Electrophysiology

I'm curious to see what others think of PVC morphology here on a 26 year old eating disorder patient holter! @The_Nanashi_O @DidlakeDW @SchakrabartiEP @syamkumarmd

@Ablationist @SchakrabartiEP @The_Nanashi_O We viewed cool down slowly after giving a beta blocker and anxiety medication over a period of 30 minutes it came down from 155 to 95

24 year old female, presented with superficial faciculations in chest, palpations, reoccurring tachycardia, costochondritis, panic attacks w/ Heart rate staying between 145 - 180. Thoughts? #EPeeps @SchakrabartiEP @The_Nanashi_O

@DidlakeDW @SchakrabartiEP @The_Nanashi_O @adribaran I'm curious if it is respiratory if it's due to unmanaged asthma! They mentioned not taking inhalers for severe asthma due to tachycardia cause by steroids.

@BonaJenn @SchakrabartiEP @The_Nanashi_O @adribaran Certainly! It’s just interesting to watch the Atrial impulse take gradual different shapes, and it seems as though aVL/V1 demonstrate this most prominently. Again, stable PRi and RR CL make me suspect a constant source, just varying “outlets”.

@DidlakeDW @SchakrabartiEP @The_Nanashi_O @adribaran Atrial Tachycardia Possibly?

@BonaJenn @SchakrabartiEP @The_Nanashi_O Wow! There is a very peculiar Atrial morphology change throughout. Almost as if the P waves are twisting at the points. Given the stable PRi, and equally stable RR CL, I wonder if there's varying exit sites along the SN territory. What does the great @adribaran think?

Is calculating a QTc on a heart rate of 140+ accurate or effective? Can you accurately tell if someone is prolonged on a resting ECG of 140+? Thoughts? @MJAckermanMDPhD

@The_Nanashi_O @SchakrabartiEP There's a ton of t on p so I understand 😅 I was thinking the same at first. I got a colleague to calculate as well we got 389

@BonaJenn @SchakrabartiEP Fair enough. I thought it had that look.

@The_Nanashi_O @SchakrabartiEP It is very hard to calculate QT at such fast heart rates, when calculated by hand QT is about 420. Comparing to other ECGs & holters qt was normal.

@BonaJenn @SchakrabartiEP Regular, narrow-complex long R-P tachy. HR ≈ 150. Could be ST (inappropriate ST) or perisinus node AT. Despite the rate and R-R interval, the QT looks like it might be prolonged with widespread TW flattening and what could be U waves. I'd be interested in the K+.

@Hapa_EP @CardioNerd1

@SchakrabartiEP @ShaojieChen1 @syamkumarmd Not defibrillated, weak but stable pulse when found unconscious.

@BonaJenn @ShaojieChen1 @syamkumarmd Thanx, nothing strikingly abnormal out from these ECGs. Was the pt defibrillated ? Any AED tracings ? Standard investigations including ECHO, CT PE, troponin, initially .

27yo M, collapsed at work. Presented to ER via Ambulance with chest pain, tachycardia, increased blood pressure of 136/97, heavy arms after 2 weeks viral lung infection. Thoughts? #EPeeps #MedicalStudents @ShaojieChen1 @syamkumarmd @SchakrabartiEP

@The_Nanashi_O @DrSanatani @DRTomlinsonEP @EPeeps_Bot

@EPLive2 @EPeeps_Bot

41 yo Female, admitted into ICU w/elevated troponin, D Dimer and chest pain! Normal ECGs, CT scan and chest x ray! 1 episode of SVT that resolved w/o intervention. Developed reduced kidney function in ICU, no infection. DXs? NSTEMI? #EPeeps #Cardiology #medicalstudent

@cardiology_in @DrSanatani @DRTomlinsonEP @DrFerminGarcia @SchakrabartiEP @ShaojieChen1 @EM_RESUS @syamkumarmd

Guess the diagnosis :-) Hyperacute T waves, 64 yo male with COPD, patient has shortness of breath, tachycardia, elevated blood pressure Correct answer at 8 pm est #EPeeps #cardiology