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.
- NOTE: This is the "easy link" = tinyurl.com/KG-Blog-Media-Pearls —
- 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; a = updated!):
- MP-78v - MP-79v - MP-80 - MP-81v - MP-82v -
- MP-84 - MP-85 - MP-86 -
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— 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) — See also ECG Blog #278 for another very fast rate —
- ECG Media Pearl #31 (5:30 minutes Audio) — ECG Blog #214 — WHY do I emphasize the phrase, "12 Leads 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 Diagnosis. How 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).
- ECG Media Pearl #51a (8:25 minutes Audio) — ECG Blog #235 — Reviews my thoughts on "Some Simple Steps to Help Interpret Complex Rhythms" — 6/20/2021 — Updated on 11/12/2021 for ECG Blog #261) — See also ECG Blog #286 —
- ECG Media Pearl #54 (5:00 minutes Audio) — ECG Blog #239 — Reviews what Echo Beats are, and clinical applications of recognizing this finding (7/4/2021).
- ECG Media Pearl #55 (4:20 minutes Audio) — ECG Blog #240 — What does the term, "SVT" mean? This Audio Pearl reviews the semantics and clinical application involved in use of this term (7/8/2021).
- ECG Media Pearl #62 (9:00 minutes Audio) — ECG Blog #248 — Reviews the Common Causes of a Tall R Wave in Lead V1 (9/1/2021).
- ECG Media Pearl #66 (11:15 minutes Audio) — ECG Blog #252 — Delves into the theme that "Common Things are Common" (with PEARLS for expediting recognition of blocked PACs — AFlutter — AFib — VT — Mobitz I vs Mobitz II — LAHB vs LPHB — and SSS (Sick Sinus Syndrome) — (9/21/2021).
- ECG Media Pearl #67 (9:10 minutes Audio) — ECG Blog #253 — Applies the wisdom from 2 of my favorite sayings to the "art" of ECG interpretation. The sayings are = "Birds of a Feather" and "Forest from Trees" (9/27/2021).
- ECG Media Pearl #77 (11:00 minutes Video) — ECG Blog #269 — Reviews assessment of R-Wave Progression as part of the Q-R-S-T memory aid in the Systematic Approach to 12-lead interpretation (includes clarification of the term "Poor" R Wave Progression vs Transition — 12/18/2021).
- ECG Media Pearl #78 (4:30 minutes Video) — ECG Blog #270 — Reviews how we define, "Q Waves" — and how to distinguish "normal" septal Q waves from Infarction Q waves (12/22/2021).
- ECG Media Pearl #79 (3:00 minutes Video) — ECG Blog #271 — Reviews how we define the ST Segment Baseline (ie, whether to use the PR or TP segment — or both? (12/26/2021).
- mmm
- ECG Media Pearl #84a and #84b (9:00 minutes and 6:00 minutes Audios) — ECG Blog #290 (Emery Phenomenon) and ECG Blog #291 — Reviews my observations on Common Errors in ECG Interpretation (special attention to rhythm and 12-lead interpretation — 3/11/2022).
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Laddergrams (How to Read and Draw Laddergrams):
- ECG Media Pearl #5 (7:00 minutes Video) — ECG Blog #188 — HOW to understand Laddergrams! (1/23/2021 — Updated on 6/26/2021). NOTE: There are numerous LINKS on Blog #188 to other posts with step-by-step Laddergrams!
- ECG Media Pearl #82 (8:40 minutes Video) — ECG Blog #280 — Detailed analysis of this challenging arrhythmia (including ECG Video with step-by-step analysis of my proposed Laddergram — 2/1/2022).
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Axis — Hemiblocks — Bundle Branch Blocks:
- ECG Media Pearl #20 (14:30 min. Video) — ECG Blog #203 — User-friendly approach to Calculating Axis (3/12/2021).
- ECG Media Pearl #21 (12:00 min. Video) — ECG Blog #203 — User-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) — also ECG Blog #282 —
- ECG Media Pearl #57 (8:00 minutes Audio) — ECG Blog #242 — Reviews the concept of rate-related Bundle Branch Block (with clinical applications) in this patient with Mobitz II (7/15/2021).
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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 — 6/17/2021).
- ECG Media Pearl #59 (9:10 minutes Audio) — ECG Blog #245 — Reviews the ECG diagnosis of LVH (and its impact clinically with both chronic and acute cardiac disorders — 8/18/2021).
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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 infarction 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 RV MI 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) — Addendum features Figures on LMain Occlusion — Isolated Posterior MI — Wellens' Syndrome — Atrial Infarction. See also ECG Blog #294 — and especially ECG Blog #337 — Link to SSmith Blog Case = tinyurl.com/KG-OMI-Example —
- 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) — See also ECG Blog #294 — XXX
- ECG Media Pearl #26a (7:40 minutes Audio) — ECG Blog #209 — What Wellens' Syndrome is — and what it is not (3/30/2021 — Updated on 9/28/2021 for ECG Blog #254).
