Does this T wave pattern mean anything?
Written by Michael Doyle DO and Timothy Palmieri MD. Edited by Bracey, Meyers, Grauer, and SmithA 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. The described rhythm was an irregular, wide complex rhythm. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin. She was successfully revived after several rounds of ACLS including defibrillation and amiodarone.On arrival to the ED the patient was intubated with normal vi...
Source: Dr. Smith's ECG Blog - October 23, 2023 Category: Cardiology Authors: Bracey Source Type: blogs

A 20-something woman with cardiac arrest.
The patient is a 20 something female. She is healthy with no known cardiac disease. She was admitted to the neurology department due to headache and vomiting. She was found to have a viral CNS infection. A few days into her hospital stay she developedchest discomfort and the following ECG was recorded. What do you think? Why such large T-waves?  Are these hyperacute T-waves? Are these ECG changes related to the CNS infection perhaps? What disease processes would you put on your list of differential diagnoses?When I saw the ECG of this patient I saw that there was definitely something " off " . I didn ' t get...
Source: Dr. Smith's ECG Blog - October 18, 2023 Category: Cardiology Authors: Magnus Nossen Source Type: blogs

Causes of heart attack and cardiac arrest in teenagers
A heart attack occurs when blood flow to a part of the heart muscle stops. Heart attacks in teenagers can be caused by rare genetic diseases, such as familial homozygous hypercholesterolemia, which increases blood cholesterol levels, and some rare diseases that affect the blood vessels of the heart, such as Kawasaki disease. Cardiac arrest means the heart stops working completely. A heart attack can lead to cardiac arrest. Inherited diseases like Congenital long QT syndrome and Brugada syndrome that cause cardiac arrhythmias and can also cause cardiac arrest in adolescents. (Source: Cardiophile MD)
Source: Cardiophile MD - June 1, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Clinical Examination of Cardiovascular System For Medical Students
Discussion on blood pressure is not included here as a separate topic is dedicated to it. Though the most commonly examined pulse is the radial, to check some of the characteristics, a more proximal pulse like the brachial or carotid needs to be examined. Following parameters of the pulse are routinely documented: 1. The rate: Normal rate in adult is 60-100 per minute. It is higher in children. Younger the child, higher the pulse rate. Rhythm: Regular and irregular rhythms are possible. Mild variation with respiration is called respiratory sinus arrhythmia, with higher rate in inspiration. Respiratory sinus arrhythmia may...
Source: Cardiophile MD - May 30, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

A woman in her 20s with syncope
Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and GrauerA woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope.Her initial vital signs revealed a temp of 97.7F, HR 125, RR 20, BP 115/90, and an oxygen saturation of 95% on room air. Upon arrival, she did not appear in acute distress. She was noted to be tachycardic and her heart sounds were distant on physical exam. She had a normal respiratory effort, and her lungs were clear to...
Source: Dr. Smith's ECG Blog - November 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

A New Seizure in a Healthy 20-something
A 20-something year old who is the picture of good health presented with a new onset seizure.  A witness described what sounded like a 3 minute tonic-clonic seizure.  Her seizure workup was negative and she was scheduled for an outpatient MRI and EEG.Because she was persistently tachycardic, an ECG was recorded.  At the time her K was 3.2 mEq/L:Here is the interpretation by the computer, confirmed by the over-reading physician:JUNCTIONAL TACHYCARDIAINTRAVENTRICULAR CONDUCTION DELAY [130+ ms QRS DURATION]ABNORMAL ECGP-R Interval 116 msQRS Interval 158 msQT Interval 422 msQTC Interval 485 msP Axis 25...
Source: Dr. Smith's ECG Blog - October 14, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs

Mexiletine – Class Ib ( & Id?)
Mexiletine – Class Ib (& Id?) Mexiletine is a Class Ib drug. But it has additional effect on late sodium current (INaL), which qualifies for Id inclusion, though it has not been included in that group in the Modernized Classification of Cardiac Antiarrhythmic Drugs [1]. By virtue of that effect, it has been used successfully in the treatment of Long QT syndrome 3 (LQT3) [2]. In addition to shortening QTc, it has been shown to reduce life threatening arrhythmic events in LQT3 patients. It has also been found useful in Timothy syndrome, which is long QT syndrome type 8 (LQT8) [3]. In the case reported, mexiletine s...
Source: Cardiophile MD - October 14, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology late sodium current Long QT syndrome 3 LQT3 LQT8 Timothy syndrome Source Type: blogs

