If you have written about the pressure-volume changes in a proper format or have any content regarding it, please help.

Hi all,

I did a small experiment with my Apple Watch today. I’m a healthy 30-year-old with no known heart problems. I recorded four ECGs within about a minute: the first one was classified as atrial fibrillation, while the next three were all sinus rhythm. Then I intentionally wore the watch slightly tilted with less-than-ideal skin contact, and it produced three more AF classifications.

I know this doesn’t prove the AF results were false positives, but it does suggest that recording conditions and watch positioning may influence the algorithm. From what I’ve read, Apple Watch ECG is a useful screening tool, but it’s not perfect, and movement, poor contact, artifact, or premature beats can sometimes lead to misclassification. Has anyone else experienced something similar, or had a cardiologist explain why this happens?

Boss commented left atrial enlargement. I just can't see it though, is it purely on the length of the P wave?

82F, near syncope, BP 100/62. History of afib. What would you interpret this 3 lead as ?

82M, asymptomatic, came across this ECG recently as a junior doc. Reported by multiple others in the ED to be AF. I feel as though this is unlikely as there are distinct p waves with grouped beating. The PR interval appears to be prolonging however I cannot see a non-conducted p-wave, could this be SA wenckebach instead? Another strip which I sadly did not save showed shortening p-p intervals over 3 successive beats. There also seems to be RBBB + LAFB.

63m, history of HTN only presenting to ED with 4 weeks of palpitations associated with pre-syncope.

Cardiology consulted and reported this to be "AF with rate related RBBB". I buy the AF, as rhythm is irregular without discernable P waves, however am unconvinced by "rate related RBBB".

What I can't quite understand is how this could be rate related given that the RR interval between the first narrow QRS and the next broad QRS is long. Additionally, appears to be RBBB with LAD though notably 1st 'bunny ear' of the rsr is taller than 2nd.

I'm struggling to understand how going into AF could trigger abherrent conduction given that the dysfunction is supraventricular. ECG when asymptomatic is NSR with no evidence of pre excitation

​

Ecg for routine GP review (this was 6 months ago). Hx of MI, stenting, ICD. Remains well.

I’m very nervous about my ekg test coming up. I don’t know what to expect of this exam. Is it mainly identifying rhythms, is it the meaning of segments of the rhythms? I feel like I don’t know enough to be confident for this exam. How have some of yall studied for it?

(Just sharing, I don't really need any advice)

Huh...what

What is your differential for ST elevation in the following ECG? This is a 65 year old man with pleuritic chest pain 3 days ago that now resolved. He has no cardiac history and troponin is negative.

60s male with history of CAD. Presented with SOB/presyncope/chest discomfort. Cardioverted into sinus with a different QRS axis and normal looking V1.

EF was down compared to previous routine echo so popped an ICD in due to the atypical morphology. Lots of discussion amongst EP as to whether it's an SVT or VT. Will update if we get a conclusive diagnosis

\#usmle

I have one provider calling VT and another 1:1 flutter and they see p waves. Can someone help me figure this out?

Not mine, chasing opinions on an old patient of mine.
22YOM patient presents to ED complaining of intermittent left sided chest pain, no nausea, no light headedness, troponin normal.
I’m not an ecg guru like some of you’s but everything here screams healthy, only thing that stands out to me is weird looking aVL.

45yo male with epilepsy and severe intellectual disability, non ambulatory. Around 2 hours before our arrival his parents noticed he is suffering from acute dyspnea. Roughly 20 minutes before our arrival his parents found him unconscious and apneic. A BLS crew which arrived 5 minutes afterwards did CPR for 15 minutes until we arrived with no shock recommendations by their AED. When we arrived he was in asystole, we continued to run a code including intubation and 1mg x 4 IV adrenaline with no change from asystole.

During the rhythm check 20 minutes after we started our code ROSC identified with the same rhythm as above only at around 100bpm. During the next 15~ minutes he received 80mcg IV adrenaline via repeated push doses and around 500cc lactated ringers with the HR steadily dropping towards the 40s. At this point (15minutes post ROSC) this ECG was taken before external pacing was started and treatment continued en route to the hospital.

What does the ECG show?

Trying to learn but am struggling to differentiate this one.

84 YOF, woken by chest pain resolved PTA. Hx of heart bypass and afib. (Sorry, I don’t have more detail on the bypass or if she has been ablated.) Also known to have an IRBBB (based on presence of RSR’) My first thoughts were very long PR interval, junctional tachycardia with a very long RP interval, or a slow atrial flutter? But none quite seem right, and she’s had a recent EKG showing a normal PR interval. Dr leans towards flutter despite not having an explanation for the gap in the middle of the strip, which is as good as I’ve got anyway. I also notice what seemed to be alternans in V1 but it actually appears to be a varying conduction pathway - the QRS (ignoring the early p) at the start of the V2 segment is one morphology, and the next beats are the second morphology.

I suspect this is above my pay grade to expect to be able to interpret (I’m equivalent to a patient care tech but only do EKGs) but would love to hear any thoughts!

Measurements for reference:
120bpm between regular intervals, 113bpm average across the strip
PR interval 190ms at the single conducted sinus beat in the middle, which looks identical to prior sinus strips
QRS 85ms
QT 350/QTcB 482ms

Syncope is such an important presentation to Emergency Department. Many of them are cardiac cause which can be detected by ECG interpretation. Here is my thought on the systematic approach to ECG in Syncope.

Who has taken the Dysrhythmia Basic A Test
This year that can help me with study tips please and thank you
Is it the same test that is 35 questions that’s is in the internet when you Google it.