CONTENTS of My ECG Videos-4,5,6: On ARRHYTHMIA Mgmt

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- To My Arrhythmia Page ( www.aafpecg.com ) -
- To Video #4 (Blog-98) - Arrhythmias (Part 1 )
- To Video #5 (Blog-99) - Arrhythmias (Part 2 )
- To Video #6 (Blog-100) - Arrhythmias (Part 3 )
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NOTE: The Easy-Link to my Google Page on the "Cardiac Arrhythmia Management" is at: www.aafpecg.com - 
  • Because of the length of this 3-Part Video Series (~90 minutes) — You may prefer to view it in more than a single setting (or to refer to specific subject areas covered in the video). I have therefore made a timed CONTENTS. Fast Forward by clicking on any of the LINKS below for whatever topic you are looking for.
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NOTE: The Timed-Links listed below will take you to the precise spot in the Video for the Topic listed IF you are working on a Computer. These timed links do not always work as well on tablet/smart phone (in which case you can manually advance to the time indicated to review the material).
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ECG Blog #98 (Video-4) - Arrhythmia Mgmt (Part 1 )
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TIMED CONTENTS (Click on Links to Fast Forward! ):
0:00 – Introduction (How to contact me).
1:07 – Case Presentation (Atrial Flutter vs Artifact?).
3:00 – Does the Patient have an Arrhythmia?
3:45 – What IF there are NO Symptoms? (arrhythmia?)
4:59 – Holter Monitoring (other monitoring; patient diary).
7:17 – Event Monitors (I-Phone Alive-Cor; catching symptoms).
10:03 – Alive-CorVideo Clip (Should we be using this more?).
10:48 – Palpitations as the Chief Complaint (arrhythmia vs psych?).
12:54 – Clinical Clues that Palpitations is the Cause of an Arrhythmia.
14:00 – Next Case (of a Patient told, “You have an Arrhythmia” ).
14:48 – Is this Patient’s Arrhythmia likely to be Benign?
15:39 – “Do Nothing – or Daily Beta-Blocker?” (Intermittent Rx? )
17:00 – PEARL: Using Beta-Blockers for Benign Arrhythmias.
17:29 – Do We Need to Know the Rhythm Before We Begin Rx?
18:00 – Is Arrhythmia like to be Benign? (underlying heart disease?).
18:58 – Are there RED Flags? (When to Refer? Syncope with exercise?).
19:56 – Might the Patient have WPW? (If so – Need to refer?).
21:26 – Next Case (Auscultation ofarrhythmias; Is the Patient aware?).
22:50 – Hearing Early Beats (Does it matter if PACs / PJCs / PVCs?).
23:43 – Initial Mgmt of Premature Beats (Similar Rx for PACs/PVCs).
25:07 – Summary of Part 1 (What we covered; What’s in Parts 2,3).
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ECG Blog #99 (Video-5) - Arrhythmia Mgmt (Part 2 )
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    TIMED CONTENTS (Click on Links to Fast Forward! ):
    0:00 – Introduction.
    1:01 – Review: Goals of Treatment (Will Patient Benefit from Rx?).
    2:42 – ECG Distinction between PACs/PJCs from PVCs.
    3:56 – REPETITIVE PVCs (couplets; nonsustained vs sustained VT).
    5:22 – Assessing a Regular WCT (Wide-Complex Tachycardia)
    6:57 – Treatment of Sustained VT (Clinical scenario? Stable?).
    8:25 – A Young Adult with Sustained VT (Adenosine responsive?).
    10:13 – BRADYCARDIA (Is Sinus Bradycardia Normal? – It depends).
    11:17 – Next Case: Sinus Bradycardia in a 60yo with Fatigue …
    13:00 – Once You Have Ruled Out Medications …
    13:42 – How to Make a Diagnosis of SSS (Sick Sinus Syndrome).
    15:07 – What is the Indication for Pacing? (Symptomatic Brady).
    15:58 – How to Assess Sinus Pauses (How long is of concern?).
    17:00 – End of Part 2.
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    ECG Blog #100 (Video-6) - Arrhythmia Mgmt (Part 3 )
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      TIMED CONTENTS (Click on Links to Fast Forward! ):
      0:00 – Introduction.
      1:06 – SVT Rhythms (Definition of “SVT”; What is “narrow” ? ).
      1:59 – Exceptions (SVT despite a wide QRS).
      2:41 – Despite a Narrow QRS in V1 – Not SVT! (Use 12 leads!).
      3:26 – Our Agenda for this Part 3.
      3:49 – Next Case: A Regular SVT (How to Use Ps,Qs,3Rs).
      5:08 – Rate Estimation (Rule of 300).
      5:56 – LIST: Regular SVT without Sinus Paves (3 Causes!).
      6:36 – Initial Mgmt of a Regular SVT of Uncertain Etiology.
      7:38 – Next Case: Regular SVT at 180/Minute (Ps,Qs,3Rs).
      8.37 – Fast Rate Estimation (Every-other-Beat Method).
      9:40 – PSVT (Illustration of AV Nodal “Reentry”; Implications).
      10:50 – Effect of Vagal Manuevers on PSVT.
      11:20 – How to Treat PSVT? (AVNRT vs AVRT; Initial Rx).
      13:06 – Common Themes in Practical Arrhythmia Mgmt.
      14:12 – Next Case: Atrial Flutter (How to assess this SVT).
      15:18 – Effect of Vagal Maneuver on Atrial Flutter
      15:39 – Using Calipers to Recognize Flutter (sawtooth).
      16:10 – Atypical AFlutter (Distinction from Atrial Tachycardia).
      16:36 – Mgmt of AFlutter (Differences in Rx vs AFib).
      18:10 – Next Case: Irregular but Not AFib (Recognizing MAT ).
      20:03 – ATRIAL FIBRILLATION: What if AFib is Slow?
      21:28 – AFib with a Rapid Response: Initial Evaluation.
      22:27 – AFIB: The 5 Initial Priorities in Management.
      23:12 – CAUSES of AFib (Which are most common?).
      24:33 – “Lone” AFib (How to Define; A Lower Risk Group?).
      25:09 – Recommended WORK-UP of New AFib (When Echo?).
      27:01 – AFIB: Slowing the Ventricular Response (Which Meds?).
      28:46 – To CARDIOVERT AFib? (Spontaneous/Meds/Shock).
      30:25 – Issues Regarding Cardioversion (Candidates? 1st Episode).
      31:29 – Anticoagulation of Rate-Controlled AFib may be Enough …
      32:00 – Effect of Lifestyle Changes for Treating Chronic AFib.
      32:32 – Most AFib Episodes are Asymptomatic!
      33:00 – Should AFib be Cardioverted in the ED (Emergency Dept.)?
      34:05 – When to Refer to Cardiology? (specifically to EP Cardiology).
      34:59 – Preventing STROKE: Who to Anticoagulate? (CHADS, etc.).
      36:58 – Newer Oral Anticoagulant Drugs (NOACDs vs Coumadin?).
      39:35 – End of Part 3.
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      2 comments:

      1. UnknownSeptember 5, 2015 at 10:26 PM

        Does adenosine contraindicated for sinus tachycardia? I mean if we unsure of SVT rhythm ,Can we give adenosine to differentiate between sinus and PSVT, What will happen if given Adenosine/ DC cardioversion for sinus tachycardia that thought to be PSVT
        Thanks with regards

        ReplyDelete
        Replies
        1. ECG InterpretationSeptember 12, 2015 at 6:57 AM

          If we KNEW that an SVT rhythm was sinus tachycardia — then we should not give Adenosine. However, the clinical situation in which this comes up is that of an undifferentiated SVT rhythm — in which case it is fine to give Adenosine for diagnostic purposes. If the rhythm turns out to be sinus — then although one may see adverse effects from Adenosine administration, these will most often resolve within 30-90 seconds. I review use of Adenosine in this pdf (taken from my ACLS-2013-ePub) — GO TO — https://www.dropbox.com/s/giup6reoue4sb7v/6.0-%20ACLS-2013-e-PUB-Adenosine-Mallet-side%20effect-VT%20pdf-(12-18.21-2014)-LOCK.pdf?dl=0 —

          Although at times one can get fooled with SVT rhythms without P waves — most of the time there are clinical clues that the rhythm may be sinus tachycardia. Sinus tach rates are rarely constant — so looking at telemetry monitoring in preceding minutes will often show variation in heart rate (even if just slight!). Telltale P waves may be evident when the rate slows slightly. In contrast, PSVT and AFlutter typically are quite regular once these rhythms are established. Comparison with prior ECGs — consideration of vagal maneuvers — considering the clinical situation for likelihood of sinus tachycardia, etc are all measures to contemplate. It is worth looking for these clues to possible sinus tachycardia, since although Adenosine rarely produces longterm adverse effects — it is not a pleasant experience for the patient — so in the stable patient with an undifferentiated SVT that I suspect is sinus tachycardia — I "go the extra mile" to try to verify sinus tachycardia before reaching for the Adenosine ...

          Delete

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