20-something with huge verapamil overdose and cardiogenic shock
A 20-something presented after a huge verapamil overdose in cardiogenic shock. He had been seen at an outside institution and been given 6 g calcium gluconate, KCl, and a norepinephrine drip.The initial K was 3.0 mEq/L and ionized calcium was 5.5 mg/dL (sorry, Europeans, for the weird units)Here was the initial ED ECG:There is a junctional rhythm with retrograde P-waves (see the dip in the T-wave in lead II across the bottom; you can follow that up to all the other leads and see the retrograde P wave). There is also Left Bundle Branch Block (LBBB). There is huge proportionally excessively discord...
Source: Dr. Smith's ECG Blog - May 26, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
What Are The Diagnosis And Tests For High Blood Pressure?
Conclusion
In conclusion, inadequate attention and poor diagnosis of elevated blood pressure can result in grave outcomes, such as severe illnesses and potentially fatal consequences.
Neglecting regular blood pressure monitoring and failing to manage the condition can result in serious health complications such as heart disease, strokes, kidney problems, and more.
It is crucial to prioritize blood pressure care and take immediate action if diagnosed with high blood pressure. At-home blood pressure monitoring is a great way to keep constant track of your inconsistent pressure levels.
Following the treatment regi...
Source: The EMT Spot - May 23, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs
A man in his early 40s with chest pain a " normal ECG " by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?
This study looked at less than 1000 cases, which is not nearly enough (see below for analysis) and they used cardiologists as the gold standard (a very poor gold standard), NOT presence or absence of Occlusion MI (which we have done in all of our ECG studies, and must be ascertained by 1) TIMI 0/2 flow on angiogram or 2) culprit + TIMI 3 flow and very high troponin. So this study is worthless and must be ignored. I have here 38 cases of " Computer Normal " ECGs which were critically abnormal and the vast majority are missed acute coronary occlusions (Missed Acute OMI) and most were recognized ...
Source: Dr. Smith's ECG Blog - May 23, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his late 30s with acute chest pain and ST elevation
Sent by Dan Singer MD, written by Meyers, edits by SmithA man in his late 30s presented with acute chest pain and normal vitals except tachycardia at about 115 bpm. Here is his triage ECG:What do you think?Dr. Singer sent this to me with just the information: " ~40 year old with acute chest pain " . I immediately responded: " cool fake! Not OMI. Do you have a prior? There is a reasonable chance of pericarditis in this case, or this could be a baseline. " It could easily be mistaken for a South African flag pattern anterolateral OMI, with STE in I, aVL, V2. But importantly there is no reciprocal STD in III (which would...
Source: Dr. Smith's ECG Blog - May 16, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
What is this strange looking ECG in a young woman?
I was reading EKGs on the system and saw this one,with no other information.What was my interpretation of these apparently abnormal precordial leads?Smith: Normal variant ST Elevation and T-wave inversion, probably in a young African American male.The Queen of Heart PM Cardio Bot also states: " Not OMI with High Confidence "Additionally, as Ken notes below, the limb leads are reversed.I later went into the chart:This was recorded in a young African American female with altered mental status (severe agitation) due to an unidentified intoxicant. She rapidly awoke and was discharged home. Electrolytes wer...
Source: Dr. Smith's ECG Blog - May 13, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest Wearable Provides Key Heart Measurements
Researchers at the University of Texas at Austin have developed a new chest wearable that can obtain both electrocardiogram and seismocardiogram data from the underlying heart. While basic ECG can be monitored via smart watches, no other wearable combines it with seismocardiography, which would conventionally be obtained by listening to the heart using a stethoscope. Pairing both measurements into one device allows clinicians to get a more complete picture of cardiac health, while freeing patients to go about their daily activities wearing an unobtrusive wearable.
Wearables are changing how we monitor patients and ...
Source: Medgadget - May 10, 2023 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology ECG electrocardiography seismocardiography UTAustin Source Type: blogs
A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day
This was sent by a colleague.A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go. She had one BP that was measured at 160/120, uncertain when and what the BP was at other moments. Home meds were labetalol and nifedipine. There are T-wave inversions in precordial leads. The patient is pain free, so it is qu...
Source: Dr. Smith's ECG Blog - May 10, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 70s with acute chest pain and paced rhythm.
Sent by Pete McKenna M.D. Edits by Meyers and SmithA man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain.Triage ECG:What do you think?This is diagnostic of proximal LAD occlusion. This is a huge anterolateral OMI. Deadly. I cannot be anything else.Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessiv...
