Sergio Pinski @SergioPinski Twitter profile

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Sergio Pinski

@SergioPinski

7 months

40 years as a physician this week. And with renewed enthusiasm.

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Sergio Pinski

@SergioPinski

3 years

33 y/o woman presents with chest pain on- and off for hours and hypotension. #ECG #Cardiology

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Sergio Pinski

@SergioPinski

2 years

ICD implant in submuscular plane via axillary incision in woman with ARVC, VT, sinus bradycardia and breast implants above the muscle.

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Sergio Pinski

@SergioPinski

1 year

Describe this ECG, be as specific as you can. #ECG #fellowsfirst

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Sergio Pinski

@SergioPinski

5 years

Today I celebrate 30 years in 🇺🇸. This picture is from my first few months @ClevelandClinic . I want to thank my mentors Jim Maloney & Dick Trohman for trusting me and giving me the opportunities

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Sergio Pinski

@SergioPinski

5 years

I was woken up this AM by a text message showing this beautiful ECG

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Sergio Pinski

@SergioPinski

10 months

An easy one. #ECG #fellowsfirst

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Sergio Pinski

@SergioPinski

9 months

Middle age man with no history of heart disease. Diagnosis? #ECG #fellowsfirst

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Sergio Pinski

@SergioPinski

10 months

72 yo woman with recurrent palpitation. Diagnosis? #EPeeps #ECG

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Sergio Pinski

@SergioPinski

5 years

My dad became a lawyer at age 70. I cannot even imagine how happy he was to fulfill his dream. #effort #Fathers

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Sergio Pinski

@SergioPinski

2 years

Evolution of conduction system disease. #Cardiology #ECG

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Sergio Pinski

@SergioPinski

4 years

"Roses are read Violets are blue. This reentrant PVC Is my gift to you" BTW, how can you tell this PVC is REENTRANT?

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Sergio Pinski

@SergioPinski

6 years

An important message of CABANA is the low mid-term mortality/stroke rate when #AFib pts are managed by experts. Once pt is anticoagulated, ample time to decide best treatment for symptoms and QOL. No need to scare pts into emergency procedures. Stroke & death are not imminent.

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Sergio Pinski

@SergioPinski

4 years

Half of my clinic work consists of stopping beta-blockers in elderly patients with bradycardia, systolic hypertension and very wide pulse pressure.

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Sergio Pinski

@SergioPinski

5 years

Young woman with ICD implanted subpectoral vía axillary fold incision.

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Sergio Pinski

@SergioPinski

2 years

Please join me in wishing a happy birthday to the one and only @ElenaSgarbossa

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Sergio Pinski

@SergioPinski

3 years

Atrial flutter with 8:3 conduction: a rare cause of trigeminal rhythm.

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Sergio Pinski

@SergioPinski

9 years

@CFKArgentina Ud se pasó 5 años gritando.

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Sergio Pinski

@SergioPinski

4 years

Fascinating bigeminal rhythm. Please comment #ECG #Cardiology

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Sergio Pinski

@SergioPinski

2 months

I just found this very old map of a CARTO ablation of an anteroseptal accessory pathway. ~ year 2000.

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Sergio Pinski

@SergioPinski

3 years

Early Carto map, circa 2000, showing cavotricuspid isthmus block during coronary sinus pacing. We have come long ways. @BiosenseWebster

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Sergio Pinski

@SergioPinski

2 years

A lot of interesting #ECG phenomena in this quadrigeminal rhythm! #Cardiology

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Sergio Pinski

@SergioPinski

2 years

Patient with complete heart block had syncope while touching a puddle at the bottom of her fridge. The fridge was not grounded upon electrical inspection. #Epeeps

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Sergio Pinski

@SergioPinski

11 months

Interesting bigeminal rhythm. #ECG #EPeeps

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Sergio Pinski

@SergioPinski

3 years

Please join me in wishing a happy birthday and many more to the kind, supersmart and beautiful @ElenaSgarbossa

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Sergio Pinski

@SergioPinski

8 months

What's going on? #fellowsfirst #EPeeps

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Sergio Pinski

@SergioPinski

5 months

What's going on? #fellowsfirst #ECG #Cardiology

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Sergio Pinski

@SergioPinski

3 years

Ventricular trigeminy with rate dependent RBBB. The compensatory pause that refreshes. #Cardiology #ECG

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Sergio Pinski

@SergioPinski

4 years

Quick firing. What's the most likely substrate in this 63 yo man. Just one shot. #ECG #Cardiology

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Sergio Pinski

@SergioPinski

10 months

Patient with permanent atrial fibrillation, s/p AV nodal ablation and septal pacing a few days prior. Diagnosis? #EPeeps #ECG

