ICU: DDD pacemaker

This is 2 year old postop. patient with DDD pacemaker. What a sinking feeling one gets upon seeing this! (Absolutely no capture of either the atrium or the ventricle).
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HCM vs. Athelete's Heart

From an editorial by B. Maron. Heart 2005;91:1380-82
(Click on the image to enlarge it)

EKG: Sinus bradycardia with Junctional Escape

4 yr old boy, s/p Ebstein's repair with bioprosthetic valve in tricuspid valve position. Pierre Robin syndrome. Intermittent stridor. Possible vocal paralysis. (Click on the image to enlarge)

X-ray: Pneumomediastinum vs. Pneumopericardium

Look for the air crossing the midline between cardiac silhouette and diaphragm as the distinction between the two conditions. Of course, there are always some exceptions.