As a paramedic, this video is by far the most clear and concise discussion of waveforms suggesting myocardial ischemia. I learned things I have never been taught before. Thank you so much.
I have been searching for this exact information for a while. I wanted to understand how to look at my ECG and see for myself what is going on with my heart. The ST segment is so important and reading it is not simple. Thanks for making this video.
Can you throw in an “um” or make a mistake at least once to make us feel normal. Exceptional delivery, concise, and relatable. Thank you. Well done, such a helpful tool.
Thank you very much you simplify the interpretation to me now i know things that no one could explain it to me before now so eager to find other lectures on EKG belongs to you on RUclips
Thank you so much!,I've always been struggled with ecg in my whole 5 years of medical student life ,never understand this much ,again thank you so much
Did some ECG's at home on my fitbit and im sure I have many of these. My doctors said I may have High takeoff, I didnt hear any mention of that on this, However Im not sure they seen all my T waves Tented and symmetrical, I have a few which have the upside smiling face, but i also have the depression too. I have flat ST segments, I have lazy ST lifting in some segments and i noticed that there was a significant change in the time between a beat just prior then all the next readings showed the same flat ST segment and tented T waves. But I also have some J point elevation on like one or readings on most ECG's. Im fairly worried as Im experiencing sharp pains in my chest I have for quite some time, i was given ADHD medicine which worked well until these chest pains became more frequent, I had to come off them the pains became dehabilitating, I belive Concerta the medication stiffens the arteries, I dont like to assume but would you say that this medicine could be dangerous and increase cardia issues if patient already displays some of these pointers in there ECG's? Im having daily pains, they radiate down my left arm. I have wha I think are panic attacks, I go super light headed and feel like im clinging on for dear life things go dark, i get an instant migrane and then when i open my eyes its like everythings super bright.. Very close to passing out breathing felt like I wasnt getting any oxygen from my breath. Im currently waiting to hear back from a recent ecg wherr they picked up some elevation but they were saying i could be fit and it could be high take off. But im not fit and im definately having serious pains. Im even thinking about going private to have myself checked properly. I just know inside theres something not right, this condition has troubled me for years but since taking Concerta It made it a daily problem. Im scared the next medicine they try on me will give me a serious attack or something. The reason im worried is when im light headed my heart rates sat at 45-50bpm all day, normally im at 77-85bpms all day long. My ECG's used to look just like my partners, now they look somewhat troubling to the untrained eye, but this video has helped me understand them so much better but yes, definately I have some of these issues well all of them in some areas. Could you please comment about High take off and what this looks like and weather I should have been sent home with ST elevation without doing a blood test or angiogram. A specialist who rang me said anyone with any form of ST elevation must be admitted to confirm exactly what it is and if its inoccent or not. Is this correct? Thanks in Advance
I got my Lexiscan stress test done today. Results came up this evening. Said horizontal ST depression of 1mm in leads V-3 to V-6. I still need to have EKG of resting heart next. Maybe ischemia? We’ll see, I hope not. I’m 74 and have been having episodes of shortness of breath.
Thank you very much,I'm still constrained by the 2nd flat ST segment example given;the line of the ST segment didn't cut through to the peak of its T wave but cut through the isoelectric line so it appeared like a flat ST segment though I think it should have been a concave ST segment rather. Kindly respond please.
I’m confused…we are taught to find the J point and if it’s elevated then it’s an MI. So the happy/sad face trick is a bit confusing to me because it can be “happy” and elevated so that’s still an MI
Plz,explain the significance of J point,ST,T changes numerically.e.g:.....mm or.... small square elevation or depression indicates MI or Ischenia.Thank u so much.
Thanks for watching. The duration varies based on the underlying rate but you could expect 160ms or 4 small boxes in an adult with a rate of 60. Peaked refers to the shape... Think about a teepee or tent.
I have another comment about what you said that concave ST segment is almost normal finding. What I've been learning for almost two months that concave ST-segment elevation implies pericarditis. According to my book 4th Edition, K. Ellis, " ST-segment elevation of pericarditis differs from that of an MI in that MI usually produces convex ST elevation, whereas pericarditis produces concave elevation." I don't know if my book is right or wrong. I'm not saying that you are wrong.
Thank you so much for explaining this. I just took a stress test and I’m leads 2, 3, AVF, and V5-V6 showed that I have 1 to 2 mm ST segment flat depressions. On Wednesday I’m having a ct scan done on my heart and if that comes back abnormal then I’ll be going in for a heart cath.
And why is a convex st segment always abnormal? no rationalization elaboration is offered. what are the mechanics and rationale? Its a bold statement. Much like saying New T-wave inversion is ALWAYS abnormal.
I thought that you supposed to draw the line from the J point to the top of the T wave, however, at 9:55 you didn't do that. You drew the line from the J point to the bottom of the T wave.
Thanks, Nishal, for watching. I see the point of confusion and am glad you asked for clarification. Indeed, the rule of thumb for determining if the ST/T wave is concave or convex is to draw a line from the J point to the peak of the T wave. If the ST/T wave falls below the line drawn, the shape is described as concave. If the ST/T lies above the line drawn, convex, and if the line drawn falls right on the ST/T wave, then the ST segment is described as flat. In the example mentioned at 9:55, the tracing on the right-hand side has a very clear J point and very clear end of the ST segment and beginning of the T wave - in this case, I wanted to illustrate the flat ST segment by drawing a flat line immediately over the ST segment. On the example shown on the left side of the scree, the J point is very clear but where does the ST segment end and T wave begin? Impossible to know, really. So, in that case, draw a line from the J point to the peak of the T wave and determine the ST/T wave location relative to the line drawn and form your conclusion! Please don't hesitate to reach out if you need further clarification and thanks again for watching! Best of luck to you in your academic endeavors.
Thanks for watching and for the great question. ECG findings should be correlated clinically. If the finding is incidental, for example during an annual physical exam, the work-up will be very different than if the patient presents to urgent care or the ED with dyspnea and chest pain. Remember, things other than ischemia can produce isolated changes to the T wave such as electrolyte anomalies and normal variants.
Thanks for your great explanation. I don't understand that : you said that: j point depression or elevation for ISOELECTRIC LINE, but there is something counterintuitive. isoelectric means there is no electrical wave so j point at isoelectric line under normal physiology. in electrophysiological perspective for those pathologies j point is real isoelectrical line, and our reference line is not isoelectrical, and this is opposite to your explain . Can anyone explain that please?
What a great question and thanks for watching. The isoelectric line represents an electrically silent period on the ECG, that is, the net amount of energy is zero, resulting in a flat (or nearly flat) line. The J point, however, indicates the moment in time when the ventricles stop depolarizing and begin repolarizing. While that normally takes place at the same level as the isoelectric line, myocardial ischemia alters repolarization in a way that it alters the location of the J point - that's where we see an elevated or depressed J point.
So, when looking at the ECG for these faces (Love the illustrations), convex/concave/flat J point - ST segment top, does it have to be associated with ST Depression or elevation, for it to be considered pathological? Hope someone can answer, trying to understand this for the first time now...
Hi and thanks for watching. Great question! The answer is no, it does not have to be associated with STD or STE, but it frequently is. Early ischemia may present with isolated ST segment and/or T wave changes with no movement of the J point itself.
Dear Bahjat: Thanks for watching. While it possible for the early portion of the ST segment to be flat, it is rare as a normal finding. It's best to associate flat ST segment with myocardial ischemia or hypocalcemia.
Thanks for your feedback, Anita. While it is possible for the early portion of the ST segment to be flat, it is rare as a normal finding. It's best to associate flat ST segment with myocardial ischemia or hypocalcemia.
Yes, my book says low calcium blood level prolongs repolarization and causes prolong ST segment, thus prolonging QT-interval. T wave inversion indicates myocardial ischemia. St elevation an upright T wave indicates Myocardial injury. That's according to my book. I don't know if there's any revision of my book.
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As a paramedic, this video is by far the most clear and concise discussion of waveforms suggesting myocardial ischemia. I learned things I have never been taught before. Thank you so much.
Just one word for such description is "Excellent".
I have been searching for this exact information for a while. I wanted to understand how to look at my ECG and see for myself what is going on with my heart. The ST segment is so important and reading it is not simple. Thanks for making this video.
Best explanation about the J point/ ST elev on youtube. Thank you very much!
I agree!
Very precise, to-the-point explanation so much clinically important.
No words to thank you.
Learned in 20 minutes what I didn't understand in a whole semester.
Excellent visuals for quick interpretation!
Wow, one of the best explanation of ekg interpretation related to ischaemia.
A million thumbs up.
Thanks.
outstanding!Iv been a paramedic over 30 years and still did not know some of these!
Excellent teaching presentation of outstanding high quality 😍
Thank you, I wish the doctors explained it to a person. That makes it much clearer!
This was awesome ! Easy to understand. I have a class coming up after watching this I feel I will ace it 👍🏽👏🏾👏🏾👏🏾
Perfect lecture ,I finally understand ischemic changes on ecg manshallah
Nice! ECG is very crucial in clinical life. We always need to remember ischemic changes in ECGs
Thank you so much for the great lesson! I have saved it for reading a few more times later.
Can you throw in an “um” or make a mistake at least once to make us feel normal. Exceptional delivery, concise, and relatable. Thank you. Well done, such a helpful tool.
Great explanation on the J point and ST elevation. Thank you very much for this vidoe.
I finally understand! THANK YOU!!
Thank you very much you simplify the interpretation to me now i know things that no one could explain it to me before now so eager to find other lectures on EKG belongs to you on RUclips
Best explanation
Very lucid and very illustrative presentation 👏😊
very well explained!! thank you!
anthonyallen146gmai
I cant thank you enough for this 💗
very nice,Dr .Raval.
The best explanation 🎉🎉
Great EKG lecture. Thanks so much!!!
Great explanation. Thank you
Please use a graph that’s easier to see
Your excellent explanations should be disseminated everywhere. Thank you. Finally understands ECG
Thank you very much sir. Excellent
very well explained.... thank you so much
Wonderful video
Thank you so much!,I've always been struggled with ecg in my whole 5 years of medical student life ,never understand this much ,again thank you so much
Very detailed content . Thanks for your efforts
Excellent. Thanks
excellent teaching
This is amazing. Thank you!
Thank you very much doctor
Great video... thanks,.
we have to make a straight line from j point to the tallest point of the t wave then in 9:58 why did you just put a straight line on the st segment
I think it depends on whether it is a case of ST elevation or depression
Hey sir, thank you for the presentation. I wish you provided a few example explanations to on how the mm's of ST elevation can be determined
amazing work thank you
Bahut badhiya
Nice explanation 👌
Thanks, very informative
Awesome lecture sir
Seems like any way the st segment presents, it’s bad. Flat is bad, diagonal is bad, convex and concave are bad. Geesh.
Well elaborated
Thank you
Very much helpful
Very very thanks sir
Did some ECG's at home on my fitbit and im sure I have many of these. My doctors said I may have High takeoff, I didnt hear any mention of that on this, However Im not sure they seen all my T waves Tented and symmetrical, I have a few which have the upside smiling face, but i also have the depression too. I have flat ST segments, I have lazy ST lifting in some segments and i noticed that there was a significant change in the time between a beat just prior then all the next readings showed the same flat ST segment and tented T waves. But I also have some J point elevation on like one or readings on most ECG's.
Im fairly worried as Im experiencing sharp pains in my chest I have for quite some time, i was given ADHD medicine which worked well until these chest pains became more frequent, I had to come off them the pains became dehabilitating, I belive Concerta the medication stiffens the arteries, I dont like to assume but would you say that this medicine could be dangerous and increase cardia issues if patient already displays some of these pointers in there ECG's?
Im having daily pains, they radiate down my left arm. I have wha I think are panic attacks, I go super light headed and feel like im clinging on for dear life things go dark, i get an instant migrane and then when i open my eyes its like everythings super bright.. Very close to passing out breathing felt like I wasnt getting any oxygen from my breath.
