Discover and read the best of Twitter Threads about #12leadthursday
Most recents (19)
2/ What do you see on ECG to identify extreme axis deviation?
Negative deflection in lead I + negative deflection in aVF = extreme axis deviation
Negative deflection in lead I + negative deflection in aVF = extreme axis deviation
3/ What about the precordial leads?
Do you notice dominant R waves, S waves, or T-wave inversions?
Do you notice dominant R waves, S waves, or T-wave inversions?
1/ What better way to end off a week of pacemakers and ICDs than recapping and revisiting our #12LeadThursday series!
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2/ Which patients get pacemakers?
Think of 2 big buckets: conduction disease and heart failure
Think of 2 big buckets: conduction disease and heart failure
3/ Let’s start with conduction disease!
Refresh your memory with this past byte - 80 y/o M with hx of CABG…what's the rhythm?
bit.ly/40cAry0
Refresh your memory with this past byte - 80 y/o M with hx of CABG…what's the rhythm?
bit.ly/40cAry0
1/ 🚨NEW PATIENT!🚨 66 y/o M found in his home unresponsive and hypothermic.
What abnormalities do you see in this EKG?
What abnormalities do you see in this EKG?
2/ Did you notice sinus bradycardia? What about intraventricular conduction delay?
Check out this slide with all 5 EKG findings!
Check out this slide with all 5 EKG findings!
3/ With these EKG findings and hypothermia, what else should you order?!
1/ Welcome back to 12-Lead Thursday #MedTwitter !
Let’s get the juices flowing with an EKG! What are the major abnormalities?
Let’s get the juices flowing with an EKG! What are the major abnormalities?
2/ Yes, those are inferolateral ST elevations!
And notice the underlying rhythm of atrial fibrillation
And notice the underlying rhythm of atrial fibrillation
3/ Continuing our patient story, the patient was taken emergently to the cath lab where angiography revealed...
Normal coronary arteries!
Normal coronary arteries!
1/ Good morning #MedTwitter ! It’s time for #12LeadThursday
Let’s jump in– can you decipher the EKG below to find out what’s wrong with this patient’s His-Purkinje system?
Let’s jump in– can you decipher the EKG below to find out what’s wrong with this patient’s His-Purkinje system?
2/ If you thought left anterior fascicular block (LAFB), you were right!
What is the formal criteria for LAFB?!
✅Left axis deviation w/o LVH
✅qR pattern in lead aVL
✅R-peak time in lead aVL of 45 ms or more
✅QRS duration less than 120 ms
What is the formal criteria for LAFB?!
✅Left axis deviation w/o LVH
✅qR pattern in lead aVL
✅R-peak time in lead aVL of 45 ms or more
✅QRS duration less than 120 ms
3/ Why do our patients get LAFB?!
Think fibrosis in the left anterior fascicle! This causes a slowed electrical conduction → EKG findings.
Think fibrosis in the left anterior fascicle! This causes a slowed electrical conduction → EKG findings.
1/ Good morning #MedTwitter, it’s time for another episode of #12LeadThursday! Remember to approach every EKG systematically. Grab your calipers, and let’s dive in!
What are potential causes of this pause?
What are potential causes of this pause?
2/ We can think about pauses in three buckets below. We’ll get into why we think a PAC is causing the pause above, but stop for a moment and consider: what would the EKG look like if AVN blockade or sinus node dysfunction were at play?
3/ In the above EKG, we see the PAC hiding in a T wave! This PAC reset the SA node, and a pause was born!
Before we move on: if the AVN is dysfunctional, how do you differentiate a blocked PAC from a dropped beat?
Before we move on: if the AVN is dysfunctional, how do you differentiate a blocked PAC from a dropped beat?
1/ It’s Thursday, #MedTwitter, which means it’s time to take out your calipers and get to business. It’s #12LeadThursday!
Remember to use your system to go through each and every ECG methodically.
Remember to use your system to go through each and every ECG methodically.
2/ Rate: ~75bpm
Rhythm: NSR
Axis: ...
Rhythm: NSR
Axis: ...
3/ Do you have a schema or framework for thinking about a right axis deviation? What’s your differential?
Let us know in the comments below, and check out the framework we’ve provided!
Let us know in the comments below, and check out the framework we’ve provided!
1/ Welcome back, #medtwitter, to the latest installment of #12LeadThursday - #covid19 edition! Let’s put those calipers to work!
Take a look at this ECG. Approach it systematically. What do you see?
Take a look at this ECG. Approach it systematically. What do you see?
2/ In the above ECG, you’ve got an irregular narrow complex tachycardia. What’s your final read? Reply with your reasoning!
3/ Let’s take a closer look. In the graphic below, we’ve highlighted what you would expect to see in flutter - and none of it is present here. Our patient is fibbin’ away, folks.
