Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

He had a prehospital ECG recorded after ROSC: What do you think? On arrival to the ED, this ECG was recorded: What do you think? But without seeing that first prehospital ECG, I would call this: "Posterior OMI until proven otherwise." See Discussion in the June 29, 2024 post of Dr. Smith' ECG Blog ).

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Dr. Smith's ECG Blog

MAY 31, 2023

I received the following text message with these 3 EKGs (providers text me ECGs all day every day; most are false positives; many are subtle true positives): "Hi Steve, here are 3 EKGs for you (my colleague's case). Academic Emergency Medicine 27(S1): S220; May 2020. A 67 yo f developed chest pain this morning."

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ALiEM

NOVEMBER 6, 2023

Wolf-Parkison-White Syndrome (WPW) Case Question: What are the characteristic ECG findings of this condition and how is this condition managed? These particular EKG findings define a “Wolff-Parkinson-White Pattern.” WPW Syndrome consists of characteristic EKG findings as well as symptomatic arrhythmias. 2006 Oct;11(4):340-53.

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Dr. Smith's ECG Blog

MAY 30, 2023

His prehospital ECG was diagnostic of inferior posterior OMI. Here is his ED ECG: There is bradycardia with a junctional escape. We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. He appeared gray in color, with cool skin.

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The Skeptics' Guide to EM

JANUARY 27, 2024

February 2023 Date: January 24, 2024 Guest Skeptic: Dr. Rupinder Sahsi is a fellow EBM enthusiast with academic appointments at McMaster University and Wright State University who works as an emergency physician in Kitchener-Waterloo, Ontario, Canada. Emerg Med J. Emerg Med J. It’s not 50-50.

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Dr. Smith's ECG Blog

JUNE 12, 2017

Here was a comment on Facebook about this post: "I was hoping this post would let me off the hook for all those "normal ekg" reading and but no, they can't replace us yet." I am working with a company that writes deep neural network software for interpreting ECGs. An ECG is recorded and the computer reads it as "normal".

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Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

Triage ECG: What do you think? It's a very "fun" ECG, with initial ectopic atrial tachycardia (negative P waves in inferior leads conducting 1:1 with the QRSs), followed by spontaneous resolution to sinus rhythm. In the available view of the sinus rhythm, we see normal variant STE which probably meets STEMI criteria in V4 and V5.

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Sensible Medicine

JUNE 28, 2024

If I had it all to do again, there is no doubt that I would choose medicine in general and academic general internal medicine in particular, but occasionally we all have a bad week. She follows up at a “highly ranked” west coast academic medical center, near where she lives half the year. I love my job.

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Dr. Smith's ECG Blog

AUGUST 2, 2024

His ECG is shown below. How does RCA occlusion fit with the ECG? The answer is that the ECG really shows right ventricular OMI. We've highlighted a considerable number of acute RV MI cases in Dr. Smith's ECG Blog ( See the October 7, 2019 and May 10, 2024 posts , to name just two ). There is non-obstructive disease here.

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ALiEM

APRIL 10, 2023

In addition, an EKG is essential given that neonates can present with irreversible total atrioventricular heart block, which can present in utero or after birth. Any baby with findings concerning for neonatal lupus should have an EKG performed. Around 2% of infants present with heart block postnatally within the first month.

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Dr. Smith's ECG Blog

OCTOBER 18, 2023

A few days into her hospital stay she developed chest discomfort and the following ECG was recorded. Are these ECG changes related to the CNS infection perhaps? When I saw the ECG of this patient I saw that there was definitely something "off". I sent the top ECG to Dr Smith with no information and without the baseline ECG.

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Dr. Smith's ECG Blog

OCTOBER 6, 2023

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. Here is the prehospital ECG. He called 911.

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Sensible Medicine

FEBRUARY 12, 2024

Academic medicine sometimes gets it right. The AF episodes we see on an ECG were simply manifestations of atrial disease. They defined atrial cardiopathy using easy clinical criteria — the ECG appearance of p-waves in lead V1, an abnormally high biomarker called BNP, or a large left atrial diameter by echocardiogram.

