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Written by Magnus Nossen Today’s patient is an overweight 77-year-old male with COPD and Stage 5 CKD (Chronic… The post What do you make of these T wave inversions? appeared first on Dr. Smith’s ECG Blog.
A 70-year-old woman with CHF, COPD, intermittent atrial fibrillation, chronic pain medication use, and recent poor intake develops sudden dyspnea at rest and is found somnolent and bradycardic in the 30s to 40s. Paramedics obtain a prehospital ECG showing apparent inferior ST elevation and activate
Written by Magnus Nossen I was reviewing ECGs at my computer when I came across today’s case. I… The post How would you interpret these T wave inversions? And what is an “innocent bystander” on angiogram? appeared first on Dr. Smith’s ECG Blog.
A 44-year-old man with severe cardiomyopathy, an LVAD, chronic amiodarone therapy, and an AICD presents with palpitations. His ECG shows a regular wide-complex tachycardia, but the rate is only 135. There also appears to be retrograde atrial activity after the QRS complexes, and the device is not fi
From Avery Kechter in Cork, Ireland (Avery is a former resident at Hennepin who married another former resident… The post Signed off as “normal, no concern” appeared first on Dr. Smith’s ECG Blog.
Written by Robert Herman, MD, PhD with Edits by Stephen W Smith (with adaptation by Ken Grauer from the original publication in… The post Reciprocally Inverted Hyperacute T-Wave. What is that? appeared first on Dr. Smith’s ECG Blog.
A 71-year-old man presents with shortness of breath, and his ECG is initially read as a junctional rhythm. On later review, it is even mistaken for atrial fibrillation. But the rhythm is actually regular, and closer inspection reveals subtle atrial activity. The diagnosis depends on recognizing what
Sent by anonymous A man in his 70s with history of hypertension experienced 5 days of worsening generalized… The post An elderly man with weakness, diaphoresis, and near-syncope appeared first on Dr. Smith’s ECG Blog.
A 60-something male with CAD w prior stenting, prior LV thrombus, ischemic cardiomyopathy, HFrEF with his last ejection fraction… The post 60 yo with Chest pain and cardiogenic shock, with acute LV failure. Does it matter what the ECG shows? And why is the entire heart affected? appeared first on D
An 81-year-old woman presents with lightheadedness and marked bradycardia. Her ECG shows more P waves than QRS complexes, but the mechanism is not immediately clear. The key question is whether the PR intervals follow a pattern or whether the atria and ventricles are dissociated. Before watching thi
Written by Magnus Nossen An 80-year-old man with a history of hypertension and paroxysmal atrial fibrillation contacted EMS… The post An 80-year-old with intermittent CP appeared first on Dr. Smith’s ECG Blog.
This was sent by a former resident. A 30-something male presented 4 hours after onset of chest pain.… The post 30-something with chest pain appeared first on Dr. Smith’s ECG Blog.
A 72-year-old man presents with chest pain and shortness of breath. His ECG shows sinus rhythm with LVH, mild inferior ST elevation, and lateral ST-T abnormalities that some interpret as simple LVH strain rather than acute ischemia. A repeat tracing 15 minutes later does not show a dramatic new STEM
Written by Magnus Nossen Today’s patient is a 60-something male with a history of atrial fibrillation managed with… The post Syncope and WCT after physical exertion appeared first on Dr. Smith’s ECG Blog.
STEMI-equivalent and STEMI-mimic ECGs are among the most difficult tracings to interpret. This study examines how Queen of Hearts AI performed against physicians when accuracy in cath lab activation decisions mattered most. The post The Queen of Hearts Returns: AI vs Physicians in STEMI-Equivalent a
A 60-year-old man presents with chest pain that seems a little better after belching, but his clinician is not reassured. The initial ED ECG shows subtle ST-segment abnormalities, the computer calls it nonspecific, and cardiology is not convinced. A repeat tracing is obtained 15 minutes later for on
A 40-something man presented with with 10/10 chest pain after cocaine use. The chest pain had been present… The post Acute chest pain and ST Elevation. Take a moment to look through the chart! appeared first on Dr. Smith’s ECG Blog.
