Intro to EKG Interpretation - A Systematic Approach
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- Опубліковано 25 лис 2024
- A summary of how a medical trainee should approach EKG / ECG interpretation, including rhythm assessment, evaluation of the QRS axis and morphology, and ST-T abnormalities
To address the question of why I assert the normal heart rate range should be 50-90 bpm and not 60-100 bpm, I have a whole video about it here: ua-cam.com/video/RHxfP5rm3Ks/v-deo.html (Sorry the video looks dated by 2022 UA-cam standards, but the information I present is still all true)
I agree, work as a technician in heart spect, for most adults above 60 the hr is 50-90 seen it many-times
Yes Dr strong I believe you my HR is in the 50s and I am perfectly healthy. It was in the 60s and 70s but came down to the 50s after I started exercisisng
"For anyone who is skeptical of this range" should have ended with "my wife is an EP cardiologist." Dr. Strong, I am on my Thanksgiving break and this playlist is my companion. You are the 3rd or 4th teacher for me on this content, and I'm finally finally getting it. Thank you. I needed the details to work it out, my brain needs reasons for patterns instead of just memorizing
Nice! Me too, Cards rotation at another hospital. Have seen these vids several times. These are the best out there
Its 2023 and I barely found this video. I like how you explain everything in an easy way. I know my ECG rhythms but your video has made me smarter.
"Through a mechanism unknown to me." Is the single most relatable statement I have heard in regard to studying to be a nurse lmao
Too bad they don't give out a Nobel prize for teaching... I'm in the first year of my anesthesia training and for my grand exam I decided to repeat my ECG knowledge (which I forget every time I don't see an ECG for a few months). Your videos were the best rehearsal; super structured, nice tempo, clear,... I hope your channel continues to prosper! All the best from tiny Belgium!
Sir your explanations are excellent and easier to understand and implement. I am glad I found this link. Thank you so much
i thought my ekg knowledge was decent but the learning never stops with your videos. thank you very much
Im so happy i clicked this video, thank you doc
sir this is the best explanation that i have seen .. thanks a lot sir... i have read many books on ecg but i was clueless on how interpret it.. I think this is the best video on youtube ...👍👍👍👍👍👍👍
Awesome! I appreciate how thorough you are.
Thank you for this video! This is a fantastic approach and helped me greatly as an early clinical student.
Sir, your videos are the best !!
thank you so much for making the time to make these videos for us !!
Thank you Dr Strong, I learn everything from you, from just know that this thing tracing call EKG to I can reasonable read EKG. I cannot blame my teacher in school, only myself for being stupid, and no such a technology like today,. I could rewatch,relearn. On day to day I might not encounter much with EKG or cardiac patients but still.
Finally somebody that agrees with me! Dubin's book is a waste of time and money.
Current MS4, my method:
1. Rhythm
2. Rate
3. Axis
4. Intervals (PR, QRS, QTc)
4. ST and T wave changes
5. Q waves
6. LVH
7. R-wave progression
8. Voltage
Thank you so much. I do oncology, want to keep my IM up to date. Your review is amazing!
Thanks for sharing your expertise.
@HappyMinion, thanks for watching! I will add thyroid function tests to the list of topics to cover, but unfortunately, that list is quite long at this point, and it may take quite a while before I will get to it.
I posted a video on thyroid function tests back in November, located on my main channel page.
Stoked I found This video less than a month before my exam... Thank you very much sir!!!
found it 2 days before xD
Very helpful and a fantastic refresher for me. Thank you very much kind sir!
Thank you as always Dr. Strong 😊
Thank you for sharing your knowledge.
Nice work..........
knowledge is powerful in medicine
Excellent summary with options for break out and greater depth. Good review.
Great video and great doctor
Excellent workout
Explaination
Thx a lot
Thankyou so much. I am just a student nurse and your video is not really hard to understand .
Thank you so much for your useful vdo.
thank you very much...from Ghana
Unfortunately I still don’t have $40 to buy this book mentioned. 😭 i agree from the positive comments. Excellent explanation.
