Muchtar Nora Ismail Siregar

Cardiologist, Electrophysiologist, Cardiac Device

[Roderick Tung @DrRoderickTung]

There are many ways to fix the intraseptal lead during LBBAP implant to achieve physiological pacing. Many use two hands.

Tips and tricks for a single left-handed technique:

1) Sheath tents RV septum with contrast
2) Advance lead tip out slowly to the point of almost displacing the sheath
3) Right hand fixes the sheath torque using syringe of contrast
4) Rapid rotations to spin the lead between left thumb and index finger- palm up
5) Contrast injection to confirm breaking through the RV endo plane in LAO

[Milan Koštek @KostekMilan]

Fascicular Ventricular Tachycardias: Potential Role of the Septal Fascicle
*
Read about the supposed anatomic nature of slow conduction area in the left lower corner (click the pic).
https://t.co/z8efJxQjp6

[Dee Khadijah @el_khadijjah]

Malaikat bertanya,
Ya Allah apa aku harus mencatat ibadah hambamu ini?
Sedangkan ia beribadah tapi hati dan pikirannya tidak.
Lalu ia hanya mengingatMu dikala sedih, setelah bahagia engkau kembali.

Allah menjawab,
Tidakkah engkau melihat wahai malaikat, hambaku ini tidak

[José de Alencar @josenalencar]

ECG tools I use teaching cardiology fellows:

1. Cardiac axis simulator → https://t.co/Xsqy5XDcO4
2. Ladder diagram generator → https://t.co/E91zjIHQLu
3. Rhythm simulator → https://t.co/02YvXak0CR
4. ECG trainer with AI feedback → https://t.co/82D9toGTpy

Bookmark this.

[Muchtar Nora Ismail Siregar @MN_Ismail]

Atau kasus kasus kematian jantung mendadak terutama usia muda paling sering umumnya dijelaskan sebagai serangan jantung karena penyempitan pembuluh darah

[Muchtar Nora Ismail Siregar @MN_Ismail]

Sayang nya… pemahaman masyarakat tentang “jantungan” atau penyakit jantung, didominasi oleh penyakit penyempitan pembuluh darah jantung

[Muchtar Nora Ismail Siregar @MN_Ismail]

Rhythm?

[Muchtar Nora Ismail Siregar @MN_Ismail]

@ecgandrhythmRoe Epsilon wave, TWI V1-V3, Polymorhic PVC—> ARVC

[Muchtar Nora Ismail Siregar @MN_Ismail]

@ecgandrhythmRoe Dual AV node nonreenterant tachycardia?

[Muchtar Nora Ismail Siregar @MN_Ismail]

Rhythm?

[Dr. Zhong @pzhong2016]

Excellent examples of using the reentrant pacing maneuver to identify the pacing site relative to the ventricular tachycardia (VT) circuit by Dr. Cooper.

[Muchtar Nora Ismail Siregar @MN_Ismail]

16 yo F with syncope.

[CME INDIA @CMEINDIA1]

Now available for download
ECG Review : Some momentous articles
Series 8
Previous all series also available

https://t.co/oph2DCdVx3

ECG Review : Some momentous articles by
Dr. DURGA PRASAD KHAITANMD (MEDICINE) FCGP (IND) FIAMS (MEDICINE) FICP FICCMD FIACM
@ECG_BUDDY_ARPI
@ecgandrhythmRoe
@ecg_lover
@EcgOxford
@smithECGBlog
@EcgsOnly
@EkgHacks
@TrackYourHeart
@escardio
@JAMACardio
Series 8

[Muchtar Nora Ismail Siregar @MN_Ismail]

Rhythm?

[Muchtar Nora Ismail Siregar @MN_Ismail]

@ecgandrhythmRoe AF with cLBBB

[Benny Lau @physiosign]

SAN (sinoatrial node)

Precisely locating the starting point of each heartbeat is extremely difficult and has been a challenge for 122 years. The reason is that the P-wave onset in traditional ECGs is a curved corner, and a slight difference amounts to 5–10 milliseconds. Therefore, the unit of measurement with a compass can only be in "seconds," while computer measurements cannot pinpoint it accurately either. Up to now, ECG remains at a rudimentary stage of data values, unable to achieve quantitative diagnosis or meet clinical needs. The heart is an organ that conducts electricity, and undoubtedly, ECG is the most direct targeted indicator of the heart. However, since receiving the Nobel Prize in 1924, it has not been revolutionized. What is recorded is merely a high-frequency trace of the heart's surface (P = atrium, T = ventricle, QRS = pulse wave). What we doctors see is only a superficial electrical trace. Signals such as SCT, various membrane potentials, and ion exchange signals are all completely blank. The correlation between ECG and diseases is simply too far apart.

The SAN (sinoatrial node) is the starting point of each heartbeat and is, of course, of utmost importance because the human heart rate of 60–100 beats per minute is determined by the SAN's working frequency. Electrophysiologists and interventional cardiologists both rely on the SAN, as it is the origin of every heartbeat. The blood supply to the SAN comes from two coronary arteries: the LCx (left circumflex artery) and the RCA (right coronary artery).

**Specialized Cardiac Tissue (SCT) was proposed by Great Hoffman in 1964.

SAN = The source of life, the very place where life resides, and the starting point of every heartbeat.

PhysioSign USA

#ecg #ekg #ep #electrophysiology #medtech #cardiology

[El Hamriti Mustapha @melhamriti]

👇 Permanent Junctional Reciprocating Tachycardia (Part 1): PJRT and ECG Findings👇

👉 PJRT is characterized by a long RP tachycardia, where atrial activation occurs retrograde via a slowly conducting, concealed accessory pathway.

👉 ECG Findings:
•Negative P-wave morphology in leads II, III, and aVF, indicating atrial activation from inferior to superior.
•Positive P-wave morphology in leads I, aVL, and V6, suggesting right-to-left atrial activation.

#EPeeps This post is a collaboration with the talented EP fellow, @N_Trajkovska 🎨🖌️

@Phiso_de @StephanWinnik @MoneebKhalaph @MBraunEP @Cardioschool @GNageler @narrowQRS @DrRajeshG1 @Koichi16423232 @nelsonpol @ecgandrhythmRoe @ecgrhythms @ECGEPSCADEVICE @EkgHacks @EcgsOnly @ArashArya_EP @ChristianHeeger @jjmt_ep @JNJ_ch @AbbottNews @BSCCardiology @Medtronic #CardioTwitter @syamkumarmd @ALFIEEP1

[Muchtar Nora Ismail Siregar @MN_Ismail]

@ecgandrhythmRoe @QabasMajid Leftmain disease

[Muchtar Nora Ismail Siregar @MN_Ismail]

@ecgandrhythmRoe Prominent U wave

[Muchtar Nora Ismail Siregar @MN_Ismail]

Acute Peripartum Pulmonary Embolism in Mitral Stenosis Patients Undergoing Vaginal Delivery Procedures https://t.co/pEkxM9GJgP