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 123

Aneurysm Stents Stent Chest Pain 123

Dr. Smith's ECG Blog

AUGUST 3, 2018

Here was his prehospital ECG, which I viewed immediately while the resident performed cardiac ultrasound: What do you think? There is a narrow complex tachycardia at a rate of 130. Here is the cardiac ultrasound which the resident performed as I viewed the ECG: This shows a huge pericardial effusion. Is is sinus? Comment from K.

Chest Pain 40

Chest Pain Tachycardia Atrial Flutter Ultrasound 40

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Smith comment: before reading anything else, this case screamed pulmonary embolism to me. I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. There is sinus tachycardia at ~100/minute.

Chest Pain 72

Chest Pain STEMI Pulmonary Embolism 72

Dr. Smith's ECG Blog

JUNE 17, 2018

There is sinus tachycardia. Sinus tachycardia, which exaggerates ST segments and implies that there is another pathology. I have always said that tachycardia should argue against acute MI unless there is cardiogenic shock or 2 simultaneous pathologies. Here is that ECG: What do you think? See Table for diagnostic utility.

Chest Pain 52

Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

The ECG shows sinus tachycardia, a narrow, low voltage QRS with alternating amplitudes, no peaked T waves, no QT prolongation, and some minimal ST elevation in II, III, and aVF (without significant reciprocal STD or T wave inversion in aVL). It is difficult to tell if there is collapse during diastole due to the patient’s tachycardia.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Patients with pulmonary embolism or aortic dissection who have normal variant ST elevation are at high risk of being diagnosed with pericarditis when what they have is far more serious!! Beware a negative Bedside ultrasound. You diagnose pericarditis at your peril! Acute MI is frequently misdiagnosed as pericarditis. Pericarditis?

Pericarditis 52

Pericarditis Chest Pain Aortic Blog 52

Dr. Smith's ECG Blog

JUNE 2, 2023

She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for a regular tachycardia, possible rales at both bases, some mild RUQ abdominal tenderness. Thus, I believe it is a regular, monomorphic, wide complex tachycardia. Or it could simply still be classic VT. What is the Diagnosis?

Tachycardia 96

Tachycardia Cardiomyopathy Electrocardiogram Article 96

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.

Chest Pain 138

Chest Pain Embolism Pulmonary Tachycardia 138

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.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

OCTOBER 28, 2023

Further ultrasound showed no B-lines (no pulmonary edema). There is very little filling, and thus very poor stroke volume. The heart rate is too fast for this poor filling. Preload must be increased and the heart rate slowed in order to allow more LV filling. These patients are often on beta blockers to prevent such a scenario.

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Preserved Ejection Fraction Sudden Cardiac Death Chest Pain Heart Failure 56

Dr. Smith's ECG Blog

APRIL 8, 2016

Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. See here for management of Polymorphic Ventricular Tachycardia , which includes Torsades. In multivariate analysis, serum potassium level was negatively and age positively related to ventricular tachycardia.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. and the patient was converted to veno-venous (V-V) ECMO due to persistent pulmonary insufficiency. Clinically — despite an initial 2-fold increased troponin, the normal bedside Echo was reassuring against OMI or pulmonary embolism. Here they are: Learning Points: 1.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

MARCH 3, 2025

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. However, there is also significant tachycardia , with heart rate of 116, and known hypoxia. She arrived to the ED with a nonrebreather mask. Her blood pressure on arrival was 153/69.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Good History and Physical exam, including a.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

APRIL 9, 2025

On arrival in the ED, a bedside ultrasound showed poor LV function (as predicted by the Queen of Hearts) with diffuse B-lines. Chest X-ray also showed pulmonary edema. Primary VF in this study refers to fibrillation occurring in the absence of shock or pulmonary edema. Initial BP was 120/96, HR 102, SpO2 98%. Potassium was 4.5

Defibrillator 62

Defibrillator Cardiac Arrest Myocardial Infarction STEMI 62

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.

Chest Pain 111

Chest Pain Embolism Pulmonary Tachycardia 111