Видео

Hello! Thank you for the compliment. As an electrophysiologist, I live in the world of ECGs and arrhythmias. I do not consider myself an expert in reading echos. ECG Academy is a world leader in electrocardiography training. Please check out my videos and my courses on the website.

Well, thank you for watching! I'm glad you appreciated the information. Good luck to you!

I usually tell people to wait 24 hours.

Hello! In which state do you live? There are many fainting specialists like me all over the country.

@@ECGDoc wow thanks for responding!! I live in Illinois, near Chicago. Every doctor I’ve seen seems to know very little about my condition and I’m having an extremely difficult time finding any help.

@@User_8889 By coincidence, I'm going to be in Chicago next weekend-- there's a major conference on autonomic dysfunction going on. You might want to research that -- there's a lot of information out there for people with syncope. Try looking up dinet.org -- it's the Dysautonomia Information Network (I'm on their medical advisory board). They have a "Find A Specialist" link that might help you find someone who can help you.

Hey, Thanks Doc!!

I think I just got a "lemon" gas burner, but since the dealer replaced the burner it has worked perfectly. The Alfa pizza ovens are made in Italy and are top quality, so they are expensive, but it's nice having a large oven where you can comfortable put two pizzas at the same time (maybe 3 if you are good at shuffling them around. Alfa strongly recommends against burning any wood while the gas jets are operating -- if you are using a wood fire they provide a very heavy cover to use over the gas jets to keep ashes from clogging up the works. I'm not sure that the wood flavors the pizza -- lots of different opinions there. But having the "dual-fuel" model is helpful if I don't have the time to build a fire and nurse the flames. Gas is way easier, but you should be prepared to make at least a couple of pies to keep the gas cost-per-pizza down. Overall, it's really nice having big oven.

Thanks!!!

Actually, yes! I used the gas to make pizza over the holiday weekend and it worked great! Thanks for asking!!

Although I recorded this 5 years ago, it is still relevant. Everything you say is true -- having AF may be a sign of an underlying inflammatory condition and is clearly associated with other medical conditions like hypertension, diabetes, and vascular disease. Pulsed field ablation may be the future of AF treatment and many centers are starting to use it because is seems safer than the standard ablation techniques. It's still not 100% effective but go to an EP center where they do a lot of them if you want the best chance of success. Good luck!

@@ECGDoc OH yes. I didn't mean to imply it wasn't relevant. Just that in the past 5 years they have started to believe Afib is a symptom, not a disease unto itself. I am at UCSF, in very capable hands, they invented ablation, and leading up to my meeting with my cardiologist I thought this was an incurable disease. Turns out the covid-work-at-home-weight and lack of exercise can be a cause. I am also in my 50's so for me, this is likely the reason. A 70 year old may and probably is a very different thing altogether. My metoprolol didn't work, and I am no longer taking it. I also was told to lift my weights, my exercise of choice, and walk for cardio and in 6 months we'll see how it is once I drop the weight. She believes it will be the way I can eliminate it altogether. At least for now. In 20 years? We'll see.

That rate is a bit slow for atrial flutter or fib, unless you are very old or are on medications. Perhaps it's not AF but rather a normal rhythm with a lot of PACs (premature atrial contractions) that make your heart rhythm feel irregular, but not from AF.

@@ECGDoc I am 76 in July,but up `till now I was in real good condition.My photo there was 5 years ago but still look the same. Several people I hadn`t seen in many years say I haven`t aged.

Hi, Crystal. Your doctor would need to change the settings. By the way, ILRs are not that good at analyzing p-waves, so they rely mostly on rate. You should be able to trigger a manual recording if you are having symptoms, but it will only go back 5 or 6 minutes. It won't show what might have been been going on for hours.

Hi, Crystal -- thanks for your question. Reading complex recordings from an ILR (or any monitor) is an art. That's why I created ECGAcademy.com -- sometimes it's hard to tell the difference between sinus tachy and atrial tachycardia coming from the high right atrium... often you can only tell looking at the way the rhythm behaves.

@@ECGDoc do you have videos or papers on sinoatrial reentry tachycardia?

@@crystalkeara8868 I do in my Expert level membership.

@@ECGDoc I’m a premier member. Sinus nodal reentrant tachycardia didn’t come up when I searched for it.

Guess you were wrong huh? After burner replacement it worked fine.

