EKG and Heart Murmur Review - Part 1

A review of basic EKG interpretation and cardiac auscultation, using actual clinical cases to demonstrate connections between patient symptoms, EKG findings, and abnormalities of auscultation. I recommend first viewing my videos on "Heart Murmurs", "Heart Sounds", "Intro to EKG: Rate and Axis", and "Intro to EKG: Chamber Enlargement", as this review will rely heavily on information present during those lectures.
I highly recommend watching in 1080p.

[@maewnam112]

Thank you. I finally understand the heart murmurs. This is such a great lecture.

[@MayuraVyamsaka]

Can case 4 be interpreted as possible dextrocardia? The ECG shows upright qRs in aVR with poor voltage, poor R wave progression and unusally rightward/extreme axis, which in conjunction with the distant heart sounds pointed me in that direction.

[@wizardito-ol9133]

CXR required probably

[@yoshua3182]

The issue is that dextrocardia means the heart is on the other side of the chest, meaning you would see at least strong conduction towards v1, strong conduction away from avR, and not strong conduction recorded in v5 as seen. The diagnosis of dextrocardia is definitely via a CXR, chest CT, or etc.

[@dragosmunteanu4183]

Thanks a lot, very interesting. With respects, Dragos Munteanu, MD, PhD, Iasi, Roumania

[@JyothiKBaby]

Thank you very much Dr Eric... I've really found these videos to be very helpful!

[@СтаниславГоршков-щ9я]

I have been enjoying listening to your course. But (it seems to me) the ekg course is not complete without analysis the turnings of the heart axis. In that video, in the 4th example we probably had such case?

[@СтаниславГоршков-щ9я]

In addition. I mean the turns of apex cordi pro and contra pendulum, of course.

[@sunving]

Thank you Dr Strong.

[@nmwoody]

very nice video. for the last case you suggest that the murmur may be partly due to relative anemia and resulting lower viscosity promoting turbulence. Might an additional factor be the increased cardiac output as an adaptation to the anemia?

[@StrongMed]

nmwoody Yes, definitely.

[@andrewg7878]

I am working on a personal project, and I would like to ask you how would the line on the ecg look different if the heart murmur was on the triscuspid valve? What i am really trying to find is what the ecg would look like with a murmur caused by a leaking triscupid valve.

[@StrongMed]

In the absence of concurrent heart problems, isolated tricuspid regurgitation (i.e. leaking tricuspid valve) would probably not lead to any significant ECG findings except for possibly an unusually tall P wave in lead II. But that would be relatively subtle.

[@andrewg7878]

@@StrongMed thank you so much! That could be why it has been so hard to find an answer ;)

[@ibtissamshahbal706]

Eric. You are the man.

[@SudiptaNaskar]

Thank you very veryyyyyyyyyyyyy much sir, for these lectures, tutorials and test exercises.. :-)

[@m.safarsayedy3906]

Case 2 :most common cause of late diastolic murmur are mitral ,tricuspid stenosis,myxoma and complete heart black.

[@sunving]

thanks Doctor Strong .

[@vinisha6892]

Wasn't there left axis deviation in case 3? Because normally we can see normal axis in lead 1 and aVF , If the QRS complex is upright in both leads ,its normal axis, if the QRS complex is negative in lead 1 and positive in aVF , it will be considered as RAD Or If the QRS complex is positive in lead 1 and negative in aVF , we can conclude that it's LAD, If it's negative in both leads ..it can be extreme axis deviation... In this case 3, he has positive qrs in lead 1,and negative in aVF ... Is it correct or not? And lead 1 shows ST depression , and why the lead 2 shows poor 'R' wave ? Isn't there LVH in case 5?, bcs she has tall R waves in v1,v2,and v3..

[@StrongMed]

Case 3: Regarding the axis determination, what you described assumes that a normal axis is defined as 0 to +90 degrees; while this is commonly taught, it's not accurate. The normal range for QRS axis is age and body type dependent, but a range of -30 to +90 is much more accepted by cardiologists. Unfortunately, this small change makes axis determination a little trickier since some patients with a positive QRS in I and negative QRS in aVF will fall within this normal range. My video on axis determination explains how to make this distinction. The ST depression in lead I are secondary repolarization abnormalities due to the LVH. Case 5: Her QRS complexes are all normal, and there are no other indicators of LVH (e.g. left axis deviation, ST depressions and T wave inversions in lateral leads).

[@vinisha6892]

@@StrongMed thank you for providing this much of details..

[@nimrahali3796]

Hi Dr, I wanted to ask that in case 1, QRS voltages in EKG are neither meeting Cornell nor Sokolow-Lyon Criteria that you as you taught in chamber enlargement videos, so how is it LVH? Are there any other criteria?

[@Delhi111]

🤣🤣🤣😅

[@yoshua3182]

Lead II is positive, lead avF is negative, meaning LAD, plus the massive RS waves in v5 indicating strain. Since it isnt LBBB, its LVH due to the strain. Sorry this comment is 4 years late

[@hussam7033]

7:08 cant we observe a p-mitral at lead1? and also the duration of the negative component in v1 seems to be prolonged? arent these consistent with left atrial enlargement?

[@StrongMed]

(assuming you mean lead II), I don't think I would label the P wave bifid per se, but there's some electrical noise in that lead which makes it hard to say for sure. Nice pick up on V1 - I agree that the negative component of the P wave probably exceeds 1 small box in area (due to prolongation), so this would be consistent with LAE. (Which also would be consistent with the overall picture of chronic AR and subsequent LVH.)

[@hussam7033]

@@StrongMed Thank you a lot for your reply doc!

[@hussam7033]

I dont want to bore you with the questions but at 12:40 isnt that qR pattern in v1 that could perhaps indicate right ventricular hypertrophy which is consistent with the right axis deviation?

[@petervad2889]

God bless you Doc

[@sharadgupta2946]

Best examples 😊😊😊😊😊😊

[@PrasannaKumar-od2wr]

Thank you sir...

[@piyushraj1709]

thanks

[@mmagdawy]

hahahaha,The music is like that of Mr,Bean..very beautiful

[@1956lele]

Eccellente!!!

[@janetzhu7652]

masterpiece!

[@kimo5059]

Could it be that the man in case 3 has a LBBB ?

[@StrongMed]

+mr Highbury That's a good thought because the directionality of the QRS complexes and the ST-T changes in V1, V6, I, and aVL are all consistent with a LBBB. However, if you look very carefully (and this may be limited by the playback resolution on your computer/device), at the beginning of the QRS complex in I and V6 are tiny q waves. These tiny q waves in the lateral leads are normally present, and are known as septal q waves because they represent the normal left to right depolarization of the septum, originating from the left bundle. So when you see those septal q waves in the lateral leads, it means that the left bundle (at least proximally) must be working. The video on bundle branch blocks has a few diagrams that might help to visualize the vectors if it's still not clear.

[@kimo5059]

+Strong Medicine thank you, I didn't see the q waves in lead I and V6 but now that you said it I looked at it again and I can see the very tiny q waves (1080p). :)

[@shawnli9284]

More ekg

[@krowa1010]

pls more very nice : )

[@damir611]

I just can hear that S4