Discover and read the best of Twitter Threads about #EPeeps

Most recents (24)

17 year girl with history of recurrent brief fainting episodes (> 8) preceded by palpitations & "anxiety". Normal vitals + physical exam on arrival at the ED.
Dismissed as panic attacks by multiple doctors, her first ever ECG.

Would you diagnose the same?
#MedTwitter Consent ✅ Image
Her ECG shows short PR intervals with slurred upstroke on the QRS complexes: Delta waves - signifying the presence of an accessory pathway which may lead to aberrant conduction & electrical "short circuits"
This is NOT a panic attack.
This is Wolff-Parkinson-White syndrome (WPW). ImageImage
Pre-conceived anchoring bias and subsequent dismissal in clinical practice of medicine is not just #gaslighting, but also causes harm.

#FOAMed #meded #CardioTwitter #EPeeps #MedStudentTwitter @EM_RESUS
Read 4 tweets
#EPeeps #ablatevt Another week another VT. Unstable induction requiring shock and CPR so case relied on functional map. S2 DEEP map shows a much more focused channel for ablation vs. sinus/paced and correlates with ADAS pre imaging. Voltage map pretty futile. See thread for EGMs
#EPeeps #ablatevt Paced vs. DEEP EGMs highlighting Hidden Slow Conduction and area of block above and below a focused channel
#EPeeps #ablatevt Focused ablation targeting DEEP channel and also correlating with border zone on ADAS pre imaging.
Read 3 tweets
Puh, du sollst mal schnell deinen ersten Ajmalin Test machen 🤔
#YoungCardiologists #Epeeps, don't panic, hier sind die wichtigsten key-facts 🔑

@YoungDgk @YoungDZHK @AGEP_DGK @AGIKinterv @sebFeickert @DjawidHashemi @jochen_dutzmann @DavidDuncker @KardiologieHH @realdocdan
1/5 - Vorbereitung
- Aufklärung ✅
- 6 h nüchtern ✅
- Monitoring (Reanimationsbereitschaft, Defi) ✅
- 12-Kanal-EKG ✅
2/5 - Durchführung
💉 Intravenöse Injektion von Ajmalin 💉
1 mg/kg Körpergewicht über 10 Minuten unter kontinuierlichem EKG-Monitoring 📺!
Read 7 tweets
1/ Had a great time writing this @EPLabDigest article with @DrCJBradley

2️⃣ different perspectives (IC And EP) using different devices (watchman/ amulet) for LAAC in the community center.

Let’s take a dive into two different LAAC programs #Tweetorial
2/ #LAAC has come a long way over the past few years and now we have two main players in the space

🔸 @bostonsci #watchman
🔸 @AbbottNews #Amulet

Both are very effective and each has pros/cons

My center focuses on Watchman FLX while @DrCJBradley center focuses on Amulet……
3/ Historically #EPeeps has taken the driver seat in this space (rightfully so) due to experience with the LA/transeptal. HOWEVER the new gen #IC/structuralist have become a vital part of the team.

#LAAC programs require:
🧑🏼‍⚕️Anesthesiologist/Cath lab team……
Read 24 tweets
When your ER colleague calls you to have a quick look on an #ecg … the 28 yo pat reports frequent episodes of palpitations since childhood that he can usually terminate with deep breathing. #Epeeps @EPeeps_Bot #CardioTwitter know what’s going on. Do’s and Don’t’s?…
10 min after giving 2mg/kg body weight Flecainid iv.…
And 2 hours later
Read 4 tweets
🫀⚡️CTI-Blockade bei rechtsatrialemp #Vorhofflattern war eine meiner ersten eigenen Prozeduren in der EP und bleibt bis heute eine faszinierende Untersuchung.

