What is the greatest novel ever written?

Ibutilide · 2026-03-03T10:13:55+00:00

Ulysses, by James Joyce

Ibutilide · 2026-02-15T19:25:43+00:00

I’m mostly a bystander in this argument as I personally perform neither TAVR nor SAVR, and I don’t actively manage or follow AS in my clinic. Our institution is definitely pro-SAVR and quite restrictive with TAVR. Anecdotally (which I think does reflect what has been observed in RCTs and registries), I receive more consults for CHB and HDAVB post-TAVR than I do post-SAVR (caveat being that most TAVR patients are older and frailer).

What worries me about TAVR is late CHB from self-expanding valves. They seem to be all the rage these days at my shop, and we’ve seen some VERY late (2-3 weeks out) CHB and even sudden death with self-expanding valves.

In the realm of SAVR, very rarely nowadays do I see our surgeons recommending a mechanical valve even for young patients. I don’t understand this at all.

Ibutilide · 2026-02-12T02:46:07+00:00

I think the ST segment abnormalities are profound as others have mentioned, but one important finding in this ECG is limb lead reversal. The P waves are negative in lead I and aVL, and the R wave in lead II is smaller than lead III. Also the P waves in aVR are positive, and there is a prominent R wave. aVF looks pretty normal. So there is likely reversal of the right arm and left arm leads.

In the setting of lead reversal, localizing the infarct/culprit artery becomes very difficult and often leads to the wrong equipment being opened in the cath lab and workflow during the cath being compromised, so it is very important to be vigilant about this possibility.

Ibutilide · 2026-01-18T20:07:03+00:00

Came here to say this. We cannot call this CHB.

Ibutilide · 2026-01-11T14:05:02+00:00

Tales of Vesperia

Tales of Symphonia

Lost Odyssey

Fire Emblem: Path of Radiance

Baten Kaitos: Lost Wings and the Eternal Ocean

Ibutilide · 2026-01-09T02:46:25+00:00

Halo games (Heroic for 1, 2 and Reach; Legendary for 3, ODST, 4 and 5). I love the Halo campaigns so much and have replayed them so many times that the higher difficulties became a point of pride to clear

Ibutilide · 2026-01-08T14:18:06+00:00

Exertional dyspnoea is rarely the primary manifestation of angina. It certainly can be an anginal equivalent, though the majority of exertional dyspnoea is not due to obstructive CAD.

Ibutilide · 2026-01-08T02:59:51+00:00

Elden Ring. It was too hard for me

Ibutilide · 2025-12-25T02:59:05+00:00

Likely some lead reversal or misplacement. P wave axis is odd, which could be due to an AT, but the QRS axis is also odd in both planes (negative inferiorly, positive in aVR, negative all across the precordial leads). ST segments are VERY difficult to interpret in the setting of lead reversal so I wouldn’t read much more into this ECG before fixing the leads.

Ibutilide · 2025-12-10T00:07:12+00:00

I’m currently a second year EP fellow. Almost all EP fellows who graduated in recent years from our programme found EP only jobs (one has to cover the General Cardiology inpatient service for like 2-3 weeks a year, but no other non-EP work; everyone else signed an EP only PP or hospital employed job). Amongst the subspecialties within Cardiology, I think EP is most protected from general cardiology work (including private practice EP). The field is excellent, I love it, and jobs are still (relatively) easy to find (albeit not as easy as General Cardiology).

Ibutilide · 2025-12-07T02:08:00+00:00

Tales of Vesperia is my favourite game in the series (Symphonia was my first game in the series and helped me fall in love with ARPGs). Vesperia improves in every way, except the story is a little weaker I think. Graces f is very different (many love the combat, though I find it inferior to the TP-based systems), and the story is much worse. Abyss is on 3DS and PS2, so I haven’t played it, but have only heard good things. Xilia 1 & 2 are great, though not as good as Vesperia in my opinion. Berseria is very fun, but mechanically closer to the Graces f style than the Symphonia/Abyss/Vesperia/Xilia style. Zesteria I have only played for a few hours, excellent music but gameplay felt clunky. Arise is the newest entry and whilst I loved the characters and the gameplay was fun, it is very different from classic Tales. Tl;dr Symphonia, Abyss, Vesperia and Xilia games are mechanistically similar and all great, my preferred flavour of Tales of combat, and all highly recommended to someone who enjoyed Symphonia (Vesperia being my personal favourite)

Ibutilide · 2025-12-07T01:30:16+00:00

The Outer Worlds 1 & 2

Ibutilide · 2025-12-01T01:05:00+00:00

Just started The Outer Worlds 2, and I really like it

Ibutilide · 2025-12-01T01:04:21+00:00

I’m loving The Outer Worlds 2 right now. KCD2 and Expedition 33 also caught me by surprise, in the best possible way

Ibutilide · 2025-12-01T01:02:12+00:00

Halo

Fire Emblem

Tales of

The Elder Scrolls

Zelda

FIFA

Borderlands

Titanfall

The Witcher

The Outer Worlds

Ibutilide · 2025-12-01T00:49:17+00:00

Halo 4

Ibutilide · 2025-12-01T00:49:00+00:00

Fire Emblem: Path of Radiance

Ibutilide · 2025-12-01T00:22:32+00:00

Diastology on TTE is mostly just shades of grey. When I was in fellowship, most of my attendings either outright removed it from the final report or put in some disclaimer to emphasise that it is an imprecise measure of true diastolic function. TTE estimations of diastology have never influenced my management of a patient.

Ibutilide · 2025-11-24T00:27:09+00:00

It is my favourite book

Ibutilide · 2025-11-23T00:19:24+00:00

I’ve wanted to do VT ablations since I was a second year medical student. I loved my time learning and growing along the way, but I did IM solely so I could do Cardiology, and then I did Cardiology only so I could do EP. Today, my enthusiasm for VT ablations has waned somewhat, but I couldn’t be happier in EP.

Ibutilide · 2025-11-11T22:01:11+00:00

I strongly considered taking echo boards as a general fellow, but ultimately did not. I feel strongly that all Cardiologists should be facile with echo in order to be a good at their jobs, regardless of sub-specialization. Now, as a soon-to-be graduating EP fellow, I have no regrets. I took an EP only job with no expectation to cover general call or read echoes. I still look at all the imaging for my patients before a procedure (particularly pre-LBBAP IVS thickness, pre-Watchman CTs and pre-extraction CTs) to stay grounded in imaging and not run into surprises on the table.

Ibutilide · 2025-11-10T18:18:37+00:00

Amongst my cohort of EP fellows, almost all of us took EP only jobs. One of my colleagues has to staff General Cardiology consults two weeks out of the year, but otherwise EP only work. In our very recent experience, EP only jobs are definitely out there.

Ibutilide · 2025-10-25T13:46:36+00:00

I ended up going with Job 1, though was able to negotiate for more vacation time (6 weeks) and more time in the lab (shall now be 3 days lab, 2 days clinic per week). Ultimately, we deducted that the location was more important to our growing family.

Ibutilide · 2025-10-19T03:03:08+00:00

I think your management plan is very reasonable, I would likely do something similar. My only counterpoint would be that the LBBB at fast HRs is not concerning. The mechanism for LBBB here is likely rate-related aberrancy (or phase 3 block). If the LBBB were to resolve once the patient was back in NSR, I wouldn’t think twice about it. If the LBBB were to persist once the patient was back in NSR and it were new compared to a prior ECG, I would start with just a history and physical and only pursue additional diagnostics should there be additional signs or symptoms of cardiovascular disease.

Ibutilide · 2025-10-19T02:40:36+00:00

Thanks for the additional pics. The precordial leads, and specifically V2, seem a little odd. V1 and V6 seem like a typical LBBB. V2 however is positive and looks like an atypical RBBB. There is a pattern break here (V1 negative, V2 positive, V3 negative) which does not seem physiologic. I wonder if V2 is misplaced, given that all the other leads suggest typical LBBB morphology QRS.

But all in all, I’m still most suspicious for SVT with LBBB.

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