A man in his 50s with acute chest pain and history of prior MI
Written by Pendell MeyersA man in his 50s with prior history of anterior MI with LAD stent presented with acute chest pain similar but more intense than his last MI. He presented around midnight with pain that had started around 9pm the night before. He had taken NTG at home with no improvement, and immediately received morphine on arrival at the ED for severe chest pain (a very bad idea if your accuracy for finding OMI on ECG is low, since ongoing pain will be your last chance to identify those with ongoing untreated OMI).Here is his triage ECG at 0012:What do you think? What is the differential of this ECG?There is sinus...
Source: Dr. Smith's ECG Blog - April 13, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
RBBB with STE in I and aVL. Will the angiogram tell you if this ECG represents Occlusion MI or not?
A middle aged male with history of STEMI and stents presented with one hour of chest pain.Here is his ED ECG:What do you think?Analysis: There is sinus rhythm with RBBB. There is ST Elevation in I and aVL which is discordant to the wide S-wave (a wide S-wave in lateral leads is a feature of RBBB). There is also some ST depression in lead V3 (inferoposterior OMI is suggested). There is no R ' -wave in V2 and so one would not expect the typical discordant ST depression and TW inversion that one often sees in V2. However, V3 does have an R ' -wave, and STD, but the T-wave isconcordantly positive, which...
Source: Dr. Smith's ECG Blog - April 11, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?
Case written and submitted by Brandon Fetterolf MD, edits by MeyersA woman in her early 30s with multiple autoimmune disorders including vasculitis presented with 2-3 hours of mid-left side chest discomfort with radiation to neck and left arm and associated with nausea, diaphoresis and dizziness. Initial ECG on presentation at 1554 (no prior for comparison):What do you think is happening to his 30s woman? The ECG shows NSR with a normal QRS except for poor R wave progression and pathologic QS-waves in V2-3. There is STE and hyperacute T waves in V2, I, and aVL with reciprocal STD in II, III, and aVF. This is...
Source: Dr. Smith's ECG Blog - April 8, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
vMap Mapping Technology for Cardiac Arrhythmias: Interview with Mike Monko, CEO of Vektor Medical
Vektor Medical, a medtech company based in San Diego, created the vMap system, a mapping solution for cardiac arrhythmias. The system is the first to identify arrhythmia sources anywhere in the heart, including the septal wall, outflow tracts, and all four chambers. The company reports that the technology takes less than three minutes to provide a result.
The system uses 12-lead electrocardiogram (ECG) data to pin-point the location of an arrythmia, and so is non-invasive. Accurate mapping of arrythmia sources is important in ensuring that subsequent treatment is successful. In the case of ablation for atrial fibrillati...
Source: Medgadget - April 4, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Cardiac Surgery Cardiology Exclusive Radiology afib vektormedical Source Type: blogs
Wearable Sensor Uses Kirigami to Improve Skin Contact
Researchers at Osaka Prefecture University in Japan developed a wearable and wireless electrocardiogram monitor that employs kirigami, an ancient art of folding and cutting paper, to ensure better skin contact, stretchability, and breathability. The kirigami design lets the researchers minimize the size of their sensor and the technology allows for long-term vitals measurements with wireless data transmission to a smartphone app. Consisting of a film made of polyethylene terephthalate that the researchers printed with silver electrodes, the sensor includes ingenious cuts that allow it to better conform to the ever-undulati...
Source: Medgadget - April 4, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Materials Sports Medicine Source Type: blogs
An asymptomatic man in his 50s with heart rate in the 160s - what is the diagnosis? How will you manage this?
Written by Pendell MeyersA man in his late 50s with history of CAD with CABG, COPD, smoking, cirrhosis, and other comorbidities presented for an outpatient scheduled stress test which had been ordered for some exertional shortness of breath, palpitations, and presyncopal episodes over the past few months. When he presented to the office for the stress test, his screening vitals before any test or intervention were remarkable only for a heart rate of 160 bpm. He denied any symptoms whatsoever.A 12-lead ECG was performed in the office:What do you think?The ECG shows a wide complex regular monomorphic tachycardia. I mea...
Source: Dr. Smith's ECG Blog - April 2, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Chest pain + troponin of 1600 + LBBB + 6mm ST elevation = occlusion MI, right?
This case is by Jesse McLaren (@ECGCases), with comments by Smith and GrauerA 50 year-old with CAD and ESRD went to their regular hemodialysis appointment complaining of two days of exertional chest pain. The patient was sent to the ED when high-sensitivity Troponin I returned at 1,526 ng/L (normal<26 in males,<16 in females). They were painfree on arrival, with BP 180/70 and other vitals normal. What do you think? There ’s sinus rhythm with LBBB and appropriate discordant ST changes: there’s no concordant ST elevation, no concordant ST depression in V1-3, and no excessive discordance...
