Category: Dr. Smith’s ECG Blog

Computer often fails to diagnose atrial fibrillation in ventricular paced rhythm, and that can be catastrophic

Case 1. An elderly patient presented with a massive hemiplegic ischemic stroke of 24 hours duration.  CT stroke series showed a middle cerebral artery thrombus. He had an ECG recorded: Case 1, ECG 1: Computer: “Electronic Atrial Pacemaker.  Electronic Ventricular Pacemaker”No other interpretation.What do you think? Answer: There is no atrial pacing spike.  This is

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

An 80-something non-english speaking patient complained of vertigo.  He was asked multiple times about chest pain or dyspnea, but repeatedly denied any such symptoms. His vital signs were all normal.  His exam was normal. He had a triage ECG at time 0 (ECG-1): Computer read, with Physician overread:Sinus rhythm.  Possible right ventricular conduction delay.What do

Chest pain and Diffuse ST depression, with STE in aVR. You probably think it is left main…..

A 75 year old woman complained of very atypical chest pain, lasting days, worse with movement and palpation. Here is her ECG (ECG-1): There is diffuse ST depression, very worrisome for ischemia. The patient had a negative initial troponin, which was puzzling to the providers. The patient was admitted and serial troponins were all below

What is the Rhythm?

—————————————————- Presentation by KEN GRAUER, MD: —————————————————- The Case: A previously healthy young man presented to the ED for shortness of breath and chest pressure that occurred ~3 hours earlier, when he suddenly felt his heart “skip a beat”, and then begin “racing”. He felt “lightheaded” (presyncopal) during the episode — with the “strong sensation of his heart beating”. He

What is going on here?? (The computer called it “STEMI” and “Intraventricular Conduction Delay”!!)

I was asked by my partner to interpret this ECG because the Veritas algorithm had called it “STEMI” and Intraventricular Conduction Delay (IVCD), and he could not see why. He also was confused by what looked like possible delta waves with short PR interval. What do you think? This is simply an accelerated junctional rhythm