alexander degkwitz

Cardio resident / ECG / Echo / POCUS and critical care

[alexander degkwitz @diggewitz]

@ross_prager @threadreaderapp unroll

[Ross Prager @ross_prager]

Rapid atrial fibrillation is common in the ICU.

How do you decide whether Afib is driving hypotension or simply an innocent bystander?

A 🧵

(1/x)

[JMC @narrowQRS]

Tell me in 6 letters what's going on here during this "mode switch" event? 😂

[El Hamriti Mustapha @melhamriti]

👇ECG and PAC/EAT Localization (Part 2): Anterior Atrium vs. Posterior Atrium👇

•P wave positive in lead aVR: Indicates that the PAC/AT likely originates from the anterior region of the atrium. This includes areas such as the tricuspid valve annulus, coronary sinus , mitral valve annulus, LAA, and septum.

•P wave negative in lead aVR: Indicates that the PAC/AT likely originates from the posterior region of the atrium. This includes structures such as the crista terminalis, near the sinus node, posterior wall, and pulmonary veins.

👉 #EPeeps The often-overlooked aVR lead should no longer be ignored! aVR covers a large region on its own and provides critical diagnostic information

This post was created in collaboration with @N_Trajkovska 🙏🙏

@Phiso_de @chris_sohns @MoneebKhalaph @MBraunEP @StephanWinnik @Cardioschool @VanessaSciacca_ @GNageler @BSCCardiology @AbbottNews @jjmt_ep @Medtronic @ALFIEEP1 @ecgrhythms @ecgandrhythmRoe @ECGEPSCADEVICE @Ecgloverr #CardioTwitter @syamkumarmd @pjsm83

[alexander degkwitz @diggewitz]

@ross_prager @threadreaderapp unroll

[Ross Prager @ross_prager]

Here are my most important learnings and reflections as an intensivist in 2024.

A 🧵

[alexander degkwitz @diggewitz]

@katiewiskar @threadreaderapp unroll

[Katie Wiskar @katiewiskar]

@khaycock2 @ross_prager @KiranRikhraj @icmteaching @IM_Crit_ @IM_POCUS @HoosierPocus @pulmtoilet @ThinkingCC @NephroP @ArgaizR @G2Disrupt @iceman_ex @FH_Verbrugge @DrGalenMD Excellent point Korbin.

Another reason I like to scan the IJ in conjunction with the IVC to assess CVP - can help make you aware of some of the common cofounders

https://t.co/OwHHzuhNXn

[alexander degkwitz @diggewitz]

@katiewiskar @threadreaderapp unroll

[alexander degkwitz @diggewitz]

@Teebi_MD @threadreaderapp unroll

[Ahmed Teebi, MD MPH MSc(Ox)🗝️ @Teebi_MD]

🧵1/Little I did know about Bachmann's Bundle (BB) before starting EP fellowship. Quick run👇

BB is the main pathway of electrical conduction between right & left atrium. BB is muscular bundle connecting right & left atrial walls.

❌Disruption of BB causes "Interatrial block"
#EPeeps #CardioTwitter

[John Mandrola, MD @drjohnm]

100% agree. We need to support and celebrate #PROFID trial

[alexander degkwitz @diggewitz]

@AThomazAndrade @threadreaderapp unroll

[alexander degkwitz @diggewitz]

@Frances98392343 @KostekMilan @AThomazAndrade @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski @Willis_Kwandou Yes and there is clear AV-Dissociation so this cannot be AT. My idea was fascicular VT (narrow) but JT may be a better idea (with supranormal conduction then).

[alexander degkwitz @diggewitz]

@Frances98392343 @KostekMilan @AThomazAndrade @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski @Willis_Kwandou Does it end with a P or with a PVC? 🧐

[alexander degkwitz @diggewitz]

@Frances98392343 @AThomazAndrade @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski Maybe it’s supranormal or pseudo supranormal conduction?

https://t.co/6gYsoOrh7X

[Antonio Thomaz de Andrade, MD 🇧🇷 @AThomazAndrade]

77y Male with very interesting Holter strip. What you think? @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski

[alexander degkwitz @diggewitz]

@andreaskardio Antiarrhythmikum geben, dann erneute eKV mit dann hoffentlich (stabilem) SR, dann nochmal dezidiert Symptome/Besserung im SR eruieren. Wenn im SR weniger Symptome/mehr Lebensqualität, dann Ablation.
VHFli-Symptome sind auch oft „atypisch“, evtl. hat er sein Leben schon adaptiert

[alexander degkwitz @diggewitz]

@Willis_Kwandou @DrRajeshG1 @syamkumarmd @The_Nanashi_O @DidlakeDW @UlhasDr I wonder if the synchrony between P waves and ventricular spikes (that we can see) could have been explained with switch on the header. What do you think? because with switch there should be NO synchrony, right?

[Sebastian Feickert @sebFeickert]

🎅 Am 06.12. gab es am @Vivantes Klinikum Am Urban in Berlin die Nikolaus-Neuauflage unseres Hands-On EP-Kurses „Hand-aufs-Herz“ –
✋➡️🫀

und was für ein Tag es war!

📚 Spannende Impulsvorträge zu den Grundlagen der Elektrophysiologie legten den perfekten Grundstein

💉 Intensive und abwechslungsreiche Live-Cases, die uns alle herausforderten und bereicherten.

🖐️ Simulator-Training: Von der transseptalen Punktion und Leistenpunktion bis zum Einsatz von Ablationskathetern konnten die Tielnehmenden ihre manuellen Skills unter Beweis stellen.

💬 Besonders begeistert hat uns der Austausch mit der Gruppe: Viele Diskussionen, wertvolle Fragen und ein beeindruckendes Engagement haben den Kurs zu einem echten Highlight gemacht.

🙏 Ein ❤️ Dankeschön an alle Teilnehmer:innen, Referent:innen und Unterstützer:innen die diesen Tag so besonders gemacht haben! Wir freuen uns schon jetzt auf die nächste Runde!

@laura_rottner @Medtronic @MDTVascular @burakduymaz