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Sergio Pinski

@SergioPinski

2 months

Supernormal conduction slides #Cardiology #ECG #EPeeps

A thorough review of supernormal conduction.pptx

A thorough review of supernormal conduction.pptx - Download as a PDF or view online for free

www.slideshare.net

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Sergio Pinski

@SergioPinski

3 years

27 years ago @CleClinicMD @CleveClinicFL @HeartVasc_CCFla

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Sergio Pinski

@SergioPinski

10 months

Interesting 3:2 AV block. #ECG #Fellowsfirst

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Sergio Pinski

@SergioPinski

4 years

Presenting a poster at NASPE in Nashville, TN, May 12, 1994.

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Sergio Pinski

@SergioPinski

9 months

Interesting bigeminal rhythm. #ECG #EPeeps

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Sergio Pinski

@SergioPinski

10 months

A bigeminal tachycardia. What's the rhythm? What's happening with the QRS? #EPeeps #ECG

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Sergio Pinski

@SergioPinski

10 months

Graduating cardiology fellows in Buenos Aires, 1988. The man in the back is our director, the great Dr. René Favaloro.

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Sergio Pinski

@SergioPinski

3 months

A veritable classic. #ECG #Cardiology #EPeeps

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Sergio Pinski

@SergioPinski

5 years

A tale of Brugada. Or the Law of Unintended Consequences 1/n A 40 yo Afro-Caribbean laborer received a dual-chamber ICD in 2002 for a marked Brugada pattern. He was asymptomatic and had no family history of sudden death.

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Sergio Pinski

@SergioPinski

7 years

Thought provoking paragraph from Homo Deus by @harari_yuval We EPs have been life-long learners from the beginning.

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Sergio Pinski

@SergioPinski

1 year

Do you want to know that your pacemaker patient had a run of nonsustained VT in a remote check? I don't. It's never an actionable finding. I propose that pacemaker software stops reporting this. It only creates extra work and liability. @Medtronic @BSCCardiology @AbbottNews

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Sergio Pinski

@SergioPinski

3 years

Interesting trigeminal rhythm illustrates several electrophysiological concepts. #ECG #Cardiology

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Sergio Pinski

@SergioPinski

6 years

Very old tracing. Pt with 2:1 AV block, narrow QRS. Paradoxical improvement after carotid sinus massage seals diagnosis of infranodal block. #ECG #Cardiology

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Sergio Pinski

@SergioPinski

3 years

Could early atrial fibrillation ablation promote stroke in the long term by removing the impetus for anticoagulation while allowing underlying atrial myopathy progress silently?

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Sergio Pinski

@SergioPinski

6 years

His bundle threshold testing in clinic. With loss of His capture VA gets longer. Retrograde P can now be seen in surface ECG. Teach your techs all the tricks. #Cardiology #dontdisthehis

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Sergio Pinski

@SergioPinski

2 years

@RodLacroix I needed somebody to say this, so I don't feel like the only one.

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Sergio Pinski

@SergioPinski

3 years

Memento from the graduating Cardiology fellows. Great doctors and great guys.

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Sergio Pinski

@SergioPinski

4 years

I had this great book in the office only because I wrote a chapter in it. Now I brought it home to actually study some sections. #EPeeps covering.

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Sergio Pinski

@SergioPinski

3 years

Atrial bigeminy with alternating right and left bundle branch aberrancy caught with @Alivecor . A rare finding. Lead I comes handy. #Cardiology #ECG

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Sergio Pinski

@SergioPinski

10 months

Last case at Cleveland Clinic Florida. Patient with ischemic cardiomyopathy and heart block, referred for "biventricular" ICD. #dontdissthehis instead.

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Sergio Pinski

@SergioPinski

6 years

Pt with His bundle pacing for heart block. Undersensing of PVCs, so programmed very sensitive. Recurrent syncope due to inhibition from P wave oversensing. Dedicated HBP devices need a safety pacing function after sensed A events! #dontdisthehis

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Sergio Pinski

@SergioPinski

6 years

I received this letter today. 81 yo woman, we ablated SVT in Jan 2015 #EPisthepinnacleofmedicine

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Sergio Pinski

@SergioPinski

3 years

72 year old man described this rhythm as a "drum solo by Ginger Baker" #Cream #EricClapton

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Sergio Pinski

@SergioPinski

11 months

Cleaning the office, I found a big folder with classical articles I inherited from one of my mentors, Jim Maloney. Time to pass the torch.

