It's been a long time since I've added to the EKG playlist. I know some of you have been waiting for a video on VT - I hope to post that next week. I'm still trying to track down one final example to include in it. Consider this video on PACs and PVCs a warm-up!
You are the GREATEST teacher when it comes to EKGs. I’ve always been so bad at reading them, but you make everything make perfect sense. I feel like I’ll be better than half of my attendings at reading soon 😂
Thank you for this video (and for all your videos)! I have very frequent PVCs. I like to know as much as possible about my medical conditions, but the learning curve for the layman is in regards to electrophysiology is... very high 😅. Your videos have been super helpful to me in learning about the heart and how it works. Thanks for all your hard work, it's greatly appreciated!
03:30 - PJC strip shows bipolar P wave form, which could indicate enlarged right atrium, assuming, by the QRS complex, that it is V1 lead. If lead III has been shown with negative T wave, it could indicate pulmonary embolism. Please, indicate the lead used for demonstration of the particular issue. Thanks for your great work in terms of education of the students who studies medicine, as well for us (geophysicists) who suffered AF and PE and who purchased ECG machines to be able to monitor heart status and interpret the results, based on excellent lectures you've created so far. Thanks again!
Thanks for the comment! Yes, good ID - the PJC strip was indeed from V1. The biphasic P that's seen in V1 can actually be a normal finding, and only suggests right atrial enlargement when the positive component exceeds 1 small box in area.
Thanks a lot for your efforts to make us understand....before this video...I was really very much confused how to recognise or Identify PVCs or PACs in EKG....but now it's really helpful to Identify the same....hope you keep Making such kinda helpful videos...Thanks a lot dude....👍🙃
I feel the PVC, and I feel the harder beat after the pause. In other words, I know the heavy beat is coming because I feel the PVC first. When the PVC happens, for a split second, I feel a sensation through my whole body, hard to explain, but its kind of a feeling of my life stop just for a second, then I expect the heavy beat to get me back to normal heartbeat. At the time Im making this comment, I'm in my 3rd week of horrible PVC episodes. Once in a while I get a relief for a few hours, but they seem to start up again when I first wake up. Had them all my life, but the last few weeks have really sucked!
Premature "beats" that raise a pulse (as in the arm artery) vs. premature beats that don't raise a pulse? Premature depolarizations that seem to be close coupled/fixed interval after the previous depolarization(s) vs. ones that seem to occur randomly but not quite as immediately after the preceding depolarization? How about a "premature beat" of any kind that occurs after a longish interval after the preceding depolarization at a time the heart rate is very slow,say,40 beats per minute? As a form of escape? Is that when a healthy heart produces a junctional beat? Do premature beats that don't raise a pulse waste energy of the heart and contribute to worsened heart failure in heart failure patients? Say if someone had an EKG rate of 70 per minute but 20 of the ventricular depolarizations were PVCs ?
Would the final EKG strip be easier to figure out (detect that there are hidden p waves/2nd degree AV block with "atrial tachycardia") if the other EKG leads tracings were presented as seen on the physician's 12 lead EKG machine printout ?
Wonder if the last one is an atrial tachycardia with 2:1 AV block and a rate-dependent LBBB. Would be interesting to see an ECG at a slower atrial rate
It could certainly be some form of rate-related aberrancy, although strictly speaking, q waves in lateral leads (like I) shouldn't be present in a pure LBBB.
In the first example, the PAC, you should an inverted P wave; wouldn't this be consistent with a PJC (junctional) since it's inverted? I've always thought that the P wave in the PAC will have a different morphology, but it should be upright. P waves that are inverted, missing, or after the QRS would be a PJC in a premature depolarization.
The morphology of PACs - specifically whether they are upright or inverted - depends on where in atria they are originating. If they are originating relatively far from the AV node, most of the atrial mass to be depolarized will sit inferior and leftward from the point of origin, and thus they will be upright in II. Whereas, if they are originating relatively close to the AV node and most of the atrial mass is "behind" them, the bulk of the wavefront of atrial depolarization will be directed superior and to the right (i.e. inverted in lead II). While PJCs always cause inverted Ps in II, they generally do not have normal PR intervals, and instead either have a very short PR, occur concurrent with the QRS complex (i.e. are "buried in the QRS" and thus not visible), or even occur within the ST segment.
Thank you, I have seen this atrial tachycardia before and I always question myself; why is there P waves on or near a PVC. Sometimes I see rhythms that I don’t really know what the interpretation is but I’m sure this will help me.
