ECG Challenge

EKG öğrenimi ve öğretisi

[Milan Koštek @KostekMilan]

🟡 VT with 1:1 VA conduction 🟡
You have no AV dissociation but one to one association from the retrograde conduction in this ventricular tachycardia.
🧵 & 🔗

[Milan Koštek @KostekMilan]

🟡 negative concordance 🟡
Limitations of the negative concordance pattern in the diagnosis of broad QRS tachycardia
🧵 from Google Search 🔍

[ECG Challenge @ecgchallenge]

@Frances98392343 @lila_enis @Frances98392343 @lila_enis
Here, a narrow QRS tachycardia is evolving into a wide QRS tachycardia. Given that this patient initially had frequent PACs and atrial tachycardia, could there be aberration or pre-excitation involved?

[ECG Challenge @ecgchallenge]

39F with a history of myocarditis, cardiac MRI showing 49% EF and LGE+. What could a wide QRS tachycardia with negative concordance during an exercise stress test indicate?

[ECG Challenge @ecgchallenge]

@Frances98392343 @lila_enis You're right. They say, 'When you hear hoofbeats, think horses, not zebras,' but they also say, 'All that glitters is not gold.'
https://t.co/mEiuruqeEu

[ECG Challenge @ecgchallenge]

In your opinion, what is the rhythm in these ECGs? (57y-old female presenting with syncopal episodes)

[ECG Challenge @ecgchallenge]

@AntoOhanian @AntoOhanian Also, there is variation in echo beats; how can we explain this?

[ECG Challenge @ecgchallenge]

A patient with NICMP. Taking amiodarone due to a history of VT. What do you think the rhythm is?

[ECG Challenge @ecgchallenge]

@AntoOhanian Do you think why are the P waves in the inferior leads sometimes positive and sometimes negative?

[ECG Challenge @ecgchallenge]

@EleanorRigby18 @Frances98392343 Could you look at V1. Before the 5th, 6th, and 7th QRS complexes, the PR interval is progressively shortening. The same pattern is also present before 9-10-11 and 13-14-15, meaning there seems to be a regular relationship. I am not sure if this is an AV dissociation.

[I.H.Tanboga, MD, PhD @ihtanboga]

https://t.co/kvRxkhqSeq

[El Hamriti Mustapha @melhamriti]

👇Typical Flutter: Quick tricuspid annulus map for diagnosis and ablation success assessment👇

👉 A very fast single-tip activation map of TV using the ablation catheter beautifully demonstrates the reentry circuit — in this case, a counterclockwise flutter around the tricuspid valve annulus.

👉 For success confirmation, pacing in the coronary sinus (CS) shows a collision of both activation wavefronts at the CTI line, without any breakthroughs across the block line.

Beautiful maps by @StephanWinnik 🤩

🎥 This illustrative video was created in collaboration with @N_Trajkovska for Young #EPeeps 🙏

@Phiso_de @GNageler @MBraunEP @MoneebKhalaph @Cardioschool @PhilippLuc @chris_sohns @ecgandrhythmRoe @Ecgloverr @KostekMilan @JNJNews @EPWaveDoc @Mo_PedsEP @ArashArya_EP #CardioTwitter @YoungDgk @AGEP_DGK

[ECG Challenge @ecgchallenge]

@FibrilloFlutter @ecgandrhythmRoe @Frances98392343 @koggelnoggel @makkyecg @DrAkhilX @LeonrMail @AbdulazizM2669 @Amhar_47 @DidlakeDW I love this algorithm

[ECG Challenge @ecgchallenge]

66 y/o male with syncope. What's the rhythm?

[ECG Challenge @ecgchallenge]

A new ECG taken 20 mV. First ecg is afib or sr+pac/pjc or wap rhythm or anything else?

[ECG Challenge @ecgchallenge]

20 y/o female has limb-girdle muscular dystrophy and is being evaluated for suspected stroke/TIA; these two ECGs belong to that patient. What do you think the rhythm is?

[ECG Challenge @ecgchallenge]

@FibrilloFlutter @ecgandrhythmRoe @Frances98392343 @KostekMilan @makkyecg @koggelnoggel @ecgrhythms @Amhar_47 @DrAkhilX @DrRazi4 Afib is more likely.

[ECG Challenge @ecgchallenge]

I am not sure, I'm just speculating. The right-sided ECG may represent a fever-induced Brugada pattern Type 1. Lead V3 resembles a Brugada pattern Type 2.

Fever exacerbates sodium channel dysfunction, destabilizing cardiac membrane potential and increasing the risk of early afterdepolarizations and re-entrant circuits that trigger VF. This pathophysiological cascade underscores the importance of aggressive fever management with antipyretics to prevent severe arrhythmic events.

[ECG Challenge @ecgchallenge]

@Frances98392343 There are polymorphic PVCs, and the tachycardia on the left has the same morphology as one of those PVCs. There’s also a capture beat. Yes, I agree with you — this is VT. Could the right side possibly represent an atrial run or tachycardia?

[ECG Challenge @ecgchallenge]

@Frances98392343 I can’t clearly identify regular atrial activity, and the P waves I do see raise a suspicion of intermittent WPW in my mind. What is your interpretation of the second ECG?

[ECG Challenge @ecgchallenge]

Although Takotsubo syndrome is often perceived as a postmenopausal female disease, it can also occur in men, particularly those exposed to physical stress. In a patient with such an ECG, coronary angiography should, of course, be performed; personally, if the results are normal, I prefer to proceed with ventriculography.
DD: MINOCA and myocarditis.