Discover and read the best of Twitter Threads about #ECG

A young man was found down in cardiac arrest. 911 was called and paramedics achieved ROSC en route prior to arrival in the ER. No further history was available. This #ECG was recorded.

What’s the diagnosis?

If you’re a new follower I always post the answer with explanation the next day. If you’re new to my account—follow me if you want to learn about medical emergencies

Answer:

https://twitter.com/em_resus/status/1622402731351621633

Read 3 tweets

ʏᴀsʜ ʙʜᴀᴠsᴀʀ

@DoctorBhavsar

AV dissociation, capture beats and fusion beats are all hallmarks of ventricular tachycardia

A simple understanding 👇

#CardioTwitter #Cardiology #Medtwitter

What’s a “capture beat” ?

During ventricular tachycardia, sometimes the SA nodal firing takes control of independent ventricular depolarization for brief moment, as this happens, “CAPTURE BEATS” appear. They are nothing but a brief moment of normal looking P-QRS pattern

Whats a “fusion beat” ?

During ventricular tachycardia, sometimes the SA nodal impulse and the independent ventricular impulse combine together to create a mix looking P-QRS pattern called fusion beats.

#ECG @EPeeps_Bot #ecglearning #CardiacArrest

Read 4 tweets

EKGDX

@ekgdx

1/ Let’s talk about T waves #CardioTwitter

The T wave represents typically ventricular repolarization. It is the most labile wave on the EKG surface.

Normal T wave

✅ Morphology: Asymmetric.
✅ Amplitude: ≤6 mm in limb leads and ≤10 mm in precordial leads.

#MedTwitter

2/ Tall upright T wave

Tall upright T waves are usually characterized by tall and peaked shape.

✅ Amplitude: >6 mm in limb leads and >10 mm in precordial leads.

Causes: Hyperkalemia, hyperacute MI, normal variant, prinzmetal angina, aortic stenosis, LVH, RVH, others.

#ecg

3/ Notched T wave

Possible causes: May be caused by morphological changes in the cardiomyocytes' action potential waveforms. Another causes include: Drugs (such as Dofetilide, Quinidine, Ranolazine, Verapamil), long QT syndrome, athletes, others.

#MedTwitter #MedStudentTwitter

Read 9 tweets

Osler

@oslertech

Are you a #juniordoctor or #medstudent?

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#meded #medschool #tipsfornewdocs #juniordocs #FOAMed #medtwitter #medstudenttwitter #juniordoctors #medstudents

Occasionally you'll need to perform sterile procedures. Make sure you prepare the best you can

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Providing basic life support is a core skill for all healthcare staff

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#basiclifesupport #bls #FOAMresus #resuscitation

Read 13 tweets

EKGDX

@ekgdx

1/ Let’s talk about the ST segment #CardioTwitter.

ST segment normally represents the interval between ventricular depolarization and repolarization.

Normal ST

✅ Usually isolectric or may vary from 0.5 mm below to 1 mm above isolectric line in L leads.

#ekgdx #Medicine

2/ ST elevation (STE)

ST changes suggesting myocardial injury:

✅ New STE ≥1 mm in all leads other than V2 or V3.
✅ New STE in V2-V3 ≥2 mm in men older than 40 years old and ≥2.5 mm in men younger than 40 years old or ≥1.5 mm in women.

#ekgdx #Medstudent #MedTwitter

3/ Types of ST segment elevation include:

✅ Convex Upward (previous pic)
✅ Horizontal (this one)
✅ Concave Upward (see next)
✅ Obliquely Straight (see next)

#ekgdx #st #MedTwitter #ecg #ekg #CardioTwitter #Medstudent

Read 9 tweets

Cliff Reid

@cliffreid

Three #cardiology cases with diagnostic ECGs in our resus room today and some learning points for emergency clinicians

#ecg #ekg

1. Sudden onset palpitations

ECG shows regular narrow complex tachycardia with rate around 140

We suspected this was atrial flutter
Rather than subject a patient to the horror of iv adenosine (which only reveals flutter - it can’t convert it), we moved the ECG limb leads around to get a ‘Lewis lead’ which better shows atrial activity

(See litfl.com/lewis-lead-s5-… )

Read 13 tweets

EKGDX

@ekgdx

1/ Let’s talk about PR Interval - Segment #CardioTwitter.

The PR interval represents the time between the onset of atrial depolarization and the onset of ventricular depolarization and reflects conduction through the AV node.

🧵by @ekgdx

2/ PR Interval

Criteria

✅ Normal PR interval: 0.12 - 0.20 sec.
✅ Prolonged PR interval: >0.20 sec.
✅ Short PR interval: <0.12 sec.