Im currently waiting to hear back from a recent ecg wherr they picked up some elevation but they were saying i could be fit and it could be high take off. But im not fit and im definately having serious pains. Im even thinking about going private to have myself checked properly. I just know inside theres something not right, this condition has troubled me for years but since taking Concerta It made it a daily problem. Im scared the next medicine they try on me will give me a serious attack or something.
The reason im worried is when im light headed my heart rates sat at 45-50bpm all day, normally im at 77-85bpms all day long.
My ECG's used to look just like my partners, now they look somewhat troubling to the untrained eye, but this video has helped me understand them so much better but yes, definately I have some of these issues well all of them in some areas. Could you please comment about High take off and what this looks like and weather I should have been sent home with ST elevation without doing a blood test or angiogram. A specialist who rang me said anyone with any form of ST elevation must be admitted to confirm exactly what it is and if its inoccent or not. Is this correct?
Thanks in Advance
excellent
I got my Lexiscan stress test done today. Results came up this evening. Said horizontal ST depression of 1mm in leads V-3 to V-6. I still need to have EKG of resting heart next. Maybe ischemia? We’ll see, I hope not. I’m 74 and have been having episodes of shortness of breath.
A great video. But can you please tell me.. what if the T wave flattened? Thanks in advance.
Great video
Thank you sir ,a great video
Thank you very much,I'm still constrained by the 2nd flat ST segment example given;the line of the ST segment didn't cut through to the peak of its T wave but cut through the isoelectric line so it appeared like a flat ST segment though I think it should have been a concave ST segment rather.
Kindly respond please.
i thought so too
frowny faces ☹ good one!
Thank sir
Super
I’m confused…we are taught to find the J point and if it’s elevated then it’s an MI. So the happy/sad face trick is a bit confusing to me because it can be “happy” and elevated so that’s still an MI
Does an IV bolus of Heparin help with STEMI'S or ST Depression?
thank you so much
well explained...
Thanks.
wow, thank you
ST should never be flat? Normal ST segment is normally at baseline and flat.
Plz,explain the significance of J point,ST,T changes numerically.e.g:.....mm or.... small square elevation or depression indicates MI or Ischenia.Thank u so much.
It's was nicely explained but where we will look for j ,st and t waves ,I mean age,avf or lead 2.oky .this must be cleared 👍👍💪
thanks so much !
Ll
You mentioned peaked and broad T waves are abnormal. What value can be considered normal and abnormal? In terms of the small boxes.
Thanks for watching. The duration varies based on the underlying rate but you could expect 160ms or 4 small boxes in an adult with a rate of 60. Peaked refers to the shape... Think about a teepee or tent.
At 7 date inferior ischemia on ecg but at 8 ecg become normal, is ischemia patients have abnormal ecg in every ecg?
cool eyeballs ,love it🤗
awesome
dear sir in 9.33 ,in the right hand picture ,isn't it a normal st segment? could anyone help me ?thanks a lot
İ have the same question in mind
how many mm of depression or elevation is significant ??
Check out circ.ahajournals.org/content/127/4/e362 under Section 2.1
I have another comment about what you said that concave ST segment is almost normal finding. What I've been learning for almost two months that concave ST-segment elevation implies pericarditis. According to my book 4th Edition, K. Ellis, " ST-segment elevation of pericarditis differs from that of an MI in that MI usually produces convex ST elevation, whereas pericarditis produces concave elevation." I don't know if my book is right or wrong. I'm not saying that you are wrong.
In pericarditis ST segment is elevated but in concave shape from upwards. Don't Mix elevation with the shape of wave
Thank youuuuuuuuuuuuu
I like the eyeballs
Thank you so much for explaining this. I just took a stress test and I’m leads 2, 3, AVF, and V5-V6 showed that I have 1 to 2 mm ST segment flat depressions. On Wednesday I’m having a ct scan done on my heart and if that comes back abnormal then I’ll be going in for a heart cath.
In leads not I’m leads.
Love the way you explained. In practice how many changes are expected. Are all 3 -J wave, st segment and T wave expected to change their morphology ?
Thanks so much for watching. In practice, any in isolation or combination can be seen. Be on the lookout for all!
And why is a convex st segment always abnormal? no rationalization elaboration is offered. what are the mechanics and rationale? Its a bold statement. Much like saying New T-wave inversion is ALWAYS abnormal.
