Good morning everyone. Here's a case for today. A 74 year old woman is brought in after nearly collapsing at home. She has felt dizzy and very tired for two days. She takes amlodipine for blood pressure and nothing else. Observations: heart rate 36, blood pressure 98 over 60, oxygen saturation 97 percent on air. ECG findings: - Regular ventricular rhythm at about 36 beats per minute - P waves are present, regular, at about 90 per minute - There is no consistent relationship between the P waves and the QRS complexes - QRS complexes are wide Three questions. Answer in the comments before you read anyone else's reply. 1. What is the diagnosis? 2. Is this patient stable, and what do you do in the first few minutes? 3. What would you check in her history and bloods that could be contributing? I'll post the full answer and teaching points tomorrow. If you're not sure, say so. A guess with your reasoning is worth more than silence. Tag a colleague who'd enjoy this one.

Hi everyone, Thank you for being here from the start. I want to be honest with you about what happens next. This community has been free while I worked out what would help you most. One of you told me ECGs in real time feel like excluding things rather than including them. That is exactly what I want to fix. From Monday 30 November this becomes a paid community. Inside: - A weekly ECG case with a full consultant walkthrough - Basic Echo teaching (extra for those who are committed) - Honest advice on getting into cardiology training and working as a junior doctor in cardiology - A live Q&A with me every fortnight - The Basic ECG Masterclass, released weekly Because you were here first, you get the founding rate: £29 a month or £249 a year, locked in for as long as you stay. It will be higher for new members. Your free access continues until Sunday 29 November. Before then I am running a free live Q&A (Sunday 22 November, 8pm). One request: reply below with the one thing you would most want from a paid community. I am reading every answer. Dr Nabila

You are reviewing a patient with sudden-onset palpitations. Their ECG shows: • A regular rhythm • Narrow QRS complexes • A ventricular rate of approximately 150 bpm • No obvious P waves What is your leading diagnosis? A. Sinus tachycardia B. AVNRT C. Atrial flutter with 2:1 conduction D. Atrial fibrillation Before checking anyone else’s answer, comment with: 1. Your diagnosis 2. The single ECG clue that influenced you most I’ll post the explanation later today. Remember: confidently reading an ECG is not about memorising hundreds of patterns. It is about knowing which clues deserve your attention first.

Genuine question, no wrong answers. What is the one ECG pattern that still makes you pause, even for a second, when you see it on a strip. Drop it below. I read every single reply and I promise you are not the only one who feels that way about whatever you name.

Good morning everyone. Continue the week with a real case. You are the doctor on call. It is 3am. A 58 year old man on the ward is reviewed by nursing staff for palpitations and mild breathlessness. He has a background of hypertension. His observations, heart rate 142, blood pressure 108 over 70, oxygen saturation 96 percent on air. His ECG shows an irregular rhythm, no clear P waves visible, narrow QRS complexes, ventricular rate around 140. Three questions. Answer below before scrolling through anyone else's replies. 1) what is the most likely diagnosis. 2) what is the single most important thing you need to check before deciding on rate control versus rhythm control. 3) does his blood pressure change your immediate management, and if so how. I will reveal the full answer and teaching points on Friday. Tag a colleague who would enjoy working through this with you.