The term “PQ interval” is preferred by some EKG lover because it is the period actually measured unless the Q wave is absent.

#PR #interval

3/ The PR segment is the segment between the end of the P wave and the start of the QRS complex.

Criteria

✅ Normal PR segment: Usually isolectric.
✅ PR segment elevation: ≥0.5 mm.

PR segment elevation causes: Atrial ischaemia/infarction, myopericarditis, PE, others.

#ekgdx

Read 6 tweets

Doc Dexter

@SolarSunil

🆘59 year male smoker
k/c/o COPD, DM, HTN with DCMP (EF=20%) palpitations and dizziness x 2 days

O/E : B/L crepts +, rest

ECG👇

#Medtwitter #MedEd2022 #ECG #CardioEd

What is the likely rhythm ?

Answer - 𝘼𝙩𝙧𝙞𝙖𝙡 𝙁𝙞𝙗𝙧𝙞𝙡𝙡𝙖𝙩𝙞𝙤𝙣

📍Absent discrete P-waves
📍Fibrillatory waves (f-waves)
📍Irregularly irregular QRS complexes

Read 6 tweets

EKGDX

@ekgdx

1/ Let’s talk about P waves #CardioTwitter.

The P wave is the first positive deflection on the EKG and represents atrial depolarization. The first half represents right atrial depolarization and the second half represents left atrial depolarization.

By @ekgdx

2/ Normal P wave

Criteria

✅ Axis: 0° to +75°.
✅ Amplitude (L leads): <2.5 mm.
✅ Amplitude (P leads): <1.5 mm.
✅ Duration: 0.08 - 0.11 sec.
✅ Morphology: Upright in I, II, aVF and inverted in aVR.

#Pwaves #ecg #ekg #ekgdx #medicine #MedTwitter #MedStudentTwitter #basic

3/ Peaked P wave

The morphology is peaked with amplitude ≥2.5 mm, usually in II, III and aVF.

The peaked P wave is a typical characteristic of right atrial abnormality/enlargement.

Causes: PE, COPD, congenital heart disease, pulmonary hypertension, normal variant, others.

Read 12 tweets

EKGDX

@ekgdx

Acute pulmonary embolism (PE) is one of the most serious form of venous thromboembolism. The clinical presentation of PE is variable and often nonspecific making the diagnosis challenging.

1/

#CardioTwitter

Criteria

✅ Sinus tachycardia (most common).
✅ S1Q3T3 pattern (may be present up to 30% of cases).
✅ Simultaneous T wave inversions in the inferior leads and right precordial leads can be seen.
✅ Right axis deviation.
✅ RBBB (complete or incomplete).

2/

#MedTwitter #ecg

CT form a real case with PE.

3/

#medicine #MedTwitter #MedStudentTwitter #ct #pe #ekgdx #ekg #ecg

Read 4 tweets

Sam Ghali, M.D.

@EM_RESUS

Here’s a very important #ECG of a 60-year-old lady who presented with chest pain and shortness of breath that began while walking her dog. She was also COVID+

What’s the diagnosis?

If you’re a new follower I always post the answer with explanation the next day. If you’re new to my account—follow me if you want to learn about medical emergencies

Here’s a video I made breaking down this very important #ECG

#FOAMed

Read 4 tweets

Sam Ghali, M.D.

@EM_RESUS

Here’s a very important #ECG that was recorded in a 50-year-old lady shortly before she suddenly went into cardiac arrest

What’s the diagnosis?

If you’re a new follower I always post the answer with explanation the next day. If you’re new to my account—follow me if you want to learn about medical emergencies

Here’s a video I made breaking down this very important #ECG case with a critical finding

#FOAMed

Read 3 tweets

Aditya Ganguly MBBS MD II Internist

@AdiG1993

ECG spotter!

#MedTwitter
#CardioTwitter
#ECG

Its WPW pattern --> Derpak Sir has provided a methology to localize the Kent bundle --> I can't call it WPW syndrome for there is no hx of pre excited NCT.

*Deepak Sir

Read 4 tweets

Michal 🇨🇦🇵🇱

@vaxxmyocarditis

Please retweet and share if you support my and others' vaccine injury recoveries.

My fiancé and I were supposed to get married in July 2022. Given the first 2 vaccine mandates, we figured that we had no choice but to keep on taking the boosters in order to be able to travel for our honeymoon / have liberties to go to stores etc.

We decided to take the 3rd @moderna_tx booster anticipating that perhaps it would also be mandated by the #Canadian #government.

