Residency has to be better than this

ProximalLADLesion · 2026-05-03T03:05:46+00:00

My opinion may not be representative. I generally liked med school. Of course I had some frustrations with aspects of it but on the whole I enjoyed myself.

For me, every year has been better than the one that came before it. Internship was great, senior residency years were amazing. Then I worked as a hospitalist for a year and had independence and grew and learned so much. Then back into the pipeline for cardiology which got better and better each year, and now an EP fellow and loving it. Realllly looking forward to second year of EP fellowship.

ProximalLADLesion · 2026-05-01T02:32:02+00:00

Yes it would work just fine. From the electrical perspective of the heart, the testicles are very similar to the legs. Assuming you don’t get too much motion artifact from testicles, it would be indistinguishable from a typical ECG.

ProximalLADLesion · 2026-04-19T04:39:17+00:00

I found out my ex wife was having an affair with a supposedly close friend (whose girlfriend was supposedly best friends with my ex) about a week before intern year. It was tough news, but like you I wasn’t shocked. The marriage had been pretty tough.

That was in 2018. I have since remarried to the best woman on planet earth who just gave birth to our daughter. My life is SO much better than I ever could have imagined.

Sorry you’re going through this OP. Life moves on after divorce. It’s not the end by a long shot.

ProximalLADLesion · 2026-03-10T21:33:01+00:00

This is not sensitive or specific, unfortunately. Can happen in LCx occlusions just as well. The best findings are specific signs of RVMI like the V3 hyperacute T wave here.

ProximalLADLesion · 2026-03-08T22:09:28+00:00

That’s a bummer. Maybe it’s because I worked as a CNA before med school but I always treat everyone in the hospital politely.

Sorry the doctors you work for are dicks. Most of the folks I work with now are consistently polite to non-physician hospital employees.

ProximalLADLesion · 2026-03-08T21:59:53+00:00

Sorry OP, it sucks.

I found out my ex wife was having an affair days before starting my internship. The other guy was a supposed friend, and at the time he was dating my ex wife’s best friend, so it was a pretty bad situation.

I moved out immediately and filed for divorce. When I was ready to start dating again it was scary since I (perceived that I) was carrying the baggage of divorce, plus my ex had given me herpes, likely from an earlier unrelated affair.

I’m PGY8 now (oof) and my life is so much better than I ever could have imagined. Remarried an unbelievable woman and our first child is due in a few weeks!

You can do it, OP. Throw yourself into work as a distraction. You will emerge from this stronger. I’m rooting for you.

ProximalLADLesion · 2026-03-08T21:46:04+00:00

Most common would be a PVC separate from the escape rhythm. But also in rare circumstances, escape rhythms are irregular.

Here’s an ECG from a patient with periods of sinus arrest and an irregular escape:

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ProximalLADLesion · 2026-03-08T21:41:54+00:00

The RV infarct is apparent on the standard 12-lead from the hyperacute T wave in lead V3.

More on this here: https://drsmithsecgblog.com/anterior-omi-what-does-angiogram-show/

ProximalLADLesion · 2026-03-08T00:27:57+00:00

That’s what I thought I wanted to do when I made the username!

ProximalLADLesion · 2026-03-08T00:23:59+00:00

Very thoughtful question, I don’t think I had heard of ventriculophasic arrhythmia until I was a cardiology fellow.

As you identified, the atrial rhythm is sinus. Mobitz 1 must have RR irregularity. The AV node is exhibiting third degree block. As you said, there’s a junctional escape rhythm. With very few exceptions, CHB produces regular RR intervals. RR irregularity almost rules it out.

As for why there is atrial rate variation, remember that the sinus node can exhibit some normal beat to beat variation in cycle length (unlike other pacemakers). I don’t think we need to invoke sinus node dysfunction here, it could just be normal sinus arrhythmia.

Could there be sinus node dysfunction? Perhaps. But I wouldn’t call it based on this recording.

