Current ECG Podcast

In this episode, Dave tackles the question: What's the difference between a normal Q Wave and a pathological one?

Also In This Episode

• The hexaxial reference grid, the Cabrera system
• Septal Depolarization
• A window to the other side of the Heart!
• Negative deflection
• Pathological Q wave criteria
• ECG examples

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In this episode, Dave talks about COVID-19 and some additional information that clinicians and emergency care providers can use to help them identify and manage some of these patients.

Also In This Episode

• ECG Tracing examples
• What does COVID-19 do to the heart?
• Not all viruses are the same
• Systemic inflammatory response
• Myocarditis: STEMI, HF, Shock
• Cytokine release
• ECG Tracing examples
• Risk factors
• Treatment

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In this episode, Dave talks about VTACH, monomorphic and polymorphic, how to define them and finding the root cause of a rhythm.

Also In This Episode

• Monomorphic VTACH defined
• Dave's story - When you're following ACLS but the patient doesn't respond as expected
• ECG Tracing example - wide tachycardia

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On this episode, Current ECG teams up with Master Your Medics to present a TCA Overdose case!

Dave discusses the pathophysiology behind sodium channel blocking medications and how they affect cardiac depolarization at the cellular level. This is important because it affects how we interpret the ECG.

Cardiac toxicity can develop quickly in TCA overdose, so get an ECG early in the clinical course if suspecting the diagnosis.

Dave also discusses how sodium bicarbonate works to alter the patients ph level as well as competitively binding to sodium channel receptors helping to reverse the acidosis and TCA availability in the blood.

Treatment options include:

• Oxygen
• Sodium bicarbonate for a QRS complex wider than 100ms.
• Assisted ventilations via BVM with potential for early intubation consideration which will help to blow off C02
• 0.9% Normal Saline

What are some signs of TCA Overdose on the ECG?

1. Sinus Tachycardia – most frequent dysrhythmia
2. Widening of the QRS complex
3. Prolongation of the PR or QT interval
4. Right bundle branch block
5. Non-specific intraventricular conduction delay (IVCD)
6. Brugada pattern
7. Wide-complex tachycardia (not ventricular tachycardia)
8. Ventricular tachycardia / fibrillation

How wide is too wide?

A QRS duration >100ms is predictive of seizures and QRS >160ms is highly likely to experience a ventricular dysthymia.

The ECG from our patient had a QRS of 144!

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Check out Master Your Medics: https://podcasts.apple.com/ca/podcast/master-your-medics/id1235264636

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In this episode, Dave talks about the importance of interpreting ECG tracings with a focus on Sensitivity and Specificity on the cardiac monitor.

Dave explains what Sensitivity and Specificity is and how it applies to you as a clinician.

Also In This Episode

• Interpreting ECG tracings
• The psychology of chest pain
• Cardiac monitor
• ILCOR
• Sensitivity and specificity

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On this episode Dave talks about collateral circulation, the lateral wall and the importance of understanding cardiovascular and coronary anatomy and physiology when you are interpreting an ECG.

Also In This Episode

• Electrical Silence
• Changes in the lateral wall appear subtle
• ECG tracing example #1
• Why is there no changes in the low lateral leads?
• ECG tracing example #2
• ECG tracing example #3
• Morphology and reciprocal changes

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On this episode Dave talks about the phenomenon of Cancellation of Electrical Forces - when an injury current is travelling to the front of the heart and at the exact same moment an injury current is travelling to the back of the heart.

Also In This Episode

• The importance of recognizing Inferior Wall MI's and knowing if the right ventricle is involved.
• Using lead V4R
• ECG tracing example - Spotting the RVI
• Lead 3 and V1 have the best view
• ECG tracing example - V4R
• What if the back of the heart is being effected?
• ECG tracing examples

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On this episode Dave is joined by Dr. Jerry W. Jones, MD FACEP FAAEM. Dr. Jones is the CEO and Founder of Medicus of Houston. He is a Board-certified emergency physician, author, speaker, instructor and and internationally-recognized expert in electrocardiography.

Dr. Jones is a diplomate of the American Board of Emergency Medicine who has practiced internal medicine and emergency medicine for over 40 years.

Also In This Episode

• History of the presenting illness & patient presentation
• ECG Tracing #1
  • ST deviations
  • Morphology of the ST Segment
  • Cancellation of electrical forces
• ECG Tracing #2
  • Low Voltage
  • ST deviations
  • Reciprocal changes focus on AvL and Lead3
  • Jone's Rule - any patient with credible symptoms of acute coronary syndrome (MI), any ST depression should be considered a reciprocal change until proven otherwise.
• ECG Tracing #3
  • Sinus rhythm
  • ST deviations
  • Inferior MI
  • Right ventricular MI
  • Starling law
• ECG Tracing #4
  • Sinus rhythm
  • ST deviations
  • Acute Inferior MI
  • Multiple MIs
  • Right coronary artery lesion
  • Cancellation of electrical forces

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On this episode Dave talks about Millimetres, does size really matter? For years we based our ECG diagnosis of myocardial infarction using a very specific set of millimetre criteria. Times have changed and ECG interpretation is changing too!

Also In This Episode

• Dr. Steven Smith's thoughts on the millimetre measurement of the ST segment
• Biology does not work on millimetre criteria
• Trusting your gut

Subscribe to the video version of this podcast to have access to the visuals that accompany the audio as well as additional tools and resources to help improve your understanding.

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On this episode Dave talks about how the QT interval is a big deal and how we should be looking at it each time we perform an ECG.

QT Interval - The time from the beginning of the Q wave to the end of the T wave.

Also In This Episode

• Please start looking at the QTc as part of your regular ECG interpretation
• Torsades de Pointes is a specific form of 'Polymorphic Ventricular Tachycardia' caused by a 'Long QT'. Watch out and prepare!
• QT little 'c' which stands for (corrected). What it is correcting for? It's correcting for 'RATE' and averaging everything to 60 beats per minute.
• QTc > 0.50 sec = a clinically significant prolonged QT interval and you need to tell somebody about it!!
• Patients at higher risk - Methadone and medications of the Mycin family are notorious for prolonging the QT interval to name just a very few. Brush up on all the other medications that prolong the QT.
• Take a closer look at the QTc in patients who are elderly and perhaps suffer from chronic renal insufficiency...they are higher risk patients for a prolonged QT.
• And don't forget...If you encounter a patient in Torsades. Once you fix the rhythm, immediately as yourself...Hmm why did this patient have a prolonged QT interval??? So it doesn't happen again.

Subscribe to the video version of this podcast to have access to the visuals that accompany the audio as well as additional tools and resources to help improve your understanding.

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And Stay Current!