EKG / ECG Interpretation Explained Clearly – Practice Case 11


Well welcome to another MedCram video here. We’ve got our next EKG Which we’re going to talk about we’re going to go through this in a methodical fashion using our tried-and-true technique of Rate Rhythm Axis Hypertrophy and then looking for ST Segments, so first up is figuring out rate, and we can see here We’ve got the QRS complex And a QRS Complex here what we’re doing is we’re looking at how many boxes are between it, and it’s a little bit more than one but less than two, in fact it’s a little bit less than one and a half so if we take 300 and divide it by less than one and a half we’re gonna be in the approximately the one sixties to one seventies the other way to look at it is to look at the number of qrs complexes so 1 2 3 4 5 6 7 8 24 25 26 27 and 28 and multiply it by 6. So if we go 28 times 6 is gonna give us a total of about 168 beats per minute so that’s where we come up with the number of beats per minute remember, this is a 10-second strip and so if we multiply it by 6 we’ll see how many times you’ll have it in one minute. So that’s rate let’s look at Rhythm next and For rhythm, We’re going to look at each of these QRS complexes and see if there’s p waves see if they’re regular Etc etc. One of the things I think that’s interesting what we’ll do here is zoom up… You can see here very clearly that there’s a little p wave after each QRS complex Which is kind of interesting right? You can also see a little notching right there after each QRS complex, and what’s going on here? This is very fast So you have tachycardia as we’ve already said But it’s also very regular and there’s p waves after the QRS complex this type of a pattern you’ll see in AV Nodal re-entrant tachycardia So I think that’s what’s going on here with the rhythm So here we have the rate of 168 we have a rhythm of AV nodal reentrant tachycardia The next thing is to go on to axis So the thing again to remember on axis if we draw a nice circle remember that the line going out this way is lead 1 and the line going down this way is AVF so If we look at lead 1 we can see here that it’s very positive, obviously these are positive QRS complexes and so we’re gonna be in This direction over on the right-hand side of the screen but on the left-hand side of the patient and then in terms of AVF we can see clearly here that we’re dealing with a slightly negative QRS complex and so therefore, we’re going to be going opposite so kind of in this direction And so it looks as though that the vector that we’re going to be talking about is slightly negative And it’s a as in fact as it turns out the computer measures it out at negative 8 so negative 8 Degrees is going this direction is very close to almost being right on to AVL Okay, and you can see here that AVL is probably one of the most positive leads Similarly ninety degrees to AVL is this one right down here? Which is lead II and so because we know that The the Vector is going almost Parallel to AVL that any lead perpendicular to the vector is going to look isoelectronic So let’s see if it is isoelectronic and lead II and sure enough We go to Lead II and you can see here that for the most part what we’re dealing with here is isoelectronic so that makes sense that our Ventricular axis is going to be slightly left. Maybe a little bit of left ventricular hypertrophy there at Negative 8.. The axis is negative 8 degrees. Let’s move on to hypertrophy and ST Segment changes So we’re gonna zoom up and look at those precordial leads. We can’t really see if there’s any atrial hypertrophy because of the AV nodal reentrant tachycardia in nature, but if we look at V1 We’re looking for right ventricular hypertrophy and specifically is the R wave Bigger than the S wave and in this case, it’s certainly not so there’s no evidence for right ventricular hypertrophy But then and looking for left ventricular hypertrophy what we’re doing there is we’re counting up the size of the S wave which in this case is 10 11 12 millimeters and Now we’re counting up and looking at the R wave in lead V5 and the R wave in lead V5 looks like it’s five six seven millimeters and we can see here that twelve plus seven is total of 19 and 19 millimeters does not meet the criteria for 35 millimeters, and so therefore there is no evidence of right ventricular or left ventricular hypertrophy Okay, what about ST Segment Depression? Well, we can see here that there is some ST Segment Depression in Lead V1 It seems to be more pronounced in II in III and also in AVF not to mention in V5 V4 Also then in V6 there’s some up-sloping here in V3 Though The J point is not exactly clear, seems to be less in the V1 and V2 area but certainly in the inferior and Also in the lateral leads, we’re starting to see some ST Segment depression it could be because of ischemia from tachycardia from the AV nodal reentrant tachycardia But definitely seeing some ST Segment depressions there So to summarize no hypertrophy seen, but there is some ST segment depression in II, III, and AVF and also in V5 and some of those lateral leads So we’ve gone through it pretty systematically, and we found this AV nodal reentrant tachycardia with a heart rate in the 160s with a left ventricular Axis deviation no hypertrophy and ST Segment depression in the inferior leads and Thanks for joining us