Pacemaker STEMI Tachycardia 
Dr. Smith's ECG Blog
SEPTEMBER 29, 2023
It's a very "fun" ECG, with initial ectopic atrial tachycardia (negative P waves in inferior leads conducting 1:1 with the QRSs), followed by spontaneous resolution to sinus rhythm. In the available view of the sinus rhythm, we see normal variant STE which probably meets STEMI criteria in V4 and V5. Triage ECG: What do you think?
Dr. Smith's ECG Blog
JANUARY 1, 2024
While the initial impression might not immediately suggest ventricular tachycardia (VT), a closer examination raises suspicion. Again, see Ken's discussion below) Discussion continued The absence of pace spikes suggests this is not a pacemaker/ICD-related rhythm in this patient with an ICD. What is the rhythm? Smith : Are they P-waves?
Dr. Smith's ECG Blog
FEBRUARY 27, 2023
In fact, sometimes the sinus node is working and acting as a pacemaker but no P waves are visible!! See many examples of Pseudo STEMI due to hyperkalemia at these two posts: Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life.
Dr. Smith's ECG Blog
MAY 19, 2022
T-wave inversions and dynamic ST elevation Tachycardia, hyperthyroid, and ST elevation. Anterior STEMI? This gradual change in P wave morphology as the heart rate varies could be consistent with a wandering atrial pacemaker. Two cases of ST Elevation with Terminal T-wave Inversion - do either, neither, or both need reperfusion?
Dr. Smith's ECG Blog
SEPTEMBER 30, 2019
Using the STEMI paradigm would have resulted in significant delays for this patient, which correspond with the doubled mortality and morbidity of NSTEMI Occlusions seen in over 50,000 subjects in NSTEMI trials. == MY Comment, by K EN G RAUER, MD ( 9/30/2019 ): == Our THANKS to Dr. I never see 2 P waves in a row with the same morphology.
Dr. Smith's ECG Blog
JULY 19, 2024
It was read by the treating physician and the overreading cardiologist as "Paced, no STEMI." As the troponin T was 1521 ng/L (peak troponin T over 1000 ng/L is typical of STEMI) and still rising, no further troponins were measured. NOTE #2: I always like to look for the presence of an underlying rhythm in pacemaker tracings.
Dr. Smith's ECG Blog
AUGUST 9, 2024
Automatic activity refers to enhanced pacemaking function (typically from a non sinus node source), for example atrial tachycardia. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. Is there STEMI? The patient continued having chest pain. What is the rhythm?
Expert insights. Personalized for you.
129 
Let's personalize your content