alexander degkwitz

@ross_prager @threadreaderapp unroll

Rapid atrial fibrillation is common in the ICU. How do you decide whether Afib is driving hypotension or simply an innocent bystander? A 🧵 (1/x)

Tell me in 6 letters what's going on here during this "mode switch" event? 😂

👇ECG and PAC/EAT Localization (Part 2): Anterior Atrium vs. Posterior Atrium👇 •P wave positive in lead aVR: Indicates that the PAC/AT likely originates from the anterior region of the atrium. This includes areas such as the tricuspid valve annulus, coronary sinus , mitral valve annulus, LAA, and septum. •P wave negative in lead aVR: Indicates that the PAC/AT likely originates from the posterior region of the atrium. This includes structures such as the crista terminalis, near the sinus node, posterior wall, and pulmonary veins. 👉 #EPeeps The often-overlooked aVR lead should no longer be ignored! aVR covers a large region on its own and provides critical diagnostic information This post was created in collaboration with @N_Trajkovska 🙏🙏 @Phiso_de @chris_sohns @MoneebKhalaph @MBraunEP @StephanWinnik @Cardioschool @VanessaSciacca_ @GNageler @BSCCardiology @AbbottNews @jjmt_ep @Medtronic @ALFIEEP1 @ecgrhythms @ecgandrhythmRoe @ECGEPSCADEVICE @Ecgloverr #CardioTwitter @syamkumarmd @pjsm83

@ross_prager @threadreaderapp unroll

Here are my most important learnings and reflections as an intensivist in 2024. A 🧵

@katiewiskar @threadreaderapp unroll

1/ #POCUS exam of both the internal jugular vein (the POCUS JVP 🤩) and the IVC can be used to estimate central venous pressure ✅ ⁉️ BUT - what happens when these two scans are discordant?? 🫢 A quick #tweetorial 🧵on interpreting contradictory IVC and JVP results

@khaycock2 @ross_prager @KiranRikhraj @icmteaching @IM_Crit_ @IM_POCUS @HoosierPocus @pulmtoilet @ThinkingCC @NephroP @ArgaizR @G2Disrupt @iceman_ex @FH_Verbrugge @DrGalenMD Excellent point Korbin. Another reason I like to scan the IJ in conjunction with the IVC to assess CVP - can help make you aware of some of the common cofounders x.com/katiewiskar/st…

@katiewiskar @threadreaderapp unroll

1/ Time for another #POCUS pitfalls thread 🧵: the infamous IVC 🤩 I have MANY thoughts on the IVC 💭 When I first started teaching POCUS, I actually disliked the IVC because it was often poorly done or incorrectly interpreted ❌ I have now come to love the IVC, BUT you have to do it right! #tweetorial

@Teebi_MD @threadreaderapp unroll

🧵1/Little I did know about Bachmann's Bundle (BB) before starting EP fellowship. Quick run👇 BB is the main pathway of electrical conduction between right & left atrium. BB is muscular bundle connecting right & left atrial walls. ❌Disruption of BB causes "Interatrial block" #EPeeps #CardioTwitter

100% agree. We need to support and celebrate #PROFID trial

@AThomazAndrade @threadreaderapp unroll

1 - There is a clear AV dissociation, which leaves only two possibilities: 1. VT 2. JET However, in addition to AV dissociation, it is also observed that the QRS of tachycardia is narrower than the sinus QRS (100 ms vs 160 ms).

77y Male with very interesting Holter strip. What you think? @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski

@Frances98392343 @KostekMilan @AThomazAndrade @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski @Willis_Kwandou Yes and there is clear AV-Dissociation so this cannot be AT. My idea was fascicular VT (narrow) but JT may be a better idea (with supranormal conduction then).

@diggewitz @KostekMilan @AThomazAndrade @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski @Willis_Kwandou I think with a P on T wave

@Frances98392343 @KostekMilan @AThomazAndrade @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski @Willis_Kwandou Does it end with a P or with a PVC? 🧐

@KostekMilan @AThomazAndrade @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski Milan, it seems to me that the tachycardia ends with a P, so shouldn't AT be excluded? What do you think? Perhaps as @Willis_Kwandou said I should have included the JT

@Frances98392343 @AThomazAndrade @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski Maybe it’s supranormal or pseudo supranormal conduction? de.slideshare.net/slideshow/a-th…

@AThomazAndrade @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski I see A rate 75 bpm, V rate ~110 bpm, AV dissociation. All of this would suggest VT, but the QRS becomes narrower with occasional wider beats (same morphology as SB and PVC).I had read about a mechanism that narrowed the QRS but I don't remember it.

@andreaskardio Antiarrhythmikum geben, dann erneute eKV mit dann hoffentlich (stabilem) SR, dann nochmal dezidiert Symptome/Besserung im SR eruieren. Wenn im SR weniger Symptome/mehr Lebensqualität, dann Ablation. VHFli-Symptome sind auch oft „atypisch“, evtl. hat er sein Leben schon adaptiert

Frage an die rhythmologen: Persistierendes VHF, oligosymptomatisch gut frequenzkontrolliert bei einem männlichen Patienten um die 65. 3x erfolglose EKV (ohne Amiodaron) Inwiefern ist die Rhythmisierung (evtl. auch mit PVI oder AAD wie Amiodaron) prognostisch relevant?

@Willis_Kwandou @DrRajeshG1 @syamkumarmd @The_Nanashi_O @DidlakeDW @UlhasDr I wonder if the synchrony between P waves and ventricular spikes (that we can see) could have been explained with switch on the header. What do you think? because with switch there should be NO synchrony, right?

@DrRajeshG1 @syamkumarmd @The_Nanashi_O @DidlakeDW @UlhasDr Atrial Lead Dislodged into Ventricle dd A/V Lead Switch on Header?

ECG for fellows. DDD pacemaker for CHB done and this is ECG taken next day morning. ⁦@syamkumarmd⁩ ⁦@The_Nanashi_O⁩ ⁦@DidlakeDW⁩ ⁦@UlhasDr⁩

🎅 Am 06.12. gab es am @Vivantes Klinikum Am Urban in Berlin die Nikolaus-Neuauflage unseres Hands-On EP-Kurses „Hand-aufs-Herz“ – ✋➡️🫀 und was für ein Tag es war! 📚 Spannende Impulsvorträge zu den Grundlagen der Elektrophysiologie legten den perfekten Grundstein 💉 Intensive und abwechslungsreiche Live-Cases, die uns alle herausforderten und bereicherten. 🖐️ Simulator-Training: Von der transseptalen Punktion und Leistenpunktion bis zum Einsatz von Ablationskathetern konnten die Tielnehmenden ihre manuellen Skills unter Beweis stellen. 💬 Besonders begeistert hat uns der Austausch mit der Gruppe: Viele Diskussionen, wertvolle Fragen und ein beeindruckendes Engagement haben den Kurs zu einem echten Highlight gemacht. 🙏 Ein ❤️ Dankeschön an alle Teilnehmer:innen, Referent:innen und Unterstützer:innen die diesen Tag so besonders gemacht haben! Wir freuen uns schon jetzt auf die nächste Runde! @laura_rottner @Medtronic @MDTVascular @burakduymaz