Arron Pearce
@Arron_Pearce_
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ECG enthusiast and ECG interpreter at Broomwell Healthwatch - Managing Broomwell's social media - Nurse by trade - Millennial (Background ECG is pre-excited AF)
Manchester, England
Joined September 2010
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Last Seen Profiles
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I will be teaching alongside Prof. Albouaini again in October. This ECG interpretation course would benefit doctors (of all grades), nurses, cardiac physiologists and paramedics. Please see details below if you are interested, and please share with others 🙏
Save the date the 11th National Virtual ECG Interpretation Course Wednesday 9/10/2024. Registration will open on 1/4/24.
Flyer on . Previous courses feedback page 3-4.
@BroomwellECG
@BritishCardioSo
@LHCHFT
@LivHospitals
#CardioEd
#CardioTwitter
#TeamLUHFT
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@syamkumarmd
For any visual learners - this artefact originates from the right arm. The artefact's largest amplitude is seen in I, II and aVR. Half the amplitude in aVL and aVF. 0 in III. And a third in the chest leads.
@BroomwellECG
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Female in her 30s
Syncope with loss of consciousness 2 weeks prior
ECG enhanced by
#pmcardio
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Most people I showed this to thought that this ECG was normal 😱
Being an avid reader of Dr. Smith's blog pays off ()
#OMI
#HATW
#ECG
#EKG
#FOAMed
#CardioTwitter
Diagnosed at
#BroomwellHealthwatch
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Here are some guides for spotting limb lead errors in practice
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Great video explaining different types of VTs and localisation
Screenshots of key slides below ⬇️
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Here is a good rhythm for you
Male in his late 20s complaining of dizzy episodes and palpitations
Athletic patient
Dizzy during the ECG
#pmcardio
#epeeps
#ecg
#ekg
#cardiology
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A concerning ECG for a male in his 40s complaining of episodes of dizziness
#Brugada
#pmcardio
#ecg
#cardiology
#epeeps
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I have a very intriguing rhythm that was sent by a colleague.
I see a long RP tachycardia with a trigeminal pattern. I have never seen a long RP behave in this way.
I think this is re-entrant. Could the cyclical nature be due to alternating retrograde pathways?
#CardioTwitter
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I'm hoping this one made it straight to PCI
Female in her 60s - central crushing chest pain
Inferior-posterior-lateral OMI
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Female in her 50s with SOB for 2-3 weeks (History of COPD and HTN)
Giant T wave inversions
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A case of RBBB with ST elevation in the precordial leads
Asymptomatic male in his 70s
ECG as part of hypertension review
#pmcardio
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An uncommon finding of inverted U waves
Patient in their 30s with palpitations and chest pain (currently asymptomatic)
History of Anomalous Coronary Artery, Congenital Heart Disease and PE
#pmcardio
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Male in his 40s with intermittent chest pain for 4 days - referred to cardiology
Any comments about the T waves?
I have a follow-up ECG for this patient
#pmcardio
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How would you describe this level of AV block?
Routine ECG for hypertension, patient is asymptomatic.
ECG enhanced by
#PMcardio
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Routine ECG
(telling you the history will give it away)
What do you see?
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Teenager complaining of intermittent palpitations and chest pain.
What do you see?
ECG enhanced by
#pmcardio
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Patient in their late 50s with orthopnea and shortness of breath on exertion
History of Angina
#pmcardio
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A scary ECG to the untrained eye 👀
18 year old with dizziness and syncope
This is non-simultaneously recorded (the first 2.5 seconds are seen in all 12 leads)
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Nice example of Atrial Septal Defect (ASD) ECG features that disappear after closure.
RBBB and Crochetage sign (R wave notching inferiorly) disappear after closure but atrial flutter appears.
#pmcardio
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Have you seen larger voltages 😱
Largest R waves are 55mm and deepest S waves 50mm
24 YOM
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Can you tell what the rhythm is?
Answer was confirmed with an easy, none invasive approach
I will post the follow up ECG shortly
80s 🚺left sided chest pain on inspiration, tachcyardic at ~120 bpm
History of Afib, valvular heart disease/aortic stenosis, HTN, T2DM
#PMcardio
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10 year old with shortness of breath on exertion and episodes of feeling faint. Currently asymptomatic.
#pmcardio
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Most interesting ECG of the day was this AVNRT with subtle alternans.
Looking forward to the weekend after analysing and reporting 320 ECGs in 4 days 😴
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What two things have changed between these two ECGs?
They were recorded just minutes apart.
Patient in their 20s complaining of chest pain but is currently asymptomatic.
#pmcardio
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Male in his 30s
History of "LBBB"
Look very closely and tell me what you see 🧐
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A patient with COPD and it looks like an old anterior infarct.
COPD features seen here:
- Low voltage lead I (Schamroth sign)
- Right atrial enlargement/abnormality
- Extreme axis devation in the frontal plane
- a degree a clockwise rotation in the horizontal
#pmcardio
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ECG due to Quetiapine monitoring/QTc check
However patient has Hypertrophic Cardiomyopathy and a LBBB.
Patient is asymptomatic but note the deep and broad T wave inversions laterally/high laterally.
