South Yorkshire Cardiology Registrars

Call for new Commissioning Editors! - 💼 Heart has a vacancy for one or more enthusiastic Commissioning Editors to help shape its scholarly agenda and contribute to strategic content development. Commissioning Editors will be responsible for identifying topics of interest, suggesting contributors, and commissioning high-quality content across the journal’s formats. They will contribute to reviewing the submissions and participate in the journal’s editorial processes. Further information on the role and how to apply can be found at the link below. The deadline for applications is 18th January 2026. bit.ly/4sq9S7z

Answer to the Christmas Quiz from yesterday: Answer: Pulse tapping artefact The ECG shows CHB at 25 beats per minute with ST-segment elevation in the anterior (V1–V5) and inferior (II, III, aVF) leads. Despite appearing as STEMI, several features argue against this (option A): Horizontal ST-segment elevation is atypical for myocardial infarction. The ST elevation does not align with a specific coronary artery territory. Discordant ST changes are seen in V5/V6 and I/aVL. The patient lacked a history of angina. Normalisation of ST changes on a repeat ECG (see below) and normal cardiac biomarkers support an artifactual origin. ECG artefacts can originate from cardiovascular or extracardiovascular sources. In this case, the ST-segment elevations consistently occurred after the QRS complexes, coinciding with mechanical systole. This suggests a cardiovascular source. Pulse-tapping artefacts occur when an electrode placed over an artery detects arterial pulsations, resulting in apparent ST-segment elevations. In this patient, the artefact was due to the pulsations of the left posterior tibial artery, as confirmed by unaffected leads like Lead I. Artefacts in chest leads can be explained by involvement of Wilson central terminal. (Option C) Lead misplacement usually affects limb lead axis or causes global distortion, but here the QRS morphology is consistent and the repeat ECG is normalised without repositioning. (Option B) Electrolytes were normal, so hyperkalaemia can be ruled out. (Option D) The patient had a coronary angiogram, which was normal, and underwent dual-chamber pacemaker implantation. bit.ly/43Grf9x

Christmas Quiz: Question What is the most likely cause of the ST-segment elevation? Acute ST-segment elevation myocardial infarction (STEMI) Lead misplacement Pulse tapping artefact Hyperkalaemia bit.ly/43Grf9x Answer tomorrow!