Monday, May 17, 2021

ECG Blog #225 — ECG Media PEARL (5-16-2021)


Dear Reader: In January, 2021 — I started this ECG Media PEARL Series. My purpose in doing so was simple: I wanted to add audio and video media to enhance and facilitate teaching.


It goes without saying that to master ECG interpretation requires seeing the tracing you are analyzing. That said — important ECG concepts are sometimes best conveyed by either a short Audio message or a brief ECG Video.
  • As the number of my Media Pearls continues to increase — it is time for a reorganization of how these Pearls are indexed. I hope my new system (below) of using Clinical Categories facilitates finding the "Pearl" you are looking for.
  • As always — I welcome your input! For comments or questions: WRITE ME at ekgpress@mac.com —

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LINKS to My ECG Media Pearls (v = video):
- MP-1 - MP-2MP-3MP-4 - MP-5v - MP-6vMP-7 
- MP-8v - MP-9v - MP-10 - MP-11MP-12 -
MP-13MP-14 - MP-15 - MP-16vMP-17 -
MP-18MP-19 - MP-20v - MP-21v - MP-22v -
MP-23MP-24 MP-25MP-26 - MP-27v -
- MP-28v MP-29 MP-30 MP-31MP-32 -
MP-33MP-34MP-35 - MP-36 MP-37 -
MP-38MP-39MP-40 MP-41 - MP-42v -
MP-48 - MP-49 - MP-50 - MP-51 -

- MP-52 - MP-53 - MP-54 -
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— To return to my latest ECG Blog = CLICK HERE 
— To access the ECG Videos — CLICK HERE —
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Use of a Systematic Approach:
  • ECG Media Pearl #3 (3:00 minutes Audio— The Ps, Qs & 3R Approach to Systematic Rhythm Interpretation (1/18/2021) — See ECG Blog #185 —
  • ECC Media Pearl #23 (7:40 minutes Audio) — ECG Blog #205 — A user-friendly Systematic Approach to 12-Lead ECG Interpretation (3/18/2021) .
  • ECG Media Pearl #27 (3:00 minutes Video) — ECG Blog #210 — Reviews the Rule of 300 for estimating heart rate — and — @ 1:25 minutes in the video, the Every-Other-Beat Method for Estimating Rate with fast rhythms (4/2/2021).
  • ECG Media Pearl #31 (5:30 minutes Audio) — ECG Blog #214 — WHY do I emphasize the phrase, "1Leads are Better than One?" (4/14/2021).
  • ECG Media Pearl #33 (7:00 minutes Audio) — ECG Blog #216 — Explores what to do when you are not certain of the Rhythm DiagnosisHow often does this really matter? (4/20/2021).
  • ECG Media Pearl #37 (6:00 minutes Audio) — ECG Blog #220 — Reviews how to determine IF Your Patient is Hemodynamically Stable! (5/2/2021).

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Axis — Hemiblocks — Bundle Branch Blocks: 
  • ECG Media Pearl #20 (14:30 min. Video)ECG Blog #203User-friendly approach to Calculating Axis (3/12/2021).
  • ECG Media Pearl #21 (12:00 min. Video) — ECG Blog #203User-friendly approach to the Hemiblocks (LAHB/LPHB) and Bifascicular Blocks (RBBB/LAHB-LPHB — 3/12/2021).
  • ECG Media Pearl #22 (13:15 minutes Video) — ECG Blog #204 — Reviews a user-friendly approach for how to diagnose Bundle Branch Blocks (RBBB/LBBB/IVCD) in a matter of seconds(3/15/2021).


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Chamber Enlargement (RAA/LAA - RVH - LVH - Acute PE ):
  • ECG Media Pearl #50 (7:20 minutes Audio) — ECG Blog #234 — Reviews the ECG diagnosis of RVH (with distinction between pulmonary disease vs RVH — XXX/XXX/2021).