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The Skeptics' Guide to EM

SEPTEMBER 11, 2021

He heads curriculum and conference for the academic year and is passionate about resident […] The post SGEM#344: We Will…We Will Cath You – But should We After An OHCA Without ST Elevations? The EKG shows sinus tachycardia with nonspecific changes and no ST segment elevations, Q waves, or hyperacute T waves.

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Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The baseline ECG is basically normal with no ischemia. Here is what the Queen of Hearts says about the Baseline ECG: Active chest pain triage ECG also read as not OMI: She says "not OMI", but she does not have access to the baseline ECG. In the future, we will be able to have her compare with previous and serial ECGs.

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Dr. Smith's ECG Blog

APRIL 29, 2020

I was texted this ECG in real time, but it turns out to actually be the 2nd one recorded in the ED. Just as interesting is EKG 1, 24 minutes before the first: What do you think here? Below, I post 4 more examples of ECGs that were recorded from patients who had Torsades. Smith showed a total of 10 ECGs in his comments above.

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Dr. Smith's ECG Blog

APRIL 22, 2019

He asked: "Hey Steve, Wanted to get your thoughts on this EKG:" What do you think? The computer called it a normal ECG Algorithm unknown Aside : [There is some "sinus arrhythmia", which is indeed a normal finding. For clarity — I’ve reproduced the first 2 ECGs that were done in this case in Figure-1. A former resident sent this.

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Dr. Smith's ECG Blog

DECEMBER 19, 2018

The pain had almost resolved by the time an ECG was obtained in the ED: Here is the computer diagnosis What do you think? But do you think the ECG is “normal?” Despite the computer interpretation, the ED physician was concerned about the ECG, and planned for serial troponins. Well, the computer thought so! It was not normal!

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Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Triage ECG (no prior for comparison): Computer algorithm read: "Sinus rhythm, low voltage QRS, inferior myocardial infarction, probably old." I texted this ECG with no information to Dr. Smith, who immediately said: "If CP, then anterior OMI until proven otherwise." Every note says "no ischemic changes on ECG."

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Downeast Emergency Medicine

APRIL 5, 2021

This year we are very fortunate to have Dr. Amal Mattu, EKG Jedi, as teaching faculty for our 39th Maine Medical Center/Maine ACEP Winter Symposium. HR 137, BP 105/50, 36C, RR 26, 95% O2 saturation on room air As he is brought in by ambulance, the paramedic presents the prehospital ECG below… do you activate the cath lab?

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Northwestern EM Blog

MARCH 1, 2025

Remove ECG leads and patches. Reattach EKG leads to back. Academic Emergency Medicine. Place a new bed sheet on the side of the bed that the patient will face when in this lateral decubitus position. Leave most of the sheet hanging. Turn patient into lateral decubitus position. Suction as needed. Strayer, R.J., Levitan, R.

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Dr. Smith's ECG Blog

APRIL 24, 2015

Here was his initial ED ECG: There is atrial fibrillation with a rapid ventricular response. Here is the post cardioversion ECG: ST depression, with ST elevation in aVR persists. and repeat the ECG, to see if the apparent ischemia persists. Academic Emergency Medicine 17(s1):S194; May 2010 The patient was cardioverted.

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ALiEM

FEBRUARY 28, 2024

We also must recognize the important contributions of media such as clinical photographs, radiology images, and ECGs. Photographs, ECGs, Radiology Images These fall into the category of “other multimedia” in the AMA Manual of Style, and here is my best attempt to interpret this to clinical media. Accessed February 20, 2024. 11th ed.

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The Skeptics' Guide to EM

JULY 2, 2022

He is also the CME editor for Academic Emergency Medicine. He is also the CME editor for Academic Emergency Medicine. His symptoms are moderately suspicious, he has a normal EKG, and a history of hypertension. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? AEM June 2022.

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Dr. Smith's ECG Blog

AUGUST 26, 2009

He called 911 and paramedics recorded a prehospital 12 lead ECG which showed a clear inferior STEMI (not shown, tracing could not be found). On arrival, the following ECG was recorded. In this case the diagnosis was clear due to the prehospital ECG. But suppose there had been no prehospital ECG? There is 0.5

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The Skeptics' Guide to EM

FEBRUARY 9, 2019

He is also the CME editor for Academic Emergency Medicine. He is also the CME editor for Academic Emergency Medicine. His heart rate is 130-140 beats per minute, irregular, and his EKG shows atrial fibrillation with rapid ventricular response (RVR). AEM February 2019. Date: February 7th, 2019 Reference: Bouida et al.