Doesn’t inversion mean ischemia?
Cool eyeballs:)))
I thought that you supposed to draw the line from the J point to the top of the T wave, however, at 9:55 you didn't do that. You drew the line from the J point to the bottom of the T wave.
Thanks, Nishal, for watching. I see the point of confusion and am glad you asked for clarification. Indeed, the rule of thumb for determining if the ST/T wave is concave or convex is to draw a line from the J point to the peak of the T wave. If the ST/T wave falls below the line drawn, the shape is described as concave. If the ST/T lies above the line drawn, convex, and if the line drawn falls right on the ST/T wave, then the ST segment is described as flat. In the example mentioned at 9:55, the tracing on the right-hand side has a very clear J point and very clear end of the ST segment and beginning of the T wave - in this case, I wanted to illustrate the flat ST segment by drawing a flat line immediately over the ST segment. On the example shown on the left side of the scree, the J point is very clear but where does the ST segment end and T wave begin? Impossible to know, really. So, in that case, draw a line from the J point to the peak of the T wave and determine the ST/T wave location relative to the line drawn and form your conclusion! Please don't hesitate to reach out if you need further clarification and thanks again for watching! Best of luck to you in your academic endeavors.
What if the only finding is symmetrical and/or flattened t waves?
Thanks for watching and for the great question. ECG findings should be correlated clinically. If the finding is incidental, for example during an annual physical exam, the work-up will be very different than if the patient presents to urgent care or the ED with dyspnea and chest pain. Remember, things other than ischemia can produce isolated changes to the T wave such as electrolyte anomalies and normal variants.
Can ischemia occur during an SVT episode?
Absolutely. Rate-related ischemia can exist anytime the rate is too fast or slow.
Thanks for your great explanation. I don't understand that : you said that: j point depression or elevation for ISOELECTRIC LINE, but there is something counterintuitive. isoelectric means there is no electrical wave so j point at isoelectric line under normal physiology. in electrophysiological perspective for those pathologies j point is real isoelectrical line, and our reference line is not isoelectrical, and this is opposite to your explain . Can anyone explain that please?
What a great question and thanks for watching. The isoelectric line represents an electrically silent period on the ECG, that is, the net amount of energy is zero, resulting in a flat (or nearly flat) line. The J point, however, indicates the moment in time when the ventricles stop depolarizing and begin repolarizing. While that normally takes place at the same level as the isoelectric line, myocardial ischemia alters repolarization in a way that it alters the location of the J point - that's where we see an elevated or depressed J point.
So, when looking at the ECG for these faces (Love the illustrations), convex/concave/flat J point - ST segment top, does it have to be associated with ST Depression or elevation, for it to be considered pathological?
Hope someone can answer, trying to understand this for the first time now...
Hi and thanks for watching. Great question! The answer is no, it does not have to be associated with STD or STE, but it frequently is. Early ischemia may present with isolated ST segment and/or T wave changes with no movement of the J point itself.
👌👍
I often wonder how lectures actually got their jobs in university cause people on utbue explain 10 times easier
O pq
I thought it's normal for the ST segment to be flat?
Dear Bahjat:
Thanks for watching.
While it possible for the early portion of the ST segment to be flat, it is rare as a normal finding.
It's best to associate flat ST segment with myocardial ischemia or hypocalcemia.
THANKS CHRIS!!
Only 5 minutes into this and you're already explaining stuff that my professor get's paid 100k a year to pretend they're teaching me.
BLESS YOU CHRIS TOUZEAU
I get confused about what you explained. You said that flat ST segment is always abnormal. I think ST segment is a bit flat preceded T wave.
Thanks for your feedback, Anita. While it is possible for the early portion of the ST segment to be flat, it is rare as a normal finding. It's best to associate flat ST segment with myocardial ischemia or hypocalcemia.
Yes, my book says low calcium blood level prolongs repolarization and causes prolong ST segment, thus prolonging QT-interval. T wave inversion indicates myocardial ischemia. St elevation an upright T wave indicates Myocardial injury. That's according to my book. I don't know if there's any revision of my book.
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