Cardiac embolism is a common cause of ischemic stroke. Atrial fibrillation (AF) can be detected in nearly 25% of all patients with stroke by sequentially combining different electrocardiographic methods (1). Advanced IAB (aIAB) has been described to predict occurrence of new onset and recurrent AF (2). We describe a case of a patient in whom detection of atypical aIAB motivated extended cardiac monitoring resulting in the diagnosis of paroxysmal AF and a subsequent decision on full oral anticoagulation strategy.

A 48-year-old man with a history of smoking, high blood pressure, moderate alcoholism, occasional cocaine consumer, sleep apnea syndrome and family history of ischemic heart disease.

Abstract: Today’s pacemakers and defibrillators include diagnostic tools for detecting and treating cardiac arrhythmias like silent atrial fibrillation as atrial high rate episodes (AHREs). This diagnostic capability is crucial to prevent the potential embolic complications this AHREs are related to. However, sometimes data retrieved from diagnostic counters may be misleading reflecting limitations of detection algorithms, which must follow mathematical rules to classify events on a beat-to-beat basis. The incorporation of stored electrograms has been an important milestone in improving the diagnostic capabilities of these devices confirming the arrhythmia diagnosis.

Abstract: Electrocardiographic artifacts are extracardiac signals that may alter the electrocardiogram (ECG) generating false diagnoses. These artifacts may simulate pathologies on ECG’s in healthy patients and result in long-term unnecessary or even deleterious treatments. On the other hand, to consider an arrhythmia as an artifact, may carry even worse consequences.

Abstract: Marijuana is considered a drug of low-toxicity, however its chronic and excessive use is regarded as a risk factor for general and cardiovascular health. Although investigated for therapeutic benefits, it can evoke electrocardiographic abnormalities in a dose-dependent manner. We report a case of a 54-year-old female who presented to the emergency department (ED) experiencing intermittent episodes of presyncope with tingling sensations around the left-side of the mouth and arm following acute inhalation of marijuana. Documented episodes of sinus arrest were noted.

Abstract: Prominent J-waves are observed in several clinical conditions many of which are highly arrhythmogenic and may lead to ventricular fibrillation (VF) and/or sudden cardiac death. We present the case of a 34-year-old male patient with hypothermia. Prominent J-waves (Osborn waves) and prolonged QT interval was evident in nearly every lead. Early recognition of these arrhythmogenic electrocardiogram (ECG) findings and treatment of hypothermia is important to minimize the risk of arrhythmic events.

Abstract: A 12-lead electrocardiogram (ECG) of a dual-chamber pacemaker with different paced QRS morphologies is presented. Such an observation is usually made when there are different degrees of fusion, in association with the intrinsic rhythm in the presence of spontaneous changes of the stimulation mode of the pacemaker.

A 49-year-old man was admitted to our hospital with a two-week history of exertional dyspnea. He was a daily smoker but otherwise, he had no significant past medical history. Two weeks prior to admission he sprained his ankle which he self-treated it with ice packs. On the day of presentation, he also experienced exertional chest pain which resolved at rest.

A 69-year-old woman with mitral regurgitation, diabetes, hyperlipidemia, and recurrent persistent atrial fibrillation (AF) was referred to the electrophysiology laboratory for transesophageal echocardiogram (TEE) and synchronized direct current cardioversion (DCCV). She was anticoagulated with warfarin for a CHADS2-Vasc score of 4.

Surface 12-lead ECG remains in the 21st century, one of the diagnostic tools most extensively used in clinical practice (1). For the internist, the anaesthesiologist, the thoracic surgeon, the respirologist and the cardiologist, maintaining ECG interpretation skills is mandatory, as the ECG allows a rapid (and inexpensive) diagnosis of a large series of entities (2). The advances of new technologies have not replaced the ECG, which still is one of the most cost/effective tools in medicine. Several interventions (in the acute and chronic phases of a disease) are still guided by the proper analysis of the surface ECG.