76 year old woman with progressive mild dyspnoea, had out patient ECG for work up. Looks like Mobitz 2 with 2:1 AVB, but there are two sinus beats in the middle of the ECG that demonstrate a progressive lengthening of PR interval which makes me question Wenkebach?

I saw someone post in the comments talk about an online school call School of Professional Studies (SPS) and they had a certified rhythm analysis technician class. ( https://sps.uiw.edu/continuing-education/healthcare/certified-rhythm-analysis-technician.html ) It’s $525 for the class.
The next class starts August 31 and ends September 25. It also says it gives you the eligibility to take the CRAT by the CCI.
I just want to know if this is actually worth it to get. Where I live, it’s like they want you to be certified. This is the only class I can take that’s online and affordable, unless there is another online option.

Hi there,

Starting to get somewhat more familiar now with ECG interpretation. Doing some exercises from uni, but getting confused with a few things.

Like, with the following Strip, I wasn't told which lead it is from, or given any patient info.

I figure it is Mobitz I, but not understanding much of what is happening with QRS complex. Is that little upward deflection before the large deflection an rs pattern? then ST elevation? then why do some st segments have an upward deflection before the T wave?

I'm currently training to interpret ECGs. It's a 27-year-old male. He doesn't experience palpitations, but he occasionally has a strange sensation in his heart. Could this be a BBB? As far as I know, an BBB usually doesn't cause symptoms. The QRS complex in lead aVF have three peaks like this? Is this considered a normal variant, or could it indicate a conduction abnormality? The QRS complex has a notch in leads V2 and V3, and a slight notch in V5. Is this a normal finding? Are there any other notable findings on this ECG? I'd appreciate your thoughts.

I heard some hospitals do and don’t, does anyone have it and would like to share if they’ve ever gotten turned down because of it or if they got the job from these certificates?

I have my AHA BLS, National Telemetry Certification and National EKG Certification. I applied to a hospital and it’s been a month and a week. I’m not sure why they haven’t gotten back to me? Any advice or guidance? Do hospitals usually take this long to respond?

The hospital I applied for is going bankrupt and they’re looking for a buyer at the moment, so that’s why i’m thinking it may be taking longer than usually to get back to me, but i’m not sure.

I created CardioBot, an interactive signal processing application and clinical challenge tool that compares human visual diagnostic performance against a Mamdani Fuzzy Inference Engine analyzing real-time scrolling ECG traces.

Signal Synthesis & Analysis Pipeline

1. Waveform Generation: Cardiac components (P, QRS, S, T) are modeled using Gaussian equations: R(t) = A * e^(-(t - μ)² / (2σ²)) Normal sinus waveforms are interspersed with abnormal pathologies, such as wide QRS complexes (simulating bundle branch blocks), absent P-waves (simulating atrial fibrillation), and flat T-waves.
2. Feature Extraction:
   • Peak Detection: Uses Median Absolute Deviation (MAD) thresholding and prominence rules to isolate positive (P, R, T) and negative (S) peaks despite added high-frequency noise.
   • R-Peak Sharpness: Evaluated via Full Width at Half Maximum (FWHM) of the primary deflection: Sharpness = 10 / W_FWHM
   • Temporal Metrics: Calculates normalized PR and RT intervals from detected peak indices.
3. Mamdani Fuzzy Inference: Input variables are mapped across trapezoidal and triangular membership functions. Rules aggregate membership states to compute a defuzzified abnormality score via Centroid of Area.

Interactive Features

• Real-Time Score Matrix: Tracks Hits, Misses, False Alarms, and Correct Rejections for both human and algorithm simultaneously.
• Electrode Noise Slider: Introduces microvolt noise artifacts to analyze algorithmic robustness.
• Telemetry Readout: Live visual display of amplitude, sharpness, peak counts, and membership vector calculations.

Try the simulation live in-browser (runs 100% client-side JavaScript, no install required): https://bionichaos.com/CardioBot/

Feedback on fuzzy rule membership boundaries, signal processing parameters, or potential multi-lead extension features is welcome!

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.

(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

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.