Does anyone have a preferred method for QTc calculation in patients with a BBB?
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A rare case where T wave/QRS disproportionality isn't due to OMI
Female in her 20s as part of a routine medical
#pmcardio
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Wider context is always important - this is not ventricular pre-excitation as seen in WPW
See below
#pmcardio
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Teenager with episodes of chest tightness, denies any palpitations.
Smart watch sensing heart rates >170 bpm at times
The probable cause is clear
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What do you see 🧐
Two ECGs from the same patient, recorded on different days. I think they were routine asymtpomatic ECGs, what cardiac history do you think the patient has?
#pmcardio
#ecg
#cardiology
#epeeps
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See how artefact originating from one of the limb leads behaves. Its behaviour is completely predictable.
Here artefact from the left leg will cause a large spike in II,III and aVF (red).
Half the artefact is seen in aVR and aVL (blue).
A third will be seen in the chest (green).
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For all the Acute MI aficionados - An OMI/NOMI case
Male in his 60s with intermittent chest pain for 5 days - impression? Culpit(s)?
I do have some follow-up for this patient
Do we have some kind of N wave laterally? 🤔
#pmcardio
#ecg
#cardiology
#MI
#FOAMed
@ChrisRylo
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Atrial bigeminy with intermittent aberration (RBBB 1st beat and RBBB with LAFB on alternate ectopics after that)
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Septuagenarian with increased SOB and high blood pressure. Denies any chest pain.
History of COPD.
#PMcardio
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AF with ventricular bigeminy - manual radial pulse will be slow ~25 bpm
Unsure if symptomatic in this case
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Another easy one for the Queen of hearts
@RobertHermanMD
?
Humans also welcome to comment.
OMI or no OMI?
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Asymptomatic male in his 60s.
Found to be tachycardic during review of medication.
History of ICD and "Hypertrophy"
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Sometimes early repolarisation can be quite dramatic.
Asymptomatic teenage male - routine ECG
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Thoughts on V2 (there is a notched J point on the rhythm strips in V2)
Elderly lady who had a fall (unsure of cardiac history)
Old ECGs below
#pmcardio
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How do you know that fine VF isn't actually AF with complete AV block and ventricular standstill? 🤔 😂
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69 YOF presents with shortness of breath, chest pain and a chronic cough
What does her ECG show?
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Atrial ectopic rhythm/arrhythmia
Helpful guide to find the SOO
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For those of you that love ACS ECGs...
Male in his late 50s with palpitations (no chest pain reported)
History of MI (>15 years ago) and stents (specifics unknown)
Old ECG in the second tweet.
Looks Aslanger-esque (but does V2 "disqualify"?)
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Interesting alternating RBBB aberration - thoughts on mechanism/how would you describe this conduction pattern?
Male in his 70s complaining of chest pain
ECG enhanced by
#pmcardio
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Late 20s male with intermittent chest pain for a month, unsure whether symptomatic during the ECG and unfortunately this is the only ECG so we cannot see the narrow complex beats in all leads.
Ecg enhanced with
#pmcardio
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Escape-capture bigeminy with intermittent LBBB aberration - patient awaiting pacemaker implantation (pre-syncope symptoms)
Enhanced by
#pmcardio
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A case of intermittent LBBB within the same traces.
In the first ECG the abberation begins when the heart rate increases subtly to 90 bpm.
In the second ECG the heart rate slows slightly and the QRS becomes narrow again.
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Escape-capture bigeminy
Our eye is naturally drawn to the 1st beat however its easier to understand this rhythm if you ignore the 1st beat and start at the 2nd: There is a P wave that conducts, followed by a short sinus pause. This is then terminated by a junctional escape...
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Walked in off the street asking for help due to severe chest pain 😱
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Female in her 90s with an irregular pulse. Thoughts on V2? I was assured placement was correct
#pmcardio
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Elderly patient complaining of palpitations
History of LBBB, AF and CHD
It smells of flutter but can we be sure its not VT
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40s male with current chest pain (for a month) - large but not hyperacute T waves
Similar to previous ECG
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Is this really Mobtiz II, Mobitz I and 2:1 AV block in the same trace, or do my eyes deceive me?
Is this all likely suprahisian block?
#pmcardio
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Junctional tachycardia with large U waves or sinus tachycardia with 1st degree AV block
Poll below 👇
Answer to follow
#pmcardio
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Male in his late 70s with chest pain and shortness of breath (History of CKD, HF and COPD)
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A nice pictorial representation of most arrhythmias that I've just seen on Facebook
Reported to be from:
Arrhythmias: tachyarrhythmias
Critical Care Medicine at a Glance, 3rd Ed. R. Leach
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Dysfunction of both the SA node and AV nodes
SA Exit Block (2nd Degree Type II) + AV Wenckebach Block
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Name the rhythm
Male in his 80s complaining of dizziness
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Male in his 60s noted to be bradycardic. He is asymptomatic
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75 female with palpitations - name that rhythm
(Not all cases look like the textbook)
ECG quality enhanced with PMcardio
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ECG of a teenage male which I believe shows Benign T Wave Inversions (BTWI)
Side note - "large" (by adult standards) QRS voltages in young slim patients is a very common finding
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