Dr. Smith's ECG Blog
JANUARY 2, 2025
Among patients with left bundle branch block, T-wave peak to T-wave end time is prolonged in the presence of acute coronary occlusion. Finally, do a coronary angiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal.
Dr. Smith's ECG Blog
JUNE 12, 2025
A 60-something with h/o Coronary Bypass called 911 for acute chest pain. On arrival, an ED ECG was recorded: Still diagnostic When a patient has severe chronic coronary disease, findings which appear to be acute can sometimes be chronic, so in this patient with h/o CABG (coronary bypass), it is wise to find a previous ECG if possible.
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NAEMSP
JULY 15, 2025
You load him in the back of your ambulance and acquire a 12-lead electrocardiogram (ECG) and it is as follows: You are 5 minutes from a local community hospital and 45 minutes from the tertiary care center with percutaneous coronary intervention (PCI) capabilities. Which hospital do you choose? This speaks to the true essence of the question.
Dr. Smith's ECG Blog
DECEMBER 3, 2024
Given the right coronary anatomy seen during angiography, it is particularly interesting that subtle T wave changes were seen on the previous EKGs in the high lateral leads that would otherwise only be expected with a more proximal RCA lesion. Another EKG was also obtained. Also: electrical instability, pulmonary edema, or hypotension.
Dr. Smith's ECG Blog
NOVEMBER 11, 2024
It can be seen in other forms of heart block as well (such as complete heart block). See Ken Grauer 's comment below for more on this. As this patient is scheduled for imminent elective surgery, it is important to determine whether this is Mobitz I (benign) or Mobitz II (requires pacing). So.Which is it? History is often helpful.
ACEP Now
OCTOBER 29, 2024
Does that normal troponin and ECG obviate the need for cardiology consultation for my patient with a concerning story for acute coronary syndrome? Coming into triage, I see a young man—Georgian-speaking—bracing himself with a hand against the wall and holding his lower abdomen.
Dr. Smith's ECG Blog
JANUARY 31, 2025
This typically occurs in the setting of a rapidly reperfused coronary artery following a myocardial infarction. The pattern is mostly described with LAD OMI, but has been reported in other coronary distributions as well. The de Winter electrocardiogram pattern is an infrequent presentation, reported to occur in 2% to 3.4%
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