Correct me if I am wrong, but in a 3rd degree or complete heart block there is no relationship between the p waves and the QRS. A "2:1" block would be a type of second degree block.
I'm engineering some good ones as we speak. I hope to have them out soon. I'll probably inundate the channel with them. Practice is the only thing which makes perfect but, I have to scrape around for new EKG's. Any duplicates are picked up by the youtube algorithm. Unfortunately, they frown on this and will take it down. As such, scrambling the current list to allow for more practice is a no-go. If you have some EKG's you'd like to have used, send them my way. You'll be helping out every subscriber on this channel.
I'd recommend being more specific with rhythms like 6:24 my instructors would most likely not accept just "bigeminy" but instead "sinus rhythm with bigeminal unifocal PVCs" or at least just put "PVCs" in there so people know they're not PACs for instance
I think this discussion has happened on another board but, I’ll do it again here. You’re interpretation is spot on and I would love it if everyone spent the needed time to interpret with that kind of accuracy. That said, if the average person can not identify the premature contractions at 6:24 are ventricular in origin and are trying to practice rhythm interpretation, they’ve put the cart before the horse. The wide complex is the more important catch there. Also, while we’re discussing it, what is the clinical significance of univocal PVCs?
@@ShadeTreeCardiology fair enough, that makes sense. And the clinical significance is that the irritable foci is originating in the same spot with every premature contraction, vs multifocal where the foci has more than one origin
Chris Yeomans Well you’re going about your education the right way. Tell your instructors I said “kudos” for being so specific. You’re in a good program!
That is a very astute observation. The concept here was to identify the name of the complex which was dropped. While the finding of 1st degree AVB and bradycardia are not insignificant, the larger issue is that of a dropped complex. In this context, a sinus pause is when a single complex is dropped. Conversely, a sinus arrest would be when multiple complexes are dropped.
3:33 is this not 3rd degree heart block. I measured the length difference in between each P wave and they are each in the same position away from each other while the QRS ventricles are shooting at their own rate
It is not third degree heart block because the spaces between each R wave are not the same here. Pay attention to the spaces between p wave and the qrs next to it: it gets longer and longer with each beat, and then the QRS diaaapears which leaves the p wave alone. This happens twice in 3:33
Don't be sorry. Let's look at it together: If you will notice, the PRI does not remain constant. This rules out 1st degree AVB. If you look at the T wave of the fourth and fifth QRS, you will notice that there is a P wave which ops up out of nowhere. This is what cinches the Dx of the 3rd degree AVB.
Thanks you, it is so helpful. There is one EKG which I may not agree with your conclusion otherwise it great work. Could you had LBBB, RBBB, ventricular hypertrophy, Pericarditis?
That is a possibility though, difficult to say with this amount of artifact. Interpretation is all about task-stacking. What is the most imperative issue? It is the triplet. Ectopy such as this can indicate ischemia and needs to be rectified STAT.
I'm afraid I don't understand your question. It seems we agree there is a 3rd degree AVB. It would then seem intuitive that the ventricular rhythm would be idio/escape, as the impulses MUST come from the ventricles in the absence of sinus or junctional involvement.
Two Questions: 1. Which rhythm, at what time? Second, If a junctional rhythm presents with no P waves at all (sometimes inverted), Exactly what PR interval are you measuring?
Mostly because the concept of Mobitz I and Mobitz II become confusing. If you call one of them a Wenckebach and the other a Mobitz II, it is mush easier for new interns to remember.
I would change the names of some of your rhythms that just say, "bigeminy." To say, "Sinus rhythm with Bigeminy unifocal PVCs" to be more correct. Or sinus rhythm with a run of Vtach as another example. Everything else was great. 🍻
While the terms are sometimes used interchangeably, the generally accepted difference is that a sinus pause is only for the length of one complex (or cardiac cycle) whereas a sinus arrest takes the time that multiple complexes would have taken.
I'm afraid not, though, I do wish it were so. It would make things easier. As with so many things in medicine: "The only absolute allowed is the absolute insistence there are no absolutes."- Francis Schaffer...except asystole is absolutely the most stable rhythm to ever exist :)
such as???? pretty gutless how those can post their opinions with NO, RATIONALE medical basis for their comments. Please feel free Daniel, to create your own website and educate the rest of us or are you just looking to be relevant with your comment?
Thanks for showing the same rhythms on different styles strips.. it’s helpful to see them like that.
I can't tell you how grateful I am for this resource. Thanks for taking the time to put this together.
I’m not in the medical field at all but I thought it was interesting to learn in case I ever need it and I got most of them right!
The amount of 3rd degree blocks in this video 😂
Finally an ECG practice with the most important rhythms!! Thank you :)
Just WOW! This was SO helpful. Thank you so much!! Exam Monday morning, and I feel so much more confident now!!🙏❤🙏
You're so welcome!
