Philip J Podrid MD

58 year old male with h/o hypertension, poorly treated, presents for routine pe. What does the ECG show? #PodridECGs #ECG #meded #cardiotwitter

Atrial flutter with variable av block(2:1 and 4:1). Atrial rate is reg at about 350 and whenever atrial rate is reg and >320 this is termed atypical atrial flutter. Typical atrial flutter has a reg atrial rate of 260-320 although may be slower due to aad or disease of la.

Patient presents with palpitations and some sob. What does the ecg show? #PodridECGs #ECG #meded #cardiotwitter

@ecgandrhythmRoe NSR with 2:1 AV block due to Mobitz 2 as with 1:1 conduction the PR intervals are the same. Also ventriculophasic arrhythmia as pp intervals around QRS complex are shorter than the pp intervals without QRS complex.

A 65-year-old woman with this ECG. What would you do if the patient were experiencing symptoms (syncope) and if she were not?

RV pacemaker that is A sensed V paced. Sinus rate is 120 bpm. Pauses due to non sensed p wave and hence no ventricular paced complex. This is because the sinus rate slightly increased and the p wave was within the pvarp. Hence the upper rate limit of the pacer is about 120bpm.

Patient with pacemaker. On PE pauses in rhythm noted. What does the ECG show? #PodridECGs #ECG #meded #cardiotwitter

Regular narrow complex tachy at a rate of 270 bpm-hence atrial flutter with 1:1 conduction.ST-TW changes likely due to superimposed flutter waves. Also seen is electrical or QRS alternans (v3-v5).

60 year old woman seen in ER for palpitations. What does the ECG show? #PodridECGs #ECG #meded #cardiotwitter

Underlying rhythm is AF. Biventricular pacemaker A sensed V paced and tracking AF at its upper rate limit of about 120 bpm.

Patient with a pacemaker placed two years ago is noted to have a rapid heart rate. What does the ecg show? #PodridECGs #ECG #meded #cardiotwitter

Rhythm is irregularly irregular. Atrial waveforms in lead v1 very prominent but they are irreg in amplitude, interval and morphology. Hence not a flutter where atrial waves are uniform. This is coarse AF. There is also LVH with associated ST-T wave changes.

Patient with no heart disease presents with new onset of an irregular and fast heart rate. What is the rhythm?

@Frances98392343 @syamkumarmd @MethaqOrman @MaruanCarlos @The_Nanashi_O @ecgrhythms @UlhasDr @DidlakeDW @DrRajeshG1 @AslangerE @adribaran @BrooksWalsh @doctor_roig @KostekMilan Bundle conduction is all or none. Incomplete bundles don’t exist. In this case, the small r’ in v1 is an ivcd to the rv and has been termed a crista pattern as the last part of the rv to be depolarized is the crista supraventricularis and conduction to this structure is delayed

@syamkumarmd @MethaqOrman @MaruanCarlos @The_Nanashi_O @ecgrhythms @UlhasDr @DidlakeDW @DrRajeshG1 @AslangerE @adribaran @PPodrid @BrooksWalsh @doctor_roig @KostekMilan Would it be correct to call it incomplete RBBB? Thank you

25F no PMHX,CP, TP ⬆️not ↘️ (isoelctric line⬆️?) ,subtle ↘️ PR ⬇️,subtle ↗️ ST II, avf v3-v6 @MaruanCarlos @The_Nanashi_O @ecgrhythms @UlhasDr @DidlakeDW @syamkumarmd @DrRajeshG1 @AslangerE @DocNikko @adribaran @PPodrid @BrooksWalsh @doctor_roig @KostekMilan #ECG #CardioTwitter

NSR with pvc and then two APCs followed by a long RP tachy that terminates abruptly to NSR. Terminates without a p wave-ie last complex before it end does not have a p wave after it. This is the wss say atrial arrhythmias terminate. Hence this is an atrial tachycardia.

37 year old woman with a history of palpitations. An ecg was obtained during an episode. What does the ecg show and what is the etiology of the palpitations? #PodridECGs #ECG # needed #cardiotwitter

NSR with RBBB and lafb- termed bifascicular disease. The pauses are the result of non conducted PACs occurring in a trigeminal pattern.

Patient seen for routine PE. Pulse noted to be irregular. ECG obtained. What is the abnormality? #PodridECGs #ECG #meded #cardiotwitter

Sinus rhythm with polymorphic VT. Sinus complex has very prolonged QT interval of 0.60 sec. Hence this is called torsade des pointes. It may be drug induced or congenital. This is establish by history of any current drug use. Given multiple episodes over time likely congenital.

36 year old with history of lightheadedness and several previous syncopal episodes. ECG in ER obtained. What does it show and what is the underlying cardiac issue? #PodridECGs #ECG #meded #cardiotwitter

NSR with one pac. Tall r wave in v1 as well as right axis and p-pulmonale (Himalayan P wave)-hence rvh. Deep S wave in v2 and tall r wave v4 c/w LVH. Hence biventricular hypertrophy with assoc state changes.

Patient presents with sob and hypertension. What does the ECG show? #PodridECGs #ECG #meded #cardiotwitter