Not all new T-wave inversion signifies ischemia. Also, what is this irregular rhythm?

 This ECG was texted to me with the question" Wellens'? "The computer read was: Atrial Fibrillation, marked ST Elevation. ***Acute MI***The QT interval is short (377 ms, QTc = 399 ms)This is NOT atrial fibrillation: There is sinus arrhythmia with an accelerated junctional rhythm that competes with the sinus node and results in some AV dissociation (no AV block!).  This is completely benign.I responded: This STE with T-wave inversion looks like a normal variant for an African American.  I would check the troponin, but I do not think it is pathologic.Here is the history: The patient was being arrested for possession of methamphetamine, was sleepy, and when awoken endorsed some active chest pain.  Then he wrote: " These are new changes compared to 4 months ago. "I went into the chart to find that previous ECG:QT = 365 ms, QTc = 409 msFirst: if there are no symptoms of ACS, it cannot be Wellens'syndrome.  It is hard to say if this patient had symptoms.  Wellens is a syndrome, not an ECG finding, and it requiresAnginalpainthat is resolved at the time of the ECG, Typical T-wave inversion, and preserved R-waves.  False positives are very common when there is high QRS voltage (as here).  This previous ECG shows typical benign ST elevation in leads V2-V4 (mimicking anterior STEMI) andlarge QRS voltage.  However,the STE is typical for this degree of voltage.  If you were to use the 4-variable...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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I was texted these ECGs." Bad chest pressure with severe left shoulder pain 3 nights ago.  Then SOB and nausea the next day.  Now appears to be in cardiogenic shock. "(Later review showed systolic BPs in the range of 55 to 83.  So she was quite hypotensive.)First recorded at time zero:There is sinus rhythm. Rate of only 70 suggests some beta blockade.The QT is very long.There is T-wave inversion in inferior leads, suggestive of reperfused or subacute MI.There is a Q-wave in III, so this may be subacuteThere is ST depression in V2-V4.20 minutes:Again, very long QT.Now, T-waves are upright in inferio...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This ECG was texted to me with no other information:Computer Diagnosis:SINUS TACHYCARDIAINCOMPLETE RIGHT BUNDLE BRANCH BLOCK [90+ ms QRS DURATION,TERMINAL R IN V1/V2, 40+ ms S IN I/aVL/V4/V5/V6]LEFT ANTERIOR FASCICULAR BLOCK [QRS AXIS
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
CONCLUSION: Prior to reviewing the literature for discussing this case — I had not fully appreciated the impact of the mechanism of cardiac compression as a causative factor in: i) altering QRS morphology; ii) precipitating supraventricular and/or ventricular arrhythmias (including VT, which can be sustained) — and, iii) producing ST-T wave changes (ST elevation and/or depression) that may mimic old or new infarction.CT imaging (as shown by Dr. Smith) clearly suggests there was compression of cardiac structures in thi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
p.p1 {margin: 0.1px 0.0px 0.1px 0.1px; font: 9.0px Helvetica}An elderly woman with history of coronary disease presented with CP and SOB and hypotension by EMS.  EMS had attempted adenosine x 2 without success.Here is her ED ECG:Here is the ED physician's interpretation:IMPRESSIONUNCERTAIN REGULAR RHYTHM, wide complex tachycardia, likely p-waves.LEFT BUNDLE BRANCH BLOCK [120+ ms QRS DURATION, 80+ ms Q/S IN V1/V2, 85+ ms R IN I/aVL/V5/V6]Comparison Summary: LBBB and tachycardia are new.What do you think?Smith:  This is indeed a regular wide complex tachycardia.  I do not see P-waves.  Retrograde P-w...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Discussion Tachycardia is a rapid heart rate that is above normal for age and level of exertion. Tachycardia is common, particularly sinus tachycardia due to normally encountered circumstances such as pain, fever or exercise. It is usually a normal physiologic process but sustained tachycardia often indicates a potentially abnormal underlying cause. Sinus tachycardia has a rapid heart rate with normal P waves and P-R intervals and variations from moment to moment and respiration. Generally it is not over 200 beats/minute. Vagal stimulation can slow the heart rate; this is a gradual slowing, not an abrupt slowing seen in ...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Publication date: January 2020Source: Archives of Cardiovascular Diseases Supplements, Volume 12, Issue 1Author(s): M. Drissa, H. Jamila, H. DrissaBackgroundAtrial septal defect (ASD) is one of the most common causes of congenital heart disease manifested in adulthood and a subgroup of patients may not develop symptoms until late adulthood.Aim of studyThe aim of our study was to describe clinical and likelihood picture of adults over 60 years born with an ASD type II.MethodsWe performed a retrospective analysis of adult's ASD referred to our institution from 2010 through 2018. Clinical, electrocardiographic, echocardiograp...
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
AliveCor is close to our hearts. Literally. David Albert, the co-founder of the company, started experimenting with handheld, wireless ECG devices in the late 90s. Approximately 10 years later we tried out their FDA-cleared, medical grade gadget. It was a truly inspiring moment. Needless to say, we’ve been keeping track of their journey ever since. In our eyes Kardia is the textbook example of technology shaping health care, empowering and supporting not only e-patients, but medical professionals as well. So, let’s take a look at their newest creation, the KardiaMobile6L! Why did the chicken cross the ro...
Source: The Medical Futurist - Category: Information Technology Authors: Tags: Health Sensors & Trackers cardiology ecg fda Healthcare heart technology Source Type: blogs
Written by Meyers, edits by SmithA 50-ish year old man was working construction when he suddenly collapsed. Coworkers started CPR within 1 minute of collapse. EMS arrived within 10 minutes and continued CPR and ACLS, noting alternating asystole and sinus bradycardia during rhythm checks. He received various ACLS medications and arrived at the ED with a perfusing rhythm.Initial vitals included heart rate around 100 bpm and BP 174/96. Here is his initial ECG, very soon after ROSC:What do you think?Sinus tachycardia.  There is incomplete RBBB (QRS duration less than 120 ms).  There is diffuse STD, maximal in V4-V5 a...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
AliveCor is giving consumers a chance to understand their heart (beats) a whole better through a pair of new indications. The Mountain View, CA-based company said its KardiaMobile ECG is now cleared for the detection of BradyCardia and TachyCardia. Previously, AliveCor had a nod from FDA for KardiaMobile to detect Atrial Fibrillation (AFib) and Normal Sinus Rhythm. The Mountain View, CA-based company said the new indications make it the only consumer-cleared device with the ability to detect the three most common heart arrhythmias. "No other consumer ECG device in the world, can tell you more about your heart than Kar...
Source: MDDI - Category: Medical Devices Authors: Tags: Cardiovascular Source Type: news
Abbott has developed an implantable device that continuously monitors the heart rhythm and allows for communication with a clinician via a smartphone. The paperclip-sized device, called the Confirm Rx insertable cardiac monitor (ICM), requires no re-...
Source: Medgadget - Category: Medical Devices Authors: Tags: Cardiology Exclusive Source Type: blogs
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