Dr. Smith's ECG Blog

JANUARY 2, 2025

CT of the chest showed no pulmonary embolism but bibasilar infiltrates. Even with tachycardia and a paced QRS duration of ~0.16 (And of course Ken's comments at the bottom) An elderly obese woman with cardiomyopathy, Left bundle branch block, and chronic hypercapnea presented hypoxic with altered mental status. She was intubated.

Tachycardia 116

Tachycardia Cardiomyopathy Blog Bradycardia 116

HeartRhythm

APRIL 30, 2024

Focal atrial tachycardias (AT) tend to cluster around the pulmonary veins, but they have been rarely reported from anomalous pulmonary veins.

Tachycardia 40

Tachycardia Pulmonary 40

Ken Grauer, MD

JUNE 22, 2024

The ECG in Figure-1 — was obtained from a middle-aged woman with positional tachycardia and diaphoresis with change of position from suprine to sitting. My THOUGHTS on the ECG in Figure-1: The rhythm is sinus tachycardia at ~105/minute ( ie, The R-R interval is regular — and just under 3 large boxes in duration ).

Blog 171

Blog Ischemia Tachycardia Cardiomyopathy 171

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 127

Cardiogenic Shock Ultrasound Tachycardia Pulmonary 127

HeartRhythm

MARCH 20, 2025

A 77-year-old male with a history of two catheter ablation procedures, including pulmonary vein isolation and superior vena cava (SVC) isolation, presented with symptomatic palpitations. A twelve-lead electrocardiogram revealed atrial tachycardia (AT) with a cycle length of 240 ms.

Tachycardia 40

Tachycardia Electrocardiogram Pulmonary Ablation 40

HeartRhythm

APRIL 30, 2024

Outflow tract ventricular tachycardia are the most common idiopathic VT and these are typically present in structural normal hearts.

Tachycardia 40

Tachycardia Embolism Pulmonary 40

Frontiers in Cardiovascular Medicine

FEBRUARY 5, 2024

Introduction Multiple abnormal electrocardiographic findings have been documented in patients experiencing acute pulmonary embolism. Although sinus tachycardia is the most commonly encountered rhythmic disturbance, subsequent reports have highlighted other findings.

Embolism 49

Embolism Pulmonary Blood Pressure Electrocardiogram 49

Dr. Smith's ECG Blog

MARCH 11, 2012

There was no pulmonary edema or hypoxia. Here was his initial ECG: Regular Wide Complex Tachycardia. Blood pressure was 180/80. Cardiac Echo showed excellent hyperdynamic function. The computer read the QRS duration as 160 ms. However, many toxins do not show up on tox screens. Sinus --Irregularly irregular?

Tachycardia 52

Tachycardia Chest Pain Pulmonary Blood Pressure 52

HeartRhythm

AUGUST 27, 2024

Epicardial Marshall bundle (MB) are frequently utilized in left atrial tachycardias (LATs) post atrial fibrillation (AF) ablation with pulmonary vein isolation and substrate modification.

Atrial Fibrillation 40

Atrial Fibrillation Tachycardia Ablation Electrophysiology 40

Ken Grauer, MD

AUGUST 16, 2024

I see the following: There is sinus tachycardia ( upright P wave with fixed PR interval in lead II ) — at the rapid rate of ~130/minute. Sinus Tachycardia and RAD — as already noted above. PEARL # 2: In the absence of associated heart failure ( cardiogenic shock ) — sinus tachycardia is not a common finding in acute MI.

Blog 156

Blog Tachycardia Cardiogenic Shock Pulmonary 156

HeartRhythm

APRIL 30, 2024

Left atrial low-voltage areas (LVAs) are an important arrhythmogenic substrate that can act as an anatomical barrier of reentrant atrial tachycardias (ATs). However, ATs are not always induced in patients with LVAs, and identification of areas with a slow conduction velocity (CV) may help us predict the occurrence of ATs.

Tachycardia 40

Tachycardia Pulmonary 40

Dr. S. Venkatesan MD

APRIL 28, 2024

Both atria develop from a combination of the primitive atrium, sinus venous, and pulmonary veins.It In all probability, this dilation is a form of atrial tachycardia and atrial cardiomyopathy. In contrast to other tachycardias, with atrial fibrillation (AF), the focus is often speculative, and ablation attempts are made accordingly.