General examination – eyes and facial dysmorphism
General examination – eyes and facial dysmorphism Clinically examination is guided by the symptoms. Unless the history is not correlated with findings, important diagnostic possibilities may be missed. Clinical examination starts off with a focused general examination followed by a detailed examination of the cardiovascular system. Relevant points in other systems like basal crepitations, hepatosplenomegaly and neurological deficits should be looked for. Examination strategy should be fitting to the clinical situation. When a patient presents to the emergency room, it should be a short but focused examination to perm...
Source: Cardiophile MD - September 21, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs

Young Man with a Heart Rate of 257. What is it and how to manage?
A 30-something was in the ED for some minor trauma when he was noted to have a fast heart rate.  He acknowledged that he had palpitations. but only when asked.  He had a history heavy alcohol use.  Blood pressure was normal (109/83).Here is his 12-lead:There is a wide complex tachycardia with a rate of 257, with RBBB and LPFB (right axis deviation) morphology.The Differential Diagnosis is: SVT with aberrancy(#)     [AVNRT vs. WPW (also called AVRT*)]    Atrial flutter with 1:1 conduction, with aberrancy    VT coming from the anterior fascicle (fascicular...
Source: Dr. Smith's ECG Blog - September 6, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs

Pediatric exercise testing – Cardiology MCQ
Pediatric exercise testing – Cardiology MCQ Indication for exercise testing in children: Sinus node dysfunction Long QT syndrome Catecholaminergic polymorphic ventricular tachycardia All of the above Click here for the correct answer The post Pediatric exercise testing – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - August 3, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on?
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely.  When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA.    ===================================MY Comment by KEN ...
Source: Dr. Smith's ECG Blog - June 27, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs

Syncope evaluation from ECG: A check list and a focused review.
In the evaluation of syncope, history is most important to arrive at a diagnosis.The first step is to confirm whether its truly a syncope or (Metabolic/TIA or seizure. We are easily carried away by the urge to order a Holter monitoring routimely. In reality, the yield is too low (<15%) .Even the utility value of Head up tilt (HUT) is being downgraded. Paradoxically, resting ECG might give important clue in many. One need to specifically look into a set pattern of ECG. It generally falls in one the following in any patient with syncope. This post specifically may not be exclusive but stresses the importance of resting EC...
Source: Dr.S.Venkatesan MD - June 10, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

A young man with back spasms
Written by Pendell Meyers with edits by Steve SmithFirst see this ECG without clinical context:What do you see? Do you agree with the computer ' s read of " nonspecific ST abnormality? "The ECG is highly suspicious for hypokalemia. There is diffuse minimal STD, with prolonged QT interval and characteristic " down-up " T-wave morphology in the precordial leads which is being caused by U-waves. V2 has an especially pronounced U-wave, but there is also a slightly wandering baseline. This morphology is very unlikely to be due to ischemia, and to an experienced electrocardiographer is nearly pathognomonic of hypokalemia +/...
Source: Dr. Smith's ECG Blog - November 7, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

Syncope in a 20-something woman
A 20-something was outside exerting herself.  She states that  it was hot outside and that she was probably dehydrated. At one point, she felt lightheaded and then can ' t remember anything until waking up in the ambulance.  Her friends saw her lose consciousness and fall on the ground.  She regained consciousness spontaneously before responders arrived. Fire department was on scene first, who noted a cyanotic color to the patient ' s face.  EMS arrived and also noted cyanotic color which improved en route to HCMC. She denies head pain, neck pain, back pain, abdominal pain or any pain at this ...
Source: Dr. Smith's ECG Blog - July 17, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Resuscitated cardiac arrest – Cardiology MCQ – Answer
Thirty year old male was resuscitated from cardiac arrest. His temperature was 37 degrees centigrade and serum potassium was 4.5 mEq/litre. ECG showed an abnormal wave at the end of the QRS complex. He is likely to have: Correct answer:  c) Arrhythmogenic right ventricular dysplasia The wave at the end of the QRS is likely to be Epsilon wave. It is sometimes called ‘post excitation’ by analogy with the delta wave seen at the beginning of the QRS in pre-excitation. Hypothermia and hypokalemia can cause cardiac arrest, which are excluded from the data given. Osborne wave in hypothermia is also seen at the end ...
Source: Cardiophile MD - June 12, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs