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- เผยแพร่เมื่อ 7 ส.ค. 2024
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This Intermediate level "ChalkTalk" shows you step-by-step how to analyze this abnormal rhythm strip. Why is the heart rate so slow? Is this "Sick Sinus Syndrome" or could it be "AV Block"? You will learn how to analyze this arrhythmia using an in-depth knowledge of physiology and determine the correct diagnosis.
Dr. Nicholas Tullo, a heart rhythm specialist, will show you all the tips and tricks you need to read basic and complex rhythm strips and 12-lead ECGs.
For an exclusive preview of the Intermediate level course, visit www.ecgacademy.com/ytIntermed....
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I'm really thankful that you have this actual strips which we cant find in google. It helps me a lot to understand more the ecg.
That slight widening of the QRS would be an interventricular conduction delay. In Lead II, it could be part of an IRBBB, but hard to tell. Anyway, it's not really relevant to the arrhythmia I was discussing, but thanks for the comment!
THANK YOU Dr. Tullo! Another excellent lesson, which I REALLY APPRECIATE.
Crystal clear!!!!!!!!!!!!
I might just be rusty on ECG interpretation, but what about the notched s- waves?
Could this be identified as Sinus Bradycardia with Bigemini PAC's?
excellent
can you do a tutorial on atrial fibrillation and give several different examples of ECGs that are atrial fib. but appear different. Thanks!
It's an Atrial Extra-Systole ( premature beats ) ?
I mean... i'm looking at the P wave first of all and i can see that they are different . Dosnt look like a " normal P wave " . They look like a notched ...
I would like to see the rest of Derivations if not all of them, cos' at first glance it would look like a RBBB if it were V1, I mean I'd like to see the whole Picture :)
Also, the P can't conduct because the ventricles are still in their absolute refractory period, and therefore the HIS bundle, bundle branches and Purkinjes at this point are not able to respond to the impulse either.
What about ST segment?
What if the patient was hemodynamically unstable with atrial bigeminy? How would we treat such patient? Thanks in advance!
It's unlikely that this arrhythmia would directly cause hypotension. Even with a sinus rate of only 60 or so, the slowest pulse you'd see is maybe 40 bpm. When the heart slows down and cardiac output decreases, the sympathetic nervous system will often cause the bp to increase in order to compensate for the slower pulse. This arrhythmia generally does not require treatment, unless the sudden slowing of the HR causes the patient to feel lightheaded. That usually won't occur unless the BP is already quite low. If it's an incessant arrhythmia, ideally you could map the focus and eliminate it with catheter ablation. Otherwise, antiarrhythmic therapy might be tried, but the choice of antiarrhythmic drug would be tricky.
VERY ENJOYABLE
Thanks! If you want to learn more, check out ECGAcademy.com 😃
Hi doc, I have encountered a strip wherein the pwaves merged with the qrs. However, i couldnt say the qrs is a delta wave bcos it doesnt look like one. It looks like an idiovent but the beats are irregular. I'm not sure if that is afib or idiovent. No fibrillatory waves noted. Its a complex scan for me. I hope I have that strip to explain further but its not allowed to take a snipshot.
Hi, Swerte -- No one can learn to read complex tracings like that from free videos on TH-cam or on a Google search. If you want to truly understand ECGs and learn what it takes to analyze difficult tracings like you describe, you need to go through an advanced course like I offer on ECGAcademy.com
why not atrial fib?
Where is intermediate 03
Hi, Elley -- if you're interested in learning about AF or any other arrhythmia, you need to check out my educational website -- ECGAcademy. For a very affordable subscription fee you'll have access to 14 HOURS of fantastic video tutorials and access to about a dozen new ChalkTalks. Check it out! -- DR. NICK
ECGDoc hello Doc, I have a question, when ventricle still not repelarazed how p wave can appear on top of T wave?
Everybody has a different interpretation. I have a hard time interpreting the rhythm. That kind of interpretation, I believe they interpret as a sinus bradycardia. The T wave, I can say is a notched T wave.
That would not be correct... the T-wave is not just notched -- the proof is that the p-wave actually occurs slightly later on the 2nd beat than on the rest of the beats, proving that it is not part of the T-wave but rather a superimposed PAC. It's subtle but it was clear to me, which is why I turned it into this lesson.
Where is intermediate 03