Asanka Migelheva

Emergency Physician special interest in Critical care, Retrieval Medicine and Toxicology #Traveller#FOAMED#Educator#Emergency physician#ECG#MD

[Asanka Migelheva @AMigelheva]

20 year old male feeling intermittently lightheaded
Vitals stable
Normal examination

[Asanka Migelheva @AMigelheva]

6 year old girl presenting to the ED with cough, when goes to sleep noted to be Brady ,ECG

[Asanka Migelheva @AMigelheva]

Post Cardio version

[Asanka Migelheva @AMigelheva]

45 year old male acute onset palpitations

[Asanka Migelheva @AMigelheva]

This was an AF with pre excitation

[Asanka Migelheva @AMigelheva]

@HiraaliCardio More towards polymorphic
Given beat to beat variation in vector and size
AF with Pre excitation

[Asanka Migelheva @AMigelheva]

25 year old previously healthy presenting with episodic self resolving palpitations.

Looks anxious
Exam Normal , no past Hx or family Hx of cardiac diseases.
Would get cardio to have a look ?

[Asanka Migelheva @AMigelheva]

@Frances98392343 Yep it was flutter with 1.1 but the rate was around 250 ( mate be senior age leading to the lower rate than expected for a flutter)
Post Amiodarone revealed flutter waves

[Asanka Migelheva @AMigelheva]

82-year-old female, unwell with cough for ~1 week. While walking to the bus she became dizzy, pale, and sweaty.
ECG one given Amiodarone by the paramedics
ECG two on arrival

[Asanka Migelheva @AMigelheva]

26 year old pregnant lady 26 weeks of POA with severe epigastric pain
-Acute pancreatitis confirmed with lipase 6000+

ECG as below ( no ECGs to compare )
Thoughts

[Asanka Migelheva @AMigelheva]

35 year old male coming with intermittent sharp episodic chest pain for the last 3 days duration

Trop 1000— peaking to 4000
ECHO normal
Angio mild muscular bridge on LAD
What do you make of the ECG and presumptive Dx?

[Asanka Migelheva @AMigelheva]

@ElsevierHealth 2 months since ordering Cases in Pre-Hospital and Retrieval Medicine, 2e (20 Nov 2025, Order #0130053513). Followed up 1 month ago, but no update to date. I’d appreciate urgent escalation.#CustomerExperience

[Asanka Migelheva @AMigelheva]

Mobitz type 11 or complete heart block ?

[Asanka Migelheva @AMigelheva]

This patient had a Saddle PE needing urgent thrombolysis

Would suspect a PE looking at his ECG ?

[Asanka Migelheva @AMigelheva]

72 F
Acute onset chest pain
Value of serial ECGs (this change was over an hour )

Anything suspicious in the first ECG about what was coming?

[Asanka Migelheva @AMigelheva]

Culprits were LAD and D1

[Asanka Migelheva @AMigelheva]

Culprit artery/arteries ?

[Asanka Migelheva @AMigelheva]

@Elb3001 Any other artery ?

[Asanka Migelheva @AMigelheva]

We were thinking of AVRT as likelyDx , but his cardiologist had the impression to be Atrial flutter with 1.1

[Asanka Migelheva @AMigelheva]

15 year old boy, acute onset palpitation with marginal BPs

BG left Hypo-plastic heart heart syndrome with 4 reversion surgeries