Doch wie war das nochmal mit dem Flattern und dem CTI - ein kleiner 🧵, nicht nur für #EPeeps

#FOAMed #CardioTwitter
Rechtsatriales Vorhofflattern basiert auf einem Makroreentry im rechten Vorhof und rotiert entweder gegen den ⏰ („typisches Vorhofflattern“) oder mit dem ⏰ um den Trikuspidalklappenannulus (TKA).
Der Begriff Makroreentry beschreibt eine kreisende elektrische Aktivierung rund um ein großes Hindernis, den TKA – schön zu erkennen im elektroanatomischen Map ⬆️👆🏻
Read 10 tweets
Fabry's CM is an X-linked inherited deficiency of alpha-galactosidase A which results in systemic sphingolipid accumulation.
Severity of manifestation depends on degree of X-chromosome inactivation => female carriers can have a wide range of phenotypes!…
This 67 yo pt presented with severe HCM phenocopy and strong family history of confirmed Anderson-Fabry's CM. She was determined to have a GLA mutation and successfully started on treatment with Fabrazyme.
Note the diffuse asymmetric LVH (wall thickness 24mm) with marked apical hypertrophy (30mm). Despite normal LVEF, her GLS was markedly reduced at -5.8%. CMR demonstrated 20% LGE and short T1 time (indicative of fat accumulation)
Read 9 tweets
From the archives/sent by a friend series
What is the dx
Digitized using #PMcardioApp
Difficulty level:⭐️⭐️⭐️

*65 yo
*h/o HTN
*pw with fatigue

What is your ECG interpretation? Poll next

What is your ECG interpretation?
🐦 ur reply if none of the 4 choices

SB-sinus bradycardia
CHB-complete heart block
SR-sinus rhythm
2AVB-second degree AV block
AHB-advance heart block
Read 7 tweets
From the 📦/📩 by a🫂series @PatSmitty1985
What is the dx
💻 using #PMcardioApp
Difficulty level:⭐️⭐️⭐

▪️16 yo
▪️ -sig ⚕️ hx
▪️p/w sz-like activity/spon recovery ~ 30 s (can't recall event)

What is the prob dx? Poll next

What is the prob dx?
🐦 ur reply if none of the 4 choices

MI-myocardial infarction
SR-sinus rhythm
AJR-accelerated junctional rhythm
isoAVD-isorhythmic AV dissociation

MI inferior wall
SR, AJR (isoAVD)
Pulmonary embolism
WPW pattern/syndrome
Tnx for the replies. I think this is the easiest so far & almost everyone got it. Pt was referred to cards coz of WPW. 📩@PatSmitty1985
Read 3 tweets
From the archives/sent by a friend series
What is the rhythm
Digitized using #PMcardioApp
Difficulty level:⭐️⭐️⭐️⭐️

▪️70 yo
▪️h/o DM HTN HF
▪️p/w palpitations

What do you think is the rhythm? Poll next

#EPeeps Image
What do you think is the rhythm?
🐦 ur reply if none of the 4 choices

AF-atrial fibrillation
ST-sinus tachycardia
VT-ventricular tachycardia
AFL/AT-atrial flutter/ atrial tachycardia
This is the ff-up ECG. This is not SR. The 🔑 to rhythm dx is in the PRI (long lead). You need a caliper to 👀 the PR difference. If you have 🦅👀 the extra P can be 👀. So, the ECG case can be explained with 1 reason.

Read 4 tweets
Great experience in my trip to Argentine.The audience was excited. We performed a live CNA case During my visit. Lots of questions arose during the case and my lectures. Here are some misunderstood tips in #Cardioneuroablation🚨Tweetorial alert. @drraviele @CarlChiefCard
1/10 Atropine blocks the effect of the vagus, by blocking muscarinic receptors, we can use it to predict the outcome of #Cardioneuroablation…. @natale_md @mdTolgaAksu @Josefkautzner @piotrowskiroman @pachon_phd @scanav1mauricio @alfieep
2/10 AT is a great tool for the selection of patients, but its effect compromises the study through extra cardiac vagal stimulation #ECVS. We always use it prior to #CNA for patien selection.
Read 25 tweets
Working with @seth_j_worley to create a reproducible, technically "easier" and systematic approach to #VeinofMarshall ethanol ablation for #EPeeps. Advance Preface sheath over CS decapolar catheter and then advance Amplatz Super Stiff to retain wire access.
Use the @MeritMedical Worley Coronary Sinus Guide Jumbo 50 cm size. The 9 Fr inner diameter is key to provide room to easily manipulate balloons, wires, inner guide catheters, etc. #VeinofMarshall is easily identified with RAO 20° cine projection.
The 5 Fr CS Vertebral shape vein selector easily advances through the 9 Fr @seth_j_worley Jumbo sheath to cannulate the #VeinofMarshall with a Boston Choice PT Floppy guidewire.
Read 5 tweets
#EPeeps Brief 🧵 on beta blocker hyperkalemia which is unfamiliar to many

