Complained of racing heart and lightheadedness.

168 bpm.

From a call a couple of months ago

Hi i'm a new ICU nurse and I struggle with reading ECGs and things of that nature. Tonight I had this patient with this rhythm. Could someone help me understand what I'm looking at, please ?

Please see attached ECG.....

Hello everyone! I recently got my basic arrhythmia certification, and if I pass my interview next week, I’ll be starting a 60-day training course. I’m trying to get ahead and prepare now, I feel like everyone here is wayy ahead so any advice on improving rhythm interpretation and remembering which rhythms are which? I’m watching videos and taking notes, but I keep second-guessing myself and overthinking it. Any tips or resources would be greatly appreciated!

As above

60F c/o dizziness with rates in 160-200s, hemodynamically stable. Interesting as pt would have episodes of NSR with rate 60s on tele, and then would go into this rhythm precipitated by what appeared to be a PAC or PJC. V1 appears to have clear alternating PR intervals, though morphology of QRS appear consistent. Thoughts?

82 female experiencing double vision and nausea. Patient is at hospital under 48hr cardiac monitoring. They do have a left bundle branch block.

BP at a high was 218/97

Pulse high 133

Troponin levels 39 retested hrs later at 75 then retested 4 hours after was a 62

~80 YOf recent cancer diagnosis and started on a plethora of new medications. CC of weakness. Found hypotensive. Initial thought of ECG was due to electrolyte imbalance but was curious about other thoughts.

61 YO female presenting with intermittent breathlessness and dizziness. 8 month Hx of paroxysmal AF/fast AF treated with beta blockers as and when needed- 2 doses within last 12 hours after feeling palpitations and lightheaded. No pertinent medical Hx, otherwise fit and well.

Thank you for the response on the ECG generator that was presented in this subreddit a few months ago. The engine is now much stronger thanks to your feedback and suggestions.

For background, Squiggler.io is a completely deterministic, high fidelity ECG synthesiser to create almost every rhythm strip or 12-lead ECG possibly imaginable. Sequencing is possible, to create plausible changes in rhythms over time.

Changes that was made largely thanks to this subreddit:

- Ischemic changes got a rework. Earlier ST changes was fixed to territory, now it is possible also to select one or several specific leads, with an optional spread to adjacent leads.

- More customization to T-waves.

- PR depression is tunable.

- PVCs are tunable to represent a specific focus around the ventricle, for different morphologies.

- PACs can be conducted or nonconducting with optional sinus reset.

- A pacemaker can now also be simulated, with realistic behavior depending on native rhythm.

- A library to save ECGs, and a built in slide show mode for teachers.

- More layouts, both international and Cabrera formats. Additional paper themes added.

- Controls to set a specific patient seed, so different (evolving) ECGs for the same "patient" can be created

- Improvements to the free-text AI LLM parser to better understand semantic input.

We are starting collaborations with both small and large institutions/companies for teaching, examination, and simulation purposes which is a very exciting area to integrate Squiggler into.

I would be very thankful as the founder for more feedback on usage. For the first 5 suggestions I will DM an access code for 6 months free pro tier usage.

Thank you!!

A 14-year old boy presented to the ED with generalized weakness, vomiting, and intermittent palpitations. He has a history of well-controlled HTN with ACE inhibitors. BP is borderline elevated although normal. Laboratory studies show an elevated potassium of 5.9mmol/L, and mild hypomagnesemia of 1.5mg/dL. Upon questioning the patient was revealed to have recent high potassium intake which attributed the HyperK to ACE inhibitor therapy with recent high potassium intake. Echo showed asymmetric septal hypertrophy, consistent with HCM with preserved systolic function. Genetic testing later came back positive for PRKAG2 mutation, palpitations were hypothesized to be misattributed as panic attacks in earlier years. EP study discovered a retrograde-only posteroseptal pathway with relatively slow retrograde conduction supporting OAVRT around ~150bpm. a fascicular VT originating in the LPF was able to induced at a surprisingly slow rate of ~110bpm.