Great video. One thing I'd add is looking at the R wave progression.
Thank you so much.
Hi Eric, thank you for another great video :-)
Concerning hypothyroidism induced low voltage you might consider the following reason:
deposition of gelatinous substance as a cause of myxoedema.
lack of fT3/fT4-induced sympathetic activatibility also causing e.g.bradykardia and hypotension in hypothyroidism.
Those are certainly possible. There's also an article and response letter from Cardiology in 2010 (PMID: 20664201) which suggests other explanations as concurrent pericardial effusion, unrecognized ascites, and soft tissue edema of the chest wall. Maybe some combination of the above, or different patients may actually have different mechanisms.
Thank you so much!!
Can't wait for new ekg video! Very helpful! Thank you!
True
Stoked I found This video less than a month before my exam... Thank you very much sir!!!
Excellent presentation, but pls mention abt which leads (limb leads, chest leads, unipolar leads) to be particularly referred for reading normal and pathological conditions of each factors. ( rythms, rate, p wave etc etc)
Eg - for rythms you had shown the readings from V5 lead only, what abt other leads why only V5. I mean lead 2 or lead 3 can also be used to calculate exact rythms or not??
Beautiful
Thanks. Appreciate
Excellent series! I feel as though it is missing a video on PACs and PVCs and what atrial/ventricular bigeminy & trigeminy are and their etiologies and such. Just a suggestion. Thanks again!
Thanks for the suggestion. I totally agree. I've got many videos in the pipeline, but this is on the short list (i.e. within the next 5-6 videos, hopefully...)
5 years later, but I finally got to it! ua-cam.com/video/gQDCgKb-7fQ/v-deo.html
You are a damn legend
really helpful, great thanks!!!
Many thanks sir
miracle! I understood!
+MultiMusik4 i agree, i feel the same thing
that's excellent. Crystal clear lecture.
Thanks!
Thanks, really informative and to the point
Excellent
Thank you so much 🙏🏾
This was amazingly done!
Really educative and well taught.Now I don't feel any difficulty in interpreting ECG's.
Nothing like some music to take you back to the colonial days LOL
There is no such era like colonial. Muricans arrogant again.
U r great teacher!! No words to explain..In short time great details....Sir, one question I have, which no one gave me satisfactory answer ,that , Why most of the females have baseline repolarization abnormalities especially in precordial leads ,(ST depression, biphasic T or T inversion),in fact many a times ,only looking at EKG one can identify that it's female EKG...Hence in a clinical practice with subtle EKG changes n non specific chest pain they get treated with anti ischemia drugs aspirin etc & many a times even hospitalisation for observation..What u say sir??
This was good teaching. Thanks.
Nice , thank u 👍👍
Keep up the good work. Thanks!
Amazing
So good!!
With no disrespect intended to the doctor here:
Mayo Clinic: 60 - 100 bpm
American Heart Association: 60 - 100 bpm
Harvard Health: 60 - 100 bpm
EMT/EMS universally accepted teaching: 60-100 bpm
I'll go with the preponderance of evidence from these respected sources over one doctor saying "They're wrong, and it's frustrating."
Thanks for the comment. I have a whole video dedicated just to this issue, full of actual evidence: ua-cam.com/video/RHxfP5rm3Ks/v-deo.html In retrospect, it starts off a little slowly, you can skip to 2:28 without missing anything.
It includes a discussion of this survey of cardiologists (pubmed.ncbi.nlm.nih.gov/8352202/ - sorry it's behind a paywall) in which 91% agreed that 50-90 bpm was a better definition of "normal range" for HR, and only 2% agreed with 60-100 bpm.
The reason for the common myth appears to be a fascinating combination of imperfect language (In the 1940s, "regular sinus rhythm" was transcribed to "normal sinus rhythm" in between editions of the NYHA's Nomenclature and Criteria for the Diagnosis of Diseases of the Heart), and a completely arbitrary decision made 100 years ago regarding how fast ECG paper is fed through a machine during recording.
