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Prolonged (63 minutes) Ventricular Fibrillation, Followed by Unusual Cardiogenic Shock by Stephen Smith Posted in: Blog Posts in Heart Health A middle-aged patient presented in continued ventricular fibrillation after 5 minutes of down time and 45 minutes of prehospital resuscitation by medics, using King Airway ... Read on »
Two (apparent wide complex) Rhythms in One Patient: First is at rate of 300, second at Rate of 180 by Stephen Smith Posted in: Blog Posts in Heart Health A middle-aged patient with no known significant past medical history had sudden onset of  palpitations, diaphoresis, dyspnea. This lasted for roughly 30 seconds.  EMS was ... Read on »
Massive Excessively Discordant Anterior ST Elevation in a Paced Rhythm by Stephen Smith Posted in: Blog Posts in Heart Health This patient has a standard DDD pacer, with RV pacing (not biventricular pacing), severe chronic nonischemic cardiomyopathy with EF of 10% (partly due to many years of hav ... Read on »
Intravenous Nitroglycerine in STEMI, with data: Avoid its use if giving tPA by Stephen Smith Posted in: Blog Posts in Heart Health If you are giving tPA to patients with STEMI, it is wise to avoid IV nitroglycerine.  I am revisiting this topic because of a recent case I posted in which a patient ... Read on »
Great Chart of Pediatric ECG Intervals: QRS, QTc, and PR. All Ages. by Stephen Smith Posted in: Blog Posts in Heart Health My friend and colleague Ben Orozco, emergency physician at HCMC, and toxicologist with the Hennepin Poison Center, put together this very useful chart of intervals in pedi ... Read on »
A 50-something year old with typical chest pain by Stephen Smith Posted in: Blog Posts in Heart Health A middle age male presented with chest pain.  Here is his ECG; there was no previous for comparison QTc is 380 ms. There is 3 mm of STE at the J-point in V2 and ... Read on »
One Hour Lecture: Supraventricular Tachycardias (including ED management of atrial fibrillation) by Stephen Smith Posted in: Blog Posts in Heart Health This is a lecture on ED diagnosis and management of supraventricular tachycardias Sinus Tach Paroxysmal SVT Atrial Fibrillation Atrial Flutter Multifocal Atrial Tachy ... Read on »
Inferior ST Elevation. BP 250/140. by Stephen Smith Posted in: Blog Posts in Heart Health This 50-something patient with no previous CAD complained of havinng had chest pressure the day prior, but stated she was asymptomatic at the time of the ECG.  Her blood p ... Read on »
9 Hours of Chest Pain and Deep Q-waves: Is it too late for Thrombolytics? (Time Window for... by Stephen Smith Posted in: Blog Posts in Heart Health There is diagnostic ST elevation with large T-waves.  However, there are deep QS-waves.   1. How do we know these QS-waves do not represent LV aneurysm? 2. D ... Read on »
Left Bundle with Convex ST Segment: Where is the J-point? by Stephen Smith Posted in: Blog Posts in Heart Health There is SVT, probably sinus, at a rate of 149, with Left Bundle Branch Block.  There is no septal r-wave in V2 or V3. Because of the convex morphology of the ... Read on »
A Very Fast Regular Narrow Complex, Followed by an Equally Fast Regular Wide Complex by Stephen Smith Posted in: Blog Posts in Heart Health This case was sent to me by for analysis by Scott Flannagan in Australia.  I am by no means a rhythm master like Dr. K. Wang, but I think I was able to figure this one out ... Read on »
Does this single lead show a wide complex tachycardia? by Stephen Smith Posted in: Blog Posts in Heart Health A woman in her 50's had a v fib arrest and required defibrillation 10 times before resuscitation to an organized rhythm. Here was the monitored rhythm ventri ... Read on »
Middle Aged Male with Burning Chest Pain -- Assess the Entire Clinical Scenario by Stephen Smith Posted in: Blog Posts in Heart Health A middle-aged male presented with “burning” mid chest pain, with radiation to bilateral shoulders ( pain radiating to both shoulder is very specific for ischemia ).  It st ... Read on »
A Very Wide Complex Tachycardia. What is the Rhythm? Use Lewis Leads!! by Stephen Smith Posted in: Blog Posts in Heart Health A patient with a history of severely reduced left ventricular function, renal insufficiency and atrial fibrillation presented with slight dyspnea, without chest pain or ... Read on »
Poor Microvascular Reperfusion ("No Reflow"): Best Diagnosed by ECG by Stephen Smith Posted in: Blog Posts in Heart Health A previously healthy woman about 50 years old with no previous medical history or coronary risk factors presented 30 minutes after the sudden onset of severe substernal ch ... Read on »
A Very Wide Complex by Stephen Smith Posted in: Blog Posts in Heart Health What do you think of this ECG from a critically ill patient? See Below I can only give minimal information in order to protect identity ... Read on »
Massive ST Elevation After V Fib Arrest, Discordant Bedside Echo Results by Stephen Smith Posted in: Blog Posts in Heart Health A woman in her 40's was brought the ED (not by ambulance) for what is believed to be a seizure.  She was reportedly very anxious and there was a question of benzodiazepine ... Read on »
The difference between Left Main occlusion and Left Main insufficiency by Stephen Smith Posted in: Blog Posts in Heart Health There are many publications stating that ST elevation in lead aVR, with diffuse ST depression elsewhere, is due to "left main occlusion."  This is even stated in the laste ... Read on »
Look at the PVCs (again)!! by Stephen Smith Posted in: Blog Posts in Heart Health An elderly woman awoke with bilateral upper chest pressure and SOB.  She called 911.  Here is the first prehospital ECG Sinus rhythm with a PVC. There is subt ... Read on »
LBBB on Cardiac Ultrasound: do not be fooled into diagnosing a wall motion abnormality! by Stephen Smith Posted in: Blog Posts in Heart Health The last case on the blog of LBBB with very high voltage was actually first identified as LBBB by ED bedside echo, which was done PRIOR to the ECG. The images were ca ... Read on »