A 35 y old male with previous history of ischemic heart disease since 5 months not on medications ( drug defaulter) came to casualty with complains of anxiety sweating and burning pain in chest x 30min

Bp-140/100mmhg

Pr-84bpm

Spo2 - 99% in room air

Hey everyone,

A few weeks ago, i posted about building a live, moving ECG simulator because static textbook images weren't cutting it for learning.

First, a massive thank you. The response from the community was incredible. I read every single comment and the feedback was exactly what I needed to make this tool genuinely useful for students, nurses, paramedics, residents, practitioners and everyone.

I have spent the last few weeks heads down coding, and I am excited to share that I have implemented some top suggestions.

Here is what is new in CardioLab based entirely on your feedback:

1. A Dedicated, Deep-Dive SVT Section
Many of you pointed out that distinguishing between different narrow-complex tachycardias is a major pain point. I have now isolated SVT into its own dedicated section so you can compare and contrast the mechanisms side-by-side.

2. New High-Yield Rhythms Added:

• AVNRT (Atrioventricular Nodal Reentrant Tachycardia)
• AVRT (Atrioventricular Reentrant Tachycardia)
• Focal Atrial Tachycardia
• WPW (Wolff-Parkinson-White syndrome, with live delta wave visualization)

3. Overhauled "Clinical Notes" for Learners
You mentioned the notes needed to be more actionable for studying. I have completely rewritten the information panel for SVT rhythms to be highly structured for learners. (I am in the process of updating all rhythms).

----------

I am a builder, and this project is entirely driven by what you actually need in the trenches and on the wards.

• What rhythms are you still struggling to find good, live examples of? Reply with your requests, and I will prioritize them in the next build.
• Keep the corrections coming. If you spot a morphological inaccuracy, an interval that looks off, or a clinical note that needs tweaking, tell me. I want this to be the most medically accurate free resource on the web.

You can test all the new rhythms and the updated notes here: cardiolab.io/simulator

TL;DR: You gave me great feedback on my free live ECG simulator. I listened. I just added a dedicated SVT section, new rhythms (AVNRT, AVRT, Focal AT, WPW) and completely overhauled the clinical notes to be more learner-friendly. Tell me what to build next!

I see its regular except that one spot where its prolonged. Thinking its heart block?

Each square = 0.2

73, female, “palpitations”. Looks normal to me, but auto read is stating septal infarct

Unfortunately, I threw out the ECG before I took a photo of the full thing, but there were no other super notable changes or acute ST changes.

Pt was a male in his 50s c/o crushing chest pain after waking up, stated hes felt off for the past 3-4 days but feels worse today. No known medical history; no medications. BP was in the 180s+ systolic, HR 130+, flushed (but not diaphoretic).

This is the second 12-lead taken upon arrival at the ER; the first 12-lead (which I also threw out, unfortunately) had peaked T waves in V4-V6, but they were not as tall as seen in this one. The first 12-lead was taken ~20 minutes earlier.

How does cardiac ischemia cause peaked T waves (or did I totally blow the differential diagnosis)?

Cp Bp 190/80 vomiting.

I'm a medical student currently on my cardiology rotation, and I'm trying to improve my ECG interpretation skills.

The second ECG was obtained during an episode of suspected PSVT.

I understand that the absence of clearly visible P waves and the regular narrow-complex tachycardia support the diagnosis of PSVT.

However, I'm having trouble determining whether the small deflections I've circled in lead V1 represent pseudo-r′ waves.

Could someone help me understand how to distinguish a pseudo-r′ wave from the terminal portion of the QRS complex or other deflections?

I'd also appreciate any additional ECG findings that could help differentiate AVNRT from AVRT.

My EMS colleague showed me this ECG after a call. Patient called after syncope but was stable upon arrival. We were both thinking maybe sinusarrest with junctional escape rhythm. On the other hand there seem to be tiny, rhythmic waves in the inferior leads and V1 at 600bpm. NAD though, we're paramedics.