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Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

Below is the presentation ECG. The above ECG shows sinus rhythm. What ECG finding may have contributed to (or precipitated) the cardiac arrest? Below is the patient’s 12 lead ECG following defibrillation. What does this ECG tell you? The ECG shows sinus rhythm. What do you think? There is a prolonged QTc.

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Dr. Smith's ECG Blog

MARCH 31, 2023

Here is the result: Next, it interprets the digital data: A perfect interpretation Unfortunately, this ECG was not interpreted as OMI and the patient did not get another ECG recorded until 2 hours later. I tell them that it is not the ECG that is nonspecific, but the interpreter who is nonspecific.

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ALiEM

MARCH 22, 2024

Laboratory Data CBC , CMP , EKG , and Troponins were normal. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. Br Ir Orthopt J. 2022 Nov 7;18(1):152-158. doi: 10.22599/bioj.280.

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Dr. Smith's ECG Blog

JANUARY 6, 2023

F Triage ECG: ECG Interpretation: Sinus rhythm with normal QRS. I do not think this ECG is by itself diagnostic of OMI (full thickness, subepicardial ischemia ), b ut comparison to a previous might reveal this ECG as diagnostic of OMI. Cardiology interpretation of the initial ECG: “ST depressions laterally.”

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Taming the SRU

AUGUST 4, 2024

to teach you and your learner something new on shift skin adhesives WITH dr. hill Dermabond is a polymer (octyl cyanoacrylate) that can be used to repair lacerations in the Emergency Department faster than sutures, allowing the ED physician to be more efficient.

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Sensible Medicine

AUGUST 21, 2023

On yesterday’s podcast , I talked with Bobby Yeh, an academic cardiologist who made a compelling case for enhancing credibility of observational research. Please do listen. Bobby is one of the smartest people in cardiology today. How is a professional coder to decide if this event was due to an MI or not?

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Dr. Smith's ECG Blog

JUNE 23, 2023

Here is the ED ECG: What do you think? The amiodarone was discontinued and the patient did well. == MY Comment , by K EN G RAUER, MD ( 6/23 /2023 ): == From an academic standpoint — I love WCT ( W ide- C omplex T achycardia ) rhythms. For clarity in Figure-1 — I've reproduced and labeled the 2 ECGs in today's case.

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Dr. Smith's ECG Blog

JANUARY 22, 2020

Here is her ED ECG: Does this reveal the etiology of her symptoms? After pacer AND conversion to sinus rhythm: Computer diagnosis: IMPRESSION ELECTRONIC VENTRICULAR PACEMAKER ABNORMAL RHYTHM ECG What is missing from this interpretation? Figure-1: The initial ECG recorded in the ED ( See text ). This shows atrial fibrillation.

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Dr. Smith's ECG Blog

DECEMBER 16, 2018

This case is contributed by Brooks Walsh , an EM physician and ECG expert from Connecticut. The initial ECG: The rhythm is regular at 150, and the QRS is markedly wide. The use-dependence of flecainide in the setting of modest toxicity was nicely illustrated on an ECG from the next day (see below). Note of Caution!

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Dr. Smith's ECG Blog

JANUARY 5, 2020

Here is the ECG: What do you think? A study of 2298 ECGs from 1085 patients which had a computerized interpretation of AF found that in 442 (19%) of these ECGs, from 382 patients (35%), the interpretation was incorrect, and that, in 92 of these 382 patients, the physician had failed to correct it. Among, 2447 ECGs, Mant et al.

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The Skeptics' Guide to EM

JUNE 22, 2019

The ECG shows atrial fibrillation without ischemic changes. Case: A 62-year-old woman with a history of hypertension presents with four hours of palpitations, described as a racing heart. Her vital signs: BP 148/90, HR 135, RR 16, T 37oC, O2 Sat 96%. How do you proceed? Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation.

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