Atrial Fibrillation 75

Atrial Fibrillation Bicuspid/Mitral Pulmonary Ablation 75

Dr. Smith's ECG Blog

APRIL 12, 2013

He was in acute distress from pulmonary edema, with a BP of 180/110, pulse 110. He had diffuse crackles on exam and B-lines on chest ultrasound, and chest x-ray also confirmed pulmonary edema. Here is his ED ECG: There is sinus tachycardia. The hypertension alone is the likely etiology of the pulmonary edema.

STEMI 52

STEMI Pulmonary Stents Stent 52

HeartRhythm

APRIL 30, 2024

Ablation of regions demonstrating spatiotemporal dispersion (SD) has been demonstrated as an alternative strategy beyond pulmonary vein isolation in patients with persistent atrial fibrillation. Occurrence of atrial tachycardia (AT) following ablation remains a limitation of this approach.

Atrial Fibrillation 40

Atrial Fibrillation Ablation Tachycardia Pulmonary 40

HeartRhythm

NOVEMBER 27, 2023

Pulse field ablation (PFA) using a pentaspline catheter is an effective and safe treatment method for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF).1,2 We present a case of a macro-reentrant atrial tachycardia in the lateral right atrium (RA) treated by PFA using a pentaspline catheter.

Tachycardia 40

Tachycardia Ablation Atrial Fibrillation Pulmonary 40

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

They had already cardioverted at 120 J, then 200 J, which resulted in the following: Ventricular Tachycardia They then cardioverted at 200 J which r esulted in the same narrow complex rhythm shown above, at 185 beats per minute. This would treat both SVT or sinus tachycardia. I suggested esmolol if the heart rate did not improve.

Tachycardia 52

Tachycardia Chest Pain Pharmacology Myocardial Infarction 52

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

HeartRhythm

APRIL 30, 2024

Besides single-shot PFA devices for pulmonary vein isolation (PVI), point-by-point PFA is also gaining importance due to many possible applications. Data on the use is sparse, especially for atrial tachycardia (AT). Pulsed-field ablation (PFA) is becoming increasingly relevant in the field of electrophysiology.

Tachycardia 40

Tachycardia Ablation Electrophysiology Technology 40

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

Dr. Smith's ECG Blog

OCTOBER 23, 2023

An Initial ECG was performed: Initial ECG: Sinus tachycardia with prolonged QT interval (QTc of 534 ms by Bazett). She was admitted to the ICU where subsequent ECGs were performed: ECG at 12 hours QTc prolongation, resolution of T wave alternans ECG at 24 hours Sinus tachycardia with normalized QTc interval. No ischemic ST changes.

Tachycardia 130

Tachycardia Cardiac Arrest ICU Blog 130

Frontiers in Cardiovascular Medicine

FEBRUARY 17, 2025

Patients in Group 2 had greater pulmonary artery systolic pressure than those in Group 1 (p-value<0.001). and paroxysmal supraventricular tachycardia (SVT) (5.3%), respectively. The most common symptoms in adults were easy fatigability and dyspnea (63.2% Overall, 88.9% and Group 2: 2.5 (IQR IQR 22.5); P-value=0.111].

Hospital 52

Hospital Exercise Tachycardia Pulmonary 52

Dr. Smith's ECG Blog

APRIL 12, 2023

She had acute pulmonary edema on exam. On arrival, lung ultrasound confirmed pulmonary edema (B lines). Conventional algorithm interpretation: SINUS TACHYCARDIA ABNORMAL RHYTHM ECG Confirmed by over-reading physician Transformed ECG by PM Cardio: PM Cardio interpretation: OMI with Low Confidence Dr.

Echocardiogram 52

Echocardiogram Pulmonary Cardiomyopathy Coronary Artery Disease 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

Journal of Cardiovascular Electrophysiology

JANUARY 28, 2024

Methods This study enrolled 233 PeAF patients undergoing pulmonary vein isolation and linear ablation including an MI, roof line, and cavotricuspid isthmus ablation. During the follow-up, 113 (64.9%) RF group patients were free from AF/atrial tachycardia compared to 41 (82.0%) EIVOM group patients (log-rank p  = .045). 0.78, p  = .006).