The mechanism is the opposite of why we use albuterol to treat hyperkalemia - beta receptor modulation of Na K ATPase, the sodium potassium exchange channel [1/]

See great diagram from @paulpengmdphd
Beta blockers rarely cause hyperkalemia in isolation, but can contribute in at-risk patients.

The patient who prompted this discussion (see link) had complex multi-system illness. Ectopy was exacerbated by diuretic-induced hypoK so had MRA + scheduled enteral KCl [2/]
One day, because of hypoK on labs, he received IV KCl replacement almost concurrent with scheduled enteral KCl… probably would not have been a big deal, except for propranolol impairing ability to transport extracellular K intracellular [3/]
Read 8 tweets
#EPeeps #FellowsFirst The cardiac ICU calls that they are preparing to cardiovert this wide-complex tachycardia. Do you agree? What may be going on?
#EPeeps Many suggested sodium channel blockade or hyperkalemia

This was BOTH! Severe transient hyperkalemia superimposed on high-dose flecainide

Very complex infant on multiple AADs including high-dose propranolol for intractable EAT

Do you know why the propranolol matters? 👇
See separate thread on hyperkalemia and beta blockers for the conclusion
Read 4 tweets
🧵 on the Algorithmic Localisation of Accessory Pathways from ECG

A concept I’m getting to grips with made easier by a beautiful review by #Crinion & @adribaran in Card Electrophysiol Clinic (PMID 33161996)

#EPeeps #MedEd #Cardiology
🫀Considerations of AP localising algorithms:

A. Only apply to manifest antegrade AP & not concealed AP which conduct retrograde

B. Algorithms focused on atrioventricular AP & not other rarer AP

C. Depend on the degree of preexcitation with

D. Cautions with multiple APs
🩻 Anatomic Nomenclature

- AP locations is described in the LAO view
- Older algorithms use anatomical descriptions derived from the Valentine heart position & not attitudinally correct nomenclature which can be confusing
Read 6 tweets
September is #AFibAwarenessMonth!
A🧵on the basics of #AFib

#ACCEP #EPeeps #CardioTwitter
#AFib is the most common sustained heart rhythm problem in the world. 🌎
#AFib increases the risk of #stroke & #heartfailure. It causes symptoms like fatigue, dizziness & shortness of breath and can reduce patients’ quality of life.
Read 14 tweets

Let's get straight to the point about #INVICTUS

The only people not surprised by the results are imagers that do TOEs (TEEs) on these patients! No way VKA was going to lose to NOACs here!😂

A 🧵...

#medtwitter #cardiotwitter #echofirst #epeeps
Patients with rheumatic MV disease typically have very different atrial appearances on TOE. No matter how well anticoagulated, there is very often spontaneous echo contrast in the LA

These atria are just different...why?

