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01- Read ECGs Like An Expert - INTERMEDIATE EKG Interpretation - want more!
- Great Video !! Thanks so much !! This helps tremendously !
- very nice explanation.
- awesome job sir. please keep it up. it helped me a lot :)
- LBBB/RBBB v.s. bundle branch escape rhythm presents similarly in QRS morphology changes..true or false? I'm trying to figure out a way to distinguish between the two in terms of presentation on ECG. If anyone can help, would appreciate it!! Thanks :)
- Thank you :-)
- Good explanation...
- Dude/dudette, V tach is precisely that.. a run of PVC's..
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- Muito bom ! Importante ,mesmo para estudantes da área de saúde
- Loved it! you explained this stuff wonderfully. Thank you!
- I think you might have cathed me for an EPS study in 1989... were you at Passaic General then? I was 14 and had WPW...
- Great explanation. Thanks!
- Transcript of a Lecture Video on Electrocardiogram by Dr. Nicholas Tullo

Type of file: YouTube video.
Duration of transcribed part: Five minutes.
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Guessed words/phrases are italicized


Transcript of the first five minutes: 

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Hey.  This is Dr. Nick from the ECG Academy with the first of the many Chalk Talks that will help you become an ECG expert.  It's easy, just log on to ECGAcademy.com for basic instructional videos, while these Chalk Talks will help you get used to reading the more complicated tracings.  Anyway, let's start with this one - it's one that we see all the time in the telemetery unit.  Nurses, doctors will often sit there and wonder what it is and ...  I'lll talk you through it.

So, first look at the forest.  There are 3 beats on the left side here that are kind of slow and then there are these six beats on the right that are a lot faster.  Well, if you look carefully at these beats, they kind of look like a normal beat: there's an upright P Wave and a fairly normal PR-Interval of about 180 milliseconds; the QRS is a little bit wide, this probably ...  a little bit of a intraventricular conduction delay there, like an incomplete Right Bundle Branch Block along those lines; and the T-Wave looks fairly narrow, nice and smooth.  This beat looks exactly the same.  

Iif we figure out the rate ...  Let's start, it's about halfway between these two dark lines.  So, let's count off: 300, 150, 100, 75, 60 ...  And it's a little bit to the right of where this one lands, so, I say it's probably 59 beats per minute, if you wanna be exact, maybe 58.  Look at the next P over, count it: 300, 150, 100, 75, 60, and it's even further to the right, so, I think 58 or 59 is perfect.  We would call this Sinus Bradycardia because it's less than 60 beats per minute and it looks like it's coming from the Sinus Node with upright P Waves and these two leads --  Remember, these two leads are going simultaneously, so you can see the beats from a different angle.

And then we got this weird kind of six-beat run of something.  It's fast.  If you measure the rate, it's a little less than two boxes.  So, this is about 150 beats per minute, this maybe 160, 165 or so, and then it slows down again.  There's these two big heavy boxes: 300, 150.  And this is a little slower, so, it's a little irregular, averaging about 150 beats per minute.  But, the QRS Complex is sort of wide and bizarre-looking, it certainly doesn't look like the normally conducted beats, so let's figure out what it is.

Well, most people realize, if --  once you've read a bunch of EKGs that a wide complex tachycardia like this is either Non-Sustained Ventricular Tachycardia coming from the bottom chambers, or some kind of atrial arrhythmia: Atrial Tachycadia or Fibrillation or something like that, that is not following the normal conduction pathways in the heart.  It's what we call Aberrant Conduction.  So, it could be a Supraventricular Tachycardia with Aberrant Conduction or maybe Non-Sustained Ventricular Tachycardia.  So, let's figure out which.  And sometimes, it's hard but I think this will become clear to you in a minute.

The best way to figure out whether this is coming from the atrium or the ventricle is to look at how it starts.  What you're looking to see is if there's a P Wave that sets off this tachycardia, and if the PR-Interval is normal, then it's likely coming from the top chamber.  Well, keep in mind that P Waves tend to be a lot spikier-looking than T Waves.  And in technical terms, the frequency component of the electrical signal is much higher.  In other words, the rate of change of voltage is much higher ...  the slope, let's just say, or the frequency content tends to be quicker than the T Waves, which are more slowly changing electrical signals with a lower frequency content.  

So, what you're looking for is a sharp spiky signal on the T Waves.  So, if you see a T Wave that looks like this or one that has a bite taken out of it like this, then chances are this high-frequency signal is a P Wave.  So, let's go back and look ...  We'll pick a different color and look at ...  This normal T Wave looks pretty smooth, and if you compare this T Wave to it, it looks virtually the same.  There's no high-frequency jiggle or any bite or anything that looks like a P Wave.  Same thing here, this T Wave looks pretty smooth compared with this one and I would say, "No, there's no P Wave."  Now, some people would argue, they'd say, "Well, what about this?  Could this little bump a P-Wave?"  Well, I'll tell you why it's not.

If you look at the bottom lead, you can see that the QRS Complex actually extends back to here just before the heavy line ...

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Copyright notice: I do not own this video, nor part of the making of this video.
Source: https://www.youtube.com/user/ECGDoc?feature=watch

#transcriptionists   #transcriber   #ecg   #ekg   #nursingreview  
- this is awesome, you explain things very well
- So we have to pay for these videos because some of his videos are missing. :(
- Seth -- You need to watch my video tutorials on basic ECG measurements such as rate and intervals to understand that.
- I'm a little lost on when counting from 300 to 150, 100 and so on... What is the rate you're counting there?
- Can that be considered PSVT- or Paroxysmal SupraVentricular Tachycardia, or is it not because it is just a short run? From 1st look, it kinda resembles just a run of PVC's-
- Very helpful! Thanks!