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Sergio Pinski

@SergioPinski

3 years

Atrial bigeminy documents progression of left bundle branch block over the course of 2 years. #Cardiology #ECG

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Sergio Pinski

@SergioPinski

6 years

I have 2 passions: fútbol (a.k.a. as soccer) and Cardiology. As the World Cup approaches, I'll be posting classic contributions to the field of arrhythmia from most countries participating in the World Cup (sorry USA, Italy and Netherlands, hopefully next time).

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Sergio Pinski

@SergioPinski

5 years

This is a case from the 90s. Something often talked about but rarely seen. 18 yo boy without previous history presents with palpitation for hours. 1/4

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Sergio Pinski

@SergioPinski

3 years

A lot to learn about aberrancy in this simple strip. #ECG #Cardiology #fellowsfirst

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Sergio Pinski

@SergioPinski

6 years

Several potential diagnoses for this bigeminal rhythm. Which one is correct? #ECG #Cardiology

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Sergio Pinski

@SergioPinski

6 years

Roses are red Violets are blue I collect tracings of bigeminal rhythms And so should you. #ECG #Cardiology

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Sergio Pinski

@SergioPinski

6 years

Complications of His Bundle Pacing by @SergioPinski #dontdisthehis via @SlideShare

Complications of His Bundle Pacing

Complications of His Bundle Pacing - Download as a PDF or view online for free

www.slideshare.net

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Sergio Pinski

@SergioPinski

4 years

Patient comes with pacemaker implanted a few months ago elsewhere. These are the scary initial findings. What is going on in the EGM?

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Sergio Pinski

@SergioPinski

6 years

The new electrocardiography of pacing: His bundle pacing normalized QRS in elderly woman with LBBB. Non-tracked PAC shows native QRS. #ECG #dontdisthehis

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Sergio Pinski

@SergioPinski

6 years

In the past, I'd have read this #ECG as "AV sequential pacing, with complete failure of ventricular capture and intrinsic conduction, long PR". Now, I know better. #dontdisthehis #Cardiology

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Sergio Pinski

@SergioPinski

4 years

Next shortage will be magnesium sulfate. #qtprolongation

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Sergio Pinski

@SergioPinski

7 years

Hypokalemia, K 1.7 mEq/L #ECG #Cardiology

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Sergio Pinski

@SergioPinski

7 years

Patient was surprised when I asked here where in Orient she spent vacation time in June. #EPeeps #Cardiology

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Sergio Pinski

@SergioPinski

6 years

I saw another pt with extensive successful #AFib ablation (including appendage isolation) elsewhere 2 yrs ago. Forgot rivaroxaban at home and missed 2 doses. Presented with embolic stroke. Appendage isolation will emerge as the strongest indication for #WATCHMAN or similar.

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Sergio Pinski

@SergioPinski

5 years

Have a happy Sunday.

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Sergio Pinski

@SergioPinski

2 months

Interesting #ECG . Not sure of the explanation. I'd love to hear different plausible hypothesis. #EPeeps #Cardiology

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Sergio Pinski

@SergioPinski

9 months

Rhythm(s)? #ECG #EPeeps

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Sergio Pinski

@SergioPinski

10 months

@ecgandrhythmRoe Mobitz II AV block is not well understood. People diagnose it very loosely, when in fact requires very strict criteria, including an almost fixed sinus rate. See this recent review by the great Serge Barold.

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Sergio Pinski

@SergioPinski

6 years

Tc-99m pyrophosphate scan in an elderly man with intractable #AFib , heart block and LV dysfunction. Diagnostic of TTR cardiac amyloid (likely wild-type)

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Sergio Pinski

@SergioPinski

6 years

We have always changed gloves before handling device (and more often during long procedures). Some evidence here that this is helpful

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Sergio Pinski

@SergioPinski

6 years

@EJSMD Maybe EP is different, but without Twitter how would I find out about the exquisite mapping/ablation techniques of @DrRoderickTung , @Dr_Santangeli or @DrFerminGarcia ; the clinical pearls from @andreanatalemd ; the device wisdom of @narrowQRS & @rdschaller ?(among so many others)

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Sergio Pinski

@SergioPinski

4 years

Fatigue? In the right bundle branch. #ECG #Cardiology

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Sergio Pinski

@SergioPinski

6 years

In summary. Differential diagnosis of alternating narrow & wide beats with little or no change in P-P and PR intervals:

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Sergio Pinski

@SergioPinski

5 years

Perm #AFib slow ventricular response. Heart failure with RV pacing. Upgraded with His lead to A channel + LV lead. Different #ECG #dontdisthehis

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Sergio Pinski

@SergioPinski

2 years

Evolution of cardiac resynchronization therapy (1/3) 55 yo woman consulted after 2 years of CRT with no clinical response. ECG with biventricular capture but wide QRS. Lead was in anterior interventricular vein. Intrinsic ECG indeed LBBB. Pacing adjusted to obtain a narrower QRS.