Source: Dr. Smith's ECG Blog - March 31, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A woman in her 50s with shortness of breath
Case written by Neha Ray, MD, with edits by Meyers, Smith, GrauerA woman in her 50s presented for evaluation of multiple episodes of syncope with shortness of breath. On EMS arrival, she was GCS 15 with HR 110s. En route to the ED, the patient had 4 more episodes of syncope and became hemodynamically unstable with SBP in the 80s and HR 160s. The first recorded SpO2 was 73%. On arrival to the ED, patient was diaphoretic and in extremis. Her initial EKG is below. Paramedics arrive to the ED and state that they are worried about inferior STEMI. What do you see? What do you think?The ECG shows sinus tachycardia...
Source: Dr. Smith's ECG Blog - March 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Is there evidence of OMI on this ECG?
This is another one from Amandeep ( " Deep " ) Singh, with many comments by Smith. Dept Emergency Medicine, Highland Hospital, Oakland.Case67yo male with h/o schizophrenia and who has become increasingly distrustful of Western medicine presents with chest pain radiating to the right shoulder associated with shortness of breath for 24 hours duration. He states that he was unable to sleep secondary to the pain. The patient seems very worried about his right shoulder and is requesting a x-ray. An x-ray was obtained, as well as an ECG and a troponin. Prior to the trop...
Source: Dr. Smith's ECG Blog - March 26, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Intermittent Chest pain with Nausea and Vomiting, resolved at this moment
This is fromAmandeep ( " Deep " ) Singh. Dept Emergency Medicine, Highland Hospital, Oakland.Case51 yo male who walked to a parked fire engine complaining of nausea and vomiting. Per patient, he started feeling nauseous when he woke up, and shortly after, vomited. On arrival at the emergency department, he reports that he has had intermittent episodes of chest pain associated with nausea and shortness of breath over the past 3 days. These episodes last about 20 minutes before spontaneous resolution. He states that he is no longer having any chest pain, difficulty breathing, or na...
Source: Dr. Smith's ECG Blog - March 23, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Understanding this pathognomonic ECG would have greatly benefitted the patient.
Written by Pendell MeyersInterpret this ECG first without context. You don ' t need context yet because this ECG is nearly pathognomonic.After having learned about benign T wave inversion pattern years ago on this blog, and having seen many cases on this blog and in my practice since then, I instantly recognize this as BTWI, a fairly common normal variant. I see maybe one of these ECGs each month in my practice. There is no ischemia, certainly no concern at all for OMI. It meets basically all of the criteria that Dr. Smith has consistently described over the years, after reviewing a large cohort of patients by W...
Source: Dr. Smith's ECG Blog - March 22, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
I was reading EKGs on the system and came across this one
ConclusionCardiologs ® 12-lead ECG algorithm improves the interpretation of atrial fibrillation.===================================MY Comment, by KEN GRAUER, MD (3/12/2022):===================================Insightful case presented by Dr. Smith that conveys a number of important teaching lessons. I ' ll add the following points.The ECG diagnosis of AFib (Atrial Fibrillation) — can at times be deceptively challenging. AFib is an easy diagnosis to make when the rhythm is obviously irregularly irregular — without P waves — and, with coarse " fib ...
Source: Dr. Smith's ECG Blog - March 20, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
False cath lab activation or false cancellation?
Written by Jesse McLarenA 40 year old developed sudden chest pain radiating to the jaw, with diaphoresis and vomiting. What do you think?What do you think? There ’s normal sinus rhythm with normal conduction, normal axis, normal R wave progression and normal voltages. There are hyperacute T wave in I/aVL and possibly V5-6, with reciprocal change in III. There’s also ST depression in V1-3. The computer interpretation labeled this ECG as “nonspecific”, and it does not meet STEMI criteria. But there are ischemic abnormalities in the majority of leads that add up to an ECG diagnostic of posterolateral Occlusion MI...
Source: Dr. Smith's ECG Blog - March 16, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Ultrathin Conductive Films for Wearables are Flexible and Durable
Researchers at UCLA created ultrathin films that are just 10 nanometers thick, but which can maintain electrical conductivity, flexibility, and strength. The molecules within the films are held together by non-bonding van der Waals forces, making them highly pliable, and the numerous sheets within the films are able to slide over each other without breaking apart. The films are also breathable and are permeable to water and air. These properties mean that the films are highly suited as a component for health-related wearables, and the resulting wearable creations can easily conform to the shape of the body part they are ap...
Source: Medgadget - March 10, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Materials Source Type: blogs
Memorize the squiggly lines - it helps save lives.
Sent by Logan Stark, MD, written by Pendell MeyersDr. Stark sent me this ECG below and said " Curious on your thoughts without context. "Here is the PM Cardio version of this phone screenshot:I replied:" The concern without context would be possible LAD OMI signs. There is poor R wave progression, slight STE, hyperacute T waves in V2-V5, reciprocal STD in inferior leads. "He gave me the context:A middle aged man had sudden chest pain and arrested in front of his family. His wife immediately performed CPR.EMS arrived and defibrillated him. He was already awake and alert by arrival to the ED.He had persistent chest pain...
Source: Dr. Smith's ECG Blog - March 9, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