Who is this?
The answer is Ludwig Aschoff (1866 - 1942), German physician & pathologist

He described what are now known as Aschoff bodies - inflammatory infiltrates in the atrial walls that eventually turn to fibrotic tissue, which contributes to the atrial myopathy we see in these patients
Read 18 tweets
🧵 1/7 Ever wondered why the Osborn wave looks the way it does? Stay with me during my newest #tweetorial. A thread 🧵1/7
#cardiotwitter #EPeeps #CardioEd #MedTwitter @TRassafMD @YoungDgk @DGK_org @YoungDZHK @AaronGoodman33 @Steph_Achenbach @fuzzymittens @AvrahamCooperMD Image
2/7 History
First described in 1953 by Osborn (camel-hump sign) upon #hypothermia in dogs. Upon systemic analysis similar #ECG patterns have been described in
➡️ hypercalcemia
➡️ brain injury
➡️ SAB
➡️ vasospastic angina / ischemia
3/7 Emslie-Smith et al showed that Osborn waves manifested more in epicardial than endocardial leads. Others finally showed that 4-aminopyridine sensitive transient outward current (Ito) is responsible and predominantly located in epicardium. ⬇️ heart rate led to ⬆️ Ito current
Read 7 tweets
🧵What does the left atrial appendage do? Is it just a nidus for thrombus?

A brief review of proposed & proven functions of the LAA👇

#CardioTwitter #EPeeps #MedEd
@drpaulfriedman @ChetRihal
#1 LAA plays a very important capacitance role.

Animal studies in 1990s showed:

- LAA is more compliant than LA
- LAA acts like a decompression chamber during systole
- The capacitance/reservoir role is key when LAP is elevated
- Eliminating LAA acutely ⬆️ LA pressure in dogs
- Effect of LAAO on hemodynamics in humans is debatable

- OBS data ➡️ that LAAO ⬆️ LAP, ⬇️ LA transport function, ⬆️ HF

- However, in LAAOS III RCT there was no ⬆️ in HF admissions w LAAO

- Caveat: epicardial closure vs ednocadail plugging of LAA don’t produce similar effects
Read 10 tweets
Another interesting "Bigemini" pattern 😀. #EPeeps #Cardiologytrainees. Try explaining the mechanism and diagnosis? @EPeeps_Bot Image
Is this true bigemini or "pseudo bigemini"? Reason?
The purpose of this post was to highlight a "measurement error". When we measure the RR intervals in wide complexes, always do from the beginnings of the R waves, not the peak. here delay in the later part of the QRS is causing an illusion of a later QRS, but RR is constant.
Read 3 tweets
2/ what is the left atrial appendage?

The LAA is derived from the left wall of the primary atrium (embryo). Its diff from the true LA and its suited to function as a decompression chamber during left ventricular systole and during other periods when left atrial pressure is high
3/ the appendage is like your fingerprint. No two are the same.

Common shapes are:

🥦Cauliflower/Broccoli (hardest)
💨Windsock (easiest)
🐓Chicken wing

#LAAO #Watchman #Structural #Cardiotwitter #EPeeps @EPeeps_Bot @TAVRBot @RadialFirstBot @EchofirstB
Read 25 tweets
Is sex a critical factor for treating #AtrialFibrillation?❤️‍🩹

New #CardiovascularResearch study examines #SexDifferences in calcium handling & therapies in patients with #AFib…

Our tweetorial explains the findings⬇️👩‍🏫

@ESC_Journals @escardio #EPeeps (1/9)
#Atrial #myocytes were isolated from patients with & without #AtrialFibrillation

Sex differences in #risk factors & therapies were considered in the analysis (2/9)
To explore #SexDifferences in the mechanisms of #Afib, calcium handling was examined & calcium handling proteins investigated (3/9)
Read 9 tweets
Tweetorial 1/7
#EPeeps PVs are not only Afib and not only in adults❗️ Here’s the case of LIPV tachy in 13 yo girl.
Lumipoint map with @BSCCardiology and @lydia_merbold #EP_Kiel #cardiotwitter @evgeny_lyan @ThomasDemming
13yo girl, hospital admission with palpitations. 24-h ECG Monitoring reveals episodes of tachycardia with on-off phenomen and HR up to 120 bpm.
Next Step➡️EP diagnostic Image
EP study reveals 2 tachys : AT1 with CL 590ms, AT2 with CL 380ms. Note the same CS activation sequence.
Next Step➡️RA mapping Image
Read 7 tweets

Related hashtags

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!