Read 76 tweets

Sam Ghali, M.D.

@EM_RESUS

Here’s the #ECG of a 68 year old man who was rushed to the ER by paramedics

BP: 80/40
HR: 150
RR: 35
SPO2: 95%

What’s the diagnosis?

Answer: HYPERKALEMIA

There’s a wide complex tachycardia with RBBB morphology. There are features here concerning for several life-threatening diagnoses including: V-Tach, Pulmonary Embolism, Acute Coronary Occlusion. But ALL these changes resolved with empiric ↑K+ treatment…

The QRS width narrowed right before our eyes. His vital signs improved dramatically. This was the repeat ECG recorded just 20 minutes later. Lead V1 is artifact but otherwise you can see that all the extreme changes have now resolved, and only a hint of peaked T waves remain…

Read 5 tweets

Daniel Messiha, MD

@realdocdan

🧵 1/7 Ever wondered why the Osborn wave looks the way it does? Stay with me during my newest #tweetorial. A thread 🧵1/7
#cardiotwitter #EPeeps #CardioEd #MedTwitter @TRassafMD @YoungDgk @DGK_org @YoungDZHK @AaronGoodman33 @Steph_Achenbach @fuzzymittens @AvrahamCooperMD

2/7 History
First described in 1953 by Osborn (camel-hump sign) upon #hypothermia in dogs. Upon systemic analysis similar #ECG patterns have been described in
➡️ hypercalcemia
➡️ brain injury
➡️ SAB
➡️ vasospastic angina / ischemia

3/7 Emslie-Smith et al showed that Osborn waves manifested more in epicardial than endocardial leads. Others finally showed that 4-aminopyridine sensitive transient outward current (Ito) is responsible and predominantly located in epicardium. ⬇️ heart rate led to ⬆️ Ito current

Read 7 tweets

Sam Ghali, M.D.

@EM_RESUS

Here’s an incredible #ECG recorded in a 60 year old man with chest pain and palpitations

What’s the diagnosis?

If you’re a new follower I always post the answer with explanation the next day. If you’re new to my account—follow me if you want to learn about Emergency ECGs

Here’s a video I made breaking down this fascinating #ECG case

#FOAMed

Read 3 tweets

Patricia🏳️‍🌈_#WearAMask

@patriciageezed

My 1st symptoms of #COVID were 7 weeks ago tomorrow.

Yesterday I went for an #ECG b/c I'm having heart symptoms that weren't there before #COVID19.

I'm also having issues with my blood sugar which weren't there before #Covid_19

The technician said he's doing several ECG's ++

daily on people who are having heart complications due to #COVID19.

I'm on leave from my job. And now I'm in need of health care I wasn't before. I'm scared of what is happening inside my body and brain.

@TimHoustonNS got rid of all the means that protected the #NovaScotia ++

population. Our health care and workers are crumbling under the weight of it all.

Businesses are closing. Housing is a mess. The climate is in shambles.

What are we going to do?

#nspoli #covid19NS #CovidIsNotOver #COVID19 #COVID

Read 3 tweets

Sam Ghali, M.D.

@EM_RESUS

Here’s an important #ECG that was recorded in a 50-year-old man just 15 minutes before he suddenly went into pulseless V-Tach

What’s the diagnosis?

This was an unbelievable case. If you’re a new follower I always post the answer with explanation the next day. If you’re new to my account—follow me if you want to learn about Emergency ECGs

https://twitter.com/em_resus/status/1552766151511392258

Read 3 tweets

FELIquis (ehmals EM-Felix)

@MergencyFe

Hey #OhGottPJ - Ihr seid alleine in der ZNA und seht diesen Monitorausschnitt - was passiert da? Und was jetzt? :D

#ekg #ecg #cardiotwitter

Man sieht irgendwas, was zu einer Breitkomplextachykardie umspringt in der Monitorüberwachung.

1. Wir sind uns ja relativ einig es handelt sich um einen potentiellen Notfall also:

In case of emergency, take your own pulse first!

2. Hilfe rufen (alleine ist blöd)

Read 12 tweets

Sam Ghali, M.D.

@EM_RESUS

Here’s a great #ECG of a 60 year old man with chest pain and shortness of breath. This is a fantastic case—with a twist!

What’s the diagnosis?

If you’re a new follower I always post the answer with explanation the next day. If you’re new to my account, follow me if you want to learn about Emergency ECGs

Here’s a video I made breaking down this rare and fascinating case of a 60 year old man with chest pain and shortness of breath

#FOAMed