What is this ECG finding? Do you understand it before you hear the clinical context?
Written by Pendell MeyersFirst try to interpret this ECG with no clinical context:The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. These are Osborn waves usually associated with hypothermia. There is also large T wave inversion and long QT.Clinical context:A man in his 50s was found down outside in the cold, unresponsive but with intact vital signs. He was intubated on arrival at the ED for mental status and airway protection due to vomiting. Initial vitals included...
Source: Dr. Smith's ECG Blog - February 2, 2024 Category: Cardiology Authors: Pendell Source Type: blogs
Proportionality is a major element in the ECG Diagnosis of OMI.
This middle aged patient presented with chest pain:What do you think?There is VERY low voltage. There is some ST Elevation, but it is MINIMAL. But look how small the QRS is!!Let ' s stretch out the QRS vertically so it is not so tiny:On upper left is the original. On the right are the precordial leads stretched vertically, so that the QRS is not tiny. Now you can see the STE and Hyperacute T-wave better.I published, and Emre Aslanger externally validated,the4-Variable formula for differentiating the ST Elevation of LAD OMI from Normal ST Elevation. It is derived/validated/...
Source: Dr. Smith's ECG Blog - December 13, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
ECG Changes in Intracranial Hemorrhage
ECG changes are fairly common in intracranial hemorrhage. Giant T inversions with QT interval prolongation may be seen in intracranial hemorrhage even without associated myocardial damage [1]. ECG changes described in subarachnoid hemorrhage include QT interval prolongation, T wave abnormalities and ST segment deviations. Mechanism is thought to be due to sustained sympathetic stimulation, probably caused by dysfunction of insular cortex resulting in reversible neurogenic damage to the myocardium which could include contraction bands and subendocardial ischemia [2].
In a study involving patients with supratentorial hemorr...
Source: Cardiophile MD - November 17, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
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
27 Dangers And Risks Of High Blood Pressure
Conclusion
Despite its silent nature, high blood pressure gradually damages organs over time. The interconnectedness of the circulatory system means that all organs reachable by blood are at risk.
Hypertension can lead to critical complications such as heart enlargement, coronary artery disease, stroke, cognitive decline, erectile dysfunction, kidney disease, proteinuria, vision problems, and vascular damage.
The importance of proactive measures to manage and prevent these adverse effects is emphasized.
Regular blood pressure monitoring, adopting a healthy lifestyle, and working with healthcare professionals ar...
Source: The EMT Spot - June 1, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs
Dangers And Risks Of High Blood Pressure
Conclusion
Despite its silent nature, high blood pressure gradually damages organs over time. The interconnectedness of the circulatory system means that all organs reachable by blood are at risk.
Hypertension can lead to critical complications such as heart enlargement, coronary artery disease, stroke, cognitive decline, erectile dysfunction, kidney disease, proteinuria, vision problems, and vascular damage.
The importance of proactive measures to manage and prevent these adverse effects is emphasized.
Regular blood pressure monitoring, adopting a healthy lifestyle, and working with healthcare professionals ar...
Source: The EMT Spot - June 1, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs
Unconscious + STEMI criteria: activate the cath lab?
Case submitted and written by Dr. Mazen El-Baba and Dr. Evelyn Dell, with edits from Jesse McLarenEMS brought a John Doe, in his 30s, who was found in an urban forest near a homeless encampment on a cool fall day. There were no signs of trauma on scene or on the patient. EMS reported an initial GCS of 8 with pupils equal and reactive. The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4.Vitals: HR 45; systolic BP was 110-120; irregular respiratory rate; oxygen saturation was normal; tympanic temperature 30; glucose was 6. In the resuscitation room, the patient had another seizure that stopped after...
Source: Dr. Smith's ECG Blog - January 21, 2023 Category: Cardiology Authors: Jesse McLaren 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
Types of Brain Hemorrhage
In our last post (part one) we introduced the subject of head injuries with an overview of trauma patterns typically found in head injury patients. Today let’s talk about bleeding inside the skull or intracranial hemorrhage.
