Decoding the Rhythm of Real World Insights in “Bring Your ECG”

During the “Bring Your ECG” session, eight presenters brought real-world clinical dilemmas to the forefront, moderated by Andrianus Oktovianto, MD, alongside esteemed panelists Andi Renata Bastario, MD, Setiawan Widodo, MD, and Ragil Nur Rosyadi, MD.

The session commenced with Putra Purnama Hairama, MD presenting an Ebstein anomaly complicated by conduction disturbance, emphasizing that interpretation must always return to first principles. Aldo, MD followed with a challenging case of wide QRS complex tachycardia driven by elevated catecholamine and accessory pathway disturbance. Then, Sai Vhimal Raj, MD presented a total AV block in a dentist who unmasked his underlying His-Purkinje ischemic disease after self-prescribing bisoprolol.

Next, Brent Ardell, MD shared a vital diagnostic lesson involving a patient with chronic kidney disease whose wide-complex tachycardia resisted classic treatments, only converting to sinus rhythm after addressing his hyperkalemia, highlighting the importance of treating the cause rather than just the monitor. Clinton Sudjono, MD then presented an incidental finding of atrial flutter during a routine checkup, reinforcing the importance of history-taking in evaluating baseline rhythm details and potential pacemaker interactions.

Exploring arrhythmia mechanisms, Putri Chantica, MD discussed a persistent tachyarrhythmia refractory to four cardioversions that spontaneously resolved, illustrating enhanced automaticity over re-entry as the central mechanism. Annisa Nur Hafika, MD presented an asymptomatic post-laparotomy patient showing a classic “shark fin” ST elevation and increased hs-troponin, highlighting this STEMI equivalent. Finally, M. Azman Pasha Maricar, MD concluded with a case of pre-excited atrial fibrillation in WPW syndrome initially misdiagnosed as ventricular tachycardia, highlighting this vital differential.