Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia
An elderly man collapsed. There was no bystander CPR. Medics found him in ventricular fibrillation. He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD.He was unidentified and there were no records availableAfter 7 shocks, he was successfully defibrillated and brought to the ED.Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines.Here is the initial ED ECG. What do you think?Rhythm: Residents asked me why it is not VT. If you use calipers (or equvalent), it is clear that the rhythm...
Source: Dr. Smith's ECG Blog - April 2, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Wide Complex Tachycardia -- VT, SVT, or A Fib with RVR? If SVT, is it AVNRT or AVRT?
A 69 y.o. male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Per EMS report, patient believes he has been in atrial fibrillation for 5 days, since coming down with flu-like illness with rhinorrhea, productive cough, SOB. Patient is on rivaroxaben, carvedilol, and dofetilide (to suppress atrial fib -- rhythm control). He states that he maybe missed a dose or two during recent illness. On EMS arrival, patient ' s oxygen sat...
Source: Dr. Smith's ECG Blog - March 28, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Palpitations and presyncope in a 40-something
Discussion: Putting all of the information together this patient is most likely suffering from arrhythmogenic cardiomyopathy (AC) better known as ARVC. The medical hx is typical, with sudden onset tachydysrhythmia during physical exertion. It is not uncommon for the initial presentation to be sudden cardiac death (SCD). In fact it is one of the leading causes of SCD in people age less than 40 years. Thus it is very important to identify this disorder. AC is a disease in which myocardium is replaced by fibrofatty tissue. This usually and predominantly affects the RV free wall and apical regions, but it can affect the left v...
Source: Dr. Smith's ECG Blog - March 24, 2024 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
M-Mode Echocardiogram in LV Dysfunction
Transcript of the video: This is a still image of M-Mode Echocardiogram. M-Mode is Time-Motion Mode. The horizontal axis is time. Vertical axis is distance from the transducer. That is M-Mode, one of the older modes, currently used mainly for taking left ventricular measurements. In the inset you can see the two dimensional image. Location of the transducer here, in the parasternal region. This is the parasternal long axis view. Right ventricular outflow tract, left ventricle, left atrium, aorta, aortic valve, mitral valve. These are the things you have seen in that inset image. This is movement of the anterior wall of the...
Source: Cardiophile MD - March 23, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
How can Warfarin be safe “ even in ” first trimester of pregnancy ? The story behind the 5 mg cut-off !
The well known pro-coagulant state of pregnancy is an evolutionary protective process to make blood clot quicker, to save fetal loss in early pregnancy and mitigate postpartum bleeding. Still, in many women, this natural adaptive process confers an enhanced thrombotic risk. The molecular mechanisms for this pro-coagulant state are, there is increased factor VII, fibrinogen, reduced protein S. It is interesting to note, while plasminogen levels are elevated, D-dimer is also increased, indicating an ongoing fight between pro & anticoagulant forces, converting the physiological maternal- placental bed a mini harmless DIC ...
Source: Dr.S.Venkatesan MD - March 20, 2024 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Pregnancy and heart pregnancy and heart disease Uncategorized carpreg registry zahara esc acc guidelines on pregnancy and heart disease first trmestr use of oac warfarin heparin switch over lmwh bridge in pregnancy Source Type: blogs
An anxious approach to a benign arrhythmia in Holter recording
A 32-year-old high-profile businessman was advised Holter monitoring for a few ectopic beats during routine screening ECG. The 72-hour extended Holter monitoring picked up a single short pause with a blocked P wave and reported as doubtful Mobitz type 2 AV block.
The cardiologist in-charge, told the patient that findings are significant, and he would need further investigation. He was referred to their associate center for an EP study. After hearing about the procedure ,the patient was freighted about inserting multiple catheters inside his heart.
This was the time he consulted me with Holter report. It was i...
Source: Dr.S.Venkatesan MD - March 19, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 2:1 av block a pilot with av block approach to av block in holter asymptomatic mobitz type 2 block ep study esc pacemaker guideline europace heart rhythm society holter monitoring hv interval mobitz type 2 av block we Source Type: blogs
Left Ventricular Noncompaction
Left ventricular noncompaction is an incidental echocardiographic finding in some while others may be symptomatic. In left ventricular noncompaction, there is a thin subepicardial compact layer and a thick subendocardial layer which is non-compact and has prominent trabeculations and recesses between the trabeculae. Blood flow into and out of these recesses can provide a spectacular view on colour Doppler echocardiography, almost looking like flames of fire near the apex, in the apical four chamber view. When non-compaction is associated with left ventricular dysfunction it is called left ventricular non-compaction cardiom...