P waves near a PVC might represent a sinus P wave which just didn't have time to propagate through the AV node before the PVC depolarized the ventricle. If the P wave is seen after the QRS complex of the PVC, it might represent a retrograde P from the PVC backwards up through the AV node (there's an example of that in the video @9:30 ). Or alternatively, it's not actually a PVC at all, but rather what you are seeing is a PAC that's being aberrantly conducted, mimicking a PVC.
I want to ask about the mechanism of PACs/PVCs .. and I frequently hear the term couplet interval (CI ) with less familiarity of significance of such. Is the last example caused by digoxin toxicity?
Coupling interval refers to the duration of time between a premature beat and the beat immediately preceding it. It's a particularly useful concept when trying to identify a rare phenomenon called parasystole: ua-cam.com/video/sa6lYhFtkkI/v-deo.html Regarding the last example in this video, yes atrial tachycardia with 2:1 AV block is a classic arrhythmia associated with digoxin toxicity, and you should think of that possibility whenever you encounter this rhythm in real life. However, because digoxin is uncommonly used these days, and we are now much better with safe dosing, most patients who present with AT with 2:1 AV block do not have dig toxicity.
It depends a little on one's intended career path and personal interest in EKGs, but in general, to me this seems at about the level of a senior IM resident or 1st year cardiology fellow - with the exception of the brief mention of concealed conduction and the final example (the "helpful PVC"), both of which are more in cards fellowship territory. My EKG videos are categorized as either "Intro to EKGs" or "Advanced EKGs". This is from the latter.
It's been a long time since I've added to the EKG playlist. I know some of you have been waiting for a video on VT - I hope to post that next week. I'm still trying to track down one final example to include in it. Consider this video on PACs and PVCs a warm-up!
Waiting for more EKG videos 😊😊
Excellent stuff as usual - colleagues and I cannot get over the quality. ECG content especially appreciated, thanks from Ireland! ✌🏼
Thank you !!!!
you are far better at explaining EKGs than cardiologists at my hospital. our lectures are a garbled mess.
Waiting for VT video ♥️♥️
Dr. Strong! you've done it again! you're amazing! A gift to med students, doctors and patients all over the world!
You are the GREATEST teacher when it comes to EKGs. I’ve always been so bad at reading them, but you make everything make perfect sense. I feel like I’ll be better than half of my attendings at reading soon 😂
You are very handsome 🙊🤭
You are very handsome 🙊🤭
I have a special spot in my ❤️ for cardiology!!
Thanks for the video!
Thank you for this video (and for all your videos)! I have very frequent PVCs. I like to know as much as possible about my medical conditions, but the learning curve for the layman is in regards to electrophysiology is... very high 😅. Your videos have been super helpful to me in learning about the heart and how it works. Thanks for all your hard work, it's greatly appreciated!
Living for this content!! Great to see you working on this again!
The last example is remarkable!
03:30 - PJC strip shows bipolar P wave form, which could indicate enlarged right atrium, assuming, by the QRS complex, that it is V1 lead. If lead III has been shown with negative T wave, it could indicate pulmonary embolism.
Please, indicate the lead used for demonstration of the particular issue. Thanks for your great work in terms of education of the students who studies medicine, as well for us (geophysicists) who suffered AF and PE and who purchased ECG machines to be able to monitor heart status and interpret the results, based on excellent lectures you've created so far. Thanks again!
Thanks for the comment! Yes, good ID - the PJC strip was indeed from V1. The biphasic P that's seen in V1 can actually be a normal finding, and only suggests right atrial enlargement when the positive component exceeds 1 small box in area.
Thanks a lot for your efforts to make us understand....before this video...I was really very much confused how to recognise or Identify PVCs or PACs in EKG....but now it's really helpful to Identify the same....hope you keep Making such kinda helpful videos...Thanks a lot dude....👍🙃
Many thanks for the interesting & helpful video
I feel the PVC, and I feel the harder beat after the pause. In other words, I know the heavy beat is coming because I feel the PVC first. When the PVC happens, for a split second, I feel a sensation through my whole body, hard to explain, but its kind of a feeling of my life stop just for a second, then I expect the heavy beat to get me back to normal heartbeat. At the time Im making this comment, I'm in my 3rd week of horrible PVC episodes. Once in a while I get a relief for a few hours, but they seem to start up again when I first wake up. Had them all my life, but the last few weeks have really sucked!
Thank you Dr Strong, wonderful lecture as always.
Keep uploading sir...always enjoyed and learned from your videos...keep it up 👍
Premature "beats" that raise a pulse (as in the arm artery) vs. premature beats that don't raise a pulse?
