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]). ------------------------------------ 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) — ------------------------------------ NOTE-2: To facilitate viewing — CLICK on the LINKS below! ------------------------------------ 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!