Sergio Pinski

Heart rhythm doctor, amateur statistician, vegan.

[Sergio Pinski @SergioPinski]

What is quite uncommon is the right bundle combined with left posterior hemiblock aberrancy. Great example.

[Sergio Pinski @SergioPinski]

Frequent PACs highlight features of aberrancy, including an infrequent form. #ECG #Cardiology

[Sergio Pinski @SergioPinski]

No need to invoke supernormal conduction. The PACs that conduct with aberrancy have shorter coupling and are preceded by a longer previous cycle.

[Sergio Pinski @SergioPinski]

@EkgHacks Atrial flutter with mostly 6:2 block. This is 2 level block: 2:1 and then Mobitz I 3:2. It’s not variable, it’s quite fixed.

[Sergio Pinski @SergioPinski]

@Arritmias_HRC @ecgrhythms 2 grams of magnesium sulfate STAT.

[Sebastian Mafeld @SebastianMafeld]

What makes a great doctor?

There’s a superpower I’ve noticed in the best doctors.

It's not knowledge, technical skill, intelligence, communication or listening. Of course all these matter.

The best doctors I know are exceptionally good at noticing.

They notice the small, subtle, unusual, seemingly minor details.

Noticing often creates an internal voice. But when said out loud, it sounds like:

Mid procedure: "did you see that?
In clinic: "did you notice how the patient said that"

Because in medicine, noticing can completely change what happens next:

You look again.
Ask another question.
Change the plan.
Cancel the procedure.
Act before the problem fully declares itself.

Some of the biggest decisions in medicine can begin with something very small:

"Did you notice that?"

Agree? What is another superpower to consider?

[Sergio Pinski @SergioPinski]

@KostekMilan @Frances98392343 @syamkumarmd @DrRajeshG1 @AThomazAndrade @DaveRichley @willyhfrick @DidlakeDW @Arron_Pearce_ @Toaster_Pastry @Koichi16423232 @rowroi558 It’s not the PVC what changes the refractory period. It’s the compensatory pause. Duration of the action potential in the His-Purkinje system depends critically on the previous cycle. Thus, the window of supernormal conduction also changes after the PVC.

[Sergio Pinski @SergioPinski]

@CarlosDCaicedo

[Sergio Pinski @SergioPinski]

@CarlosDCaicedo The pause that refreshes.

[Stephen W. Smith @smithECGBlog]

80 year-old female with epigastric burning and previously diagnosed LBBB

https://t.co/HENR9qePOZ

@ECGcases @PMcardioApp

[Sergio Pinski @SergioPinski]

@KostekMilan @AThomazAndrade @doctor_roig @ecgrhythms In that hypothetical case, the PR should be longer, not slightly shorter.

[Sergio Pinski @SergioPinski]

@AThomazAndrade @KostekMilan @doctor_roig @ecgrhythms Also do a His bundle study. You’ll be surprised that the HV interval is not very long during the conducted beats with LBBB.

[Sergio Pinski @SergioPinski]

@AThomazAndrade @KostekMilan @doctor_roig @ecgrhythms If you have access to the patient, perform carotid sinus massage and you will see the rhythm emerge.

[Sergio Pinski @SergioPinski]

@AThomazAndrade @KostekMilan @doctor_roig @ecgrhythms How do you explain the fusion beat with pseudonormalization of the QRS?

[Sergio Pinski @SergioPinski]

@KostekMilan @AThomazAndrade @doctor_roig @ecgrhythms No. The RBBB beats are not conducted. It’s a fascicular rhythm at a similar rate to the sinus. But the PR is not constant, if the strip were long enough, you would eventually see the dissociation.

[Sergio Pinski @SergioPinski]

@KostekMilan @AThomazAndrade @doctor_roig @ecgrhythms How do you explain the narrow beat just at the transition? It’s a fusion beat. The “RBBB” is indeed a rhythm from the injured fascicle. If you pay attention the PR is not constant. It’s much shorter in the last beat.

[Sergio Pinski @SergioPinski]

@Frances98392343 @KostekMilan You should be able now.

[Sergio Pinski @SergioPinski]

Atrial bigeminy with 2 alternating foci. The one with the shorter coupling interval conducts with right bundle branch block aberrancy. Another form of "bigeminy of the bigeminy" #ECG #Cardiology

[Sergio Pinski @SergioPinski]

Alternating atrial and ventricular bigeminy. Another variant of "bigeminy of the bigeminy". #ECG #Cardiology

[Sergio Pinski @SergioPinski]

A la final! #Argentina