THanks alot Dr Strong Medicine
Thanks
very useful to me, thanks
this is freaking awesome dude!
Perfect!
nice video
Great Job
Thank you sir
HI! In the table shown at around 7:17, 2nd degree type II AV block is listed as irregularly irregular, but if there are always fixed number of p waves preceding a QRS complex, which seems like a predictable pattern, could it be listed as regularly irregular? Thank you!
Would also love an explanation to this, did anyone figure it out?
Some examples he showed for type 2 2nd degree AV block might have shown that the rhythm, 2nd degree type 2 appears to be regularly irregular.
However, this is not the case as the block can occur at unpredictable intervals.
For example, on the 10secs rhythm strip, the first two P waves might be conducted while the third P wave is blocked. Then, the next three P might be conducted while the next p wave might be blocked, then the next two P wave might be conducted while the subsequent P is blocked. Overall, the PR interval stays constant while you have three blocked P wave at varying intervals throughout the 10 secs rhythm strip, resulting in a irregularly irregular rhythm.
great video! thanks !
wow! very interesting
That is excellent
At around 4:10, you mentioned that for an 80 year old person, a heart rate of 170bpm is not sinus tachycardia. How is that? The maximum heart rate should be 220-80=140, so 170 is definitely high. Great video, well done!
That's the point exactly. The max HR theoretically in an 80 year old via sinus tach is 140, so something more than that has to be something else (AFib RVR, atrial flutter, etc).
Thank you for your reply :) I mistakenly thought that a rate over 140 could also be sinus tachycardia
Hello Dr. Strong,
Greetings. Your videos are exceptionally good. One doubt pls. Can you please provide with a reference for the Normal heart rate which you said is between 50 - 90 bpm, cause I'd be able to quote it in case I use it somewhere.
Thank you very much and do continue with the great job.
A fan from India.
the source is "trust me bro" and "I made it up"
Nice video
Where can I find your videos for EKG interpretation for beginners
Dear Dr Strong, thank you so much for this excellent explanation of ECG's. I was wondering whether there was any possibility I could purchase the slides you created for this presentation so I could use them as revision? Many thanks
I'm very glad you like the presentation, but unfortunately I don't sell my slides. I've found far too many people plagiarizing them, including other professors!
Cvc
very helpful. cute. easy to remember too.
I have a pacer/defibrillator implant. Will that change my QT time and if so, what is the “normal” change on that? Thank you for your time.
This is not intended to be individualized medical advice...but yes, the presence of a pacemaker will change the expected range of QT interval - but for only those heart beats triggered by the pacemaker. There is no universal consensus on the normal range of QT interval in a patient with a pacemaker, but many electrophysiologists will use something called the "JT interval" which is the time interval from the very end of the QRS complex to the end of the T wave. The JT interval then needs to be corrected for heart rate, just the same way that the QT interval is.
I have a whole video on the QT interval, and the section on the JT interval starts around 10 min 30 sec: ua-cam.com/video/UTek1i23yuQ/v-deo.html
Great videos! Thank you very much!
What is the meaning of downslope st ot t below line
Is there a print out
thank you!!!!
Dear Dr. Strong ! Are there any Good resources you would recommend to learn and strenghten ekg Skills?(like Short Cases)
Another question: Regarding axis, I've read and heard conflicting accounts as to whether left ventricular hypertrophy (LVH) is correlated to left axis deviation (LAD), with some saying LAD is a correlation to LVH, some denying it, and others basically saying "maybe there's a correlation." I think the controversy seems to be that LAD is uncommon among those with LVH, that most people with LVH have a normal axis. The latest thing I read on this seems to imply that even among LVH patients with a normal axis, the axis is shifted left but still in the normal range. I hypothesis that LVH manifests itself somewhere along the -30° border, around 2 to 3 o'clock, sometimes being LAD but not always.
Am I close to correct or am I off base? Do most LVH patients have LAD or normal axis? About what is the average LVH patient's degree of axis?
Doc ! could the explanation to the low voltage in hypothyroidism be the slower body metabolism ?