- ECG Media Pearl #35a (4:50 min. Audio) — ECG Blog #218 — WHEN is a T Wave Hyperacute vs a Repolarization variant (4/26/2021 — Updated on 11/4/2021 for ECG Blog #260).
- 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 #39a (4:45 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 — Updated on 11/3/2021 for ECG Blog #260).
- 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 #46a (6:35 minutes Audio) — ECG Blog #230 — Reviews HOW to compare Serial ECGs (ie, "Are you comparing Apples with Apples or Oranges?" — 6/1/2021 — Updated on 11/3/2021 for ECG Blog #260).
- ECG Media Pearl #60 (8:30 minutes Audio) — ECG Blog #246 — Reviews use of the "Mirror Test" to facilitate recognition of: i) Acute Posterior MI; ii) Acute High-Lateral or Inferior MI (ie, the "magical" reciprocal relationship between leads III and aVL); and, iii) Anterior ST elevation due to LVH (that is not indicative of anterior MI) — (8/23/2021) — See also ECG Blog #285 — XXX
- ECG Media Pearl #70 (10:20 minutes Audio) — ECG Blog #258 — Reviews HOW to "Date" an Infarction based on the initial ECG (10/27/2021).
- ECG Media Pearl #73 (5:40 minutes Audio) — ECG Blog #265 — Reviews the concept of "Shark Fin" ST Elevation (11/30/2021).
- ECG Media Pearl #74 (6:45 minutes Audio) — ECG Blog #266 — Reviews how to distinguish between deWinter T Waves vs Posterior Infarction (12/4/2021).
- ECG Media Pearl #78 (4:30 minutes Video) — ECG Blog #270 — Reviews how we define, "Q Waves" — and how to distinguish "normal" septal Q waves from Infarction Q waves (12/22/2021).
- ECG Media Pearl #79 (3:00 minutes Video) — ECG Blog #271 — Reviews how we define the ST Segment Baseline (ie, whether to use the PR or TP segment — or both? (12/26/2021). This blog post also highlights diffuse Subendocardial Ischemia ( = ST dep. in ≥7-8 leads with ST elev. in lead aVR) — See PEARL #1 under "Putting It All Together", toward the bottom of the page.
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Diagnosis of Ventricular Tachycardias (VT vs SVT — with review of Aberrant Conduction):
- ECG Media Pearl #13a (12:20 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 (2/20/2021 — Updated on 11/21/2021 for ECG Blog #263) — SEE also ECG Blog #220 and ECG Blog #283 —
- 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) — See also ECG Blog #278 —
- 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; and, ii) 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) — See also ECG Blog #279 —
- 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) — See also ECG Blog #279 —
- ECG Media Pearl #30 (7:40 min. Audio) — ECG Blog #213 — HOW 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 my LIST #1: 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 (7/5/2021).
- ECG Media Pearl #47 (5:45 minutes Audio) — ECG Blog #232 and ECG Blog #243 — Reviews the concept of a Bigeminal Rhythm (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) — See also ECG Blog #287 —
- ECG Media Pearl #55 (4:20 minutes Audio) — ECG Blog #240 — What does the term, "SVT" mean? This Audio Pearl reviews the semantics and clinical application involved in use of this term (7/8/2021) — See also ECG Blog #287 —
- ECG Media Pearl #64 (10:50 minutes Audio) — ECG Blog #250 — Review my LIST #2: Common Causes of a Regular SVT Rhythm (9/8/2021) — See also ECG Blog #287 —
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Diagnosis of AV Blocks/AV Dissociation (Group Beating):
- ECG Media Pearl #4 (4:30 minutes Audio) — The AV Blocks & WHEN to Suspect Mobitz I (1/21/2021) — See ECG Blog #186 —
- ECG Media Pearl #6 (9:30 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 laddergram) (1/30/2021 — Updated on 6/26/2021).
- ECG Media Pearl #8 (7:00 minutes Video) — ECG Blog #191 — Distinguishing between AV Dissociation vs Complete AV Block (2/6/2021 — Updated on 6/24/2021).
- ECG Media Pearl #9 (4:45 minutes Video) — ECG Blog #192 — Reviews the 3 Causes of AV Dissociation — and emphasizes why AV Dissociation is not the same thing as Complete AV Block (2/9/2021 — Updated on 6/24/2021).
- 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 #19a (6:45 minutes Audio) — ECG Blog #202 — A few quick things to look at that allow you to rule in or rule out complete AV Block within seconds! (3/10/2021 — Updated on 10/15/2021 for ECG Blog #257).
- ECG Media Pearl #41a (3:45 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 (5/17/2021 — Updated on 11/9/2021 for ECG Blog #262).
- 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).
- ECG Media Pearl #52 (15:00 minutes Video) — ECG Blog #236 — Reviews the 3 Types of 2nd-Degree AV Block — plus — the hard-to-define term of "high-grade" AV block (6/24/2021) — (This video is also highly relevant to the case presented in ECG Blog #237).
- ECG Media Pearl #47 (5:45 minutes Audio) — ECG Blog #232 and ECG Blog #243 — Reviews the concept of a Bigeminal Rhythm (which may be due to Atrial or Ventricular Bigeminy, Wenckebach conduction — or other causes — 6/10/2021).
