Sorry to bother you doctor, but I don't get the part about" pp intervals progressively decrease". You said it's analogous to decrease in RR intervals in type 1 of second degree av block,I also don't get this one! can you explain why the RR intervals in type 1 of second degree av block must decrease?It's more logical that RR intervals should increase each time,because SA node sends its impulses regularly but each time it takes more time for the impulse to reach from SA node to the ventricles, so RR intervals must progressively increase prior to the pause! 😢
Very helpful having just suffered 45 and 25 sec pauses, admitted as emergency for pacemaker ..... I now have a better understanding of this condition after video. Very clear explanation.
Was 25 and misdiagnosed for years and finally had a heart implant that showed the long asytole or pause of over two minutes or so on one thank god for medtronics implants and it shows the pauses and sick sinus syndrome
Dr strong, how do you differentiate between sinus pause and sinus arrythmia? How do you know if it is respiratory if a patient brings an ecg to your office?
Excellent video.. without doubt the best video I have seen.. I have been trying to understand sinus pause, arrest & Exit blocks. I have noticed that in practice it's quite difficult to distinguish between them. Could you tell me a how to distinguish between sinus pause or arrest from Second degree Type 2 SA block. Is it just on the basis of PP interval?
Ivan Petrosevic Thanks for the feedback. I try to balance between providing enough examples to be instructive, without making the videos too long. But I completely appreciate that both repetition and seeing numerous, slightly different examples of the same diagnoses are both critical to becoming skilled at reading ECGs. Also, I have a limited number of examples myself, particularly of the less common diagnoses, since I only include the "pure examples": ECGs which demonstrate only one significant finding and which are free of artifact. Once I've covered all of the ECG topics I hope to (another ~13 videos to go), I'll take the leftover ECGs and rhythm strips, and probably create one or more practice videos like the "Practicing Tachyarrhythmia Identification" and "EKG and Heart Murmur Review" videos, but inclusive of all diagnoses covered in the series. Thanks for watching!
In sinus node exit block 2nd degree type 2, the pause between P waves is exactly twice the normal P-P interval. With sinus pauses, the pause between P waves is a seemingly random duration.
I don't know where else to ask this but, how can you tell the difference between sinus exit block and 2nd degree heart block type 2? Is sinus exit block more of a one time thing and 2nd degree heart block type 2 a rhythm so ongoing? How can you tell the difference between the two on a 6 second strip?
In "2nd degree heart block type 2" (which implies AV block, since it's much more common than SA block), there are P waves that are not conducted. In other words, only QRS complexes are intermittently missing. In type 2 sinus node exit block, there are missing P waves in addition to the missing QRS complexes. Both AV block and sinus node exit block can be either temporary or permanent.
What is the mechanism behide SA nodal exit block, and how we can distinguish between it and AV block, especially in case of type 2 of 2nd degree block because I feel like it look indentical to the type 2 of 2nd AV block? Anyhow, thank you so much for sharing and teaching us.
trieu ho Regarding how to distinguish 2nd degree SA exit block and 2nd degree AV block, in AV block there are non-conducted P waves within the pauses in rhythm, while in SA block there are absent P waves. Regarding the specific mechanism of SA block, I didn't know the specifics. So I consulted my wife (an electrophysiologist), her collection of EP textbooks, and a brief literature search, and I am still unable to come up with anything more substantial than a list of etiologies.
FNP here studying to get ECG-BC with American Board of Cardiovascular Medicine. This def. helped me get through the ABCM's study questions for Advanced ECG interpretation. Thank you!
For the sake of discussion.. why PP interval shortens in 2nd degree SA type 1 block? Logically if there is a delay in propagation, then each following P wave should come delayed and PP should increase. In the example looks like SN is discharging faster and faster..
The heart block will have EKG changes. 1st degree will have a longer P-R interval, anything longer than .20 is a 1st degree. 2nd degree type 1 will have progressively longer P-R intervals till the dropped beat then resumes this pattern. 2nd degree type 2 will have normal P-R intervals with occasional P wave with no QRS complex. 3rd degree will have no correlation between P waves and QRS complexes and more than likely will have wide complexes due to the ventricle conduction. This is a great video that explains the different issues of the sinus node well, I just thought I would throw my 2 cents in as well.
Got here searching for Sicko Mode
Great video, Dr Eric.
The EKG videos are the ones I like the most, and they've helped me a lot so far.
Please keep up the excellent work.
Semangat Jekaa... Tapi tolong latih terus foot work, wrestling dan jiu jitsu nya supaya lebih pede lagi🎉🎉
Sorry to bother you doctor, but I don't get the part about" pp intervals progressively decrease". You said it's analogous to decrease in RR intervals in type 1 of second degree av block,I also don't get this one! can you explain why the RR intervals in type 1 of second degree av block must decrease?It's more logical that RR intervals should increase each time,because SA node sends its impulses regularly but each time it takes more time for the impulse to reach from SA node to the ventricles, so RR intervals must progressively increase prior to the pause! 😢
Very helpful having just suffered 45 and 25 sec pauses, admitted as emergency for pacemaker
..... I now have a better understanding of this condition after video. Very clear explanation.
