Kevin Butler

What’s the rhythm? First portion just looks like PACs in a pattern of bigeminy hitting a partially refractory AV node with resulting long PR. But why do the PAC PR intervals suddenly shorten at the end?@DidlakeDW @ecgrhythms @The_Nanashi_O #ECG #CardioTwitter

@anujtiwari11 Alcohol

Patient admitted for intestinal obstruction, admitted and operated, long stay in hospital, develops tremors. The culprit drug? #MedTwitter #MedX

@dan___kim ALWAYS on a Saturday overnight. “That’s when the hospital is the least busy”, says some exec who doesn’t understand the difference between a post-op patient sleeping upstairs and a crush of ambulances pouring into the ED needing immediate management.

Not only will my night shift tonight be an hour longer (courtesy of the anachronism that is daylight savings), but it will thoughtfully be accompanied by an EHR downtime Thoughts and prayers please #EmergencyMedicine

@DidlakeDW 95% mid RCA, LAD 99% proximal and mild-moderate distal, D1 with severe proximal, mild circumflex. They did culprit lesion emergently, RCA the next day

@KBuMD80 Do you know if there was any comment about additional stenosis? Plenty of ECG abnormalities (apart from culprit lesion) to assess patent LIMA, graft sites, etc, for CABG as I’m very suspicious of MVD here.

60s M w/ no sig PMH p/w acute onset CP and L arm pain @DidlakeDW @The_Nanashi_O @smithECGBlog @BrooksWalsh @EM_RESUS @ecgrhythms

@DidlakeDW @The_Nanashi_O @smithECGBlog @BrooksWalsh @EM_RESUS @ecgrhythms From echo report

@KBuMD80 @The_Nanashi_O @smithECGBlog @BrooksWalsh @EM_RESUS @ecgrhythms LAD OMI, worried that the corresponding Sinus Tach is concomitant LV dysfunction (the LBBB-like IVCD certainly heralds an ischemic cardiomyopathy, I think).

@BrooksWalsh @adribaran This looks similar (from @smithECGBlog 1/4/13) and also has an initial segment that doesn’t meet triangle base criteria. And I believe according to latest guidelines fever-induced Brugada is considered “unmasked” and not phenocopy. I’m not sure what I would do with this!

I'm not going to have follow up, lo siento. Syncope, fever. Labeled as "possible Brugada" I am dubious. (Yes, yes base of triangle @adribaran but EP calipers doesn't calculate that!)

3/3: However, pt had 2 negative HST and many unchanged ECGs, then a negative stress. Is it possible that a LAFB is causing the PRWP which is combined with large T waves of early repolarization? I don’t have another good explanation for the precordial findings

2/3: I felt that the T waves and ST changes in the anterior leads were concerning for OMI. The near absence of R waves (sum of R waves V2-V4 < 15) would seem to exclude ER, and TW are too large for old MI

60s M w/ PMH HTN p/w ~8 hours CP with nausea. No vomiting, no diaphoresis, not exertional. Initial ED ECG, no old for comparison. @DidlakeDW @smithECGBlog @The_Nanashi_O @AslangerE @RobertHermanMD @ecgrhythms

@BrooksWalsh @DidlakeDW @smithECGBlog @The_Nanashi_O @AslangerE @RobertHermanMD @ecgrhythms I don’t believe there was reversal, there were multiple separate ECGs done that looked the same, but I wasn’t there personally so I can’t say for sure

@DidlakeDW @KBuMD80 @smithECGBlog @The_Nanashi_O @AslangerE @RobertHermanMD @ecgrhythms LA/LL reversal. P wave I >II; III fully inverted.

@BrooksWalsh Oh great… scratch what I said about “not losing sleep”

@KBuMD80 Yeah well I had bad luck that day. twitter.com/BrooksWalsh/st…

Older person, presyncope. Doing chores around the house, felt lightheaded after bending over to pick something up, fell onto their keister. Got up after < 1 minute. ED ECG and old ECG below. Bedside echo showed flat IVC. Labs all fine. Admit vs f/u outpt cards?

@mohda_nas @smithECGBlog @EM_RESUS @PendellM @PMcardioBot @The_Nanashi_O Like others I’m curious about Ca. After seeing this I did a quick search on bromadiolone toxicity and I can find no report of EKG changes, explanatory electrolyte changes, etc. There are case reports of CNS injury, maybe causing giant J waves?

Young adult male nkmi with alleged ingestion of bromadiolone. Post rosc with vf. Echo no regional hypokinesia but with irregular contraction. No enzymes taken . @smithECGBlog @EM_RESUS @PendellM @PMcardioBot #ECG #EPeeps @The_Nanashi_O

@AlanaKinrich This is based on the very faulty notion that the only thing standing between a patient’s symptoms and a diagnosis is the incomplete knowledge of the physician. I think this, in part, is the medical version of the “CSI effect”

@EcgsOnly I don’t believe there is 2:1 block. If the deflections in V2 are dropped p waves it would make the p-p interval that includes the QRS longer than between the QRS, which would be unusual. Could be LA/LL reversal, but Abdollah criteria are not very specific.

DX ?

I activated the cath lab on arrival, where he was found to have clean coronaries! Echo normal. Cardiology suspects coronary vasospasm, there were no EKGs recorded while pt was asymptomatic to look for change. I was very surprised and glad he didn’t have an OMI

60s M w/o sig PMH p/w 30 minutes acute onset nausea and diaphoresis. Initially no CP, but developed some CP after ED arrival. ED EKG below, pre-hospital EKG looked the same. No old EKG for comparison. #ECG #CardioTwitter