03- Read ECGs Like An Expert - ADVANCED EKG Interpretation

Dr. Nicholas Tullo, a heart rhythm specialist, presents this "ChalkTalk" for the ECG Academy. This instructional video features an irregular rhythm and is designed for people who already know the basics but want to get used to reading more complicated tracings. For basic, intermediate, and advanced video instruction on interpreting ECGs, visit ECGAcademy.com.

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[dcekinovich]

I had this diagnosed as 2:1 2nd degree Type II w/ junction escape beat. I see your reasoning to why it is a hemifasicular vs junctional beat. Good lesson. Do bundle branch beats normally have a longer QRS interval? And can you pinpoint based on morphology of the QRS where the beat originated: His, right, left?

[ECGDoc]

Thanks for the comment! Bundle branch beats and hemifascicular beats should have a wider QRS duration because in order for the ventricle to be activated the impulse has to travel UP from wherever in the conduction system it's originating from, turn around at the His bundle, and then proceed down the other bundle or hemifascicles. That takes longer than if it started in the node or the His bundle itself, so the QRS should be wider.

[ECGDoc]

A clue as to where the beat originates from is that if the 12-lead morphology looks like a bifascicular block then the beat is coming from the remaining hemifascicle. Eg. if the escape beats resemble a RBBB/LPFB, then the beats are likely coming from the left anterior hemifascicle. As the beat travels up from there it makes the other two fascicles fire later (ie. delayed) giving the appearance of a bifascicular block. Hope that helps! -- Nick Tullo, MD

[xxxtazmanxxxx]

you keep saying to go to the website but I go there and I can't sign up. log in or subscribe so therefore the website is useless at this point

[ECGDoc]

@xxxtazmanxxxx -- I sincerely apologize for that. I produced these videos so that people can continue to view them for years to come. I am in the process of developing the website, so it's not quite ready. But if you like my teaching style on these ChalkTalks, you'll really like the videos on the website! Stay tuned!

[striae]

isnt it resumed on the qrs notch in v1 lead?

[ECGDoc]

@striae -- Thanks for your comment, but I'm not sure what you are asking.

[mistywind08]

YOU ARE AMAZIIIIIIIIIIIIIIIIING!!!! THANK YOU SO MUCH!!!

[ToMMiTTo]

fantastic and very clear lesson! thank u so much!