1/ Goood morning, #medtwitter! It’s #12LeadThursday, and you know what that means!
Remember to approach each and every EKG systematically. Grab your calipers, and let’s get started!
First off, what do you see?
Remember to approach each and every EKG systematically. Grab your calipers, and let’s get started!
First off, what do you see?
2/ For those of you who spotted the prolonged QT, how did you spot it? Do you have a preferred formula for calculating the QTc?
For our previous post on TDP/PVT, click the link: coreimpodcast.com/2018/03/08/60m…
For our previous post on TDP/PVT, click the link: coreimpodcast.com/2018/03/08/60m…
3/ All of us have used the Bazett formula, even if we’ve never seen it before - this is what the computer uses to spit out a QTc at the top of your printout.
Now, what’s your differential for prolonged QT? How do you prioritize that ddx given the patients HPI and PMH?
Now, what’s your differential for prolonged QT? How do you prioritize that ddx given the patients HPI and PMH?
1/ Goooood morning #medtwitter!
It’s #12LeadThursday, which means it’s time to bust out your calipers and get to work.
Here’s your tracing, and remember: you have a system. Use it!
It’s #12LeadThursday, which means it’s time to bust out your calipers and get to work.
Here’s your tracing, and remember: you have a system. Use it!
3/ Brugada! The eponym comes from not one not two but three brothers who have published papers on the characteristic ECG findings and underlying genetic mutations that cause the syndrome, the first of which came out in 1992.
1/ Happy #12LeadThursday!
Practice your skills and take a swing at our latest EKG. What’s the diagnosis?
Use your system:
🔘Rhythm
🔘Rate
🔘Axis
🔘Intervals
🔘Morphology
#FOAMEd #cardiotwitter #medtwitter
Practice your skills and take a swing at our latest EKG. What’s the diagnosis?
Use your system:
🔘Rhythm
🔘Rate
🔘Axis
🔘Intervals
🔘Morphology
#FOAMEd #cardiotwitter #medtwitter
2/ We’re mixing it up today: we’ve got one finding that’s a throwback to a previous #12LeadThursday, combined with a new finding that’s a little more specific.
Low voltage + electrical alternans = ?
Low voltage + electrical alternans = ?
3/ Remember, specificity = true negatives / (true negatives + false positives). Highly specific findings rarely produce false positives, so you can be pretty sure this 🚴🏽♀️ has developed tamponade physiology.
What do you do next?
What do you do next?
1/ Feeling low energy today? Need a late afternoon pick-me-up? This week’s #12leadthursday should elevate your heart rate!
#FOAMEd #Cardiotwitter @smithECGBlog @ecgrhythms
#FOAMEd #Cardiotwitter @smithECGBlog @ecgrhythms
2/ Stop! Differential time! What can cause a low voltage ECG?
3/ It’s helpful to think about WHY the voltage is low - you don’t have to memorize the differential; rather, it can follow logically from your reasoning.
1/ Happy #12LeadThursday!
Here’s a chance to practice your skills. Make sure you don’t miss a beat...or drop one 😜
Step 1:
🔘Rhythm
🔘Rate
🔘Axis
🔘Intervals
🔘Morphology
#FOAMEd #cardiotwitter #medtwitter
Here’s a chance to practice your skills. Make sure you don’t miss a beat...or drop one 😜
Step 1:
🔘Rhythm
🔘Rate
🔘Axis
🔘Intervals
🔘Morphology
#FOAMEd #cardiotwitter #medtwitter
2/ Is this what you identified?
If yes: good work! What’s your ddx? What additional history do you want?
If no: take a moment to review the ECG. What did you get right? Where did you go wrong? If it hurts, good; that’s what learning feels like!
If yes: good work! What’s your ddx? What additional history do you want?
If no: take a moment to review the ECG. What did you get right? Where did you go wrong? If it hurts, good; that’s what learning feels like!
3/ Major development!
Take a moment to refine your ddx.
What’s your next step?
Take a moment to refine your ddx.
What’s your next step?
#12leadthursday: 80M with hx #CABG with progressive decreased ET
Quiz urself before scrolling down! ✔️
What’s the rhythm? 🤔
What would you do next? 🤔
#FOAMed #cardiotwitter #MedEd
Quiz urself before scrolling down! ✔️
What’s the rhythm? 🤔
What would you do next? 🤔
#FOAMed #cardiotwitter #MedEd
Another #12LeadThursday, another EKG puzzle to keep you thinking until the weekend. #cardiotwitter #EKG #ECG #medtwitter
It's #12leadthursday-- time to test those #cardio skills! Look out for answers tonight so you don't miss a beat ☺️ #FOAMed #cardiotwitter
