Tag Archives: Dr. Smith’s ECG Blog

The early repolarization experiment

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Any paramedic who has studied the STEMI mimics has heard of the classic benign early repolarization pattern of a "fish-hooked" J-point with upwardly concave (smiley-faced) ST-segment, often best appreciated in lead V4. But, as the excellent work of Stephen Smith, M.D. demonstrates, not all cases of early repolarization present this way, and it can often […]

Left ventricular aneurysm vs. acute anterior STEMI

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Some of you expressed concerns about the possibility of the ECG abnormality we sometimes refer to as left ventricular aneurysm (persistent ST-elevation after previous MI).

Excessive discordance as a marker of acute STEMI in LBBB

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Positively deflected QRS complexes can be expected to show ST-depression and inverted T-waves.

Discordant ST-Segment Elevation in LBBB or Paced Rhythm

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If you’ve been following the Prehospital 12-Lead ECG blog for a while, you know that I’m advocate of using Sgarbossa’s criteria to help identify acute STEMI in the presence of left bundle branch block (LBBB) or paced rhythm. According the Sgarbossa’s original criteria, 5 mm of discordant ST-segment elevation is required to identify AMI in […]

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
John
Adenosine given for a narrow-complex tachycardia over 150
If things such as Sepsis, Drug Use, Medication issues, Anxiety, Pain, etc.. have been ruled out, and the rate is still >160 (or whatever number you use). How else do you determine S-Tach Vs. SVT? Does a 12 Lead Help (QRS Complexes facing different directions due to different pathways etc..) or a simple 4 Lead?…
2015-01-19 19:44:32
Brandon O
Adenosine for sinus tachycardia: Try to avoid this!
She may not have had anxiety, but I bet she was a carrier...
2015-01-18 02:31:08
Brooks Walsh MD
Adenosine for sinus tachycardia: Try to avoid this!
Highly unusual for this to be sinus at that rate!
2015-01-17 19:21:04
Mel
Adenosine for sinus tachycardia: Try to avoid this!
I experience bouts of tachycardia. I had it investigated about 5 years ago after being woken during the night by projectile vomiting and feeling my heart racing/thumping with carotid pulse that I could certainly palpate but had no chance of counting (whether the 2 symptoms were related or coincidental, I don't know). I've had multiple…
2015-01-17 18:47:19
Chee Yong Chuan
90 year old male CC: "Possible stroke"
This is a non diagnostic ECG The history is actually not typical of a stroke. Sounds more like a pre-syncopal attack, however, a transient ischemic attack cannot be confidently ruled out. There was no neurological deficit upon arrival of the paramedics. The ECG shows: -Sinus rhythm -Regular, QRS complexes narrow, beating at a rate of…
2015-01-17 12:18:13

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