Please help me, my ECG test wrote
t abnormality in high literal leads
Nonspecific ST-T abnormality (Elevation)
I'm sorry but I can't give specific, individualized medical advice here. I recommend you discuss your concerns with the physician who ordered the test.
❤🙏
My book says that the normal resting rate is 60-100. So if the normal rate is 50-90, then why the author of the book or doctors don't know it? They should revise the book.
Many doctors don't know this. And yes, many books are flat out wrong about it, and they should be revised!
Amaaazing dr. your videos are better than books and even some drs. I've reached the level that if I don't find the topic I want in your videos, I will not understand it clearly. Many thanks.
Could you please make videos about arrhythmia and valvular diseases ?
Haytham, thanks for the feedback. 1-2 videos on arrhythmias will be coming in about 4 weeks (hopefully). If you are interested in valvular diseases, you may find my video on heart murmurs helpful. I also have 2 videos that combine EKGs and cardiac auscultation within the context of clinical cases; they are available on both the cardiac exam and EKG playlists.
Many thanks :)
Isn't the low voltage caused from hypothyroidism due to down-regulation of B1 receptors?
I love you
Is there a particular book you recommend for interns and residents ?
Can you interpret my EKG taken at time of tachycardia,please?
I'm very sorry, but I cannot offer individualized medical advice or provide interpretations of specific medical tests.
My question is, should I disregard the Dale Dubin rapid EKG interpretation book? I've always heard of it preached as the gold standard for learning EKG interpretation. 3rd year med student here.
The Dubin book isn't the absolute worst that's out there, but it's not remotely the best. It's not so much that it's factually wrong (for the most part), but it presents info with these subtle mischaraterizations that betray the fact that the author doesn't really understand the topic himself. I've literally never once heard the book recommended by a cardiologist. A much better introductory textbook written at the same level and with the same audience in mind is The Only EKG Book You'll Ever Need.
Can you please share the reference for the heart rate, 04:07. I've been trying to find a citation for this ever since.
I have a whole video about why the normal heart rate is more accurately described as 50-90: ua-cam.com/video/RHxfP5rm3Ks/v-deo.html
@@StrongMed Thank you very much, Dr. Strong. I am a first-year resident, and your videos have been very helpful in refreshing my EKG knowledge.
180-X=2nd angle,just reading protractor, 1,10 degree,2 20,3,30,...,9,90, with fingers too 90 , catch it? 90-X, ( X, Y ) pairs. Horizontal, x,-x. Virtacal y, -y. On grid. Try roots math cos-1( X/r)E,Cos-1(Y/r)F, (E*1.11111111)grad, (F*1.11111111)grad angles, sq ft X2+Y2=r, john.
Does the rate scale the interpretation ranges? EX: Does 120 bpm halve the ranges, or do they remain the same? Awesome video. Thanks!
Do you mean the normal ranges of the PR, QRS, and QT intervals? If so, the rate does not significantly impact the normal range for PR and QRS interval, but it does very much impact the normal QT interval. This is why the normal QT range is commonly described as "half the RR interval", but even this rule this only applies at normal heart rates. The issue of correcting the QT for heart rate is discussed in more detail in my dedicated video on the QT interval: ua-cam.com/video/UTek1i23yuQ/v-deo.html
@@StrongMed Thank you so much for your response. The dedicated video you linked was very helpful. Again, thanks for all you do!
nice video....
This is great; could do with some timestamps x
is this video for the level of an IM resident?
I'd say we cover about 80% of it in the first 2 years of our med school - though I'm sure many of the details are forgotten and relearned multiple times before internship.
Hey Doctor,
Is Dubin’s book really that bad? Was planning on reading it over the winter break to prepare myself for cardiology but your comments have me reconsidering. Is there another book you could recommend instead?
In short, it's not the worst introductory EKG book out there, but it's definitely not the best. I strongly recommend Malcolm Thaler's The Only EKG Book You'll Ever Need. Similar scope and length as Dubin, but it's more accurate. And the author isn't a sexual predator...
Cristal clear