cause of the sudden tachycardia? A VSR is more likely to occur in patients who are older, female, hypertensive, have chronic kidney disease, and have no prior history of smoking.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Dr. Smith's ECG Blog

JANUARY 1, 2024

His medical history includes hypertension, a decade-long battle with diabetes, ischemic heart disease, a coronary bypass graft surgery ten years ago, a diagnosis of congestive heart failure for the last five years, and a prior ICD implantation five years ago. What is the rhythm? Smith : Are they P-waves?

Tachycardia 111

Tachycardia Blog Ischemia Heart Failure 111

MIBHS

JANUARY 31, 2025

Early detection of conditions like AFib, bradycardia, or tachycardia allows patients to address issues before they become critical. Risk Reduction Data from wearables can identify potential risks, such as undiagnosed arrhythmias or hypertension, allowing healthcare teams to address these issues before surgery.

Heart Rhythm 52

Heart Rhythm Technology AFIB Exercise 52

HeartRhythm

APRIL 8, 2024

A 70-year-old male with a history of hypertension, hyperlipidemia, coronary artery disease, and CABG, presented with symptoms of moderate-intensity palpitations that terminated with Valsalva maneuvers. He was noted to have supraventricular tachycardia (SVT) on an event monitor.

Coronary Artery Disease 40

Coronary Artery Disease Tachycardia Hypertension 40

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 68

Chest Pain Embolism Pulmonary Ischemia 68

Circulation

NOVEMBER 11, 2024

He was counseled to abstain from cannabis use.Conclusion:At low to moderate doses, cannabis can lead to a surge in sympathetic activity causing tachycardia and hypertension, while parasympathetic activity is predominant at higher doses, causing bradycardia and hypotension.

Bradycardia 40

Bradycardia Coronary Artery Disease Kidney Disease Outpatient 40

Journal of Cardiovascular Electrophysiology

FEBRUARY 10, 2025

Results Patients who developed >20% RV pacing ( n =148, 1.3%) had a higher likelihood of being older, male, and with a history of syncope, ventricular tachycardia or cardiac arrest, hypertension, previous or ongoing AF, and longer PR, QRS duration and BUN level ( p 230ms, history of AF, ongoing AF at time of implant, history of VT or cardiac arrest, (..)

Defibrillator 40

Defibrillator Cardiac Arrest Tachycardia Hypertension 40

Stroke Journal

JANUARY 30, 2025

Propensity score-matched analysis (PSM) (1:1) was performed with matching for age, gender, race, BMI, hypertension, diabetes mellitus, chronic kidney disease, hemoglobin level, low-density lipid (LDL) level, left ventricular ejection fraction, and various drugs including ACEi, ARBi, ARNI, beta-blockers, and diuretics. years, with 49.27% men.

Outcomes 40

Outcomes Atrial Fibrillation Heart Failure Tachycardia 40

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 conventional computer algorithm called “ sinus tachycardia, otherwise normal EKG ”.

Chest Pain 119

Chest Pain Blog Hospital Tachycardia 119

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. Christmas Eve Special Gift!!

Atrial Flutter 52

Atrial Flutter Tachycardia Arrhythmia Blog 52

Ken Grauer, MD

MARCH 27, 2024

In the context of today's case — these P waves are diagnostic of RAE = P Pulmonale ( See ECG Blog #75 ) and almost certain associated pulmonary hypertension. Retrospectively — I interpret this 1:1 retrograde conduction as diagnostic of a reentry SVT rhythm as the etiology of the initial tachycardia.

Blog 186

Blog Congenital Heart Disease Congenital Heart Disease 186

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

My answer: "This is classic for PE, but it can also be present in any hypoxia due pulmonary hypoxic vasoconstriction and resulting acute pulmonary hypertension and acute right heart strain. Tachycardia (or nearly) 2. Tachycardia, = 1.8. An ECG was texted to me (Smith) without any clinical information: What did I say?

Chest Pain 52

Chest Pain Pulmonary Tachycardia Embolism 52

Dr. Smith's ECG Blog

AUGUST 14, 2023

Chronic RVH is due to chronic pulmonary hypertension, and these patients are extremely difficult to manage when they are acutely ill. Obviously he has multiple reasons to have pulmonary hypertension. But in pulmonary hypertension, RV perfusion is greatly diminished, especially when there is hypotension. How about management?

Chest Pain 52

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter 52

All About Cardiovascular System and Disorders

FEBRUARY 14, 2024

Crochetage sign on ECG in ASD ECG in ASD with severe pulmonary hypertension: Tall R’ in V1, ST depression in inferior leads and V2-V5, and T inversion in inferior leads and V1-V6 are seen. Sharp P waves in V1 and 3 mm tall P waves in lead II suggest right atrial overload.

Congenital Heart Disease 52

Congenital Heart Disease Congenital Heart Disease VSD 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Past medical history included diabetes and hypertension. There is sinus tachycardia at ~100/minute. As often emphasized by Dr. Smith — sinus tachycardia is not a common finding with acute OMI unless something else is going on (ie, cardiogenic shock ). Vitals were normal. The initial ECG for Patient #2 also shows RBBB.