Atrial Fibrillation 75

Atrial Fibrillation Ablation Bicuspid/Mitral Tachycardia 75

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

APRIL 15, 2019

Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. The estimated pulmonary artery systolic pressure is 37 mmHg + RA pressure. QTc was 374, and the formula value was quite high, consistent with LAD occlusion.

Tachycardia 40

Tachycardia STEMI Chest Pain Ischemia 40

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 115

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Dr. Smith's ECG Blog

JANUARY 8, 2024

Smith interpretation: This is highly likely to be due to extreme right heart strain and is nearly diagnostic of pulmonary embolism. It is of course pulmonary embolism. No d-dimer or CT pulmonary angiogram was done when they discovered that she had normal coronary arteries. Junctional tachycardia? ).

Chest Pain 71

Chest Pain Pulmonary Embolism STEMI 71

Dr. Smith's ECG Blog

MAY 30, 2024

Putting all the findings together; dyspnea, slight tachycardia, delayed R-wave progression, prominent lateral S waves and ST depression maximal where the P waves are largest all point toward pulmonary disease as the cause of the ECG findings. Bedside echo was without wall motion abnormality.

Ischemia 88

Ischemia Coronary Angiogram Pulmonary STEMI 88

HeartRhythm

JULY 14, 2024

In addition to single-shot devices mainly used for pulmonary vein isolation, focal PFA may provide a treatment option that increases the versatility of the technique. Pulsed field ablation (PFA) has become increasingly important in the treatment of cardiac arrhythmias.

Ablation 40

Ablation Tachycardia Pulmonary Arrhythmia 40

Journal of Cardiovascular Electrophysiology

JANUARY 5, 2024

Abstract Introduction It would be helpful in determining ablation strategy if the occurrence of perimitral atrial tachycardia (PMAT) could be predicted in advance. We calculated their E-PMCT.

Bicuspid/Mitral 40

Bicuspid/Mitral Tachycardia Atrial Fibrillation Ablation 40

Ken Grauer, MD

FEBRUARY 28, 2023

The ECG and long lead II rhythm strip in Figure-1 — was obtained from a COVID positive patient with persistent tachycardia not responding to Diltiazem. Figure-1: The initial ECG — obtained from a patient with persistent tachycardia. ( Hypoxic injury ( from pneumonia or other acute pulmonary complication ).

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Blog COVID-19 AFIB Pulmonary 78

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 124

Aneurysm Stents Stent Chest Pain 124

Dr. Smith's ECG Blog

AUGUST 3, 2018

There is a narrow complex tachycardia at a rate of 130. ECGs: there is a regular narrow complex tachycardia still at a rate of exactly 130, with no P-waves and also no change since the prehospital ECG. During tachycardia, in this case, the baseline continuously undulates especially in leads II, aVR and V1; very good for atrial flutter.

Chest Pain 40

Chest Pain Tachycardia Atrial Flutter Ultrasound 40

HeartRhythm

APRIL 30, 2024

Vein of Marshall ethanol ablation (VOM-EA) as an adjunct to pulmonary vein isolation (PVI) has been reported to improve freedom from atrial fibrillation (AF) and atrial tachycardia (AT).

Atrial Fibrillation 40

Atrial Fibrillation Ablation Tachycardia Pulmonary 40

HeartRhythm

APRIL 30, 2024

Atrial tachycardia (AT) involving the surgical cuff between the donor pulmonary veins (dPV) and recipient left atrium (rLA) following lung transplantation (LT) typically occurs in the late postoperative period.

Transplant 40

Transplant Tachycardia Pulmonary 40

HeartRhythm

APRIL 30, 2024

In repaired tetralogy of Fallot (rTOF), the septal anatomical isthmuses (AI), 3, between the ventricular septal defect (VSD) and pulmonary annulus, and 4, between the VSD and tricuspid annulus, are important ventricular tachycardia (VT) substrates when slow conducting.

VSD 40

VSD Tricuspid Tachycardia Pulmonary 40