Pacemaker spikes

Pacemaker spikes are usually very sharp and narrow. They may be difficult to see as some ECG machines can filter them out.

See also: Other waves

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In the ECGquest archives, this ECG has been tagged with: - Hypotension Pacemaker spikes Wide QRS Ventricular pacemaker Hyperkalemia 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
What will you do for this altered and bradycardic patient? Repeat ECG after transvenous pacemaker

This ECG is from a woman in her 60s who presented from a nursing home with altered mental status, hypotension, hypoxia and bradycardia. This was the repeat ECG after placement of a transvenous pacemaker.

This ECG shows a very wide ventricular paced rhythm with widespread excessive discordant ST elevation. The cause was hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Regular Tachycardia Wandering baseline Excessive discordant ST depression. Excessive discordant ST elevation Pacemaker spikes Wide QRS Ventricular pacemaker Multi-vessel disease 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
Can you see through this wide complex rhythm?

This ECG is from a man in his 70s who presented with intermittent dyspnoea and chest pain over the past 2 weeks. He had a history of a pacemaker, heart failure, aortic stenosis, diabetes, hypertension, stroke, ischemic heart disease, chronic kidney disease and peripheral vascular disease. This was his initial ECG.

This ECG shows a wide complex tachycardia with ventricular pacing. The excessively discordant ST changes in V4-6 and aVR suggested diffuse subendocardial ischemia. He was found to have severe three vessel disease and a proximal left circumflex stenosis was stented.

In the ECGquest archives, this ECG has been tagged with: - Syncope Pacemaker spikes Failure to capture 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 10th September 2018 – Interpretation

This ECG is from a man in his 90s who presented following an episode of syncope.

In the ECGquest archives, this ECG has been tagged with: - Bradycardia Extreme Axis LA/RA electrode reversal Regular Pacemaker spikes Wide QRS Ventricular pacemaker 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 27th August 2018 – Interpretation
In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Discordant ST changes Excessive discordant ST elevation Pacemaker spikes Ventricular pacemaker 12-Lead Dr Smith's ECG Blog CC BY-NC
Patient with Paced Rhythm in Severe Cardiomyopathy Presents with SOB due to Acute Decompensated Heart Failure

This ECG is from a middle-aged male who presented with paroxysmal nocturnal dyspnoea and hypoxia on a background of heart failure, biventricular pacemaker, ICD and previous LV thrombus.

This ECG shows biventricular paced rhythm with RBBB-like morphology and discordant ST elevation in I, aVL, V3-5 due to acutely decompensated heart failure.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dizziness Left Axis Deviation Absent P waves Discordant ST changes Pacemaker spikes Wide QRS 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 2nd April 2018 – Interpretation

This ECG is from a man in his 70s who presented following several episodes of chest pain and dizziness.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Left Axis Deviation Normal rate Anterior ST elevation Concordant ST elevation Excessive discordant ST elevation Pacemaker spikes Wide QRS Ventricular pacemaker Acute Anterior MI 12-Lead Serial 12-lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 25th December 2017 – 60 min later

This ECG is from a woman in her 80s who presented with chest pain. She had a history of 2nd degree AV block with PPM in-situ. This repeat ECG was recorded 60 min after presentation when she had further chest pain.

This ECG shows ventricular pacing with concordant ST elevation in I and V6, and excessive discordant ST elevation in V2-4. The cause was an acute anterior MI.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Left Axis Deviation Normal rate Concordant ST elevation Discordant ST changes Pacemaker spikes Wide QRS Ventricular pacemaker Acute Anterior MI 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 25th December 2017 – Interpretation

This ECG is from a woman in her 80s presented with chest pain. She had a history of 2nd degree AV block with PPM in-situ. This was the initial ECG.

In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Fatigue Excessive discordant ST elevation Pacemaker spikes Ventricular pacemaker Acute Inferior MI Acute Posterior MI 12-Lead Serial 12-lead Dr Smith's ECG Blog CC BY-NC
See what happens when one fails to diagnose STEMI in LBBB and Paced Rhythm 3 – later that night

This ECG is from a female in her 60s presented with 2-3 days of fatigue and shortness of breath. She called EMS when her symptoms acutely worsened while she was shopping. EMS arrived and recorded a heart rate of 27. On arrival to the ED she was noted to be in complete heart block. She was given atropine with transient increase in HR to 80s. This ECG was recorded later that night after a transvenous pacemaker was placed.

This ECG shows ventricular paced rhythm with excessive discordant ST elevation in II, III and aVF. There is reciprocal depression in aVL and I. The cause was an occluded proximal right coronary artery. This diagnosis was delayed and the patient died.

In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Fatigue Pacemaker spikes Ventricular pacemaker Acute Inferior MI Acute Posterior MI 12-Lead Serial 12-lead Dr Smith's ECG Blog CC BY-NC
See what happens when one fails to diagnose STEMI in LBBB and Paced Rhythm 2 – with pacing

This ECG is from a female in her 60s presented with 2-3 days of fatigue and shortness of breath. She called EMS when her symptoms acutely worsened while she was shopping. EMS arrived and recorded a heart rate of 27. On arrival to the ED she was noted to be in complete heart block. She was given atropine with transient increase in HR to 80s. This ECG was recorded after a transvenous pacemaker was placed.

This ECG shows a paced rhythm with excessive discordant ST depression in lead I and borderline excessive ST elevation in III and aVF. The cause was an occluded proximal right coronary artery. This was missed and the patient died.

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