تئوفیلینوس

پزشک متخصص. بیشتر در مورد مسائل مرتبط با کارم مینویسم. گهگاه هم روزمره نویسی میکنم.

[تئوفیلینوس @GloktaSand]

@mightymaryam اگر دقت کنید slight ST elevation در V1 و aVR میشه دید، احتمالا main stem یا proximal LAD درگیره.

[تئوفیلینوس @GloktaSand]

@havayepaeez @ehsan7j بیشتر توی اروپا استفاده میشه، توی سیستم پزشکی امریکایی ندیدم.

[تئوفیلینوس @GloktaSand]

@ecgandrhythmRoe @UlhasDr because of aVR polarity and V6 morphology I think it is most probably a (fascicular) VT

[تئوفیلینوس @GloktaSand]

@ecgandrhythmRoe You r right, these are probably ectopic beats from right upper PV.
The ECG is somehow strange: sinus bradycardia of 35/min but QT is about 400ms! ectopic beats are very rapid (200-240ms) but have a relatively long (400ms) coupling interval to the sinus beat...

[تئوفیلینوس @GloktaSand]

@MaruanCarlos Sorray AVs interval.

[تئوفیلینوس @GloktaSand]

@MaruanCarlos Most probably continuous prolongation of AVp interval due to an algorithm such as VIP, search AV+,... to promote intrinsic AV conduction. Due to lack of intrinsic conduction the device switches back to a shorter AVp interval.

[تئوفیلینوس @GloktaSand]

@ecgandrhythmRoe @EkgHacks sinus rhythm and artifact!

[تئوفیلینوس @GloktaSand]

@swahz7788 It is "atrial capture management" of a medtronic pacemaker.

[تئوفیلینوس @GloktaSand]

@Hiren_PatelMD @willyhfrick @syamkumarmd I thought obout TWOS as well, especially because there is no obvious trigger for the tachy (such as a PVC,...), but TWOS classically shows the tram track appearance. without EGMs, I prefered just to give an evidence based explanation😁.

[تئوفیلینوس @GloktaSand]

@willyhfrick @syamkumarmd the tachy falls from the beginning in the VF zone, there is an unsuccessful(?) ATP while charging and then comes the successful shock.

[تئوفیلینوس @GloktaSand]

@ecgandrhythmRoe Most Probably slow VT terminated through a vent. Burst.
2 another things: first the episode Nr. 2840 ist somehow strange!
secondly I think ATP with 220ms(280/min) for almost 20 beats seems very aggressiv for this slow VT. Interestingly we see capture by every burst beat!

[تئوفیلینوس @GloktaSand]

@willyhfrick @syamkumarmd @narrowQRS @SergioPinski @AThomazAndrade @DaveRichley @The_Nanashi_O @Arron_Pearce_ @ecgrhythms @jeffrey_vinocur @ecgandrhythmRoe I think tachy 1 terminates due to AVblock with a max. preexcited beat and not a PVC! So AT and antidromic AVRT very unlikely. tachy 2 shows intermittent loss of preexcitation, it rules out an antidromic AVRT. In summary I think AP is just bystander and the tachy is AVNRT.

[تئوفیلینوس @GloktaSand]

@IrmaMDv @ecgandrhythmRoe I think it is dextrocardia!

[تئوفیلینوس @GloktaSand]

@capuzzi_luciano @ecgandrhythmRoe @IrmaMDv I didnt get your point!

[تئوفیلینوس @GloktaSand]

@IrmaMDv @ecgandrhythmRoe Interpreting PM ECGs can be very challenging, especially if the pacemaker cofigs are unknown. Other explanations are probably possible too. by the way, the sweep rate of the ECG must be 25 mm/s?

[تئوفیلینوس @GloktaSand]

@ecgandrhythmRoe @IrmaMDv It is most probably not a VT. I think The PVC induces an antegrade AV conduction prolongation/block, the PM begin to stimulate in RV and most probably induces a PMT. PMT is terminated due to retrograde AV conduction prolongation. Anyway i think it is PM-induced.

[Benoy Shah MD @dr_benoy_n_shah]

Deep dive on #EARLYTAVR from ##TCT2024

Lots already said & discussed

It takes time to read the paper, read the supplementary appendix, analyse the results, think about them etc!

Some thoughts...🧵

[تئوفیلینوس @GloktaSand]

@Mkamalr2 @efshaye_aleph به نظرم شما بیشتر بهت برخورده، البته شاید هم حق داری.

[تئوفیلینوس @GloktaSand]

@KSxDashraF جسارتا شعر متعلق به سعدی است و نه شفیعی کدکنی:
" سعدي به روزگاران مهري نشسته در دل
بيرون نمي توان کرد الا به روزگاران"