Chest Pain 72

Chest Pain STEMI Pulmonary Embolism 72

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

MARCH 12, 2018

This includes, but is not limited to, PE, asthma/COPD exacerbation, hypoxic vasoconstriction from pneumonia, acute pulmonary hypertension exacerbation. Acute coronary occlusion (especially during reperfusion) is very rarely accompanied by tachycardia. and tachycardia, 1.8. The T-waves simply look different in Wellens'.

Chest Pain 40

Chest Pain Pulmonary Embolism Tachycardia 40

All About Cardiovascular System and Disorders

MARCH 20, 2024

Right atrial hypertrophy as in tricuspid stenosis, pulmonary stenosis and pulmonary hypertension. But in a VSD with pulmonary hypertension A wave is not prominent. One is ventricular tachycardia with regular retrograde activation. We noted that prominent V waves or CV waves can occur in tricupsid regurgitation.

Tricuspid 52

Tricuspid Pericarditis VSD Heart Failure 52

All About Cardiovascular System and Disorders

MARCH 30, 2024

The cyanosis in Ebstein’s anomaly, is usually not due to pulmonary hypertension, but because tricuspid regurgitation jet is directed across the atrial septal defect. This is one important cause of supraventricular tachycardia in Ebstein’s anomaly. Electrophysiological study will show that, and this pathway can be ablated.

Tricuspid 52

Tricuspid Arrhythmia Congenital Heart Disease Electrophysiology 52

EMS 12-Lead

MARCH 19, 2023

Vital signs were noted to be unremarkable with respect to any hypo-hypertensive crisis, hypoxia, etc. He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. Fire/EMS crews found him clammy and uncomfortable.

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 52

EMS 12-Lead

JULY 24, 2023

Category 2 : An increase in myocardial oxygen demand due to tachycardia, elevated ventricular afterload (BP or aortic stenosis), or increased wall stretch (admittedly this latter is more complicated) or a decrease in oxygen supply due to hypotension, anemia, hypoxia, or a combination of all of the above. This results in Type I MI.

Angina 52

Angina Ischemia Coronary Angiogram Stenosis 52

Dr. Smith's ECG Blog

JANUARY 27, 2024

This ECG has Q-waves, but they are not very wide nor very deep, and so I doubt that the inferior STE is due to old MI. See these posts: Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab?

Chest Pain 116

Chest Pain STEMI Aneurysm Stents 116

Dr. Smith's ECG Blog

JULY 1, 2019

Case 2: sent by Dr. James Alva A man in his 50s with diabetes, hypertension, and hyperlipidemia presented to the ED with chest pain and shortness of breath off and on over the past three days, with associated vomiting. The rhythm is sinus tachycardia at ~105/minute. The rhythm is sinus tachycardia at ~115/minute.

Chest Pain 52

Chest Pain Ischemia STEMI Blog 52

Ken Grauer, MD

FEBRUARY 13, 2023

She had a history of hypertension, and was on medication for this — but she was otherwise healthy. The ECG in Figure-1 was obtained from an older woman — who presented with chest pain and palpitations over the previous hour. BP = 140/90 mm Hg in association with the rhythm in Figure-1. How would YOU interpret the rhythm in Figure-1 ?

Blog 78

Blog Arrhythmia Exercise Chest Pain 78

Dr. Smith's ECG Blog

DECEMBER 14, 2016

The patient had no hypertension, no tachycardia, a normal hemoglobin, no drug use, no hypotension/shock, no murmur of aortic stenosis. Acute myocardial injury: Is it myocardial infarction, or perhaps myocarditis? If it is MI, is it type 1 or type 2? Is it STEMI or NonSTEMI? Is it acute persistent occlusion?

Chest Pain 52

Chest Pain STEMI Aortic Pulmonary 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. BP was 110 and oxygen saturation was normal.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Conquering CHD

JUNE 20, 2023

POTENTIAL SIDE EFFECTS : While diuretics can be effective in managing symptoms such as edema and hypertension, possible side effects include electrolyte imbalances, dehydration, and hypotension. This can relieve swelling and shortness of breath caused by fluid buildup in the lungs or other parts of the body.

Congenital Heart Disease 52

Congenital Heart Disease Congenital Heart Disease ACE Inhibitor 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. 4) There is well formed J-point notching. Case 2: What do you think?

Chest Pain 52

Chest Pain STEMI Document Ischemia 52

Frontiers in Cardiovascular Medicine

FEBRUARY 24, 2025

Hypertension and diabetes were the two most common risk factors identified. were male, with the average age of 56.313.5 The average time to present to the emergency room after symptom onset was 3.7 The majority of patients (67.9%) have been diagnosed with ST- Elevated Myocardial Infarction and were classified as Killip class I.

Hospital 98

Hospital Myocardial Infarction Chest Pain Electrocardiogram 98

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. C linically — the rhythm we see in the long lead II of ECG #3 behaves similar to MAT, even though there is no tachycardia. 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

MARCH 2, 2019

My L IST includes the following: i ) LVH with strain; ii ) Ischemia; iii ) Digoxin use; iv ) HypoKalemia and/or HypoMagnesemia; v ) Tachycardia; and , vi ) Any combination of i-thru-v. Does this patient have hypertension and/or heart failure that has worsened? Often more than one entity is operative as is likely in this case.

Sickle Cell Disease 52

Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52