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Diagnosis of Acute Ischemia/Infarction:
  • ECG Media Pearl #1 (3:00 minutes Audio) — Regarding deWinter-like T waves (1/10/2021) — See ECG Blog #183 -
  • ECG Media Pearl #2 (2:15 minutes Audio) — The "magical" mirror-image opposite relationship with acute ischemia between lead III and lead aVL (1/15/2021) — See ECG Blog #184
  • ECG Media Pearl #7 (4:50 minutes Audio) — ECG Blog #190 — When to suspect RMI on a standard 12-Lead ECG (What is the "culprit" artery?(2/3/2021).
  • ECG Media Pearl #10 (10 minutes Audio— ECG Blog #193 — Reviews why the term "OMI" ( = Occlusion-based MI) should replace the more familiar term, "STEMI" — and presents the basics for predicting the "culprit" artery (2/10/2021).
  • ECG Media Pearl #11 (6 minutes Audio) — ECG Blog #194 — Reviews how to tell IF the "culprit" artery has reperfused (using clinical and ECG criteria(2/14/2021).
  • ECG Media Pearl #26 (6:00 minutes Audio) — ECG Blog #209 — What WellensSyndrome is — and what it is not (3/30/2021).
  • ECG Media Pearl #35 (5:20 min. Audio) — ECG Blog #218 — WHEN is a T Wave Hyperacute vs a Repolarization variant (4/26/2021).
  • ECG Media Pearl #38 (11:30 minutes Audio) — ECG Blog #221 — Reviews the ECG Diagnosis of Acute MI when there is BBB (5/6/2021).
  • ECG Media Pearl #39 (5:15 minutes Audio) — ECG Blog #222 — Reviews the concept of Dynamic ST-T Wave Changes (and how this ECG finding can assist in determining if acute cardiac cath is indicated(5/9/2021).
  • ECG Media Pearl #44 (3:30 minutes Audio) ECG Blog #228 — What is a "Silent" MI? — and How OFTEN do "Silent MIs" occur? (results from Framingham — 5/24/2021).
  • ECG Media Pearl #46 (7:20 minutes Audio) — ECG Blog #230 — Reviews HOW to compare Serial ECGs (ie, "Are you comparing Apples with Apples or Oranges?"6/1/2021).

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Diagnosis of Ventricular Tachycardias (VT vs SVT — with review of Aberrant Conduction):
  • ECG Media Pearl #13 (13:15 minutes Audio) — ECG Blog #196 — Reviews "My Take" on assessing the regular WCT (Wide-Complex Tachycardia) — with tips for distinguishing between VT vs SVT with either preexisting BBB or aberrant conduction (2/202021).
  • ECG Media Pearl #14 (8 minutes Audio) — ECG Blog #197 — What is Idiopathic VT? — WHY do we care? Special attention to the 2 most common forms = RVOT (Right Ventricular Outflow Track) VT and Fascicular VT (2/23/2021).
  • ECG Media Pearl #15 (5 minutes Audio) — ECG Blog #198 — Is Monomorphic VT Regular? — with attention to the 2 Caveats that emphasize how: i) Fast AFib may look regular; andii) Monomorphic VT is not always perfectly regular (2/26/2021).
  • ECG Media Pearl #28 (4:40 minutes Video) — ECG Blog #211 — Reviews WHY some early beats and some SVT rhythms are conducted with Aberration (and why the most common form of aberrant conduction manifests RBBB morphology(4/5/2021).
  • ECG Media Pearl #29 (8:00 minutes Audio) — ECG Blog #212 — Reviews WHAT the Ashman Phenomenon is ... — HOW do we use it? — and — Is it accurate when the underlying rhythm is AFib? (4/8/2021).
  • ECG Media Pearl #30 (7:40 min. Audio) — ECG Blog #213HOW to distinguish between Aberrant Conduction vs Ventricular Ectopy — when the underlying rhythm is AFib? (4/11/2021).
  • ECG Media Pearl #34 (6:00 minutes Audio) — ECG Blog #217 — Are YOU really seeing AV Dissociation in that WCT Rhythm? (ie, Is the rhythm VT?(4/23/2021).
  • ECG Media Pearl #36 (7:45 minutes Audio) — ECG Blog #219 — Reviews distinction between Ventricular Tachycardia vs AFib when the Wide Tachycardia is Not Regular (4/29/2021).
  • ECG Media Pearl #37 (6:00 minutes Audio) — ECG Blog #220 — Case Study that reviews in detail distinction between VT vs SVT with preexisting BBB or aberrant conduction. Audio PEARL = How to determine IF Your Patient is Hemodynamically Stable! (5/2/2021).
  • ECG Media Pearl #48 (5:00 minutes Audio) — ECG Blog #231— Reviews the ECG and clinical distinction between PolyMorphic VT (PMVT) vs Torsades de Pointes.
  • ECG Media Pearl #47 (5:45 minutes Audio) — ECG Blog #232 — Reviews the concept of Bigeminy (which may be due to Atrial or Ventricular Bigeminy, Wenckebach conduction — or other causes — 6/10/2021).

