ECG Video-15 (Blog 118) - QRST changes-Systematic Approach (9-22.1-2015)

This is the 15th installment of my ECG Video Blog (http://www.QRSTecg.com). The video is 65 minutes long — so you may want to view it in more than a single session (NOTE the detailed linked CONTENTS below — that allows you to easily navigate through this video!). There are 3 main parts to the Video: i) Initial thoughts on the use of a Systematic Approach to ECG Interpretation; ii) Detailed discussion on how to assess for QRST Changes (assessing Q waves; R wave progression/Transition; ST-T wave changes); and iii) Practice Tracings that put concepts presented in the first 47 minutes of the video together. NOTE: I aimed my content at an Intermediate level interpreter (with emphasis on BASIC concepts plus LOTS of PEARLS for more advanced interpreters along the way). Hope you enjoy this! I welcome your feedback! (KEN GRAUER, MD – [email protected]).
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NOTE-1: Links to my ECG Videos (including a folder with Power Point Shows of these videos) — as well as info on my other ECG Resources can be found at — http://www.videoecg.com — Your Questions and Feedback are welcome! (9/23/2015) —
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NOTE-2: To facilitate viewing — CLICK on the LINKS below!
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0:00 – INTRO (How to Contact Me).
1:17 – The KEY: You Need a Systematic Approach.
2:00 – The 2 Steps (Descriptive Analysis/Clinical Impression).
2:45 – EXAMPLE: The Cause of Anterior T Inversion?
4:52 – Distinction between Description vs Interpretation.
5:30 – The Systematic Approach We Favor (6 Parameters).
6:40 – Where QRST Changes “fits” in … (What it is … ).
7:49 – Is this an Acute STEMI? (Why a System is Needed … ).
10:36 – Assessing for QRST Changes.
11:27 – Looking for Q Waves (Definitions of Q,q,QS,rS).
14:29 – What are “Normal Septal q Waves?”
16:22 – vs Infarction Q Waves (Describe what you see … ).
17:09 – The “R” in QRST (R Wave Progression).
18:04 – Why Include the “R” in QRST?
18:58 – Is R Wave Progression “normal”? (Transition).
21:41 – TRANSVERSE View: Septal q waves? / Why an “r” in V1?
23:29 – WHERE is Transition? (Early vs Delayed Transition … ).
25:00 – Problems with the term, “Poor R Wave Progression” …
27:21 – Schematic CHEST Leads: Has there been Anterior Infarction?
30:39 – The “S” and the “T” in QRST (ST segment deviations).
31:10 – What is the ST “Baseline”? (Use of the PR vs TP baseline).
32:54 – EXAMPLES of ST Elevation / Depression (Using the baseline).
34:05 – KEY Point: Normal T Inversion / Q Waves Leads (Reverse “Z”).
38:00 – The T wave vector often follows the QRS vector …
38:46 – The SHAPE of the ST segment is Most Important …
39:36 – Appearance of a “normal” ST segment (vs “nonspecific” change).
42:26 – ST DEPRESSION (asymmetric vs symmetric ST-T depression).
45:16 – ST ELEVATION (“smiley” vs “frowny” shape … ).
47:17 – PRACTICE Tracing #1: New-onset Chest Pain …
48:22 – Analysis of Tracing #1.
51:38 – Clinical Impression of Tracing #1.
52:50 – PRACTICE Tracing #2: An Asymptomatic Young Adult …
53:20 – Analysis of Tracing #2.
54:52 – “Smiley”-shape ST elevation … (Early Repolarization).
55:54 – Clinical Impression of Tracing #2 (ERP vs anything else … ).
57:10 – Same Descriptive Analysis: What if this patient had Chest Pain?
58:43 – PRACTICE Tracing #3: Atypical Chest Pain (“strain” vs ischemia?).
58:53 – Analysis of Tracing #3.
1:01:49 – Did you notice any ST elevation?
1:02:30 – ST Elevation in Lead aVR …
1:03:00 – Clinical Impression of Tracing #3.
1:04:37 – That’s it for today!