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Procedure: Electrocardiogram
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Total 559 results found since Jan 2013.
iRhythm-Verily Partnership: Interview with iRhythm CEO Kevin King
iRhythm and Verily announced a partnership last month to “co-develop solutions intended to provide early warning, diagnosis and management for patients, particularly for those with silent or undiagnosed AF.” We spoke with iRhythm CEO Kevi...
Source: Medgadget - October 11, 2019 Category: Medical Devices Authors: Ben Ouyang Tags: Cardiology Diagnostics Exclusive irhythm verily Source Type: blogs
Do you understand these T-wave inversions?
Case submitted and written by Alex Bracey, with edits by Pendell MeyersA man in his 50s without prior medical history was sent to the emergency department from an urgent care facility for concern of an " abnormal ECG " after he had complained of chest pain earlier in the day. He was symptom free at the time of arrival.Here is the triage ECG at the Emergency Department (we did not immediately have access to the urgent care ECG just yet):ED ECG#1What do you think? What do you think his urgent care ECG (done during pain) will show?This ECG shows sinus bradycardia with terminal ST depressions in II, III, aVF, V3-V6, with recip...
Source: Dr. Smith's ECG Blog - October 9, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
Shark Fin morphology recognized only by EM physician
Case submitted by Alex Bracey, Written by Alex Bracey and Pendell MeyersA man in his 70s complained of acute chest pain followed by witnessed cardiac arrest. He received immediate bystander CPR prior to EMS arrival. EMS found him in VF and administered 4 shocks, multiple doses of epinephrine, and amiodarone with intermittent ROSC, however he was in arrest on arrival to the ED with ongoing CPR via LUCAS device. Overall down time was 35 minutes from the time of arrest to arrival at the ED.First rhythm check in the ED showed PEA with a wide complex at a rate of approximately 30 bpm. Calcium and epinephine were given at CPR wa...
Source: Dr. Smith's ECG Blog - October 3, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 70s with chest pain during a bike ride
Case written and submitted by Ryan Barnicle MD, with edits by Pendell MeyersWhile vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding. It was a constant ache on the left side of his chest that forced him to stop cycling and call for an ambulance. It was radiating to his bilateral upper arms. It was associated with nausea but he denied dyspnea, dizziness, and headache.He explained that he had the same chest pain the day prior as well, on and off....
Source: Dr. Smith's ECG Blog - September 29, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
Chest pain with NonDiagnostic ECG but Diagnostic CT Scan
An elderly woman presented with chest pain that radiated to the back for several hours.Here is here initial ECG:There is only a nonspecific flat T-wave in aVL. It is essentially normal.The first troponin returned at 0.099 ng/mL (elevated, consistent with Non-Occlusion MI)Providers were concerned with aortic dissection, so they order a chest aorta CT.This showed no dissection but did show the following:Notice the area of the lateral wall (lower right) that has no contrast enhancement (It is dark, where areas of enhancement are light-colored). This transmural ischemia, but not necessarily completed infarction...
Source: Dr. Smith's ECG Blog - September 26, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Bathroom Scale Combined with ECG for At Home Heart Failure Monitoring
Conclusion: This work demonstrates that high quality BCG signals can be collected in a home environment and used to detect the clinical state of HF patients. Significance: In future work, a clinician/caregiver can be introduced to the system so that ...
Source: Medgadget - September 24, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiology Source Type: blogs
5 Cardiologists said this is not a STEMI. But was it an OMI?
Written by Pendell MeyersA male in his early 50s presented with waxing and waning chest pain starting at rest. He had multiple cardiovascular risk factors and the EM physician strongly suspected ACS.Here is his initial ECG:What do you think?Sinus rhythm-STE in V1-V5, possibly a tiny amount in V6, and small amount in I and aVL, and II-Reciprocal STD (although perhaps isoelectric at J point, immediate STD after the J point) with very ischemic appearance in lead III (down-up T-wave is strongtly suggestive)-Large T-waves in V2-V4, which may be either a normal variant or hyperacute-Very tiny Q wave in lead V2, as well as V6, I,...
Source: Dr. Smith's ECG Blog - August 14, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
The ECG was correct. The angiogram was not.
