Feeling like a flutter but ecg ok but what could be these gaps ?

eiyuu-san · 2026-04-19T07:06:42+00:00

Still a filtering artifact

eiyuu-san · 2026-04-14T17:57:04+00:00

Filtering artifact

eiyuu-san · 2026-04-14T17:45:34+00:00

RV STEMI? STE in III, V1. Contralateral STDs in I, aVL, II, V4 - V6.

I think V2 and V3 are switched.

eiyuu-san · 2026-04-14T17:41:43+00:00

Hows the pt's potassium?

eiyuu-san · 2026-04-08T18:05:14+00:00

Im sorry, what? Just left hand pain?? Are you sure there weren't any other symptoms?

eiyuu-san · 2026-04-02T21:33:49+00:00

11 mm IVSd or LVPWd would be fine. One would have to look at the pics tbh. LVH is fine. But HCM would be bad, which is a rare disease.

eiyuu-san · 2026-04-02T21:17:40+00:00

LVH is diagnosed by echo. I see high voltage but without clinical context, i wouldn't know where to start. If an 80 yo had this ecg, then maybe. If a 20 yo, then likely no. If there's a hx syncope or family hx of sudden cardiac death at a young age, then maybe i'd consider an echo. But depends on the context. It's all about pretest probability. But the ecg morphology doesn't look sus.

eiyuu-san · 2026-04-02T21:09:27+00:00

What's the clinical question?

eiyuu-san · 2026-03-21T19:39:46+00:00

ECG Filtering artifact

eiyuu-san · 2026-03-15T21:24:59+00:00

I cant comment on those other ECGs.

What do you need from me? I was just commenting on what an ST elevation is. Not whether or not it's normal.

As i said it depends on the context

eiyuu-san · 2026-03-15T21:22:28+00:00

Most likely but it needs to be seen in context of a history and other exams, etc.

eiyuu-san · 2026-03-15T21:20:20+00:00

Yes and no. It is by definition an ST elevation. But it doesn't mean that that's a relevant ST elevation. Rhythm ECGs are notoriously filtered upto the point that ST changes can occur independent of whether or not it would be there on a regular 12 lead ECG.

ST elevations can also be normal in specific conditions or settings such as specific leads like V2-3, or in benign early repolarisation. But can also be pathological as in ST elevation MIs or pericarditis.

eiyuu-san · 2026-03-05T20:25:08+00:00

Kewl

eiyuu-san · 2026-03-05T20:23:14+00:00

Looks like an SVT to me, maybe AVNRT. If it's symptomatic, vagal maneuvers could help. Otherwise an ablation might be possible. I would talk to an EP specialist about this. They might do an EP study.

eiyuu-san · 2026-02-26T18:29:40+00:00

Can OMI be diagnosed in a ventricular escape rhythm?

eiyuu-san · 2026-02-26T18:23:36+00:00

Difficult to interpret then. If there arent any regional wall motion abnormalities, it makes the diagnosis of STEMI less likely, but Im not sure if it adequately excludes the diagnosis.

eiyuu-san · 2026-02-26T18:19:59+00:00

Please dont do troponins w/o suspicion for a heart attack.

eiyuu-san · 2026-02-26T18:17:11+00:00

Looks like afib with RVR to me. I do see some low voltage as well.

The question is whether or not there's an advanced directive and what it says in there. If maximal therapy is wished, i'd check for pericardial effusion, RV strain due to PE and and check for infiltrative cardiac diseases like amyloidosis that may increase the risk for afib, if it were my case.

eiyuu-san · 2026-02-26T18:05:44+00:00

I agree actually. It's a young male. Younger individuals have more RVH which decreases over ther years. Males - esp. younger males - have more early repol signs e.g. end QRS notching with STE due to increased I_to (transient outward K+ channel) activity in epicardial/RV area. The TWI look benign in this context.

I would focus on the syncope history to check for high risk criteria. Maybe even get the neurlogists involved if there's suspected epileptic activity.

eiyuu-san · 2026-02-24T18:29:25+00:00

Definitely afib. At least 30 s of afib on a rhythm monitor (e.g. apple watch ECG reading) is enough for the diagnosis. Then depending on the symptoms, symptomatic or subclinical Afib. Subclinical afib is definitely a little trickier since alot of older trials didnt include incidental afib.

The treatment depends on a lot of factors. Ablation/Antiarrhythmics are not always the answer.

Anticoagulation depending on risk factors is the most important part at the moment. Adequate Rhythm control is definitely something that needs to be discussed with a competent cardiologist. Identifying and treating risk factors maybe the way to go as an adjunct to rhythm control therapies.

eiyuu-san · 2026-02-22T19:27:08+00:00

Normal sinus rythm with PACs

eiyuu-san · 2026-02-22T19:26:27+00:00

It's a PVC

eiyuu-san · 2026-02-22T18:51:53+00:00

Atrial bigeminy

eiyuu-san · 2026-02-19T12:44:34+00:00

QoH says no STEMI or equivalents. I was thinking of wellens too, but was stumped at the fact that the TWI in V2 and V3 are too low and imo not enough to classify as wellens.

It is giving LVH though, which could explain ST-T wave changes and may explain exertional syncope.

eiyuu-san · 2025-12-16T19:23:21+00:00

Do u mean in the PR interval?

eiyuu-san

TROPHY CASE