#ImageOfTheWeek by Willis Kwandou and Bambang Budiono from Primaya Heart and Vascular Center Hospital, Makassar, Indonesia.

What diagnosis does this ECG pattern suggest? https://ow.ly/jQgk50Y4HvJ

#cardioed

#ImageofTheWeek by Willis Kwandou, Agnes Lucia Panda, & Gratiani Eben H. Reppi from the Department of Cardiology & Vascular Medicine at Sam Ratulangi University, R. D. Kandou General Hospital, Manado, Indonesia.

What is the most probable diagnosis
ow.ly/BQSf50VaQ5l

#echosky when performing intraoperative (post procedural) TEE for MV & TV surgery be aware of possible regional wall motion abnormalities due to coronary artery injury/distortion

👉 always look at TG mid SAX
👉 use the mnemonic code ALPIS

To activate your 🧠 do the same for TTE

Role of multi-modality imaging for assessment of LA & LAA.
Clinical consensus statement of #EACVI, #EHRA of #ESC

#CardioSky #EchoSky #EchoFirst #YesCCT #WhyCMR
academic.oup.com/ehjcimaging/...
@escardio.bsky.social @sarahmoharem.bsky.social @victoriadelgadomd.bsky.social @gimelliale.bsky.social

Sorry for late reply, looks like that one was not cor triatriatum, it was a Big Giant Pulmonary Artery with Dissection Flap

Interesting ECG, it seems the P-P Interval Is Constant

Other R-R Interval Seems Constant Beside R4-R5

IMO there is a change conduction into slow pathway, from the Red pathway P Arrow to Blue pathway P Arrow

😨, great case.. thanks for sharing 🙏

Pretty impressive, no?

#echosky #cardiosky

I agree looks like VSP, perhaps there is atrial spike within the R1 (Possibly Atrial Lead Did not Sensed the P Before R1 and Pace As the Moment of Native R wave and Trigger VSP)

I think purple arrow is really correlated with pace spike.. is that spesial ECG feature for detecting pacemaker spike?

Carcinoid Syndrome?

I vote for VT as well

Presence of Structural Heart Disease, Atypical RBBB with R<S at V5 and V6, Same PVC Morphology in 2nd ECG Favors for VT

The Location of VT IMO is Mid Inferolateral LV, maybe correlated with mid lateral scar at MRI

Another Echo View A5C

Another Echo View PSAX

Another Echo View Suprasternal Right Aortic Arch

Here Is The CT Scan, Any Opinion About Diagnosis Terminology? And How Should We Manage? #Cardiosky #Echosky #Echofirst #YesCCT #CTSky

Wonder what echofirst community would think about this Echo in Adult with Congenital Heart Disease? #Echofirst #Cardiosky #Echosky

Parahisian

I think This Red P Wave Is Conducted because repetitive same PR Interval Manners

Other QRS are Junctional Escape Beat

Consult from ED for CHB.

Hint: Patient was asymptomatic

#ECGsky #cardiosky #medsky #EPeeps

2nd ECG, I think atrial lead is also not sensing at all, it seems capture

But i suspecting the black arrow the atrial lead is pacing but failed to make a spike (Fail to Pace)

Somehow A. Lead Alternating Capture and Failed to Pace

Atrial Lead Problem (Fracture or Insulation Breach)?

CMIIW 🙏

Amazing Tracing, May I give my opinion doctor? Please correct me if i'm wrong

Below ECG, I Think This is Atrial Lead Undersensing and Does not Capture

Blue Arrow => Intrinsic P Wave
Green Arrow => P Wave That Conduct to Ventricle
Red Arrow => VSP due to sensing intrinsic beat After AP

#EPeeps Two ECGs that looks similar from afar but contain key information on close inspection (the first is the new one, second is the prior)

I'm not the expert, but i like to push my brain figure out tracing like this

I don't see any atrial pacing on 2nd follow up ECG, i suspect that was AF and modeswitch to DDI pacing.

So i suspect the 1st ecg was AF undersensing, but i think we need to confirm presence of CHB to support my opinion

I'm not good at diagnosing this one yet, but I think this is repetitive nonreentrant ventriculoatrial synchrony.

Attached figure and citation.

#EPeeps #ECGsky #cardiosky #medsky

Wow, nice tracing.. can we get more detailed about baseline patient? And Pacemaker Indication? Does the patient have previous AF history and Complete Heart Block or Undergoing AVN ablation?

Thanks for tagging, i think i'm agreed with you Ventricular Escape Rhythm with Variation CL

At 1st Glance I was thinking if there was a grouped beat and consider VE rhythm with weckenbach exit block (Just Like Left Image),but it seems the CL is very variated within the group beat and previous ecg

The PR interval preceeding Junctional With Retrograde Beat Appear Larger than Junctional Beat with No Retrograde Conduction

Maybe that is also the reason the retrograde conduction happened

Here is the example i found from EHRA EP book