00:01
Welcome to our video series
on electrocardiogram.
00:04
I like to think of this one is the
slow dance or couple skate of ECGs.
00:10
We're going to take a look at
sinus brady.
00:13
Now at this point,
we all know this is a normal ECG.
00:17
But if we do this, would you
consider it to be abnormal?
What if I tell you
it belongs to this guy.
00:24
So taking this into account,
should we consider this
a good or a bad thing?
Well, let's find out together
in this course.
00:33
We've got the seven steps
of how to analyze any strip.
00:37
We're not going to go
into detail on those here
because we do in our other videos.
But there they are.
00:42
If this is one of your first videos
to watch with us,
you want to pause the video,
walk through
each one of the seven steps,
and make sure you know
what that means
and how you would do that.
00:54
Otherwise,
the rest of this video
may be a little bit
of a struggle for you.
00:59
Once again, let's recap.
01:01
Remember,
the electrical impulse
travels from the atria
to the ventricles
and its trajectory is what gets
documented on the ECG strip.
01:10
At first, the electrical impulse
gets created in the SA node
and starts traveling
toward the AV node.
01:17
This causes contraction of
the musculature of the atria
and the formation of the P wave.
01:23
Now, when the impulse
reaches the AV node,
it doesn't just pass through it.
It gets delayed.
01:29
This delay is documented
in the ECG strip
as the PR segment.
01:34
So the PR segment corresponds
to the passage of the impulse
through the AV node.
01:40
Next, we have the QRS complex.
01:43
The QRS complex represents
ventricular contraction,
which is caused by the migration
of the impulse from the AV node
to the Purkinje fibers.
01:53
Moving on,
we can see the T wave
which is caused by repolarization
or relaxation of the ventricles.
02:00
And as previously mentioned,
the interval between the ventricular
depolarization and repolarization
gets documented as the ST segment.
02:10
Finally, we have the U wave,
which is believed to be the product
of a delayed repolarization
of the Purkinje fibers.
02:17
And remember,
this wave may or may not be present
on the ECG strip.
02:23
So a normal P wave is the
atrial contraction precedes
every QRS complex in sinus brady.
02:31
The rhythm is regular but can
vary slightly during respirations
in any sinus rhythm.
02:37
The rate ranges between 60 and 100
for normal sinus rhythm.
02:43
The P wave is positive
in Lead I, Lead II
that you're looking at here,
and the biphasic in lead V1.
02:53
Now, on these seven steps,
we're going to walk
through this strip.
02:57
So I want you to assess
the heart rate and rhythm.
03:01
Remember, find
a six second section of the strip,
count the number of QRS complexes,
and you want to multiply that by 10.
03:11
So use this strip as an exercise
and match your answer
to the one you see on the screen.
03:20
Now let's look at the P waves.
03:22
Are they all there? Do we have
one P wave for every QRS?
We do.
03:28
Do the P waves all look the same?
They do. Excellent.
03:34
So, measure the PR interval next.
We have a P wave for every QRS.
03:40
So you're going to want
to measure that PR interval
to make sure
it's within the normal range.
03:44
Now, normal range for PR
is 0.12 to 0.20 seconds,
or 3 to 5 small squares
on an ECG paper.
03:54
So what is the PR interval
on this strip?
Take the time to measure it
using the small boxes
and compare your answer with
the answer you see on the screen.
04:05
Step four.
Measure the QRS duration.
04:09
Now, less than 0.12 seconds
or three small squares
is considered normal.
04:15
Pause the video,
measure the QRS duration
on this strip
and compare your answer
with the one that will display.
04:25
Step five.
Examine the ST segment.
04:28
Make sure there is no
depression or elevation.
04:32
Is there any depression or elevation
on this strip?
Now, compare your answer
to the one that we display.
04:41
Now, let's do step six.
Take a look at the T wave.
04:45
In order for them to be normal,
you want them rounded
and not peaked or tall.
04:51
Number seven,
measure the QT interval.
04:54
And we want it to be
less than 0.46 in women,
less than 0.45 in men.
05:00
So let's wrap up this section
on sinus bradycardia.
05:04
The heart rate will be less than 60.
The rhythm will be regular.
05:09
The P wave will be for
each QRS and be identical.
05:12
Now, the PR interval will be
0.12 to 0.20.
05:17
And the QRS will be
less than 0.12.
05:21
Now, let's go back to that patient
we talked about in the beginning.
05:25
Remember the marathoner?
Well, if this was his rhythm strip,
would I be alarmed?
No. Most likely I would not.
05:34
Because he's awake, alert.
He's talking to me.
05:36
And I would always check
a blood pressure.
05:39
If his blood pressure
is normal for him,
it's right along with a trend
that he normally runs.
05:45
He has no complaints of
dizziness or weakness.
05:48
He's doing fine.
He's just incredibly fit.
05:52
He has excellent
cardiovascular health.
05:56
However, if I take a 64-year-old and
they're telling me they're dizzy,
and they're weak,
and they feel lightheaded,
they have this rhythm,
and they have a
low blood pressure with this.
06:07
we would consider them symptomatic.
06:10
And they're going to need
some type of treatment.
06:12
So marathoner, who's fine,
blood pressure stable,
awake, alert and oriented,
no complaints.
06:18
We'll let you go right along
with this sinus bradycardia.
06:22
Not a problem.
06:24
But for our older client,
or any client
that tells you they feel dizzy,
they feel weak,
they feel lightheaded,
and their blood pressure is low,
they are the ones we're
going to pursue treatment for.
06:35
We consider them symptomatic.
06:38
Thank you for watching
our video series today.