ECG.Hacks
@EkgHacks
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Learning the written language of the heart #OneBeatAtATime #TeamaVR ECG tips and hacks!
Joined March 2021
50 yo male, no cardiovascular history, ER doc administered adenosine with no response... Diagnosis?
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A very educational exchange between @adribaran and @JL_MoralesArt on parasystole
@KostekMilan Everybody: Which are the 3 criteria to determine Ventricular Parasystole? Which criteria are present in Milan’s case? @ecgrhythms @ecgandrhythmRoe @Ecgloverr @EkgHacks @TheEKGGuy @smithECGBlog @DidlakeDW @JL_MoralesArt @DrAndresArteaga
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The rhythm below is recorded from a right-sided MCL-1 monitoring lead. — Does a run of VT (Ventricular Tachycardia) begin with beat #6? How certain are you of your diagnosis? — GO TO — https://t.co/QAC8sh5W1M —#ECG - #ECG_Ken_Grauer - #EKG — :)
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Crowdsourcing this ECG that a colleague sent me. I don't know much history other than there has been no heart surgery and no dig use RR intervals are stable (I have never seen such a thing.)
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Tomorrow I'll be having my interview for the electrophysiology fellowship program in my dream hospital! Please send good vibes for the cause!
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Super interesting 👇🏻 The 12-lead ECG is an amazing medical test. No harm. No pain. And like $25.
R-wave amplitude changes in lead aVL predict outcomes in cardiac resynchronization therapy: Exploring the role of papillary muscle dyssynchrony and mitral regurgitation @BPTHOSP @MassGeneralNews #EPeeps
https://t.co/vBOVe9t0kj
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True.
Cardiac App of the year = @PMcardioApp Just starting using (thx for rec @drjohnm ) and its impressive.
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ECG traces for this thread taken from Textbook " Strategies for ECG Arrhythmia Diagnosis" by George J. Klein.
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With a fairly long PR interval (slow pathway) and a very short (QRS-P interval), this is most probably AVNRT. Always look for the "wobble" and try to discover if the A follows the V or the other way around specialy when considering AT in the diferential as this can rapidly
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In this similar example, watch how observing the slight irregularity of this tachycardia we can conclude the qrs to qrs CL is driving the p to p wave CL... thus making AT impossible.
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Moreover, we can see the RP interval is constant even though there are CL variations, this can only mean the AV node is a critical component of the tachy mechanism!
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Observe the following trace, it looks fairly regular but at closer inspection we can see a slight cycle lenght variation with a RR interval change driving the PP interval change... this of course means atrial tachy is out of the differential!
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CL change starts at or above where you see it—not downstream... if the PP interval changes precede the RR that means the atria are the main driving mechanism of the tachy. On the other hand, if the RR interval changes precede the PP this means the Vs are drivng the As
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Using the "Wobble" as a strategy to narrow down the differential in narrow complex qRs tachys: The "wobble" refers to cycle lenght variations on the ECG trace ( differences in RR or PP intervals), which can help us rule out or in certain tachy mechanisms...
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This trace is from a 73 yo male. He comes to the ER after initial episode of palpitations and chest pain. It was interpreted as atrial fibriliation at first... what would you say this rhythm is?
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Sorry about the tracing's definition, I got this ekg recently... Male, 62yo no CVD history... 6 hours of chest pain... What is your take?
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This trace was published originaly in George J. Klein's textbook: "Strategies for ECG Diagnosis"
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There is AV nodal delay with wenkebachs as the pattern shows progresive pr lenghtening. This allows the RBB to align it's refractory period with the LBB so both ventricles depolarize in sync!
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This trace reminds us about the importance of physiologic reasoning when analysing the ekg. Notice how the PR lenghtens right before qrs narrowing. This acomodation effect reflects the bundle branches refractoriness!
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