Brain hemorrhage occurs when blood vessels inside the skull rupture. There are some non-traumatic causes as well. Ruptured aneurysms and hemorrhagic strokes would be a few examples of non-traumatic intracranial hemorrhages.
We classify bleeding in the skull by location, using the layers of the meninges as a guide. You may recall from EMT class that the meninges are fluid coated membranes that s...
Source: The EMT Spot - November 10, 2022 Category: Emergency Medicine Authors: Steve Whitehead Tags: EMT Source Type: blogs
See what happens when the consultant is " Not convinced of STEMI "
Sent by Arjun V, written by Pendell Meyers, edits by SmithA man in his early 40s with history of HTN and obesity suffered sudden out of hospital cardiac arrest. EMS arrived and found him in VF. He was defibrillated successfully, but had several more episodes of VF arrest on the way to the Emergency Department. Here are some examples of his prehospital rhythms:At the ED, sustained ROSC was achieved. He was intubated with minimal available neurologic exam.He had several ECGs recorded in the ED soon after ROSC:The ECGs show likelyAFib with RBBB morphology. There isprofound right axis deviation, which likely r...
Source: Dr. Smith's ECG Blog - July 13, 2022 Category: Cardiology Authors: Pendell 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
Collapse, Ventricular Tachycardia, Cardioverted, Comatose on Arrival. OMI is a clinical diagnosis.
A middle-aged woman cried out, then collapsed. She had bystander CPR. First responders palpated a pulse. Paramedics found her to be in Ventricular Tachycardia. She underwent synchronized cardioversion.On arrival, she had this ECG:What do you think?There is sinus rhythm. The ECG shows unequivocal ST Elevation in I and aVL, with reciprocal inferior ST Depression, and also STE in V3-V6. There is unequivocal subepicardial (transmural) ischemia on this ECG. This is probably a proximal LAD occlusion, right?Not so fast!!This patient dropped to the ground, and in spite of VT with a pulse (not VF...
Source: Dr. Smith's ECG Blog - December 20, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Agitation, Confusion, and Unusual Wide Complex Tachycardia. What is it, why did it occur, and how to treat?
A 50-something male ran a 10 mile race, after which he complained of a headache. The next day, he collapsed and had a witnessed seizure.He arrived agitated and the monitor showed a wide complex tachycardia. He was very hypertensive and tachycardic.A 12-lead ECG was obtained:What is it? What therapy?There are wide complex QRS ' s with 2 different morphologies:1. RBBB configuration with an axis of about 135 degrees (lower right axis toward III)2. IVCD (neither RBBB nor LBBB) with a " Northwest " (upper right) axis toward aVRThere appear to be 3 possible P-waves, but they are not consistent and not definitel...
Source: Dr. Smith's ECG Blog - November 6, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Giant T inversion and NSVT
Giant T inversion with NSVT
Holter tracing showing giant T wave inversion and non sustained ventricular tachycardia, both at the beginning of the tracing and at the end. Ventricular ectopic beats are also seen in between. Variation in QRS amplitude of the NSVT beats are evident. It is likely that this will soon progress to torsades des pointes in the setting of gross QT interval prolongation. QT interval is seen as 640 ms in a cycle with cycle length of 600 ms. So, the QTc will be 640 ms. The first ventricular ectopic is followed by a good compensatory pause while the second one is almost an interpolated ventricular ecto...
Source: Cardiophile MD - February 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs
A woman in her 60s with chest pain and prominent J waves
Case submitted by Dan Singer MD and Ryan Barnicle MD, Written by Pendell MeyersA woman in her 60s with history of smoking presented to the ED with left sided chest pain radiating to the left arm and back, starting at about 1330. She described the pain as a " heaviness, " without exacerbating or alleviating factors. Her pain at the time of arrival was 10/10.Here is her triage ECG (no prior for comparison):What do you think?Findings: - Sinus rhythm at around 100 bpm - Grossly normal QRS complex - 1.0 mm STE in lead III, and just a hint of STE in aVF (both of which have to be measured just after significant J w...
Source: Dr. Smith's ECG Blog - September 22, 2020 Category: Cardiology Authors: Pendell Source Type: blogs
