ECG Interpretation Tutorial - ChalkTalk 282 Basic Level
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- Опубликовано: 30 июн 2017
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This Basic level "ChalkTalk" features an irregular rhythm strip. What arrhythmia is occurring? And what caused the pause? "Dr. Nick" explains step-by-step how to approach complex rhythm strips in his weekly ChalkTalk video tutorials on ECGAcademy.com. Learn how to analyze ECGs that don't look like the ones in the textbook!
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.
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So interesting! First thing I thought of is that it is a differential path but there is an integral that is common: the distance across the av node itself. Since it's common to the differentual in "fourths", the plane of the paper encodes the distance across the av node in the "regular irregularities" and the peripheral 'timekeeper" intervals that are convenienttly dispersed with P wave intervals that aren't the same duration but they "envelop" a nice place to put your calipers if you can tip them to 45 degrees. Those baselines set, you could fold the paper such that the √1.5, "middle", and ✓9 :3 av nodes are 'folded toward the middle, made regular. The intervals are then layered and distorted, but not at the av nodes themselves or between the""av node:p wave" points you use your calipers to measure from. Essentially, the node commons are like the marks on a slide rule measured from the marks across the thickness of the slide rule. Why bother? Because, like a jig on a router, it only needs to be done once. The paper is scaled the same and suddenly you have a bubble you're measuring through instead of lines you're metering. You have six points at one concentric, two points at another, and the hourglass shape is all of the places where the "tip" from positive to negative happen. What a great reference, for comparing breathing to heartbeating, left shoulder to right arm etc. The dummy end of the tape measure is "corrected" in time by the peripheral points en route to the stickies. Hypothetically, you could measure the cables by the hairs suck to them. Ouch.
I was diagnosed with WPW about 12 years ago; got to take a trip to the city (Edmonton AB) and a Dr. Gulemhusein (sic) at the U of A stuck a stick in my leg, ran a fishing rod up and branded the short circuit while I watched on tv. He used some drugs to speed up and slow down my heart sparks so he knew he was shishkebobbing the right hot dog. Anyway, I have never experienced anything quite like feeling my heart pounding in my chest, then slowing down, speeding up etc without the rest of the effects like panic or worry or anything like that. Just my heart poubding in my chest. Joke in my family was that my father (a diesel locomotive electrician) should retire if he couldn't even wire me right.
Doc had me in and out in a half a day. It was one of the most interesting days of my life.
Peace be to you! I'm a new subscriber! This is REALLY valuable! Thanks!
I'm happy that you are enjoying my tutorials!
Isn't the heart rate irregularly irregular?
Yes, yes it is. But that doesn't tell you what the rhythm is. When people think "irregularly irregular" often they assume it's atrial fibrillation, but in this case it's clearly not.