Dr. Smith's ECG Blog

OCTOBER 23, 2023

Conduction and refractoriness alternans may be seen with WPW-related as well as AV Nodal-dependent reentr y tachycardias — atrial fibrillation — acute pulmonary embolus — myocardial contusion — and severe LV dysfunction. Therefore — identification of QRS alternans during a regular SVT does not prove the existence of an accessory pathway.

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Tachycardia Cardiac Arrest ICU Blog 130

All About Cardiovascular System and Disorders

MARCH 20, 2024

That occurs in right heart failure and constrictive pericarditis. Constrictive pericarditis is an important cause for Kussmaul sign or inspiratory increase in jugular venous pressure. On the other hand, the Y descent is very prominent in constrictive pericarditis, and it is known as Friedreich’s sign.

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Tricuspid Pericarditis VSD Heart Failure 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2017

The combination of findings consistent with acute coronary occlusion in the anterior and inferior leads is likely due to a large "wraparound" LAD occlusion, should not be confused with the "diffuse" ST elevation of pericarditis, and will usually show reciprocal ST depression in aVL.

Chest Pain 52

Chest Pain Pericarditis Embolism Stents 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. Q waves in association with RBBB are usually not seen in anterior leads unless there is pulmonary hypertension or anterior infarction.

Tachycardia 115

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

Then the patient's pain then resolved spontaneously after 2 sublingual nitroglycerine and another ECG was recorded ECG 2 at 16 minutes ST ELEVATION CONSISTENT WITH INJURY, PERICARDITIS, OR EARLY REPOLARIZATION Overread same Smith : The T-waves are now MUCH smaller. The estimated pulmonary artery systolic pressure is 27 mmHg + RA pressure.

Chest Pain 115

Chest Pain Myocardial Infarction STEMI Pericarditis 115

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis. Less common etiologies include uremia, bacterial or tubercular pericarditis, chronic idiopathic pericarditis, hemorrhage, and other causes such as autoimmune diseases, radiation, myxedema, etc.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

JANUARY 12, 2023

CT pulmonary angiogram was negative for pulmonary embolism. If the patient continues to have reperfusion, then we would expect progressive terminal T wave inversion then full T wave inversion over time in the future ECGs. Second troponin T resulted at 1,318 ng/L. Chest x-ray was read as normal. Heparin was started. Reocclusion!

Chest Pain 52

Chest Pain STEMI Blog Stenosis 52

ECG Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life.

Chest Pain 52

Chest Pain STEMI Blog Embolism 52

Dr. Smith's ECG Blog

MARCH 11, 2019

You do NOT see this in normal variant STE, nor in pericarditis. The computerized interpretation for this tracing was, “Sinus rhythm; Normal ECG” — and attention of acute care providers was apparently focused on attending to this patient’s pulmonary problems. There is upsloping ST elevation in III, with reciprocal ST depression in aVL.

Chest Pain 52

Chest Pain Ischemia Aneurysm Myocardial Infarction 52

DAIC

MARCH 28, 2024

The VARIPULSE Platform is designed to enable pulmonary vein isolation with the versatility of a catheter loop, a simple generator user interface, and a mapping system that provides an intuitive, reproducible workflow with real-time visualization, contact indicator, and PF tagging mechanisms.

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Atrial Fibrillation AFIB Ablation Pulmonary 110

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. In fact, Kosuge et al. Accessed May 28, 2024. This is a quiz.

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Chest Pain Embolism Pulmonary Tachycardia 138

Dr. Smith's ECG Blog

JULY 18, 2014

When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP). What complication is the patient with post-infarction regional pericarditis at risk for? If detected early by ultrasound, the patient can be saved. 3) Oliva et al. (4)

STEMI 52

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

JULY 7, 2013

When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP). Rupture can be either free wall rupture (causing tamonade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock.

STEMI 52

STEMI Myocardial Infarction Pericarditis Ultrasound 52

Circulation: Arrhythmia and Electrophysiology

DECEMBER 19, 2024

Patients with paroxysmal or persistent atrial fibrillation underwent pulmonary vein (PV) isolation under deep sedation or general anesthesia and returned for remapping at 90 days to evaluate chronic durability. paroxysmal, and 58.5% deep sedation) were treated. Eighty patients (98%) underwent remapping.

Atrial Fibrillation 40

Atrial Fibrillation Ablation Arrhythmia Outcomes 40

Circulation

NOVEMBER 11, 2024

She had idiopathic ventricular fibrillation in 1992, treated with an EPD (Picture 1A), later replaced by a transvenous ICD.She was diagnosed with left femoral deep venous thrombosis and bilateral pulmonary embolism and started on therapeutic anticoagulation. However, patients with EPDs from the 1990s may present with delayed complications.

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Defibrillator Cardiac Arrest Sudden Cardiac Death Coronary Angiogram 40

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. He had multiple cardiac arrests with ROSC regained each time. This is a quiz.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. According to a recent systematic review and meta-analysis, spontaneous type 1 ECG had 2.4%

Sudden Cardiac Death 52

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 17, 2024

The initial computer and final cardiology interpretation was a differential: “ST elevation, consider early repolarization, pericarditis, or injury.” But STEMI criteria ignore all this and look at ST segments in isolation. Based on STEMI criteria and unhelpful computer interpretation, the patient was rushed to the cath lab.

Chest Pain 118

Chest Pain STEMI Myocardial Infarction Blog 118

Dr. Smith's ECG Blog

JANUARY 9, 2023

CT angiogram chest: no aortic dissection or pulmonary embolism. Serial chest xrays: progressive bilateral pulmonary edema. Pericarditis? No further troponins were measured. Echo: severely dilated LV, severely reduced EF at 10%, severe hypokinesis of LV from mid-apical segments with basal segments better preserved.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

The exception is with postinfarction pericarditis , in which a completed transmural infarct results in inflammation of the subepicardial myocardium and STE in the distribution of the infarct, and which results in increased STE and large upright T-waves. These findings together are more commonly seen with pericarditis.

Chest Pain 89

Chest Pain Pericarditis Myocardial Infarction Dementia 89

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.

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Chest Pain Embolism Pulmonary Tachycardia 112