Willy Frick

Even with AI technology, clinical judgement remains essential.
This ECG shows a lot of ST elevation, and the sophisticated AI ECG interpretation also points towards acute occlusion, but just barely.
Activate the lab?
@willyhfrick.bsky.social
drsmithsecgblog.com/stemi-positi...

Another explanation for the ECG, which appears to be missing some retrograde P waves?

@narrowqrs.bsky.social @shah.md @danacjohnson.medsky.social @jeffreyvinocur.bsky.social @alexturinmd.bsky.social

Do #EPeeps believe in AVNRT upper common pathway (block)?

This patient had:
1. AH jump
2. Septal VA < 80 ms
3. Concentric A during SVT
4. During RVP: (Stim-A)-(V-A) > 85 ms
5. During RVP: PPI-TCL > 115 ms
6. SVT terminated by RV burst pacing
7. Ablation in TOK rendered non-inducible

Ablation in this location was successful.

Arrhythmogenic cardiomyopathy, epicardial access. Pacing from ablator.

@narrowqrs.bsky.social @shah.md @jeffreyvinocur.bsky.social @danacjohnson.medsky.social

#EPeeps

Now I'm really ready to start fellowship. ⚡⚡⚡

#EPeeps

hqmeded-ecg.blogspot.com/2025/06/ante...

Does the culprit match?

#ECGSky #Medsky #cardiosky

Strictly speaking we try to avoid pacing asymptomatic patients

Yeah I was surprised. This ECG is years ago and he actually still does not have a pacemaker!!

But then how will I know to give six units of FFP for rebalanced coagulopathy of cirrhosis 😉

Does the constancy of the PVC coupling interval suggest triggered mechanism?

#ECGSky #MedSky #CardioSky

@jeffreyvinocur.bsky.social @narrowqrs.bsky.social @shah.md @danacjohnson.medsky.social @daverichley.bsky.social @alexturinmd.bsky.social

Interns are not (yet) poisoned by the STEMI/NSTEMI paradigm Emergency cardiac care, cardiology, EKGs, ECGs, electrocardiography, echocardiography, dysrhythmias, arrhythmias, STEMI, NonSTEMI, NSTEMI, cardiology

I’m very proud of Dr. Lin for his first post on the blog.

#ECGSky #MedSky #CardioSky

Read our editorial at the link below!

www.termedia.pl/Occlusion-my...

#ECGSky #Medsky #cardiosky

@ecgcases.bsky.social

My EP attending says EPs invoke superconduction and concealed conduction when they don't know what is happening 😂

I'm open to different interpretations for the changing QRS axis. I shared the ECG with a few folks and not everyone was convinced by that. What do you think explains the axis shift?

Jerry, thanks for all your detailed thoughts! Agree re: lead I, most of what I said was geared at skepticism from one person I shared the ECG with so I thought others might have similar skepticism.

What happens when a clinic does not have troponin testing for chest pain patients? Stress testing? Emergency cardiac care, cardiology, EKGs, ECGs, electrocardiography, echocardiography, dysrhythmias, arrhythmias, STEMI, NonSTEMI, NSTEMI, cardiology

#ECGSky #MedSky #CardioSky

Multilevel block in the atrioventricular node during atrial tachycardia and flutter alternating with Wenckebach phenomenon. The electrocardiograms of 100 patients with rapid and regular PP intervals during atrial arrhythmias (because of atrial tachycardia or flutter, or pacing) were examined for periods of irregular atriov...

I thought I had read this somewhere but I checked to make sure I wasn't just making stuff up. It was not actually from the Kosowski paper (which I thought is where I read it), it's from this one.

heart.bmj.com/content/42/4...

And now for something completely different (a very difficult electrophysiology case) Emergency cardiac care, cardiology, EKGs, ECGs, electrocardiography, echocardiography, dysrhythmias, arrhythmias, STEMI, NonSTEMI, NSTEMI, cardiology

How many findings can you name?

#ECGSky #EPeeps #cardiosky #medsky

I also saw the rhythm start and stop with PVCs.

And this? Premature but with unchanged morphology. Concealed fusion with nearby PVC? Wobble feels unsatisfactory since cycle length is otherwise stable.

@narrowqrs.bsky.social @danacjohnson.medsky.social @shah.md @jeffreyvinocur.bsky.social @alexturinmd.bsky.social @daverichley.bsky.social

Help.

60M with severe ischemic cardiomyopathy, prior inferoposterior OMI.

Overall impression is VT with fusion complexes. But...fusion with what? I thought supraventricular capture at first, but I am leaning more toward fusion with unrelated PVCs now.

I can't figure out an elegant explanation for the intermittent aberrancy.

Anyone?

#ECGsky #Medsky #cardiosky #EPeeps

I’ve noticed this on Instagram as well.

Discussed with some rhythm friends, not everyone is convinced by superconduction. Thoughts?

Including a prior sinus-ish tracing for comparison.

@danacjohnson.medsky.social @narrowqrs.bsky.social @shah.md @jeffreyvinocur.bsky.social @alexturinmd.bsky.social @daverichley.bsky.social

My interpretation: Reverse typical flutter with dual level AVB as shown. Native complexes conduct with LAFB. R2 is Ashman beat. R4, R6 with superconduction through LAF. R8 unclear? Possible superconduction through a subdivision of LAF?

So much to see here!! What explains the various QRS morphologies?

#ECGsky #cardiosky #EPeeps #medsky

I always thought it's hard to give people interested in EP a "taste" of what it's really like to know if they'd be interested. So far, your videos are by far the best resource I know of for interested trainees.

VT Entrainment Mapping of Scar/Reentry VT YouTube video by Dr. Joshua Cooper - Arrhythmia Education

VT entrainment.
Some of you want to learn it from the beginning.
Some just want the punchline.
Here's a direct link to the climax of the video, with examples of all the possible entrainment locations (isthmus, entrance, exit, bystander, outer loop, etc)
youtu.be/XykkZNLm9bc?...

Answer: This is sinus tachycardia with complete heart block. Attach transcutaneous pacer pads and begin pacing at high output. Continuing CPR will do nothing for this, and he will always be pulseless at pulse check.

This is why PEA can be a dangerous “diagnosis.”

🤦‍♂️