Source: Cardiophile MD - February 26, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Phenotypes in Arrhythmogenic Cardiomyopathy
Arrhythmogenic Cardiomyopathy was better known as Arrhythmogenic Right Ventricular Dysplasia or ARVD and sometimes as Arrhythmogenic Right Ventricular Cardiomyopathy or ARVC earlier. When left ventricular [1] and biventricular involvement became increasingly recognized, the terminology has been revised to Arrhythmogenic Cardiomyopathy. A study published in JACC has compared the phenotypic expression and clinical outcomes in patients with arrhythmogenic cardiomyopathy [2]. Of the 446 patients, 44% had arrhythmogenic right ventricular cardiomyopathy, while 23% had arrhythmogenic left ventricular cardiomyopathy. 33% had bive...
Source: Cardiophile MD - February 24, 2024 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs
Why ICDs are less effective in Non Ischemic DCM ?
We wish, our understanding about cardiac contractile physiology is deep and nearly complete. Heart is an irreversibly coupled electro-mechanical organ , right from the fetal days until the final heart beat. In myocardial pathology, the genesis and sustainability of ventricular arrhythmia are intricately related to the degree of LV dysfunction of any cause.
SCD is the leading cause of mortality in heart failure. Tackling SCD was in God’s domain, until the brilliance of Dr. Michel Mirowski shrunk the defibrillator and implanted it under the chest in 1980. (Dr. MM’s s a unique and inspiring story, from Poland a...
Source: Dr.S.Venkatesan MD - February 20, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized crt device crt-p vs crt-d danish trial ischemic dcm madit trial non ischemic dcm Source Type: blogs
Collection of a few ECGs in congenital heart diseases
Classical QRS pattern in ASD is the rSR’ in V1 suggestive incomplete RBBB. This pattern in ASD is due to RV volume overload. QRS axis is usually rightward, more so when there is severe PAH. Left axis deviation is feature of ostium primum ASD. First degree AV block may be noted in both primum and secundum ASD. Familial ASD with first degree AV block has been reported in secundum ASD. This type of familial ASD has an autosomal dominant inheritance pattern. There is also a higher incidence of SCD in this group.
IRBBB pattern in ASD
Crochetage sign in ASD, manifest as notching of R wave near the apex in inferior leads (a...
Source: Cardiophile MD - February 14, 2024 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs
In Short About Idiopathic dilated cardiomyopathy
(Source: Cardiophile MD)
Source: Cardiophile MD - February 3, 2024 Category: Cardiology Authors: Johnson Francis Tags: Cardiomyopathy Source Type: blogs
What kind of AV block is this? And why does she develop Ventricular Tachycardia?
Discussion: The initial ECG in today ' s case is pathological for any patient, especially for a 50-year old previously heathy female. Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). Usually the medical history will provide clues to the cause. Even though the primary suspicion was not ischemic heart disease, a CT angiogram was performed, and it revealed normal coronary arteries. This ruled out coronary disease as the cause of conduction system disease. When assessing patients with early onset high grade conduction disorders and ventricular tachydysrhythmi...
Source: Dr. Smith's ECG Blog - January 23, 2024 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
Two patients with chest pain, with QRS obscured: which was STEMI positive, and which had Occlusion MI?
Written by Jesse McLaren Two patients
presented with acute chest pain, and below are the precordial leads V1-6 for
each. Patient 1 (ECG on the left) was a 45 year-old male, and patient 2 (ECG is
on the right) was a 70 year-old male. The limb leads have been removed because
there was no ST elevation in those leads, the QRS complexes have been
obscured because this is irrelevant to STEMI criteria, and red lines have been added to measure ST segment elevation. Using the
current paradigm, can you tell which patient had an acute coronary occlusion? Using
T wave amplitude, can you tell which ECG has hyperacute T waves?...
Source: Dr. Smith's ECG Blog - January 17, 2024 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Orthostatic hypotension onset after invasive procedure?
Written by Willy FrickA man in his 70s with a history of HFrEF and sick sinus syndrome s/p dual chamber pacemaker placement was admitted for overnight observation following outpatient placement of a mitral valve clip. The procedure note indicates uncomplicated clip placement. The next morning, the following ECG was obtained.What do you think?The tracing shows sinus rhythm with PVCs and non-specific ST&T wave abnormality. But there is something more important to notice, which is the pacer spikes. They do not make sense. Some of them are in the middle of or after P waves, and there ' s even one that falls at the end...
Source: Dr. Smith's ECG Blog - January 13, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?
The patient is female in her 80s with a medical hx of previous MI with PCI and stent placement. She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The last echocardiography 12 months ago showed HFmrEF.She presented to the emergency department after a couple of days of chest discomfort. The ECG below was recorded. What is your assessment? How would you manage this patient?The ECG was interpreted as showing atrial flutter with 2:1 conduction. The patient was deemed stable and...
Source: Dr. Smith's ECG Blog - January 10, 2024 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
