ECG Challenge

👇Typical Flutter: Quick tricuspid annulus map for diagnosis and ablation success assessment👇 👉 A very fast single-tip activation map of TV using the ablation catheter beautifully demonstrates the reentry circuit — in this case, a counterclockwise flutter around the tricuspid valve annulus. 👉 For success confirmation, pacing in the coronary sinus (CS) shows a collision of both activation wavefronts at the CTI line, without any breakthroughs across the block line. Beautiful maps by @StephanWinnik 🤩 🎥 This illustrative video was created in collaboration with @N_Trajkovska for Young #EPeeps 🙏 @Phiso_de @GNageler @MBraunEP @MoneebKhalaph @Cardioschool @PhilippLuc @chris_sohns @ecgandrhythmRoe @Ecgloverr @KostekMilan @JNJNews @EPWaveDoc @Mo_PedsEP @ArashArya_EP #CardioTwitter @YoungDgk @AGEP_DGK

Transcatheter or Surgical Aortic-Valve Replacement in Low-Risk Patients at 7 Years: @NEJM 🥸 I think the surgical community should start doing "randomized clinical trials" instead of criticizing the available evidence from randomized experiments! 😱 Summary 👇👇👇

@FibrilloFlutter @ecgandrhythmRoe @Frances98392343 @koggelnoggel @makkyecg @DrAkhilX @LeonrMail @AbdulazizM2669 @Amhar_47 @DidlakeDW I love this algorithm

Culprit vessel ⁉️⁉️

66 y/o male with syncope. What's the rhythm?

A new ECG taken 20 mV. First ecg is afib or sr+pac/pjc or wap rhythm or anything else?

20 y/o female has limb-girdle muscular dystrophy and is being evaluated for suspected stroke/TIA; these two ECGs belong to that patient. What do you think the rhythm is?

@FibrilloFlutter @ecgandrhythmRoe @Frances98392343 @KostekMilan @makkyecg @koggelnoggel @ecgrhythms @Amhar_47 @DrAkhilX @DrRazi4 Afib is more likely.

Afib or AFL ⁉️

I am not sure, I'm just speculating. The right-sided ECG may represent a fever-induced Brugada pattern Type 1. Lead V3 resembles a Brugada pattern Type 2. Fever exacerbates sodium channel dysfunction, destabilizing cardiac membrane potential and increasing the risk of early afterdepolarizations and re-entrant circuits that trigger VF. This pathophysiological cascade underscores the importance of aggressive fever management with antipyretics to prevent severe arrhythmic events.

Good afternoon/evening, dears. Digital version thanks to my friend @ecgandrhythmRoe Which of these two ECGs, presents an electrocardiographic pattern diagnostic of Brugada? Right or left ECG One patient had fever and other syncope Please explain your choice in detail Thank you.

@Frances98392343 There are polymorphic PVCs, and the tachycardia on the left has the same morphology as one of those PVCs. There’s also a capture beat. Yes, I agree with you — this is VT. Could the right side possibly represent an atrial run or tachycardia?

I suspect VT, I think it's a capture beat ( left), but what's happening on the right?

@Frances98392343 I can’t clearly identify regular atrial activity, and the P waves I do see raise a suspicion of intermittent WPW in my mind. What is your interpretation of the second ECG?

43 year-old man with mild global left ventricular systolic dysfunction and SN dysfunction underwent dual chamber pacemaker implantation. Left: ECG prior to pm implantation Right: ECG obtained at the time of pm interrogation

Although Takotsubo syndrome is often perceived as a postmenopausal female disease, it can also occur in men, particularly those exposed to physical stress. In a patient with such an ECG, coronary angiography should, of course, be performed; personally, if the results are normal, I prefer to proceed with ventriculography. DD: MINOCA and myocarditis.

Trops. 165-270-350, apical akinesia, normal angio, Takotsubo is likely IMO

BREAKING NEWS: The rationale and design paper of the DIFOCCULT-3 Trial (prospective evaluation of STEMI to OMI paradigm shift) is now online at jacc.org/doi/10.1016/j.…

@healthefyheart @ecgandrhythmRoe @DrRazi4 @ECGEPSCADEVICE @Ecgloverr @ecgrhythms @smithECGBlog @nihar_nayak2 @TheECGMedic SR, PVC bigeminy (may be end diastolic)

Very interesting ECG done as part of PAC before knee Sx. Asymptomatic. Escape bigeminy, VPCs in bigeminy or rate related BBB? @ecgandrhythmRoe @DrRazi4 @ECGEPSCADEVICE @Ecgloverr @ecgrhythms @smithECGBlog @ecgchallenge @nihar_nayak2 @TheECGMedic

@KostekMilan I'm not good with mechanisms, and my English makes it difficult for me to understand texts with heavy terminology. Still, could these two articles contain the appropriate answer to the question you asked. pmc.ncbi.nlm.nih.gov/articles/PMC69… pmc.ncbi.nlm.nih.gov/articles/PMC30…

Can anyone explain what is the mechanism in this bidirectional VT in the last pic ❓ The lower channel in blue beats are RBBB-like morphology and the red beats are LBBB-like morphology. How do you explain the constant rate cca 950msec of 🔵 beats and varying CIs of 🔴 beats?

Digox level 4,3 ng/mL. What is the rhythm?

@Frances98392343 @Ecgloverr @lila_enis @FibrilloFlutter @ecgandrhythmRoe The previous/first ECG showing AV dissociation and fusion beats suggests VT. This ECG, which is very similar but slower and has QRS complexes with different morphology (there also seems to be av dissociation). Do you think it could be pleomorphic VT?

The full-strip recording of the 2nd ECG

2 different ECGs belonging to the same patient. What do you think the rhythms are?

Universal agreement on how to assess for LVH on ECG is lacking. How can there be agreement? — when more than 50 sets of criteria for LVH have been published in the literature. Practically speaking — none of these 50-plus criteria are optimally accurate. All suffer from imperfect sensitivity, which is no better than 55% by even the best of electrocardiographers. This means that up to half of the time when LV (Left Ventricular) thickening or LV chamber enlargement is present beyond the normal adult range — that it will not be detectable based on ECG assessment. @ekgpress ecg-interpretation.blogspot.com/2013/08/ecg-in…

25 ms/10mV. Is there LVH or not?

@Ecgloverr Second ecg too?

@ecgchallenge Scar-mediated Ventricular Tachycardia with Fusion & PVC