Correct me if I am wrong, but in a 3rd degree or complete heart block there is no relationship between the p waves and the QRS. A "2:1" block would be a type of second degree block.
you are correct
I'm glad that I was not the only one confused; 3rd deg. HB has P waves not associated with QRS; seen a couple of 3rd HBs that seemed to be 1st deg.
Thank you..awesome practice,!! More videos practice please!
I'm engineering some good ones as we speak. I hope to have them out soon. I'll probably inundate the channel with them. Practice is the only thing which makes perfect but, I have to scrape around for new EKG's. Any duplicates are picked up by the youtube algorithm. Unfortunately, they frown on this and will take it down. As such, scrambling the current list to allow for more practice is a no-go. If you have some EKG's you'd like to have used, send them my way. You'll be helping out every subscriber on this channel.
very good practice. Thank you.
more atrial flutter and how to differentiate between a flutter and a fib. Junctional rhythms as well please.
Need this practice!! Thx!
Amazingly good Self test for EKG...THanks so much !!! God Bless
Glad you liked it!
This was fun!
Exactly what I needed prior to my interpretation test THNX 😎
اللهم إنى أسألك علماً نافعاً و رزقاً طيباً و عملاً متقبلاً
إِنْ شَاءَ ٱللَّٰهُ
8:28 there's irregularity from R to R in beat 5 to 12, IMO it's a rapid AFib
Example @ 13:18 is KILLER!!
You can just BEARLY see the P wave on the T wave on the third beat. Beautifully tricky example
totally thought that was a first degree av block
5:06 AF with runs of VT, or AF with WPW? Complex #8 especially looks like preexcitation...
Thank you for this!!
You can’t convince me that 4:26 isn’t sinus tach… the HR is just over 100? No?
Great refresher
Thank you so much for your video! It helps me alot 🥰🥰🥰🥰
I'm so glad!
thanks for making this super helpful!
Great review. Thank you.
Great 👍🏾 practice video
Thanks for this video. Please i will be grateful for your permission to use it in my training for my work colleagues
Go ahead!
Excellent. Thank you.
I'd recommend being more specific with rhythms like 6:24 my instructors would most likely not accept just "bigeminy" but instead "sinus rhythm with bigeminal unifocal PVCs" or at least just put "PVCs" in there so people know they're not PACs for instance
I think this discussion has happened on another board but, I’ll do it again here. You’re interpretation is spot on and I would love it if everyone spent the needed time to interpret with that kind of accuracy. That said, if the average person can not identify the premature contractions at 6:24 are ventricular in origin and are trying to practice rhythm interpretation, they’ve put the cart before the horse. The wide complex is the more important catch there.
Also, while we’re discussing it, what is the clinical significance of univocal PVCs?
@@ShadeTreeCardiology fair enough, that makes sense. And the clinical significance is that the irritable foci is originating in the same spot with every premature contraction, vs multifocal where the foci has more than one origin
Chris Yeomans Absolutely! It’s Awesome sauce to see people keeping their edge as sharp as this.
@@ShadeTreeCardiology haha I have a leg up, I just learned this like a week ago (I'm about 2 months into paramedic school) but thanks!
Chris Yeomans Well you’re going about your education the right way. Tell your instructors I said “kudos” for being so specific. You’re in a good program!
Sir,plz upload video with the explanation about each rhythm.
Looking through the videos, you will find individual rhythms explained along with the interventions necessary. :)
Oof that's going to be hours of content right there.
Rhythm @ 6:35 is Bradycardia + 1st degree AVB.
That is a very astute observation. The concept here was to identify the name of the complex which was dropped. While the finding of 1st degree AVB and bradycardia are not insignificant, the larger issue is that of a dropped complex. In this context, a sinus pause is when a single complex is dropped. Conversely, a sinus arrest would be when multiple complexes are dropped.
awesome practice!!!! thank you!
13:11 is not 3rd degree. It's 1st degree. P's and Q's are equal. PR interval is greater than 0.20.
Thank you so much. Super useful
cool MoD!!! I am for the ICU again!!
You're there for me. Well done.
Rock on!
3:33 is this not 3rd degree heart block. I measured the length difference in between each P wave and they are each in the same position away from each other while the QRS ventricles are shooting at their own rate
It is not third degree heart block because the spaces between each R wave are not the same here. Pay attention to the spaces between p wave and the qrs next to it: it gets longer and longer with each beat, and then the QRS diaaapears which leaves the p wave alone. This happens twice in 3:33
1:27 what does a biphasic T wave indicate?
At the time 13:10 it is not 3rd degree AV block, I think it's a 1st degree Av block. But if you're right I am sorry.
Don't be sorry. Let's look at it together: If you will notice, the PRI does not remain constant. This rules out 1st degree AVB. If you look at the T wave of the fourth and fifth QRS, you will notice that there is a P wave which ops up out of nowhere. This is what cinches the Dx of the 3rd degree AVB.
@@ShadeTreeCardiology Thanks for your answer, now I can see the diference, just at first look was it a 1st degree AVB.👌😁
2:44 Shouldn't 2:1 be second degree AV block not third degree?