A 60-year-old woman presents with palpitations and an irregular wide-complex tachycardia. The computer calls atrial fibrillation with a left bundle branch block, but a subtle clue in the precordial leads suggests this is more than just an arrhythmia. Sometimes, one lead is enough to diagnose an acut
A 68-year-old man has syncope, then has a second syncopal episode while lying still on a stretcher during evaluation at an outpatient clinic. He is sent emergently to the ED. On arrival he remains lightheaded with borderline blood pressure and a ventricular rate in the low 50s. The arrival ECG shows
A 49-year-old man arrives with palpitations and chest discomfort. The monitor shows an irregular, wide-complex tachycardia with varying morphology and rates nearing 250 to 300 bpm. The team debates polymorphic VT versus another high-risk rhythm and reaches for a familiar antiarrhythmic. The followin
A 53-year-old man presents with palpitations and lightheadedness. The following ECG is obtained on arrival and appears very rapid and irregular with changing QRS morphologies. He starts showing signs of instability shortly after arrival. Before watching this week’s workout, review the arrival ECG ca
A young man with recurrent palpitations presents to the emergency department hemodynamically stable during an episode. The arrival ECG shows a wide complex, regular tachycardia and the computer interpretation calls probable ventricular tachycardia. He converts after treatment, but then develops a na
ABSTRACT Beta-blockade is generally regarded as a standard therapy for thyroid storm. However, this practice isn’t evidence-based. Recent studies have emphasized that beta-blockade often cause cardiovascular collapse in this context. Until more evidence is available, thyroid storm with sinus tachyca
A critically ill 38-year-old man presents hypotensive, pale, and diaphoretic with abdominal pain and rectal bleeding. Upright chest X-ray shows free air under the diaphragm, and the patient is headed urgently to the OR. The following pre-op ECG is obtained and the computer interpretation calls an ac
ECG findings you should know... EMCrit Project by Scott Weingart, MD FCCM.
A 54-year-old man presents to the emergency department by EMS with acute shortness of breath. A prehospital ECG triggers a STEMI alert based on the computer interpretation. The tracing shows dramatic ST-segment abnormalities that appear convincing at first glance, but a systematic ECG review reveals
A 68-year-old man is brought to the emergency department by EMS with acute chest discomfort. The following prehospital ECG was obtained and shows concave ST elevation across multiple leads. The computer interprets the tracing as having signs of both early repolarization and ischemia. Before watching
A 51-year-old man with lung cancer presents with shortness of breath and tachycardia. The arrival ECG shows an S1Q3 pattern and seems to support a familiar diagnosis that would normally trigger immediate anticoagulation: Before watching this week’s workout, review the arrival ECG carefully and consi
What to do about Electrical Storm in patients already on VA-ECMO... EMCrit Project by Katrina Augustin.
