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Assalamuaikum dr. I have seen 2 ecg with sinus arrythmia in pregnancy, with irregular rythm but p wave present. I have read  this   changes occur as we exhale and inhale. So its not pathological right dr? But is it common to see in pregnant mother?

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Is there any link or can teach us more about pacemaker rythm?
Tasha

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Salam hye dr azlan.  Wanna ask about LVH criteria. Among all those criteria ie sokolov/modified cornell/mohit/voltage and non voltage,  which one that shud i use?  And also which one is the most specific/sensitive?

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Tq fatin for asking. Stemi in LVH is challenging as lvh may give rise to ST elevation too due abnormal repolarisation esp affecting v1-v3. Presenting history is crucial to help establish dx. As for ecg features, lvh follows specific features as attached: (look for ST : rs ratio, if more than 25% involving 3 leads or more, suggesr stemi.
https://www.ncbi.nlm.nih.gov/m/pubmed/22738872/

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STEMI in LVH

Assalamualaikum,Dr
What is the criteria of STEMI in LVH? because found so many pt. with LVH 😅?
Thank you Dr.
- Fatin

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No. It wont give u only certain changes in one leadbut completely normal in other leads. As ecg is summary of electrical activities in the patients’ hearts. All leads should have similar pattern if taken at the same period

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Thank you Dr for the explanation.
If there is only sine wave (absent P) at lead I only for example, but other lead show sinus rythm, can still we call that sine wave in lead 1 sine wave Dr?
-Wan

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Hi wan. wslm. Sine Wave is the feature of the ECG as a whole. not only seen in lead ii only. The features of broad bizarre QRS with absent P is also seen in other leads. Hence The 12 lead ECG is needed to see all the features to support HyperKalemia. however, if patient is only cardiac monitor, so only lead ii is seen, presence of any Broad Complex Rhythm, looks like VT but not tachycardic, need to rule out Sine Wave Severe HyperKalemia

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Assalamualaikum Dr.
May I know, do we look the sine wave in hyperK in lead II only?

- wan

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As far as i know, u calculate QU if merged. If the qt terminal margin still seen, then cannot include u wave in the calculation. U wave sometimes can also be seen in normal individuals

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Nope. Or else org xmo mkn😊

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Also, is oral and mist potassium painful like IV KCl?

- Faiz

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Good morning, Dr. Regarding ECG changes is hypokalemia, if U wave is present but not at all merged with T wave,  is QT interval still considered till the end of U wave?

(like if the "regular QT is still within normal range, but if we take the end of U wave as QT interval it becomes > 1/2 R-R interval. even though if the U wave is not at all fused with T wave)

- Faiz

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Thechanges are not always sequential. But atrial ectopics are often seen in mild hyperK, p wave reflect SAN node function so itvwill be the last man standing. The last conduction tissue to be affected

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I also have some questions about Hyper/ Hypo- kalemia.

1. I remember you mentioning that the atrium is most susceptible to potassium change. So why is the earliest ECG sign in hyperkalemia tall T wave (which is a ventricular event) n not a change in P wave?

- Faiz

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Thank you for the clear explanation, Dr. Out of curiosity, is the "2 in 1" device available in the Malaysian setting, or is it only available in more developed (or rich) countries?

- Faiz

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Tq faiz. Icd and pacemaker are 2 different device for diff indications. However now there is a device that combine both functions. Icd is implantable cardiodefibrillator that gives shock when ptn goes into arrest, while pacemaker replace the function of the SA node to stimulate the heart function and to contract according to the predetermined rate set.

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Good morning, Dr. Is ICD the same thing as pacemaker? Because they both look similar.

- Faiz

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wslm. before i answer, if i may request those who ask question to put ur name or nickname. easier to refer to.
regarding qrs: easier to remember the width should not be more than 3 small box ie 120ms or 0.12s. to be exact, the normal range of qrs width is 0.08-0.11sec.

drlanhelmy

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How narrow is narrow QRS complex? In the slide, it is written normal one should be 0.08-0.10. But in other sourcethat i read it is anything less than 0.12s. Which one is used in local hospital?

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wslm. slide 20 referring to which note ye? actually u dont have to memorise the whole thing, u just jave to understand the concept then it will all make sense to you slowly. As for the angles, it helps to understand the axis concept of the heart so u will be able to determine the axis of the heart.
dr azlan

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the ecg horizontal axis refers the ecg speed. The standard calibration is 25mm/s. and the vertical axis refers to the voltage and the standard calibration is 10mm/mV

dr azlan

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asalam Dr, in hospital, the ecg's horizontal axis is usually 1/25 or 1/50 if I may know?

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asalam Dr. I want to know, do we need to really know about the angles and like everything in the slide 20? is it enough if i just memorize which leads represent which area of the heart? because its tiring to learn these huhu. thank you in advance.

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A good kickstart revision on ECG; https://www.youtube.com/watch?v=xIZQRjkwV9Q&t=417s

Kindly watch this before our session ya, insyaAllah will share more revision later 😉

Dr Iliana 💝

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Hi to all. Dr Azlan here. Feel free to ask me anything here regarding ECG before our class this Sunday. 😊