Right. It's 2nd degree.. And it's 1:1 ..... Not 2:1
It's third degree. Look more closely for the P waves, while combining information from both leads. You will see.
@@mdabdulhadi7730 I'm afraid not. Please see the response to the OP
Thank you soooooo much u r the best🤙🏾🤙🏾🤙🏾🤙🏾
Thanks you, it is so helpful. There is one EKG which I may not agree with your conclusion otherwise it great work. Could you had LBBB, RBBB, ventricular hypertrophy, Pericarditis?
You may find this old video helpful ruclips.net/video/NN3cybv9N8Y/видео.html New content coming soon .
What does Afib w/R.O stand for. I don't think its trying to say rule out VT
Thank you for your video
That was awesome!!
Excellent test practice 👏😃
Thank you! Cheers!
Was able to diagnose almost all except 4
Rhythm @ 4:36 is technically sinus tachycardia (rate > 100 bpm).
Thanks a lot
at 6:45 would the underlying rhythm be junctional?
That is a possibility though, difficult to say with this amount of artifact. Interpretation is all about task-stacking. What is the most imperative issue? It is the triplet. Ectopy such as this can indicate ischemia and needs to be rectified STAT.
The best ❤
super good thanks for posting
Could that sinus brady ( second rhythm ) be Wellens?
You should only attempt to identify Wellen’s syndrome in 12 leads and then only in the first three precordial leads.
9:34 ... does it suggest 3rd deg AV block with escape rythmn from ventricles ?
I'm afraid I don't understand your question. It seems we agree there is a 3rd degree AVB. It would then seem intuitive that the ventricular rhythm would be idio/escape, as the impulses MUST come from the ventricles in the absence of sinus or junctional involvement.
V helpful
@6:40 it is a 1st degree AVB, good video but I definitely did not agree with every strip but for the most part you got your interpretations down
I spent quite a bit of time verifying these with both text and colleagues. Please take a second look.
at 3:01 i literally jumped, as i diagnosed the issue properly .....
Especial thanks for 13min:14 sec example.!
2:30 torsades de pointes ?
Thanks for sharing.
Thank you
thank you for this :)
That is not Junctional; it IS ectopic atrial paced. The PR interval is atrial not junctional...
Two Questions: 1. Which rhythm, at what time? Second, If a junctional rhythm presents with no P waves at all (sometimes inverted), Exactly what PR interval are you measuring?
@@ShadeTreeCardiology I don’t know
Thx
Dr: please answer my question..why you are calling only wenckebach?can you explain me please.thank you!
Mostly because the concept of Mobitz I and Mobitz II become confusing. If you call one of them a Wenckebach and the other a Mobitz II, it is mush easier for new interns to remember.
@@ShadeTreeCardiology thank you..I get you Dr.
What does "W/R.O." stands for?
Hopefully you found your answer...with run of
This was AWESOME!!!!
I would change the names of some of your rhythms that just say, "bigeminy." To say, "Sinus rhythm with Bigeminy unifocal PVCs" to be more correct. Or sinus rhythm with a run of Vtach as another example.
Everything else was great. 🍻
Liked
i think 6:40 is mobitz 2 not sinus pause since pr is more than 1 box
PR interval is up to 3 small squares(0.12 up to.0.20 sec)
Hello, sir..sinus pause and sinus arrest are the same? Right??
No sir. I sinus pause is when only one complex is missed. A sinus arrest is when multiple complexes are missed. I hope this clears things up.
@@ShadeTreeCardiology yes..thank you so much, Sir..
Really appreciated the video!
what is the difference between a sinus pause ans sinus arrest?
While the terms are sometimes used interchangeably, the generally accepted difference is that a sinus pause is only for the length of one complex (or cardiac cycle) whereas a sinus arrest takes the time that multiple complexes would have taken.
Generally a sinus arrest involves more than one complex being dropped.
Quality
7:10 I have ZERO medical knowledge and I can tell you this one is bad
❤❤❤❤❤❤
i kept getting 3rd deg wrong! Ahhhh
Don't feel bad. We ALL have an Achilles heel.
All junctional rhythms have narrow complexes.
I'm afraid not, though, I do wish it were so. It would make things easier. As with so many things in medicine: "The only absolute allowed is the absolute insistence there are no absolutes."- Francis Schaffer...except asystole is absolutely the most stable rhythm to ever exist :)
In 12 minute you said BIGEMINY, but looks like PVC.. did you agree bro? Just check..
I assume you mean at 12:18. Bigeminy is a PVC every other beat. So yes, it is both a PVC and Bigeminy.
@@ShadeTreeCardiology Thank you sir, ur answer
alot of mistakes im seeing here
Such as?
such as???? pretty gutless how those can post their opinions with NO, RATIONALE medical basis for their comments. Please feel free Daniel, to create your own website and educate the rest of us or are you just looking to be relevant with your comment?
Back it up Danny boy. Please explain. I'm waiting?
thank you
Thank you