Premature depolarizations that seem to be close coupled/fixed interval after the previous depolarization(s) vs. ones that seem to occur randomly but not quite as immediately after the preceding depolarization?
How about a "premature beat" of any kind that occurs after a longish interval after the preceding depolarization at a time the heart rate is very slow,say,40 beats per minute? As a form of escape? Is that when a healthy heart produces a junctional beat?
Do premature beats that don't raise a pulse waste energy of the heart and contribute to worsened heart failure in heart failure patients? Say if someone had an EKG rate of 70 per minute but 20 of the ventricular depolarizations were PVCs ?
Well done mate! Very informative.
I’m having these rn 💀
Very nice, thanks
awesome
hello can u explain us how to know if it is a PVC or abberancy ( a video will be great thx )
Would the final EKG strip be easier to figure out (detect that there are hidden p waves/2nd degree AV block with "atrial tachycardia") if the other EKG leads tracings were presented as seen on the physician's 12 lead EKG machine printout ?
Wonder if the last one is an atrial tachycardia with 2:1 AV block and a rate-dependent LBBB. Would be interesting to see an ECG at a slower atrial rate
It could certainly be some form of rate-related aberrancy, although strictly speaking, q waves in lateral leads (like I) shouldn't be present in a pure LBBB.
@@StrongMed Thank you for the response.
How come a ventricular contraction doesn’t follow the retrograde p wave? 10:06
In the first example, the PAC, you should an inverted P wave; wouldn't this be consistent with a PJC (junctional) since it's inverted? I've always thought that the P wave in the PAC will have a different morphology, but it should be upright. P waves that are inverted, missing, or after the QRS would be a PJC in a premature depolarization.
The morphology of PACs - specifically whether they are upright or inverted - depends on where in atria they are originating. If they are originating relatively far from the AV node, most of the atrial mass to be depolarized will sit inferior and leftward from the point of origin, and thus they will be upright in II. Whereas, if they are originating relatively close to the AV node and most of the atrial mass is "behind" them, the bulk of the wavefront of atrial depolarization will be directed superior and to the right (i.e. inverted in lead II). While PJCs always cause inverted Ps in II, they generally do not have normal PR intervals, and instead either have a very short PR, occur concurrent with the QRS complex (i.e. are "buried in the QRS" and thus not visible), or even occur within the ST segment.
I thought inverted p waves is pjc??? 6:19
Sweet!
Is the non compensatory pause in PACs the same? Or will the p-p interval be LESS than twice?
Thank you, I have seen this atrial tachycardia before and I always question myself; why is there P waves on or near a PVC. Sometimes I see rhythms that I don’t really know what the interpretation is but I’m sure this will help me.
P waves near a PVC might represent a sinus P wave which just didn't have time to propagate through the AV node before the PVC depolarized the ventricle. If the P wave is seen after the QRS complex of the PVC, it might represent a retrograde P from the PVC backwards up through the AV node (there's an example of that in the video @9:30 ). Or alternatively, it's not actually a PVC at all, but rather what you are seeing is a PAC that's being aberrantly conducted, mimicking a PVC.
Thank you for the reply and explanation 😊
I want to ask about the mechanism of PACs/PVCs .. and I frequently hear the term couplet interval (CI ) with less familiarity of significance of such. Is the last example caused by digoxin toxicity?
Coupling interval refers to the duration of time between a premature beat and the beat immediately preceding it. It's a particularly useful concept when trying to identify a rare phenomenon called parasystole: ua-cam.com/video/sa6lYhFtkkI/v-deo.html
Regarding the last example in this video, yes atrial tachycardia with 2:1 AV block is a classic arrhythmia associated with digoxin toxicity, and you should think of that possibility whenever you encounter this rhythm in real life. However, because digoxin is uncommonly used these days, and we are now much better with safe dosing, most patients who present with AT with 2:1 AV block do not have dig toxicity.
Are non compensatory PVC pauses more dangerous?
I don't think they are either more or less dangerous.
Just curious, what level of knowledge is this? IM resident? Cardiology fellow? EP fellow? Seems rather nuanced
It depends a little on one's intended career path and personal interest in EKGs, but in general, to me this seems at about the level of a senior IM resident or 1st year cardiology fellow - with the exception of the brief mention of concealed conduction and the final example (the "helpful PVC"), both of which are more in cards fellowship territory. My EKG videos are categorized as either "Intro to EKGs" or "Advanced EKGs". This is from the latter.
Please make a video topic pft diffusion feno
You're in luck! Already have a series on PFTs here: ua-cam.com/video/6TApeMJ-rkc/v-deo.html
@@StrongMed thankyou so much