J.M. Cooper

Patient with biventricular ICD, in hospital for heart failure. Sudden jump up in heart rate on tele and unusual wide complex grouped beating. What's going on? What should be done?

And it was a phenomenal educational resource in the medical community. Totally destroyed.
#MedEd
#EPeeps

And "here's either 2 small cats kissing or one fat cat looking at us with her mouth open."

8 yo daughter wanted to try to make an optical illusion cutout.
"It's either 2 fish kissing or a cute axolotl looking at us!"

Any family history of pacemaker at younger age? Cardiomyopathy? Your cardiologist might consider a cardiac MRI and/or myocardial PET scan to look for sarcoidosis or other inflammatory condition. And doing a cardiac genetic testing panel is not unreasonable as well. And a 2-4 week heart monitor.

Coronary artery disease is not a common cause of bundle branch/fascicular blocks. The most common is age-related dysfunction of the conduction system, but 60 yo is on the younger side for that. Genetic conditions and acquired infiltrative or inflammatory conditions should be ruled out.

Patient with biventricular ICD, in hospital for heart failure. Sudden jump up in heart rate on tele and unusual wide complex grouped beating. What's going on? What should be done?

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Here's the associated telemetry strip.
Patient went into rapid AT/AFL.
Always interesting to see the dynamic between electrical events and mechanical events!

How do physicians get our hands on one, just to have for a witnessed emergency?

Looks like nine sinus beats and then 16 or 17 irregular beats, judging from the pulse waveform...
But you are right, there are additional non-producing beats... I'll post the telemetry strip component shortly

Any guesses on the ventricular rate?

“Both of them.”

Click BP tracing to expand.
What do you think the heart rhythm is before and after the transition?

Yes, that's the point. Individuals have autonomy and it's heartbreaking to watch people make bad choices and self destruct, even in the face of kindness, support, and mentorship attempts. When this is in the context of a failing relationship, it's gutting to see that person's authentic self 😞

Rare but possible.
Close friends:
-boy dates girl, she's diagnosed with lymphoma (~18 yrs ago)
-family & friends advise him not to remain invested, he tells them to pound sand
-they get married, have 2 kids, extremely loving relationship
-she goes thru hell with 6 relapses, died recently
-true love

My dad (and brother) might give him a run for his money! 🎣

Kids playing Ozzy's Crazy Train on xylophones

So glad to see this quotation. I have often used left-handedness as an analogy when talking about being transgender for example, explaining that is simply how the brain is working and it is not a voluntary decision.
I never meant to trivialize identity by comparing to handedness, but it works.

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Most people who write letters and make drawings don't use gloves while doing so. Consequently, they leave their DNA on the paper 🤔
@wsj.com

This is literally what we reported would happen. www.status.news/p/skydance-c...

This is what I came to see

Empathic teaching: Making an impact on direct and indirect patient care “What is the left atrium? Or PVCs? Love Josie to Dad.” My 8-year-old daughter had slipped a note under my home office door (Figure 1), not long after I sat down to write about teaching. Apparently, sh...

Short piece on medical teaching.

www.heartrhythmcasereports.com/article/S221...

Be careful with that.

Please be careful with that.

The RNRVAS phenomenon always involves AP/VP with atrial non-capture due to retrograde VA conduction, and when the cycle ends (usually with a PVC), the rhythm reverts to AP/VS with native conduction. This case has the additional finding of VP w pseudofusion/fusion. See other examples below...