Sam Aznaurov, MD, FACC, FHRS

Our #FITSurvivalGuide continues with antiarrhythmic drugs! (AADs) 1️⃣Basic concepts 2️⃣Classification 3️⃣Class 1(a/b/c) 4️⃣Class 3 5️⃣Amio/dronedarone 6️⃣Clinical use 7️⃣Pearls and pitfalls

Been a while since I’ve posted a mystery ECG, but this one is too good to pass up. Hx AFib, with treatment options exhausted, save for pacer/AVN. Why are they not a candidate for the procedure? Bonus question: what’s a “hail Mary” strategy we could use to allow pacer/AVN??

@AshleyGWinter To be fair, SCDs are pretty annoying, so I feel ya.

Also, I don't know what this commentary about "men not knowing how this feels," means. My husband was crying tears of joy all night after my C-section. I was complaining about my Foley and SCDs.

Ok but the nurses are never gone. They may not be in your room, but they are never gone

@TomGregorich2 @Toaster_Pastry Start with the part of the ECG that shows sinus rhythm, and march out the QRS peaks, into the questionable part of the ECG. You might have trouble identifying a couple of them, but the rest clearly show up on time.

@Toaster_Pastry Serious question: how do you tell it's artifact?

I could have been at home watching football instead of doing a consult for this nonsense.

I want to find the person who invented the term “sinus arrhythmia”, and cut them with something dull and rusty. Who’s with me?

PSA: Basic communication skills matter more than ever. “Dizziness” is NOT a medical term. It’s not the patient’s job to speak our language. It’s on US to determine whether we’re discussing lightheadedness vs vertigo vs imbalance.

@PyrrhicVictory6 @RealEmirHan Gary Old Man was perfect in that role… the “noon” scene was incredible

@RealEmirHan Don’t forget this guy.

@sassistheword @TheEtherMan Protip: do it yourself with an eyeglasses screwdriver and some Locktite (the blue! not the red)

@LostMyDisguise @BadMedicalTakes Well now you’re just perpetuating THEIR narrative

Oh interesting this is a rare ophthalmic disorder known as fake

@AshleyGWinter @rkh_md We need MOAR HEMOSTASIS

@rkh_md And it appears that they only use hemostats

Every scrub tech and anesthesiologist on the planet is having a heart attack looking at this

Also for the record, AF doesn’t feel like coronaviruses look.

I asked DALL-E 3, “What does atrial fibrillation feel like?” I think it’s still got some learnin’ to do in terms of electrocardiography, but the emotional content is on point. #dalle3art #EPeeps

With the recent approval of Pulse Select from Medtronic and expected approval of the Farapulse system from Boston Scientific in Q1, there is a need to critically appraise the existing PFA data. As the 3rd leading enrolling site for Pulsed AF and the current leading enroller in Advantage AF, our center has significant experience with both systems. The intent here is to attempt to provide one EP's review of the existing data in a dispassionate, unbiased way. This 🧵 represents my first pass at doing that (and my first Tweetorial). If there are errors or omissions, please call them out! @PraveenRao_EP @SA_Sandberg @cooper_dh @DoctorPhillEP @VivekReddyMD @Ed_Gerst @noseworthypeter @SurajKapa @Drdevignair

@fuzzymittens @1chaosplace This statement applies outside of DIA as well 🤪

@amyfaithho @plasticolicious Acknowledgement of risk is step one in risk reduction. You don’t have to fear avocados, you just have to respect them.

@plasticolicious True confession: I am one of those people who hold the avocado in my hand while pitting/slicing it…yes, even though I know better 😳😳😳

Dear America, Happy Thanksgiving. Some pro-tips from the ER: 1. Do not drop a frozen turkey into a deep fryer. It is basically a bomb. Defrost…asap if you haven’t started already. 2. Don’t become carved meat. Avocados are the fingers’ nemesis…followed by mandolines. Use caution. 3. Drinking and driving: don’t ever do it, but be cognizant it may be on roads especially during holidays. 4. If you’re going to talk (ahem, argue) religion/politics/old family drama at the dinner table with your hot-headed distant cousins and crazy uncle…remove any pointy implements first. 5. If you do your once-a-year visit of Nana in the nursing home at Thanksgiving, be aware…it is possible Nana may be different than she was a year ago when you last saw her. This is not usually a reason to take her out of the nursing home, bring her to the ER, and insist we find a new/better nursing home for her. Sad, but true…can’t say how often I see this one at TGiving/Xmas/NY. Sure my fellow healthcare workers have many more…Happy 🦃🦃🦃 Day! #medtwitter

@dirtymayosister @Marble3yedRaven @CharlieHorseToy Tell me you’re a sociopath without telling…. you know what, nevermind, just don’t talk to me.

Got to work this morning and this the the cafe next door. Tell me how any of this is sustainable???

@lvertiz @macrotargeting @hjessy_ I still say we go to the Knoxville

@yasser_gabr @VLSorrellImages Aha! I think this is the most likely answer. Beyond the fact that there were several jets, it was bugging me how small each one was. This makes sense.

@epTicTocDoc @VLSorrellImages looks like a fenestrated septum despite the Bi-caval view to delineate the inf. Rim might be helpful in the diagnosis of the inf. SV ASD

Hey #echofirst peeps, and especially @VLSorrellImages - am I seeing PFO, secundum ASD, and inferior sinus venosus defect all in the same image?? Help out a simple electrician, I just wanted to see the LAA, now I have to think about something other than voltage 😭

@VLSorrellImages Nope! This patient hasn’t had a transseptal puncture before, although I agree, that was actually my first comment, it looks just like a prior transseptal. And there’s also a tiny jet at inferior/posterior septum, which I’m not sure what to make of.

Is this a trick Q? Looks like definite PFO & probable ASD (iatrogenic?). I Dont see another ASD. Teach us !!! Did you cross the septum as I suspected?

@DrGregMichaud Paper with marks Folded paper Finger width/knuckle length/etc 80% of the time while my caliper is in my scrubs pocket

What else have #epeeps used besides proper calipers?