@@jameswilliford5478 OOOOOK Jimbo.... Bless your heart (and the others that buy based on youtube videos by people that don't have any idea what they are talking about), I guess there will always be people who want the real thing and don't have any patience to really understand the how/why real ovens are built and also aren't willing to save up to buy properly made ovens vs buying whatever fits your "budget" today and "ON SALE!" drives your buying decisions - Alfa ovens show nothing that they are durable or anywhere close to worth the price - they are just welded steel with some superwool (ceramic insulation blanket) in it which is an insulator and not thermal mass but hey lets don't argue over real details on how good ovens are built.... Don't worry, you will see in a couple years that this thing was a bad mistake. Or maybe you will just struggle the entire time because you won't ever realize what a well built oven can actually do vs these overpriced, cheap ovens - if you absolutely MUST buy a metal oven just buy a "pizza steel" - a thick piece of steel that you place in your home oven and use that as the oven floor. It will cook a crap ton better than this alleged...ahem, oven..... and will save you a few thousand bucks, you are welcome :)

Well, yes.

You're welcome!

By the way, no one with SVT should ever require a shock unless they are unconscious. Adenosine is very effective.

Hi! First, PAT is a type of SVT, so those terms are sometimes confused and may be used interchangeably, but some SVTs are not PAT, so keep that in mind. POTS, on the other hand, is an inappropriately rapid heart rate when someone stands up, so it's actually SINUS tachycardia. That's why it's different than SVT. Now, some (about 20%) of POTS patients do have excessive adrenaline (so-called "hyperadrenergic POTS") and it feels like "fight or flight" all the time. Then again, stress or increased sympathetic stimulation can, in people with the substrate for an arrhythmia, trigger SVT. So it can feel the same. SVT can be ablated. POTS cannot. Good luck to you!

@@ECGDoc I definitely have POTS. I take Corlanor for it. I also know I have atrial tachycardia. I wear a loop monitor which picks it up when it’s over 100 bpm lasting longer than 4 hours. My loop recorder has also labeled SVT episodes over 170 bpm. Haven’t seen my EP yet so I don’t know if those episodes are also atrial tachycardia (PAT), the report says SVT. I’ve tried coming off the Corlanor many times but all my POTS symptoms come back and the SVT episodes seem to increase. Thank you for always taking the time to respond. Your videos really helped me. I no longer worry about my episodes even though I feel like I’m going to pass out. Unfortunately they seem to happen at the worst times. Feeling like I’m going to pass out while driving is the worst. I just want it to go away!

Hi, Ali! Thank you SO much for all the positive feedback! I'm really glad you're learning lots! This Wednesday's Masterclass is going to be a BLAST! I think it will have a few heads spinning! 😲

Hey! Thanks for the positive feedback. I always say the three most important things about syncope is History, History, and History. I do a new ECG Masterclass every month through ECGAcademy.com. -- you should check them out. Next one is this Wednesday. They are all clinical, with discussion of management, not just diagnosis.

Well, thank you SO much! 🙂

It generally won't. Corlanor affects the sinus node only. Some people have tried using it to slow the AV node to help control the rate of atrial fibrillation but it does not work very well for that.

😇🙏 Thank you!!

Thank you! You are very kind!

I am glad I could help! There is more to it. My course has more info...

Thank you! I really appreciate that!

Yes. Because there is a larger S-wave in aVF, the net signal is smaller than in Lead III. A "Typical" qR does not give you the diagnosis -- the axis does.

Thank you !

I have very good device-related videos on my website, ECGAcademy.com

Thank you SO much! I'm glad you enjoyed it!

I'm happy that you were one of the first to watch it! It's "hot off the presses". 🙂

There are many factors to consider. First and foremost, are they long and uncomfortable enough to interfere with your lifestyle? Or are they just a minor annoyance? Are you willing to risk a 1-2% risk of serious complications to get rid of them? If they are very short, they may not even be inducible in the EP lab and an ablation may not be possible. Have you tried meds? This is a conversation to have with an electrophysiologist. Good luck!

@@ECGDoc do you have a video on Sinoatrial Nodal Reentrant Tachycardia

Who wants to know?

You're welcome, Doc!

Trouble is, Rick, that the story doesn't make sense. The Micro AV2 is not capable of increasing your heart rate -- it only "tracks" what your own sinus node is doing and paces the ventricle synchronous with that. It "reconnects" your atrial and ventricles, but perhaps since you were dropping beats for so long then maybe you aren't used to a normal heart rate.

@ECGDoc good point, still feels like it's pounding

You are not supposed to use both simultaneously. That's because the ashes created by the wood may clog up the gas jet openings, which are quite small. There is a heavy metal cover that protects the gas jet, and that should be used when making a wood fire.