Was 25 and misdiagnosed for years and finally had a heart implant that showed the long asytole or pause of over two minutes or so on one thank god for medtronics implants and it shows the pauses and sick sinus syndrome
Strong??? This guy is a beast of a doc. (in a good way. Ive learned so much more). Thank you!!!
My only problem that I don’t what torques colour is.
Dr strong, how do you differentiate between sinus pause and sinus arrythmia? How do you know if it is respiratory if a patient brings an ecg to your office?
Excellent video.. without doubt the best video I have seen.. I have been trying to understand sinus pause, arrest & Exit blocks.
I have noticed that in practice it's quite difficult to distinguish between them.
Could you tell me a how to distinguish between sinus pause or arrest from Second degree Type 2 SA block. Is it just on the basis of PP interval?
Thank you Doctor Strong , once again I am just a slow learner and quick to forget. A wonderful lecture .
I can't understand madam, please explain in English or Hindi
Many thanks from Italy.
SA nodal exit block is AV block? From the 3 degrees of block same like AV
2nd degree ( either) and respitory sinus Arrythmia at the same time = tricky interpretation.
I had a sinus arrhythmia show up on a ekg without significant abnormalities i was having jumped beats that day and thats what showed up on the ekg
Nice work....تم
This was very educational. Please include more ECG examples.
Ivan Petrosevic Thanks for the feedback. I try to balance between providing enough examples to be instructive, without making the videos too long. But I completely appreciate that both repetition and seeing numerous, slightly different examples of the same diagnoses are both critical to becoming skilled at reading ECGs.
Also, I have a limited number of examples myself, particularly of the less common diagnoses, since I only include the "pure examples": ECGs which demonstrate only one significant finding and which are free of artifact. Once I've covered all of the ECG topics I hope to (another ~13 videos to go), I'll take the leftover ECGs and rhythm strips, and probably create one or more practice videos like the "Practicing Tachyarrhythmia Identification" and "EKG and Heart Murmur Review" videos, but inclusive of all diagnoses covered in the series.
Thanks for watching!
+Strong Medicine Its great bro ... But screw the gay music man haha
If the sinus Pause is too long can we lose conciousness
Thank you Doctor Strong , last time was 10 months ago time fly.
Rare teacher who pours his heart while imparting knowledge.
so how do you differentiate sinus pauses from SA nodal exit block 2nd degree type 2?
In sinus node exit block 2nd degree type 2, the pause between P waves is exactly twice the normal P-P interval. With sinus pauses, the pause between P waves is a seemingly random duration.
Good discussion
Thank you .It was very helpful
You are trully one of the best teachers I've had. Keep up the good work!
I don't know where else to ask this but, how can you tell the difference between sinus exit block and 2nd degree heart block type 2? Is sinus exit block more of a one time thing and 2nd degree heart block type 2 a rhythm so ongoing? How can you tell the difference between the two on a 6 second strip?
In "2nd degree heart block type 2" (which implies AV block, since it's much more common than SA block), there are P waves that are not conducted. In other words, only QRS complexes are intermittently missing.
In type 2 sinus node exit block, there are missing P waves in addition to the missing QRS complexes.
Both AV block and sinus node exit block can be either temporary or permanent.
@@StrongMed Thank you so much! I totally forgot about the p waves in 2nd degree type 2!
wow sir! such a splendid explanation!
What is the mechanism behide SA nodal exit block, and how we can distinguish between it and AV block, especially in case of type 2 of 2nd degree block because I feel like it look indentical to the type 2 of 2nd AV block? Anyhow, thank you so much for sharing and teaching us.
trieu ho Regarding how to distinguish 2nd degree SA exit block and 2nd degree AV block, in AV block there are non-conducted P waves within the pauses in rhythm, while in SA block there are absent P waves.
Regarding the specific mechanism of SA block, I didn't know the specifics. So I consulted my wife (an electrophysiologist), her collection of EP textbooks, and a brief literature search, and I am still unable to come up with anything more substantial than a list of etiologies.
Thank you very much.
Thank you. Dr Strong,
Best video on the topic
Excellent presentation
تم التحميل.....
Great work
Thank you
Great explanation!
Man that was great.
Thanks
Great Video!!!
Excellant
Thank you!
FNP here studying to get ECG-BC with American Board of Cardiovascular Medicine. This def. helped me get through the ABCM's study questions for Advanced ECG interpretation. Thank you!
For the sake of discussion.. why PP interval shortens in 2nd degree SA type 1 block? Logically if there is a delay in propagation, then each following P wave should come delayed and PP should increase. In the example looks like SN is discharging faster and faster..
The heart block will have EKG changes. 1st degree will have a longer P-R interval, anything longer than .20 is a 1st degree. 2nd degree type 1 will have progressively longer P-R intervals till the dropped beat then resumes this pattern. 2nd degree type 2 will have normal P-R intervals with occasional P wave with no QRS complex. 3rd degree will have no correlation between P waves and QRS complexes and more than likely will have wide complexes due to the ventricle conduction. This is a great video that explains the different issues of the sinus node well, I just thought I would throw my 2 cents in as well.
Zachary Taylor he was talking about SA node block, you are discussing AV node block.