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Sergio Pinski

@SergioPinski

1 year

39 yo healthy woman feels poorly while playing tennis and records 1st tracing with AppleWatch. 2nd tracing 3 minutes later, feeling better. Evaluation, including MRI and stress test, normal. What to do next? Poll below

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Sergio Pinski

@SergioPinski

6 years

Repetitive nonreentrant ventriculoatrial synchrony is not a benign phenomenon. @AbbottGlobal needs to incorporate algorithm to prevent pacing close to an atrial sense in refractory #Cardiology #EPeeps

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Sergio Pinski

@SergioPinski

9 months

Rare simultaneous atrial and ventricular bigeminy. #ECG #Cardiology

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Sergio Pinski

@SergioPinski

6 years

By the way, I celelebrate 35 years since medical school graduation this week! 35 años de medico!

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Sergio Pinski

@SergioPinski

4 years

Pacemaker syndrome is having a comeback since the wide adoption of the leadless pacemaker. Personal observation. Please discuss.

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Sergio Pinski

@SergioPinski

5 years

Converted with infusion of ibutilide. I strongly believe that IV ibutilide is the drug of choice (in the USA) for tolerated rapid pre-excited #AFib . It produces much less hypotension than procainamide.

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Sergio Pinski

@SergioPinski

5 years

Proposed sequence for HOT-CRT plus AV nodal ablation from above #dontdisthehis

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Sergio Pinski

@SergioPinski

6 years

His bundle pacing from right side narrows LBBB in elderly woman post TAVR. #Cardiology #dontdisthehis

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Sergio Pinski

@SergioPinski

5 years

ICDs in nonischemic cardiomyopathy by @SergioPinski #cardiomyopathy #defibrillator

ICDs in nonischemic cardiomyopathy

ICDs in nonischemic cardiomyopathy - Download as a PDF or view online for free

www.slideshare.net

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Sergio Pinski

@SergioPinski

2 years

🇺🇸 has underdelivered in soccer, but is king in EP. Wiggers, Beck, Zoll, Lown, Josephson, Jackman have pushed the limits of electrical therapies with a good dose of rugged American individualism.

Termination of Ventricular Fibrillation in Man by Externally Applied Electric Countershock | NEJM

VENTRICULAR fibrillation is usually a rapidly fatal arrhythmia that may occur in cardiac patients, in any patient under anesthesia and in drowning and electrocution. In cardiac patients it is a fre...

www.nejm.org

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Sergio Pinski

@SergioPinski

10 months

Very old tracing. Stokes-Adams syncope due to paroxysmal heart block

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Sergio Pinski

@SergioPinski

1 year

Evidence for concealed fasciculo-ventricular connections as revealed by His bundle pacing. . Very provocative observations; we may need to rethink many concepts. Merits careful reading.

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Sergio Pinski

@SergioPinski

7 years

Chest pain, VT, hyperacute T waves, subtotal thrombotic occlusion of LAD at level of 1st diag #ECG #cardiology

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Sergio Pinski

@SergioPinski

2 years

Termination of atrial tachycardia CL 300 ms by 5th burst of antitachycardia pacing in 89 yo man with h/o atrial fibrillation. Atrial ATP can be helpful in preventing persistent atrial fibrillation. #Cardiology

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Sergio Pinski

@SergioPinski

7 years

I'm on call. STAT consult. #Cardiology fellow figured it out.

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Sergio Pinski

@SergioPinski

7 years

Near miss. End-stage HF on home milrinone. #ECG #Cardiology

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Sergio Pinski

@SergioPinski

6 years

@RossAlbertMD @sargsyanz @adamcifu Decline is a better term for this. You offer, she declines.

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Sergio Pinski

@SergioPinski

5 years

Great time at #HRS2019 connecting with old & new friends from here & there. Great science also.

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Sergio Pinski

@SergioPinski

7 years

@medicalaxioms Paroxysmal complete heart block with narrow QRS. If you don't want to call for pacemaker, often times responds to theophylline.

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Sergio Pinski

@SergioPinski

7 years

@ClinicalPearl @medicalaxioms I cannot understand how some Cardiology fellows are not electrified by Electrophysiology. Their high resistance results in non capture.

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Sergio Pinski

@SergioPinski

7 years

Atrial bigeminy with alternating aberrancy, eventually triggering #AFib . Beauty. #ECG #Cardiology

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