Thanks for your comment, Lindsay. Many people assume that if it is irregular, then it must be AF. Let's dispel that notion together! :-) Best of luck to you!

Thanks for taking the time to comment! I'm glad my video helped you! Good luck!

Hi! First, the wide QRS beat is not a ventricular premature beat-- it's not premature. It's an escape beat. It's presence hides our ability to see if the 2nd p-wave would have conducted or not, so all we see is one blocked p-wave. We cannot say if it's "Type 1" or "Type 2" because we cannot tell if the PR changes prior to the dropped beat since we don't see two PR intervals in a row to judge. I only referred to the prior ChalkTalk (#2) because that one showed Type 2. If you just saw this strip alone, you cannot tall Type 1 or Type 2. This is a complex case but we see escape beats that frequently throw our ability to "classify" AV block into neat little cubbyholes into chaos. That's why understanding what's actually going on is far better than trying to pin a label on the strip based on a classification algorithm. "High grade" implies that at least every other p-wave blocks, or that 2 P waves in a row block (i.e. 3:1) but we cannot say that here because the escape beat gets in the way. I hope that's a bit more clear.

That makes it so much more clear! Thank You Dr. Nicholas! I really enjoy learning from your videos! You have such flair for traching complex things, you make them all so interesting!

Hello, Soor. I think you made a good decision to say "no" to a pacemaker. It is very rare that such a young patient would need one. Certainly, if he keeps fainting and if you are sure that the fainting is due to a very slow heartbeat, then you can reconsider. However, you have to establish a clear relation between the slow heartbeat and the faint. Just having a slow heartbeat on a monitor is generally not a reason to have a pacemaker unless there are clear symptoms because of the slow beat.

​@ECGDoc ,sir, we went for a second consultation with other Dr, and showed the same report to him . he also said that to fix pacemaker, at that time my husband was fainted and unconscious for 1 min, sir alternative to pacemaker catheter ablation or medicine to cure him.reply me sir.thanku .Dr said he has slow heart rate .he was physically normal for 1 weak when we consult to Dr it made him faint because of fear or slow heart rate.

@@sooriyaselvaraj8065 Well, in the end you should listen to the specialists who are taking care of your husband. I cannot tell you what you should do over the internet. I'm just trying to help educate people.

Hey! Thanks for your positive comment! Good luck with your exam!

Pacemaker leads can be repositioned if they have come loose or are not making good contact within a few weeks of insertion. If a non-functioning lead cannot be repositioned, the optimal solution is to remove and replace it, but extraction of a lead that's been in for more than a couple of years can carry some risk of serious complications. Sometimes we just abandon a broken lead and simply insert a new one along side it to take its place. Aside from interrogating and testing the pacemaker system, a chest x-ray is useful to see where the leads are.

Well, heart rates of 350 are very difficult to hit in normal individuals. The AV node will usually block such rapid rates unless there's a problem with the function of that structure as well. Who is analyzing the strip for you? Sometimes there can be artifact that won't be recognized as such on the "official" reading. Even cardiologists make mistakes sometimes. Plus, you say "the rhythm doesn't change" -- that's not expected if the heart rate is truly going up and down as you suggest.

@@ECGDoc I’m looking at the rate box that’s above the rhythm section on the ILR. It shows the time I recorded symptoms. Most of the time the rate was around 170 with very short spikes in rate. The highest was 350. It’s literally just one spike. There’s multiple sudden spikes in a row like this anywhere from 200 to 350 bpm. Both the rate section and rhythm section show the 7 minutes where I triggered the recorder. It looks like there are PACs happening when the rate is spiking up. I will be speaking with my EP. The report said I had 3 SVT episodes this past month that were above 170. I don’t think they count anything below 170 bpm. I have LOTS of episodes below that 130 - 150 bpm. I signed up on your website to get a better understanding of what’s going on which has helped me not worry about these episodes anymore. Unfortunately they still cause presyncope and other symptoms. Wish RUclips would allow me to share a photo of the heart rate spikes. It clearly shows multiple spikes as high as 350. I don’t know if that’s an error or not 🤷‍♀️ Just wanted your thoughts on the interpolated PACs. It looks like I have those but they don’t interrupt the sinus rhythm. I can’t find much information on them. It looks like I have some sort of beat sandwiched in between beats that don’t change the main rhythm. That’s when the spikes occur 200-350 bpm

Hi, Sam! I have a couple of ideas. It will probably happen middle of January some time. I'm happy to take requests! 🙂

Looking forward to it as always! I think it would be interesting to take a look at the different types of LQTS genes and how they manifest on the ECG as well as their overall prognosis. @@ntullomd