ECG Tip 6. "Is this sinus tachycardia, SVT or flutter?"

Welcome to this series of short videos of "ECG Tips" that hopefully will help the beginners to build up good basic knowledge in ECG interpretation skills & basic science in an easy way without them even realizing they are learning, then they can use the "EPEC Case Series" in the same channel to link the dots together & apply the tips to practice.
Here is the 6th tip, it is the second of a series of tips about the P waves, & in this one we will talk about the DD of narrow complex tachycardia & how to differentiate them using the P wave & the value of the "Bix Rule" .
Here is also a link to the booking page for the next Emergency Physician's ECG Course (EPEC) that will be on the 2nd of December 2021.
www.eventbrite.co.uk/e/emerge...
Here is also a link to the "From Zero To Hero in ACS Course", please check it out & see what you think. There is also a discount code HESHAM3 that you can use when you apply that will give you 10% off, so don't forget this. 😊
www.medguru.digital/s/store/c...
I hope you find this useful.
Stay safe,
Hesham

[@chrism6904]

I love UA-cam. I have learned more about Cardiology/ECG's than I did at school lol. Thanks for the video! Definitely appreciate it!

[@Fromzerotoherohesham]

Thanks a lot Chris, comments like this is what keeps me going.
I really appreciate.

[@osamabheleel4798]

Very comprehensive explanation, thank you very much

[@Fromzerotoherohesham]

You are welcome. Glad you found it useful.

[@miriamsaeyalrifai3072]

SO helpful, thank you! this will definitely influence my practise!

[@Fromzerotoherohesham]

Thank you so much Miriam for your supportive comment.

[@drgadham]

Excellent presentation ❤

[@Fromzerotoherohesham]

Thank you so much for your continuous support ☺️

[@ghadasayed422]

Thanks

[@Fromzerotoherohesham]

Thank you for your continuous support

[@malea654]

Thank you Dr. This is a gem to take away.
I had a question, in the 2nd ecg why do we consider that wave in lead III as p wave and not as T wave?

[@Fromzerotoherohesham]

Thanks for your comment.
T waves don't usually come just in the middle between the complexes, & they are usually slightly asymmetrical (compared to the P waves that are usually symmetrical).
Of course, there is no guarantee with an ECG like this one, but at least you now have another differential diagnosis to what you are looking at.

[@emmswave]

How does the Bix Rule fit with 1st degree av block which may put the p wave in that same position? Many thanks

[@Fromzerotoherohesham]

I agree with you that this can be difficult sometimes, but the chances of having a first degree AV block that moves the P wave backwords to be just in the middle between 2 complexes is very low, as with sinus tachycardia, any change in the heart rate will change the position of the P waves in relation to the complex before it.
If there is a confusion between sinus tachycardia & atrial flutter, there are 2 clues you can use:
1) The ventricular rate in atrial flutter is usually around 150 b/m.
2) If you connect the patient to a cardiac monitor & ask the patient to breath deeply in & out, you will notice a change in the heart rate with sinus tachycardia (respiratory sinus arrhythmia) while atrial flutter rate will stay the same.
I hope this answers your question.

[@Ahmed_Adam7]

I will add this (Bix rule) to another golden piece of information that I have learned from you during my few days worked with you
thanks alot Boss👍🏽
totally changed my practice from surprise to anticipation