Irma

Look what I found today! This heart has at least 2 problems. Which ones?

@shakilED Imagination is a luxury these days, rationed like light in a narrowing world. And hope— not always a blessing— can chain us to what will never be.

Imagination is no luxury— it is the breath of defiance, the unseen air that keeps hope alive.

I think of you so often, more than words could ever say, in quiet moments, fleeting thoughts that never fade away. You have no idea, how softly you remain— a whisper in my every day, a warmth I can’t explain. 🎨 Kirchner

@TruthinMindBody Yes, we do! 🙂

@IrmaMDv Not much doubt about automatic NSVT (instead of escape mechanism due to sinus dysfunction). I'd say the escape QRS after the termination of VT was from lower junction. Obviously I think we know what 'automatic VT' means.

Looks like the sinus node is a bit lazy, huh? Time for someone to jump in — am I right?

@aloobhat It might be a bit too fast for AIVR :)

@IrmaMDv Accelerated idioventricular rhythm.

@KostekMilan Yes, ventricular escape beat.

@IrmaMDv Escape beat at a low rate usually has broader QRS. One can see it also after adenosine for AVNRT that during the AV block from adenosine there are one or two broader beats.

@KostekMilan I agree!

@IrmaMDv What about the strip with two ectopies shown later in the rhythm strip. There seem no big pauses after them. Sinus is overall around 60 bpm. Probably no sinus node dysfunction. Were there slower sinus rates or long pauses after isolated PACs (or SVTs when present)?

@usufgasim I like your answer!

@IrmaMDv This Holter ECG strip depicts 8 beats of wide-complex ventricular rhythm at 120 bpm amid sinus bradycardia (60 bpm), humorously implying the slow sinus rate invites the "jump-in" escape focus then a pause and again back to sinus . NSVT

@KostekMilan "bradycardia dependent bundle block"..... I don't understand

@IrmaMDv Tiny P waves (difficult to see AV dissociation or retroconduction). Perhaps one P can be seen at the end of ST of the 1st QRS in this short run of VT at the rate of cca 120 bpm (not 85 as written) with sinus cca 60 bpm. The last broad beat is bradycardia dependent bundle block.

Here is some additional information about the patient: Dual-chamber PM with epicardial leads. Atrial undersensing during AF was observed; additionally, a marked increase in the right ventricular pacing threshold was noted. The programming was adjusted. Mode switch activated.

An asymptomatic patient noticed a low heart rate.... What do you see in this 3-lead ECG?

@momochaname Thank you!

@IrmaMDv AF with SVR and intermittent complete AVB with VER. V pacing and sensing failure. NSVT 4beats.

@Frances98392343 Very nice!

I've been waiting for a long time for the opportunity to document the onset and end of a tachycardia with a standard ECG. What do you think?

@elvihots Not yet. I don’t know the patient — in my job I see far more ECGs than patients....

I think so. Do we have some information about number of leads, pace mode, etc.?

@elvihots Thank you!✨️ Could there be an issue with the ventricular PM lead?

@IrmaMDv Nice trace! I think, aFib with infranodal scape rhythm. PVCs. Failure of pace and sense ventricular. It looks like tiny spike (bipolar) without ventricular capture, in any beat appears in the ST segment. The ventricular capture beats have a superior axis.

@Frances98392343 🔴Could this be a ventricular escape rhythm?

@IrmaMDv Irma, can you give us an update on the pacemaker check? 🙏

@Frances98392343 Thank you! Great interpretation. I totally agree — and I had the same questions. 😅 Lucky to work with such fascinating ECGs.

@IrmaMDv without a spike?) 🟣 Why does the spike appear at ~80 BPM? It seems unlikely to me that the spike is from the A lead, given the presence of AF. 🤔

@MiguelP23970914 Thank you! ✨️ I should probably have written: "We ARE actually already on that boat." I wanted to highlight the ambivalence these people feel — between loss and hope, and between fear and fait.

@IrmaMDv Good evening dear Irma. I loved this poem; I especially liked "We all could be on this boat"... Thanks for sharing.❤️💙💛🌹

@Frances98392343 @KostekMilan Ah, now I see… definitely too many. 😁

@KostekMilan @IrmaMDv Too many question marks. The last one is a mistake 🤷

What do you think about this little pause here? The heart taking a tiny break?