Hammad

Internal Medicine Resident| ECG Enthusiast
| Sky is the limit | MBBS 🇸🇩 | SCFHS 🇸🇦| USMEL STEP 1&2, ECFMG certified 🇺🇸 | Ireland Medical Council 🇮🇪

[Hammad @HDforOneHD]

🧵🫀ECG read it like an expert thread.

I will begin sharing tips and tricks for better ECG analysis🫀. Some could save a patient's life in critical situations and others will let you better assess stable patients with ECG changes.

#Cardiology #Medicine #Shock #STEMI #CCU #PCI

[Hammad @HDforOneHD]

@GaltMD Tbh I disagree with you unless you have a nicer way to ask a PT with non specific and non urgent complaints. We often ask this question to catch what we are missing and need to draw our attention to it.

[Josh Farkas MD 💊 @PulmCrit]

The approach to CT scanning has changed (for sure), but I think this actually makes sense.

Why CT scans make more sense in 2026 than 10-30 years ago:

[1] Modern contrast dye isn't nephrotoxic.

[2] Modern patients are increasingly complex. I'm increasingly seeing patients who simply wouldn't have been alive 1-2 decades ago (e.g., post-TAVR patients).

In critical care, this is the basic math behind CT scanning:

[1] Aside from very young patients (where radiation is a greater consideration), scans are highly safe.

[2] There is often a finite possibility of finding an occult, life-threatening disease process.

If there is significant doubt about what is going on, this will favor CT scanning.

I'm not saying we should scan everyone. But in the context of complex, sick, frequently altered/sedated patients CT scans can be extremely helpful.

[Hammad @HDforOneHD]

@Arron_Pearce_ CHB with ventricular escape rhythm

[Hammad @HDforOneHD]

@ecgdoujou Non sustained vt

[قورجس @gorgeous4ew]

سبيد بعد هدف مصر على الأرجنتين:

"يلا حبيبي .. السلام عليكم .. الله أكبر" 🇪🇬🔥

[Hammad @HDforOneHD]

Thank you Cr7 for everything
You inspire me

[Ahmed Mohsen @drahmedmohsen85]

"ومن أحياها فكأنما احيا الناس جميعا "

الحمد لله

انتهز الفرصة واعيد المعلومة مرة أخرى

عقار Rivaroxaban 15 or 20 mg لازم يتاخد بعد الأكل عشان نحصل على المفعول الكامل

لو اخدته على معدة فاضية بيفقد جزء كبير من تأثيره

وبالتالي لا يوفر الحماية الكاملة من السكتات الدماغية

[Hammad @HDforOneHD]

💡 Key difference between PACs & PJCs:

Both have many similarities e.g. narrow QRS complex & pauses but the key difference is the PR interval.

👉 If PR interval <120 ms then it is junctional ectopics.

👉 If PR interval >120 ms then it is atrial ectopics.

👉 Absent P wave: PJC

[Hammad @HDforOneHD]

👉 In this ECG, ectopic is present. P wave is inverted and present after or buried in the QRS complex.

👉 Similar to PACs, PJCs are followed by incomplete pause and the next beat will arrive earlier than expected, because the ectopics will reset the SA node.

[Hammad @HDforOneHD]

💡ECG features of PJC:

1- No preceding P wave. Or
2- Retrograde P wave (inverted): appears before, during or after QRS complex. (If before, then will show in inferior leads).
3- Narrow QRS complex: Normal AV node function.
4- PR interval <120 ms: If retrograde P wave is present.

[Hammad @HDforOneHD]

👉 Pause: a prolonged period between heartbeats caused by ectopics. PACs can reset the heart rhythm by activating the SA node, thus PACs will be followed by an incomplete pause.

👉Incomplete pause: The next heartbeat will arrive earlier than expected. (Unlike PVCs pauses).

[Hammad @HDforOneHD]

💡 ECG features of PAC:

1- Abnormal P wave shape: different p wave shape than sinus p wave.
2- If PACs originate close to AV node, then it causes retrograde activation of atriums showing as inverted P wave.
3- Narrow QRS complex: AV function is normal.
4- PR interval > 120 ms.

[Hammad @HDforOneHD]

💡PAC originates from any area within the atria except the SA node. While PJC originates from within the AV node.

💡Both have similarities on the ECG but small details can tell the difference between them and tell you what you are looking at.

[Hammad @HDforOneHD]

🧵ECG Read it like an expert.
5/ PAC vs PJC: How to tell and differentiate between the two.

PAC 👉 Premature Atrial Complex
PJC 👉 Premature Junctional Complex

Both originate from areas other than the SA node, thus will have different morphology on the ECG than a sinus rhythm.

[Hammad @HDforOneHD]

@jpcostabel 2nd degree Hb type 2 with 2:1 and junctional escape rhythm. I see deflections after qrs complex, are these P waves?
I am divided between saying CHB and VER and above answer.

[Hammad @HDforOneHD]

@drahmedmohsen85 Very interesting page and summary. Thank you Dr. Mohsen for sharing.

[Ahmed Mohsen @drahmedmohsen85]

Do you know the appropriate dose of NOACs for AF, ACS/PCI, and DVT/PE? 🤔

❓When should doses be reduced?

❓Which NOACs need heparin first?

❓How does renal function affect dosing?

📖 Find all the answers in Tips and Tricks in Cardiology.

📚 Interested?
Comment "Tips" 👇

[Hammad @HDforOneHD]

@0music6 AF going into V tach

[Hammad @HDforOneHD]

@ACCinTouch @escardio @HRS_CaseReports https://t.co/tjTwB6A7Xm

[Hammad @HDforOneHD]

🧵ECG Read it like an expert.
5/ PAC vs PJC: How to tell and differentiate between the two.

PAC 👉 Premature Atrial Complex
PJC 👉 Premature Junctional Complex

Both originate from areas other than the SA node, thus will have different morphology on the ECG than a sinus rhythm.

[Hammad @HDforOneHD]

🧵🫀ECG read it like an expert thread.

I will begin sharing tips and tricks for better ECG analysis🫀. Some could save a patient's life in critical situations and others will let you better assess stable patients with ECG changes.

#Cardiology #Medicine #Shock #STEMI #CCU #PCI

[Hammad @HDforOneHD]

@ACCinTouch @escardio @HRS_CaseReports 4th lesson:

[Hammad @HDforOneHD]

🧵4/ Heart blocks on ECG:
HB can occur at any point in the cardiac conduction system causing SA node dysfunction, AV block, bundle branch blocks, and fascicular blocks. PT can have even more than one block at the same time.

I will talk about some of them & the ECG findings ⬇️.