A 43-year-old woman with sharp left-sided chest pain and minimal cardiac risk factors has an initial ECG that is not diagnostic for STEMI. She looks stable, but one feature on the ECG is hard to ignore: Before watching this week’s workout, review the arrival ECG carefully and consider: What ECG find
A 68-year-old man presents after syncope with profound bradycardia. The ECG shows a very slow ventricular rate with high-grade AV block. The reflex move is to focus only on pacing, but the tracing has additional clues that could change the urgency and destination of care. Before watching this week’s
A 62-year-old man presents to the emergency department with acute chest pain associated with diaphoresis. He has cardiac risk factors including tobacco use. An initial 12-lead ECG is obtained on arrival and is read by the computer as non-acute with no clear ST elevation meeting STEMI criteria. Sympt
A 92-year-old man presents to the emergency department with gradually worsening dyspnea on exertion that has progressed to exertional chest “fullness”. He is asymptomatic on arrival with normal vitals. The following arrival ECG is obtained and noted to have a bifascicular block that is unchanged fro
Antithrombotic therapy is a cornerstone in the treatment of atrial fibrillation (AFib), though it carries a significant risk of bleeding. While Vitamin K antagonists (VKAs), the oldest anticoagulants, were largely supplanted by direct oral anticoagulants (DOACs) following trials like ARISTOTLE and R
A 35-year-old woman arrives at the emergency department after a witnessed seizure and brief cardiac arrest with ROSC. Her arrival ECG shows a very wide complex rhythm that the machine labels as ventricular tachycardia. Before watching this week’s workout, review the arrival ECG carefully and conside
Atrial fibrillation with rapid ventricular response (AF with RVR) is one of the most common dysrhythmias encountered in the emergency department and often requires prompt rate control. Diltiazem remains a go-to agent due to its rapid onset, AV nodal selectivity, and reliable heart rate reduction. Ho
The QT interval is a vital part of ECG interpretation, reflecting the heart’s electrical recovery after each beat. When prolonged, it can set the stage for torsades de pointes. Understanding how to measure and correct the QT interval, identify high-risk medications, and act quickly when TdP occurs i
We did the arrest, now let's talk about the afterwards... EMCrit Project by Scott Weingart, MD FCCM.
All things electrical storm - part 1 EMCrit Project by Katrina Augustin.
Cardiac Arrest on 1:1 Nursing EMCrit Project by Scott Weingart, MD FCCM.
Mike Cadogan Top 20 Online ECG Courses We take a Google deep dive to bring you the Top 20 best #FOAMed and paid ECG courses available online.
Robert Buttner VT versus SVT: It’s as easy as ABCDE The long list of VT "suggestive" ECG features is difficult to recall and apply in real time. Simple ABCDE approach to this common dilemma
Robert Buttner and Mike Cadogan Apical hypertrophic cardiomyopathy (AHC) Yamaguchi syndrome: Apical hypertrophic cardiomyopathy (AHC) Hypertrophic non-obstructive cardiomyopathy with giant negative T waves
Robert Buttner and Mike Cadogan ECG Made Easier ECG made easier a free, innovative, interactive online application to assist in honing and refining your ECG interpretation skills
Robert Buttner and Emre Aslanger Killer ECG Patterns: Part 2 8 deadly ECG patterns NOT to miss -- Part 2, the occlusion version. These patients require immediate cardiology referral for emergent reperfusion therapy.
David Schaack and Mike Cadogan Cardiac Axis Trainer Learning cardiac axis interpretation can be tedious. Open source webapp hosted on CardiacAxis.com to analyse axis in English and German
Robert Buttner and Mike Cadogan Crochetage sign Characteristic R wave notching seen in inferior leads in a large proportion of patients with ostium secundum ASD
Mike Cadogan and Robert Buttner Osborn Wave (J Wave) The Osborn wave (J wave) is a positive deflection at the J point (negative in aVR and V1). It is usually most prominent in the precordial leads and most commonly associated with hypothermia.
Robert Buttner Atrial fibrillation/flutter in pre-excitation In patients with AF and pre-excitation, the presence of an accessory pathway allows for rapid AV conduction, with a risk of degeneration into VT and VF
Robert Buttner Atrioventricular Re-entry Tachycardia (AVRT) Tachyarrhythmia that occurs in patients with accessory pathways, due to formation of a re-entry circuit between the AV node and accessory pathway
Mike Cadogan and Robert Buttner De Winter T Wave First reported by de Winter in 2008, the de Winter ECG pattern is an anterior STEMI equivalent that presents without obvious ST segment elevation
Ed Burns and Robert Buttner Killer ECG Patterns: Part 1 The average Emergency Clinician is interrupted every 6 minutes. When busy, it can be tempting to quickly “sign off” an ECG. These are the patterns not to miss.