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Types of SupraVentricular Rhythms (SVT-AFib-Flutter-MAT, etc):
  • ECG Media Pearl #16 (2:20 minutes Video) — ECG Blog #199 — What is MAT (Multiple Atrial Tachycardia)? How is it diagnosed? (3/1/2021).
  • ECG Media Pearl #17 (3:30 minutes Audio) — ECG Blog #200 — What is a Wandering Atrial Pacemaker (as opposed to MAT)? (3/4/2021).
  • ECG Media Pearl #40 (9:45 min. Audio) — ECG Blog #223 — Rhythm Diagnosis: Assessing P Waves and Atrial Activity (5/13/2021).
  • ECG Media Pearl #43 (1:45 min. Audio) ECG Blog #227 — Reviews the Bix Rule (which explains why it is uncommon to see sinus tachycarda with 1st-degree AV block) — (5/23/2021).
  • ECG Media Pearl #45 (10:00 min. Audio) ECG Blog #229 — Why is Atrial FIutter so commonly overlooked? Reviews PEARLS regarding the ECG diagnosis of AFlutter — and — about distinction between AFlutter vs Atrial Tachycardia (5/29/2021).
  • ECG Media Pearl

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Diagnosis of AV Blocks/AV Dissociation:
  • ECG Media Pearl #4 (4:30 minutes Audio— The ABlocks & WHEN to Suspect Mobitz I (1/21/2021) — See ECG Blog #186 —
  • ECG Media Pearl #(12:00 minutes Video ECG Blog #189 — What type of AV Block? Detailed analysis of this challenging arrhythmia (including ECG Video with step-by-step analysis of this complex ladderegram(1/30/2021).
  • ECG Media Pearl #8 (8:20 minutes Video) — ECG Blog #191 — Distinguishing between AV Dissociation vs Complete AV Block (2/6/2021).
  • ECG Media Pearl #9 (5:40 minutes Video) — ECG Blog #192 — Reviews the 3 Causes of AV Dissociation (2/9/2021).
  • ECG Media Pearl #12 (6:40 minutes Audio) — ECG Blog #195 — Reviews the phenomenon known as isorhythmic AV Dissociation (in which the atrial and junctional [or ventricular] rate is virtually equal, but P waves are not conducting to the ventricles(2/17/2021).
  • ECG Media Pearl #19 (5:00 minutes Audio) — ECG Blog #202 — A few quick things to look at that allow you to rule out complete AV Block within seconds! (3/10/2021).
  • ECG Media Pearl #41 (4:00 minutes Audio) — ECG Blog #224 — Reviews HOW to recognize within seconds (!!!) a Mobitz I ( AV Wenckebach) 2nd-degree AV Block when there is ongoing Inferior STEMI (5/15/2021).
  • ECG Media Pearl #42 (11:00 minutes Video) — ECG Blog #226 — Reviews this case of a recent Inferior MI with dual-level AV Wenckebach (5/21/2021).

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Laddergrams (How to Read and Draw Laddergrams):
  • ECG Media Pearl #5 (7:00 minutes Video ECG Blog #188 — WHAT to Know about Laddergrams? (NOTEThe video refers to a laddergram I discussed in ECG Blog #186(1/23/2021).


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Technical Issues (Recognizing Artifact; Lead Misplacement):
  • ECG Media Pearl #18 (7:45 minutes Audio) — ECG Blog #201 — On recognizing Artifactand — using Einthoven's Triangle to determine within seconds the "culprit" extremity causing the Artifact on your ECG (3/7/2021).
  • ECG Media Pearl #32 (7:30 minutes Audio) — ECG Bog #215 — Reviews the Cabrera ECG Format — and doing ECGs at a recording speed of 50 mm/second (4/17/2021).

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Computerized ECG Interpretation ("Friend or Foe"? ):

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Miscellaneous OTHER Entities (Peri-Myocarditis-XXX ):


I hope my ECG Media PEARLS are helpful to you. 
  • My contact information (email) is listed at the top of this page.





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