Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life.
Written by Pendell Meyers with edits by SmithA man in his 60s called EMS apparently for shortness of breath. EMS found him in distress and hypoxemic requiring 4 L nasal cannula to maintain oxygen saturation greater than 93%.Here is his triage ECG:What do you think?An old ECG was available on file, from 2 years ago:RBBB, otherwise normal.The triage ECG is diagnostic of life threatening hyperkalemia (sodium channel blockade would also produce this pattern, but the patient was not known to be on any sodium blocking medications). There is the very common brugada pattern STEMI mimic seen in V1 and partially in V3 and aVR....
Source: Dr. Smith's ECG Blog - January 16, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Wide Complex Tachycardia with Huge ST Elevation. What is going on?
This 70-something woman with no significant past history (no previous ECGs or cardiac history) presented by EMS with fairly acute chest pressure and shortness of breath, with nausea and diaphoresis. " Like an elephant sitting on my chest. " She had no history of atrial fibrillation and was not on any anticoagulants.She stated that she had had a similar episode a couple weeks earlier, lasting 24 hours, with rapid heart beat but without chest pain, that spontaneously resolved. She thought she was having a panic attack. Since then she has had " little spurts " of the same thing lasting 1-2 hours.E...
Source: Dr. Smith's ECG Blog - January 12, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
What does LBBB look like in severe hypothermia? Is there a long QT? Is the QT appropriate for the temperature?
This patient was found down in a Minneapolis winter. He was very cold with frostbitten fingers and toes. He was alert but encephalopathic and delirious and very agitated and could not be adequately calmed with olanzapine and lorazepam, so we intubated him. The first reliable temperature could only be obtained with a Foley thermistor, and it was 26.5 degrees C (79.7 F).His BP was 76/60. K was 2.8 mEq/L.Here was his first ECG:There is sinus bradycardia with left bundle branch block (LBBB), with proportional ST-T, and VERY long QT and a PVC. I measure the QT at 800 ms. Notice that there are ...
Source: Dr. Smith's ECG Blog - January 6, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Knowledge check in Brugada syndrome : A rapid fire session
A 5-minute session: Answers are my own. Please cross-check.
1. Is Brugada syndrome clinical or ECG diagnosis?
Always clinical. Never get confused on this.
2. Spontaneous type 1 vs Induced Type 1 (from type 2) which carries more risk?
Both are risky since they are close cousins. But, spontaneous type 1 is the dreaded devil.
3. Is Brugada primarily a defect of myocardial depolarization or repolarisation?
Not clear. Often in both. In fact a mismatch between them. (Don’t ask how Na+ Channel defect affects repolarisation !)
4. Is Brugada VT is monomorphic, polymorphic?
Both. What determines m...
Source: Dr.S.Venkatesan MD - January 5, 2022 Category: Cardiology Authors: dr s venkatesan Tags: cardiac electrophysiology cardiology -Therapeutics Cardiology -unresolved questions Cardiology-Arrhythmias early repolarisation syndrome Electro physiology Electrocardiography-ECG ICD and Pacemakers amiodarone for brugada brugada syndrom Source Type: blogs
7 steps to missing posterior Occlusion MI, and how to avoid them
This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by SmithCaseYou ’re shown an ECG from a patient in the waiting room with chest pain. What do you think?Sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. There ’s primary ST depression in the precordial leads maximal in V3-4, and an inverted T wave in V2. There’s also a down-up T wave in aVL with a tiny bit of ST depression (which suggests inferior MI), but without associated inferior findings. Step 1 to missing posterior MI is relying on the STEMI criteria. A prospective valid...
Source: Dr. Smith's ECG Blog - January 3, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