In this study, approximately 10% of Transient STEMI had no culprit found:Early or late intervention in patients with transient ST ‐segment elevation acute coronary syndrome: Subgroup analysis of the ELISA‐3 trialOne must use all available data, including the ECG, to determine what happened.Final Diagnosis?If the troponin remained under the 99% reference, then it would be unstable angina. If it rose above that level before falling, it would be acute myocardial injury due to ischemia, which is, by definition, acute MI. If that is a result of plaque rupture, then it is a type I MI. The clinical presentat...
Source: Dr. Smith's ECG Blog - August 12, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
How does acute left main occlusion present on the ECG?
Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. In these ...
Source: Dr. Smith's ECG Blog - August 8, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
OMI Confirmed by POCUS Echo in a 50 year man
Case submitted and written by Alex BraceyA man in his 50s with no significant past medical history presented from a local beach with epigastric " burning " pain that had been intermittent for 4 days until this morning when it became constant at rest. He had associated nausea and diaphoresis, but overall looked well and had arrived by private vehicle to front triage. An ECG was performed there and brought to me for review:What do you think?STE in V2-4 that might just barely meet STEMI criteriaSTE in aVL, and to a lesser extent lead IObvious reciprocal STD in II, III, aVFRegardless of whether this ECG truly meets STEMI crite...
Source: Dr. Smith's ECG Blog - August 1, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
Flexible Body Monitor Measures ECG, Breathing, Heart Rate Continuously for Weeks
Continuous, long-term monitoring of physiological activity can provide doctors, caretakers, and scientists with nuanced information about someone’s health. Children, the frail and elderly, and people with all sorts of conditions often have diff...
Source: Medgadget - August 1, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiology Diagnostics Geriatrics Pediatrics Sports Medicine Telemedicine Source Type: blogs
What is the Diagnosis in this 70-something with Chest Pain?
This is a very commonly missed ECG of a terrible condition. In this case, it was almost dismissed. I present many other similar ECGs at the bottom that were indeed missed or dismissed.CaseI was texted this ECG from a physician assistant who works by himself in several small Emergency Departments.He is a particularly smart and well trained emergency medicine PA (because he trained at Hennepin).He added the words:" What do you think? 70-something male with DM, HTN, no previous MI, with Chest pain "What doyouthink?Here was my response:" Definite Huge Occlusion MI (OMI). STEMI! This is a bad one. There ...
Source: Dr. Smith's ECG Blog - July 27, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Withings Releases Two Fashionable Wireless Blood Pressure Monitors
Withings is releasing two new wireless blood pressure monitors, the BPM Core and BPM Connect, one of which is a bit more than just a BP cuff. As always, the French company has given a lot of attention to the design of these cuffs, giving them a user-...
Source: Medgadget - July 18, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiology Medicine OTC Sports Medicine Source Type: blogs
A Text Message in the Middle of the night. Do you give thrombolytics?
I awoke in the morning and discovered a text with this ECG that was sent 6 hours prior by a former resident:" 60 year old with classic chest pain. The cath lab is occupied for the next 90 minutes. Cards says " not a STEMI " . Thinking of giving lytics. "What do you think?What do you do?I texted back: " Sorry for delay! Was sleeping. This is OMI!! Did you give lytics? Proximal LAD. Great catch! "There is 0.5 mm of ST Elevation in V3-V6. The T-wave in V4 is far too large for the QRS. The LAD occlusion formula would be very high due to the extremely small R-wave in V...
Source: Dr. Smith's ECG Blog - July 16, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 40 year old man with chest pain since last night
Written and submitted by Ashley Mogul, with edits by Pendell Meyers and Steve SmithA man in his 40s with recent smoking cessation but otherwise no known past medical history presented due to chest pain since the previous evening. The pain has been constant and associated with vomiting and diaphoresis. He decided to present the following day when the pain had not stopped.Here is the presenting ECG (no prior available):What do you think?Relevant findings include slight STE in V1 with an upright T-wave, slightly large T-waves in V2-3 (possibly hyperacute if compared to baseline), and slight reciprocal depression in II, III, a...
Source: Dr. Smith's ECG Blog - July 10, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