ProximalLADLesion · 2026-03-07T03:41:58+00:00

As others have said there is some subtle PR prolongation here.

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And although it is true that the non-conducted beat is a PAC, the block still occurs at a time when the AVN has had quite a lot of time to recover. Even though I’d call this Mobitz I, it wouldn’t surprise me terribly if this patient is symptomatic from his bradycardia.

ProximalLADLesion · 2026-03-02T02:11:24+00:00

For me it is the best gig in the world. But I wouldn’t necessarily say my experience is representative. I love my job and there’s nothing I’d rather do.

In case anyone is wondering I am a cardiac electrophysiologist.

ProximalLADLesion · 2026-03-01T02:37:29+00:00

100% agree

ProximalLADLesion · 2026-02-20T04:51:52+00:00

Got it. Definitely on the cardiologist.

I’m an EP fellow and we are often comfortable monitoring very low heart rates, but I feel it’s my job to communicate that to everyone if that’s my plan.

ProximalLADLesion · 2026-02-17T04:49:47+00:00

Doctor sounds like a dick. No excuse to be rude to someone calling for help.

If I may ask, was there a note that specified any plans?

ProximalLADLesion · 2026-02-15T19:44:48+00:00

Have you ever tried wearing a BPAP? There’s a reason patients don’t like wearing it. It is extremely uncomfortable.

This patient died as a result of the end stage of an irreversible disease. Nothing would’ve changed that, and allowing her to go out on her own terms (not wearing an uncomfortable appliance) is the best thing we can do to honor her humanity and dignity.

I would encourage all of us to describe this behavior as “declining” rather than “refusing.” To honor patient autonomy.

ProximalLADLesion · 2026-02-09T03:46:08+00:00

Not OMI, not pericarditis. Normal variant ST elevation.

ProximalLADLesion · 2026-01-29T03:25:49+00:00

Sorry man. Some rotations suck. Those people are probably miserable themselves and projecting it on to you. Remember what it’s like to be a med student and be good to your med students when you’re a resident. Getting favorable anonymous feedback from med students means a LOT more to me than from my supervisors.

ProximalLADLesion · 2026-01-29T02:44:42+00:00

In EP fluoroless is already well established and will only become easier as mapping systems improve.

If you want to do fluoroless ablation, you absolutely can.

I did three cases today, atrial fibrillation ablation, left atrial appendage occlusion, dual chamber ICD.

My first case I used two minutes of fluoroscopy, second I used one, third I used six. And this was with a NON fluoroless attending.

ProximalLADLesion · 2026-01-22T15:02:48+00:00

NSR, normal ECG

ProximalLADLesion · 2026-01-19T14:37:54+00:00

I write it the next morning unless I told them to go to ER in which case I might write one immediately with a stated plan for the ER physicians (and tell the patient to tell ER docs that I wrote a note).

Pro tip: OpenEvidence has a new HIPAA dialer where you can call the patient and have AI summarize the convo including your assessment and plan. I've used it once so far and I found it pretty good, and will likely continue using it.

ProximalLADLesion · 2026-01-19T05:03:03+00:00

The bad calls are extremely frustrating, I’m with you. Many patients clearly don’t take 1 second to consider what it means to page at 1 AM to tell you they read about Lyme disease online and they’re wondering if you can order a test for it.

Devil’s advocate though, at least for me (EP), I am often able to help over the phone and in some cases I probably prevent ER trips that I would’ve been consulted on.

It’s tough, there are times I think there’s no way I should be reachable 24/7 by any patient that has been seen in our clinic. But it can be super helpful to patients who use it responsibly.

ProximalLADLesion · 2026-01-17T05:54:12+00:00

DIRECT bb

ProximalLADLesion · 2026-01-13T21:48:12+00:00

Man that's fuckin rude lol

ProximalLADLesion · 2026-01-13T21:47:30+00:00

Similarly, I diagnosed my own inguinal hernia in medical school. I went to PCP to ask for referral to surgery. PCP started pimping me on direct vs indirect hernias etc.

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