- ECG Media Pearl #61 (5:45 minutes Audio) — ECG Blog #247 — Reviews HOW to Tell IF a P Wave is Conducting? Being able to answer this question is KEY for determining the etiology of complicated AV Block/AV Dissociation tracings (8/27/2021).
- ECG Media Pearl #65 (6:20 minutes Audio) — ECG Blog #251 — Reviews HOW a cycle of AV Wenckebach may End (as well as reviewing the "Footprints" of Wenckebach — 9/16/2021).
- ECG Media Pearl #18 (7:45 minutes Audio) — ECG Blog #201 — On recognizing Artifact — and — using Einthoven's Triangle to determine within secnds the "culprit" extremity causing Artifact on your ECG (3/7/2021) — (I also used this Audio Pearl for ECG Blog #255 on 10/6/2021 for a case in which Artifact mimics AV Dissociation! ).
- ECG Media Pearl #68 (6:15 minutes Audio) — ECG Blog #256 — Reviews the meaning of the term, "Escape-Capture" (this being a special form of Bigeminal Rhythm — 10/10/2021).
- ECG Media Pearl #69 (2:45 minutes Audio) — ECG Blog #256 — Reviews the ECG findings of SSS = Sick Sinus Syndrome (10/10/2021 — excerpted from the Audio Pearl presented in Blog #252).
- ECG Media Pearl #71 (5:45 minutes Audio) — ECG Blog #259 — Reviews the phenomenon of Dual-Level Wenckebach out of the AV Node (HOW to recognize this phenomenon — and how to distinguish it from Mobitz II — 11/2/2021).
- ECG Media Pearl #75 (6:10 minutes Audio) — ECG Blog #267 — Reviews how to tell IF a Junctional (AV Nodal) Rhythm is pathologic or appropriate (12/9/2021).
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Technical Issues (Recognizing Artifact; Lead Misplacement):
- ECG Media Pearl #18 (7:45 minutes Audio) — ECG Blog #201 — On recognizing Artifact — and — using Einthoven's Triangle to determine within seconds the "culprit" extremity causing the Artifact on your ECG (3/7/2021) — (I also used MP-18 for ECG Blog #255 on 10/6/2021).
- 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).
- ECG Media Pearl #72 (5:45 minutes Audio) — ECG Blog #264 — Reviews how to suspect Limb Lead Reversal (especially LA-RA lead reversal — 11/25/2021).
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Computerized ECG Interpretation ("Friend or Foe"? ):
- ECG Media Pearl #24 (9:00 min. Audio) — ECG Blog #207 — The Pros & Cons of the Computerized ECG Report (3/24/2021).
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Miscellaneous OTHER Entities (Peri-Myocarditis-Brugada-Electrolyte disorders ):
- ECG Media Pearl #25 (9:50 min. Audio) — ECG Blog #208 — Reviews the ECG Diagnosis of Acute Pericarditis (3/27/2021).
- ECG Media Pearl #49 (7:40 min. Audio) — ECG Blog #233 — Reviews the ECG finding of Anterior T Wave Inversion (with emphasis on not overlooking acute PE as the cause! — 6/12/2021).
- ECG Media Pearl #53 (9:00 min. and 8:00 min. 2-part Video) — ECG Blog #238 — Reviews the ECG diagnosis of Brugada-1 and Brugada-2 ECG patterns — and distinction of Brugada Syndrome from Phenocopy! (7/1/2021).
- ECG Media Pearl #56 (5:35 minutes Audio) — ECG Blog #241 — What are Osborn Waves? — (HINT: Osborn waves are not ony seen with Hypothermia! — 7/12/2021).
- ECG Media Pearl #58 (8:30 minutes Audio) — ECG Blog #244 — Reviews some lesser-known Pearls for ECG recognition of HyperKalemia (7/23/2021).
- ECG Media Pearl #63 (3:15 minutes Audio) — ECG Blog #249 — Examines the question of whether Hyperkalemia can cause VT? (and whether this matters clinically? — 9/4/2021).
- ECG Media Pearl #76 (3:10 minutes Audio) — ECG Blog #268 — Briefly reviews the concept of "Supernormal" Conduction — in which conduction for a brief period in the cardiac cycle is better-than-thought-to-be possible (12/12/2021).
- ECG Media Pearl #80 (4:00 minutes Audio) — ECG Blog #272 — Reviews the ECG finding of Low Voltage (and potential clinical implications of low voltage in the setting of acute MI — 12/30/2021).
- ECG Media Pearl #81 (9:50 minutes Video) — ECG Blog #276 — Summarizes my Systematic Approach to 12-lead ECG interpretation (during the first 2:50 minutes of this video) — after which I apply this Systematic Approach to a case while working through the Causes of Giant T-Waves (1/16/2022).
- ECG Media Pearl #83 (7:30 minutes Audio) — ECG Blog #281 — Reviews the ECG Finding of Electrical Alternans (2/4/2022). For more on this subject — See ECG Blog #83.
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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