Source: Dr. Smith's ECG Blog - May 8, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
An Unusual Bradycardia
==================================Case Presentation by KEN GRAUER, MD (5/5/2023): — Edits by Drs. Meyers& Smith ...==================================Dr. Smith was reading ECGs — and he sent myself and Dr. Meyers the tracing shown in Figure-1. At the time we did not yet know the history ...What do YOU think?Figure-1: The initial ECG in today ' s case. No history yet ...Our Initial Thoughts on the ECG in Figure-1:Dr. Meyers said the following: " I see 2 different atrial foci — one sinus and one ectopic. There is AV block — but unclear why. T...
Source: Dr. Smith's ECG Blog - May 5, 2023 Category: Cardiology Authors: ECG Interpretation Source Type: blogs
A 50-something with acute chest pain, a computer " Normal " ECG, and a HEART score of 3 (low risk)
A 50-something with no previous cardiac history and no risk factors presented to the ED with acute chest pain (pressure) that radiated to the left arm. An ECG was immediately recorded:Computer read: Normal ECGWhat do you think?There is ST depression in V1-V3. We showed that this isdiagnostic of OMI (of the posterior wall). Moreover, there is ST elevation in V6 (which is getting close to the location of posterior lead V7). Thre is also absence of S-wave in V6, which is not entirely abnormal, but is suggestive of OMI (when this finding is in V2 or V3 in the setting of STE in V2 or V3, we call...
Source: Dr. Smith's ECG Blog - April 29, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 20-something with intermittent then acute chest pain
This was sent to me by a partner:" Curious what you think of this one we had overnight. Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. He had another episode the day before after exerting himself. No pericardial effusion on ultrasound. "What do you think?First, many on Twitter said " Pericarditis " . This is NOT pericarditis, which virtually NEVER has ST depression any where except aVR. When there is ST depression (as in aVL, V2, V3), then top on the differential is OMI or myocarditis.See our publication: ST depression in ...
Source: Dr. Smith's ECG Blog - April 25, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Localisation of Ventricular Tachycardia by Surface ECG
Surface ECG can be used to identify the site of origin of ventricular tachycardia. QRS morphologic patterns and vectors are helpful in discerning the activation pattern of the myocardium. Chest wall deformity as well as metabolic and drug effects can cause limitations in analysis sometimes [1]. Identification of site of origin of VT is useful while planning catheter ablation. It is also useful in correlating with the clinical situation as in post myocardial infarction scar related VT. Another instance is for correlation with findings on imaging modalities like echocardiography and cardiac magnetic resonance imaging [2].
F...
Source: Cardiophile MD - April 23, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Learning new lessons from a stressful “ ST segment ”
This is the Incidental ECG of an apparently healthy 50-year-old businessman, recorded while applying for health insurance
How will you describe this ECG?
Let me magnify it for you
Why this big fuss about this ECG?
Such ECGs are so common. Looking at the ST segment, we are supposed to think of significant CAD,, LVH, Aortic stenosis or variants of cardiomyopathy, and sometimes electrolytic shifts. The fact that it is recorded at rest, and the patient is absolutely asymptomatic, it is very unlikely there is ongoing ischemia.It could be a myocardial origin or an unk...
Source: Dr.S.Venkatesan MD - April 22, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized non specific st segment Source Type: blogs
50 year old with acute chest pain, with ‘normal’ ECG and falling troponin
Written by Jesse McLaren, with comments from SmithA 50-year old patient on the medical wards developed acute
chest pain, with an ECG labeled (see computer interpretation at the top) and confirmed as normal. What do you
think? There ’s normal sinus rhythm, normal conduction, normal axis,
normal R wave progression, and normal voltages. Lead aVL jumps out as abnormal
because there is a discordant T wave inversion and mild ST depression. This is reciprocal to inferior
mild ST elevation and hyperacute T waves (wide based, bulky, and symmetric, and in III taller than
the QRS complex), and adjacent to ST depression in...
Source: Dr. Smith's ECG Blog - April 21, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Compare these two ECGs. Do either, neither, or both show anything important?
One case sent by Dr. Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve SmithTake a look at these two ECGs below from two patients in the ED, first without any clinical context. Full case details and outcomes are below.Case 1:Case 2: Case 1:What do you think?This was sent to Dr. Smith by SamGhali (@EM_RESUS) with zero other info. Smith ' s response was: " OMI Mimic. "Later, this info was supplied by Sam:This
ECG was recorded in a 23-year-old African American man with a history
of psychiatric illness, acute alcohol/drug intoxication, brought in by
police officers status post being ...
Source: Dr. Smith's ECG Blog - April 17, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
